Summary

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.