Monday, January 30, 2012

Early Intervention - It's Great in Theory

Since we last spoke, our pediatrician referred us to a psychiatrist here in town.  The psychiatrist told someone in the pediatrician's office that he needs us to go to a counselor first and get referred from there, and even told us which counseling office to go to.  So we did.  This counseling appointment was a frustrating experience because once again, Little Man had to just sit there and play while we talked about him with him in the room.  And after all that the counselor suggested a book called 1-2-3 Magic.  Which I'm sure is a lovely book on discipline, but we've been working for over 2 years to ensure that Little Man understands the expectations for his behavior and that we have immediate, logical consequences for him.  I'm willing to read and try the techniques in this book, but his violence & outbursts aren't going to be solved by counting to 3.  I did schedule a follow-up for us with this counselor.  She's quite young and the book thing frustrates me, but I do feel that she's sincerely trying to figure out what will work for Little Man.

She, like the pediatrician, suggested high-functioning Aspergers.  It's funny that people who have interacted with him (psychologist briefly, and a family member who is a child psychiatrist, plus Daddio and me) don't see Aspergers, but people who have spent little time with him and are making assessments primarily on what has been written about him (pediatrician, counselor) say Aspergers.  We're willing to get assessed for it and I've contacted the VT Autism Clinic, but I was told immediately that the waiting list is up to a year long.  At that point we might as well take him to a city that has more resources to get him assessed.  But since Daddio and I are both still skeptical of this path, I'm not sure how many hoops we're willing to jump through.  The Autism Clinic gave me the name of a psychiatrist/ physician duo in Roanoke who may be able to help.

The counselor also said it seemed funny to her that a psychiatrist is requiring us to see a counselor when we've already been referred to psychiatry by our pediatrician.  So I went ahead and called the counseling group that this psychiatrist is with.  And they don't see kids under 10.  You have got to be kidding me!  So I called the pediatrician's office back.  They seemed a bit confused.  One message they gave me was that they knew that this office doesn't see under 10.  But then they kept referring back to a note that said that this psychiatrist will manage medication for kids of any age.  I updated the person working on the referrals on what we've done so far and where we're at in regards to his assessment/ treatment, and she's trying to find something that will work for us.

In the meantime, we sent everything we have to a family member who is in child psychiatry.  He said that any psychiatrist we see will suspect bipolar disorder due to family history and Little Man's unpredictability.  But it's just too early to tell on that.  Plus, mood stabilizing drugs are difficult to manage, especially in little people.  He felt that ADHD is a decent theory to explain Little Man's "poor frustration tolerance" and violent outbursts.  We are just about convinced to try an old-school stimulant-based med.  These work quickly and metabolize out quickly.  So if there are negative side effects, they'll be gone by the end of the day.  There was one that he specifically recommended against due to the possibility of a developing mood disorder in Little Man.  However, as I mentioned in my prior post, our pediatrician isn't willing to medicate.  Which is part of the reason we need a psychiatrist.  Alternately, we could switch his primary care physician to someone willing to medicate.  I don't think we're there yet, though.

And hence, the name of this post.  Early Intervention - It's Great in Theory.  We are really trying to intervene on behalf of our son to get him ready for Kindergarten.  And ultimately, our goal is to find techniques that we and his teachers can use to cope now, but also that he can use to cope throughout his life.  And we've all heard that early intervention is key.  But it's darn hard to get early intervention.

Up Next: I experienced a violent outburst personally and lived to tell about it.

Friday, January 20, 2012


Sorry to abandon you so soon in our relationship, blog.  Actually dealing with Little Man has left me with little emotional energy with which to document it.  Here's an edited version of a summary I sent someone late last week:

Little Man's violence has gotten worse.  He punches a classmate or teacher 2-3 times per week now.  The daycare instituted a policy this week that if he hurts someone, we have to pick him up immediately.  This is the third day this week I've picked him up early.

Here are the results of the things we've investigated:

Non-Verbal Learning Disorder: Psychologist gave him the WPPSI.  His verbal IQ is 34 points higher than his performance IQ, which qualifies him for Non-Verbal Learning Disorder.  She feels that if his attention span were better the performance IQ would come up, but that it would still be far enough away from the verbal IQ to qualify him for this disorder.  We have an appointment on Monday with a speech pathologist to do her own evaluation.

Sensory Processing Disorder: The Occupational Therapist said she noticed a few things but nothing to qualify him for OT.  She did think she saw anxiety in the frequency that he checked in with me during the appointment.  For example, he interrupted to ask me when we were going to gymnastics again.  We haven't done gymnastics in almost 2 years.

ADHD: After spending 45 minutes with Little Man giving him the WPPSI, the psychologist concluded that he has ADHD and is approximately in the mid-range of kids who have it.  Our pediatrician, however, feels that the violence (which at this point is all Daddio and I care about, not whether he can sit still during circle time) is not a symptom of ADHD and that to medicate a 4-year-old for something that's not his primary problem would be unwise.

Anxiety: Little Man has been observed by the elementary school psychologist in our county and the special ed and preschool coordinators of the school we're zoned for.  The psychologist feels strongly that Little Man is more anxious than other kids.  He said that in one hour Little Man ground his teeth 6 times and set his jaw (the visual is an adult preparing to run a race or do some other daunting task) 12 times.  He was not able to see one of Little Man's outbursts.  The private psychologist, however, told us that kids who suffer from anxiety are obsessed with death or harm.  Little Man is not.

