MH issues in 5 year olds other than ASD?

[Flyingwasp]

If anyone has a child around 5 with a diagnosed MH issue thats not (typical) ASD. Could you pls tell me about the most telling signs (or quirks) that prompted the specific diagnosis?

My 5 year old seems to be struggling a lot and it has really impacted our lives. It’s been going on for years and I gave up on hoping he’ll outgrow it. Of course, I thoroughly read up on ASD and ADHD but quite frankly these don’t seem to fit (even at a stretch).

I know I’ll need a professional to diagnose him but I’d at least like know what direction to look. Any kind of professional diagnosis will be years away as he’s high functioning and it’s normally the “wait and see” advice I’m getting.

Family members think it’s only due to bad parenting and I agree that’s very much a possibility. But, still, there’s a possibility he has some underlying problem that would need a specific approach to manage, so I’m just trying to gather more info.

@BertieBotts thanks for the link, i’ll have a read. I think he may have some extra sensitivity to noise, touch and lights in some situations but not really consistently.

One of mine is exactly like this. A really really rigid routine with firm boundaries have helped with behavioural regulation. Contrary to modern parenting beliefs children thrive off strong boundaries and push you until you provide them. I hate being so firm but my child has become so much more settled when life has become more predictable. They know what to expect and when, there are no surprises sprung on them, bedtime is always at the same time every night.

It's extremely restrictive but we are looking at an ASD diagnosis here however by being so rigid it's led to almost no violent meltdowns. I have got one of those picture charts where you can plan the day for them - up, washed and dressed, breakfast, TV while mummy gets ready, when mummy comes downstairs it's shoes on and out the door etc etc.

So that would be my advice. Give them security in routine.

@Jules912 just looked up interoception and this is definitely an issue with our DS too.

@Whatwasthepoint thanks, I realise this works for a lot of families, but it’s completely unfeasible with DS. It really doesn’t matter if we set out a “bed time”, this will not be respected, he just won’t sleep or be quiet in his room, he will just scream in fright and trash the room. Same with dressing up etc, he just won’t cooperate, dressing up can take any time between 5 minutes to an hour depending on how lucky we are… it’s not like we haven’t attempted more structure, it’s that he just won’t go along with the routine and I can’t make him comply with these kind of demands.

What consequences are there to his actions?

Meant to add OT said most autistic children also have sensory issues but the reverse isn't necessarily true.

@Whatwasthepoint no matter what, he doesn’t care (things people often suggest, like take away a toy, say ur not going to the park if you don’t put on your shoes; these don’t have any effect as he just says ok, don’t care and he really doesn’t care.). If he gets sent to his room he just trashes it, this only frightens him but nothing improves. I’m open to suggestions of course, but I haven’t found anything that works.

Put everything up on shelves that he can't access and have his room pretty bleak/safe for him to trash. Everything he throws out/smashes pick up calmly and put in a bin liner. Everything gets put in a bin liner and he earns them back. First thing goes back when he calms down has a cuddle and says sorry (and means it). The rest he earns back over a period of tasks that he completes without a fight. It's tedious but he needs to know you mean business and he's not in charge of calling the shots.

Even if he had a diagnosis of some description you would still need to take a firmer line with your parenting and give him safe places to meltdown without you getting cross. Calmly repeat "you're safe you're loved it's ok I know you're feeling sad but I'm here for you" and lay down the foundations when he's calm. Get a squashmallow type toy that he can pummel when he's cross and encourage him to use it when he's calm.

Then, as time goes on, try and unpick what's going on. Is he anxious about school? Has something scared him (an unexplained noise at night) and he can't process it? Has he over heard a conversation and has turned it into a big thing like 5 year olds are prone to do?

This may not work, and I'm sorry if you've already tried it all! I wish you luck. It's horrible when they're scaring themselves and you can't fix it quickly

He sounds like he is in fight or flight mode all the time. There is no point handing out consequences when kids are terrified because they can't take any information in.

Try reading the explosive child by Ross greene and the out of sync child and see if they ring true for you.

When you say tantruming. Is this behaviour is response to being told no to something such as sweets and would it stop of you gave him the sweets?
Or is it more like a meltdown in response to something and stopping that thing dorsnt instantly stop the behaviou, the behaviour just has to work its way through?

I would agree with this.

Yes DS had diagnosed anxiety at aged 5 and the NHS waiting list was LONG! He started hurting himself as punishment for feeling anxious so we panicked (self harm) and started private play therapy.

