Asking for help with 4 year-old’s behaviour

[Preschoolerhelp]

Hello, NC’d for this.
Ds is just four.
He is like two different children. He can be happy, sunny and fun and then just turns on a sixpence. Anything nice you do for him, he throws it back in your face.
He has this really nasty facial expression that he does and you know when you see that expression that there is some pretty horrendous behaviour coming. He hits and hurts me, his dad and his older sister when he gets in one of his nasty moods and breaks his sister’s things.
E.g. today was lovely whilst we were doing things that he wanted to do - nice 1:1 time with me, fun playing etc. Then we went to pick up his sister, which he didn’t want to do. She came out of school with a really long daisy chain she’d made - he broke it before we’d left school. He then started hitting her and me all the way home. I had to physically block him from hitting us and saying clearly and calmly ‘I won’t let you hit me and your sister’ etc. Wouldn’t apologise, just stomped off. Later he said he hit me because he ‘likes hitting’.
The other day he smiled at his sister out of the window as we came to collect him, then he was let out and immediately went over and smacked her.

He has a sensory impairment and I have a general progress meeting with the nursery SENCO and someone from the sensory team tomorrow. I really feel like I need support with his behaviour now as nothing I do is working.
What do I say at the meeting to get the right help with his behaviour?

He was seen by a paediatrician last year due to an unrelated issue and she flagged she thought he had sensory processing disorder (in addition to his specific sensory impairment). She recommended an ASD assessment.

He saw another paediatrician to kick off the asd referral process but as he was smiley and making eye contact and engaging with the dr’s games the dr thinks it’s unlikely he has asd. However he did put us on the referral pathway just in case - about a 3 year wait.

I asked for an occupational therapy referral for the sensory stuff but they won’t take him on. Can’t seem to find any private OTs locally. He had a referral to the dietitian due to restricted eating but they just sent us a fact sheet.

Is there such a thing as behaviour support you can get for children? At the moment I think he will really struggle when he moves to school with these behavioural issues on top of his existing difficulties.

He is having an EHCP written but I don’t believe it will include 1:1 as his sensory impairment is not severe enough.
He has no official diagnosis of anything else although I’ve asked nursery to note the sensory difficulties on the application for the EHCP.

Nursery did raise concerns about hitting when he was about 2.5 but at the moment he is the golden child whilst there.

Thank you for reading - please help! Any advice on strategies to try or people to approach would be brilliant. Especially anything I could mention at this meeting tomorrow.

You might get more replies if you ask MNHQ to move your thread to the SN boards.

The right help can come via the EHCP.

Where are you in the EHCP process? Has DS not had an OT assessment as part of the EHCNA process? You can ask for a dietician assessment too. Has he also had SALT and psychiatrist or clinical psychologist assessment via the EHCNA?

Are the preschool supporting him with his emotional literacy, social skills and sensory difficulties?

Have you tried keeping a detailed diary to spot triggers and doing an ABC chart? The difficulties picking DD up may be about transitions.

Also, have you spoken to the school DS will be attending?

@Imitatingdory
Thank you so much for your reply. That is so many things to think about already, thank you. The problem is the EHCNA has been put together mainly on the basis of his sensory impairment as that is something he has a diagnosis for, is under the hospital for etc. Nursery have basically pulled it together for us.
The sensory processing stuff written in the EHCNA is basically me detailing what he’s like at home. He hasn’t had any SALT or psychology involvement- just this paediatrician who says ‘his scores are below age expected level in speech and social interaction’.

I had a meeting with nursery and they have put in place extra sensory activities etc and try and encourage him but the main sense I get from them is everything is generally ok there, except he plays alongside other children often rather than with them.

I have spoken to school but their SENCO has now left - once his place is definitely confirmed, I’ll arrange further meetings.

Thank you for this food for thought. I didn’t realise I could ask for a dietitian assessment in preparation for an EHCP. When he was referred to them initially they just sent a letter with YouTube links but I’d like to get him properly assessed as his safe food list seems to be shrinking all the time.

Have the LA agreed to assess yet or haven’t you got that far? As part of the EHCNA the LA must seek advice from:
a) the child’s parent or the young person;
b) educational advice (usually from the head teacher or principal);
c) medical advice and information from a health care professional;
d) psychological advice and information from an educational psychologist;
e) advice and information in relation to social care;
f) advice and information from any other person the local authority thinks appropriate;
g) where the child or young person is in or beyond year 9, advice and information in relation to provision to assist the child or young person in preparation for adulthood and independent living; and
h) advice and information from any person the child’s parent or young person reasonably requests that the local authority seek advice from.

If DS has a HI &/or VI advice from a suitable professional must also be sought.

H can reasonably include SALT, OT, psychiatrist, clinical psychologist, dietician in your case.

You don’t need the behavioural, emotional, social and sensory difficulties to be diagnosed. Support is based on needs, not diagnosis.

Just because DS seems to cope OK at nursery and explodes at home doesn’t mean the problem is home and not school. It’s known as the coke bottle effect. Also, there may be signs at nursery that they just aren’t recognising. It would be reasonable to ask the Area SENCO for advice if they haven’t already.

I don't have any advice to add to imitatingdory but my DS3 was so very similar at that age.