Bipolar Disorder: We informed the private psychologist that bipolar disorder runs in the family (I had some family history here).  She said that she does not see bipolar disorder in Little Man at this time.  I also understand that bipolar disorder usually becomes apparent later in life.

Future Steps:
Our pediatrician has referred us to a psychiatrist.  However, all psychiatrists who treat children in our area or even in the closest city have a 6 month waiting list, and even at that point they require you to see their psychologist first.  We're going through the steps of that process now, but it will be a long time before we'll see any results.  Our pediatrician is thinking that Little Man's problem is Oppositional Defiant Disorder (which I pretty much self-diagnosed in him a year ago) and perhaps Autism Spectrum Disorder.  We're skeptical about Aspergers but willing to do anything that could help.
The behavioralist for our county school system has an appointment to observe Little Man at school on February 7.

We have been working closely with our daycare as well as the special ed department in the county.  We are confident at this point that consequences for his behavior are consistent.  There has been no improvements.

Little Man does have outbursts at home, which result in us putting him in his room with the understanding that we'll talk to him when he's done.  He can rage on for quite a while, the longest being 90 minutes.  He has never hurt Sprout.  He doesn't hurt animals.  He hasn't ever hurt friends in a private setting such as our home, someone else's home, or sports.  In fall soccer one team we played against was aggressive and he was pushed to the ground more than once.  He didn't seem tempted to retaliate, and instead told an adult that he was pushed.

He sleeps well and eats well.  Dentist and doctor have cleared his health.  Intellectually he knows how to behave.  We talk about how feeling angry feels in his body; we talk about things you can do when you're angry that aren't hurting others.  He'll say, "I want to make good choices, but my body won't let me."  I don't now if that's genuine or if he's playing me, but I am mostly convinced that in those moments when he hits someone, he is completely out of control.  Which is why consequences don't work.

I work from home, so when he's sent home to be with me I send him to his room to spend the day alone without toys so that I can do work and to ensure that he's not having a fun at-home day.  We also tried having him clean the house after he gets sent home but that was an untenable amount of work for me, and he actually enjoyed it.

Wednesday, January 11, 2012

And Again

The call for pickup came at 10:30 today.  He punched a child in the face because, as I understand it, he didn't believe his turn in the soccer game was coming quickly enough.

I'm at a loss.

Tuesday, January 10, 2012

Met with the Pediatrician

Daddio and I had a long meeting with the pediatrician this morning.  We brought Little Man under the instruction of an administrator in the office, but turns out Dr. didn't need to see him so he hung out with a nurse and ate his lunch the whole time.

Dr. said that after reviewing all the materials we sent her, including the report from the psychologist in Roanoke, she would not medicate him at this time.  She said that ADHD is not our biggest problem.  It may wind up being a factor for him as he gets older, but the outbursts that he has aren't typical of a child with ADHD.  It's a separate problem.

She also figuratively patted us on the back a few times saying she feels that discipline isn't the problem in this case.

She said that after reading the documentation we sent, she is leaning towards 2 things.  One is Oppositional Defiant Disorder.  I said, "I've heard of that, but I understood that it's usually present with another thing like ADHD or an Autism Spectrum Disorder.  She said, "Well, not necessarily, but you've hit on the second thing I was thinking, which is Autism Spectrum Disorder."  We're a bit skeptical of that one, but she was saying how a high functioning individual on the Spectrum may be social and enjoy people and not have the typical autism stim, etc.  He may just be socially awkward, getting people's attention in inappropriate ways.

The long and the short of it is that we left the pediatrician's office with a referral to a speech therapist re. the Nonverbal Learning Disorder that was previously diagnosed.  Dr. is also going to have her front desk work on getting us in to a pediatric psychiatrist; they're going to try someone local and someone in Roanoke.  She warned us, however, that the average wait in this area is 6 months.  And even then, the required first step is to meet with their psychOLOGIST before they'll make a referral to the psychIATRIST.  And we'll get a referral to a counselor for the behavioral therapy part of the equation.

Monday, January 9, 2012

New Policy

I'm going to start documenting our adventures raising Little Man, our fun, intense, challenging, smart, impulsive boy.  I'll get you caught up eventually, but for now I'm just going to start with today.

On Friday we got a call from the daycare that going forward, if he hurts someone, we will get a call and he will need to be picked up immediately.  I knew we wouldn't get far into this week.  Day 1 of the new policy he made it until 3:30.  He punched a friend in the face after a skirmish over a book.

He was still a bit aggravated when I got there and gave me attitude because he'd been warned on Friday that he was going to have to work for me if he was sent home early.  The policy is that he has to work until Daddio and Sprout get home from school.  By the time we got home he'd decided upon a healthy snack (string cheese and whole grain toast).  He's currently scrubbing the kitchen table and chairs.  I'm not sure what I'm going to have him scrub after that - he's going a little faster than I would like but the attention to detail of a 4-year-old is not the best.  So basically it's a full-time job for me to think of jobs for him to do and manage him.

I might need to get a small vacuum cleaner.