It was incredible and the school said he's back to his usual self within 2 sessions!! We stuck with it for 6 sessions and then reduced the frequency.

It was £45 per session. And about 45 mins (I think!)

There is no point handing out consequences when kids are terrified because they can't take any information in.

no but you can calmly remove the missiles as they land and reassure them in a soothing tone while you do so. The discussion around consequences can happen when the meltdown has passed.

"Ok I get you were scared, let's hug it out. You know there are better ways of managing big feelings don't you? Let's get you some of these toys back shall we? Let's get ready for bed and you can have X toys back..."

what does school say op?
you dont have to diagnosis but you can ask for a referral to a paediatrician

The therapist told DS that in the old days when we were cavemen, we used to panic and worry about predators hence our hearts being jittery and panicky at times.

But she said we don't have to worry anymore so we need to learn to put our inner cave person back in the cave (in our brains!)

And basically explained that panic was a redundant emotion.

But also, lots of play and talking.

Another vote here for The Explosive Child book. It's not diagnosis-specific - it's helpful for children who struggle with emotional regulation, demands and flexibility regardless of diagnosis. It really helped us navigate a way out when our DD was particularly dysregulated.

Consequences don't always work with dysregulated children and can make their dysregulation worse (certainly was the case for my DD).

OP have you read about Foetal Alcohol Syndrome? This diagnosis is having a massive overhaul at the moment and is also like a spectrum. It's now believe that even a small amount of alcohol at a critical point after conception and often before women are aware they are pregnant can cause FASD.

Have a read, it's more of a spectrum disorder now and can overlap with ASD and ADHD.

@Geneticsbunny this is absolutely true, thats what concerns me as I don’t get why he needs to feel this way. His environment is not what you’d call stressful by any common standard.

ASD isn't a mental health problem

This would work with a less severe situation but it sounds like this little boy is tantruming/ panicking/ throwing things every hour so there probably isn't much time in the day, if any, that he would be calm enough to be able to take any information in.

When similar happened to us we just lowered our expectations to the bare minimum, food, sleep, health and just went with whatever was least stressful for the whole family. This removed most pressure and triggers from him. Then we slowly introduced things which we knew supported our son like his favourite sport so that he had access to things he enjoyed in a low key non pressured way.

Slowly over time he became less terrified and happier. Obviously calm reassurance is brilliant whilst this is going on but on its own it won't fix the issue once it has got this bad.

My ds was also an angry little boy - only he wasn't, he was a very stressed and anxious little boy. He was later diagnosed with autism. I really wish I'd understood what I saw as anger was actually anxiety when he was younger.

I have no idea either but my guess is that there is some combination of things he finds hard to deal with that are currently too much for him.

They could be external (sensory) or internal (thoughts). You can't do much about the thoughts at the moment so focus on reducing sensory stuff and pressure to behave.

It was explained to us that we all have a box that gets filled up every time we have to do something tricky like ignore an annoying sound, or listen to someone talking (hard if you have speech processing issues), or eat (could be hard if you are dyspraxic) or behave. Each time you add something to the bucket it gets fuller until you explode. Somedays you wake up and the bucket is already half full because you haven't slept etc. Removing all demands should give you breathing space to work out what his difficulties are. Once things are a bit better you can use an ABC chart to work out what specifically is adding to his bucket and then you can help to minimise those things going forwards. Definitely get your GP to refer you for assessment for developmental difficulties (dyslexia, dyspraxia, speech and language processing disorder, ASD, ADHD?could even just be sensory processing disorder). There is clearly something going on and I think you need help working out what.

What support is the school providing? Does DS have an EHCP? OT, SALT and MH support?

If you haven’t already had one ask a home OT assessment to look at making the house saver. You could also look at a SafeSpace bed and ask about melatonin.

Well, setting consequences is hard, he really doesn’t care about toys/objects and whether he gets them back (same for future activities). Being in the same room while he’s trashing it is not safe, and quite frankly it’s not a “soothing” meltdown, he wants to break out, break the door down, destroy everything, break windows. He certainly doesn’t take himself to a quiet corner to calm down… no point talking to him at that point, it just irritates him, can’t just cuddle as he is violent with full force. He obviously can’t control this.

What triggers the full on meltdowns or just the random aggressive things is varied, often it’s being said no, often it’s out of the blue and just starts hitting. It can be a lot of things really, find it hard to predict.

Do you have a safe space for him to meltdown in?