The afternoon school run to collect him older siblings was a regular trigger. DS4 was a baby and there were times I had to carry DS4 with DS3 going apeshit in the double pram because he'd hit DS4 if I left him in there. He had staying power and could keep going for hours, it was so stressful. Nursery never saw a peep of it and in fact his leaver certificate was that he was "the most charming of x class"!!.

He was diagnosed with autism whilst still at nursery but they didn't really buy it. Nor his reception teacher for the first 2 terms. I'll park it there as it went a tad downhill.

@Imitatingdory we are waiting for the LA to agree to an EHCP at the moment.
That info is so useful - really appreciate it, thank you. And v interesting re the coke bottle effect.

@ArianaDumbledore gosh, thank you for sharing, that is interesting about the pick up being a trigger.

Yes nursery definitely seems to see the best of my ds at the mo. I am quite jealous of the staff when they come out and say he’s had a great day with them!

OP my DS is neurotypical (as far as we know - never any inkling of any issues) and almost 4. He still has tantrums and behaves badly - will hit me and his younger sister (not hard but obviously not acceptable) - usually when he’s tired but he also suffers a lot from jealousy when I interact with his sister.

Anyway, while I agree that you should try to access all the support you can and get on waiting lists etc, I also wouldn’t assume that it’s necessarily down to his sensory issues. Partly this is just what having a 4 year old is like I suspect.

We are going to try to introduce some kind of reward system for DS to see if that helps.

If you see that far on in the process, you should have already had all the necessary assessments. As provision in EHCPs is taken from the reports if DS hasn’t had SALT, OT or MH assessments there won’t be any SALT, OT or MH provision in the EHCP. You should ask the LA now for them.

In order for the LA are to meet the statutory timescales they should send you a draft by week 14.

@Preschoolerhelp we found that DS3 really struggled with short trips and no amount of visual strategies helped. It was better when the picking up was tagged on to the end of something else. There was also DS3 really missing DS2 and having all kinds of feelings on him being at school and not being the oldest. Things that he has only been able to articulate as his speech has developed.

When he was assessed by SALT she found that his receptive language was quite delayed but because his expressive is age appropriate it's easy to forget. Misunderstandings of what is happening account for a lot of his meltdowns.

He also now has a diagnosis of ADHD and there are times he is shocked by his own reactions.

It's worth looking at strategies for Pathological Demand Avoidance - I'm not suggesting your DS has that diagnosis, but we find with DS3 what many might view as a treat is actually quite anxiety-inducing for him.

When he's in good form he really lights up the room and can be the kindest and most thoughtful child. When set an exercise on asking Santa for presents for someone other than themselves, all the other children nominated their mum or other family member. DC3 asked that Santa give food and presents to all the children in the world who had none. His teacher (who was not overly fond of him!) got really choked up.

@ThreeBalloons

OP my DS is neurotypical (as far as we know - never any inkling of any issues) and almost 4. He still has tantrums and behaves badly - will hit me and his younger sister (not hard but obviously not acceptable) - usually when he’s tired but he also suffers a lot from jealousy when I interact with his sister.

Anyway, while I agree that you should try to access all the support you can and get on waiting lists etc, I also wouldn’t assume that it’s necessarily down to his sensory issues. Partly this is just what having a 4 year old is like I suspect.

We are going to try to introduce some kind of reward system for DS to see if that helps.

Thank you. Yes, I appreciate it’s a tricky age and don’t want to over-medicalise him. I feel like I do need some extra support at this point though as nothing I do to stop the behaviours is working and I can’t allow it to continue for dd’s sake.

@Imitatingdory

If you see that far on in the process, you should have already had all the necessary assessments. As provision in EHCPs is taken from the reports if DS hasn’t had SALT, OT or MH assessments there won’t be any SALT, OT or MH provision in the EHCP. You should ask the LA now for them.

In order for the LA are to meet the statutory timescales they should send you a draft by week 14.

Ok, that’s really good to know, thank you. We submitted 2-3 weeks ago so I had better get moving!

[quote ArianaDumbledore]@Preschoolerhelp we found that DS3 really struggled with short trips and no amount of visual strategies helped. It was better when the picking up was tagged on to the end of something else. There was also DS3 really missing DS2 and having all kinds of feelings on him being at school and not being the oldest. Things that he has only been able to articulate as his speech has developed.

When he was assessed by SALT she found that his receptive language was quite delayed but because his expressive is age appropriate it's easy to forget. Misunderstandings of what is happening account for a lot of his meltdowns.

He also now has a diagnosis of ADHD and there are times he is shocked by his own reactions.

It's worth looking at strategies for Pathological Demand Avoidance - I'm not suggesting your DS has that diagnosis, but we find with DS3 what many might view as a treat is actually quite anxiety-inducing for him.

When he's in good form he really lights up the room and can be the kindest and most thoughtful child. When set an exercise on asking Santa for presents for someone other than themselves, all the other children nominated their mum or other family member. DC3 asked that Santa give food and presents to all the children in the world who had none. His teacher (who was not overly fond of him!) got really choked up.[/quote]
That’s really interesting, thanks for sharing. Yes we do find that ‘treats’ often cause more trouble than they are worth..

If you only submitted an EHCNA request 2-3 weeks ago you aren’t waiting to hear if the LA will issue an EHCP you are waiting to hear if they will assess, they have 6 weeks to inform you whether they are or not.

Yes sorry, thanks for correcting. Bit of a long-winded process - keeps confusing me.