If I think my 3 year old needs help to whom do I ask to be referred?

[lisalisa]

I think I need help with my 3.6 year old dd4. She is number 6 of a large family. I'll cut to the quick here and say my concern is mental illness.

From birth when she was in her little bouncy chair she would startle and scream inconsolably when strangers came into the house. My husband's dn was a case in point and he could not approach her until she was past the age of 2 without her hyperventilating from fear.

Instead of her enjoying the attentions of her older siblings who were desperate to cover her in cuddles she would alternately ( as she got older) either call them yukky or say she wasn't their friend or she didn't like them when they tried to give her attention or play with her. She still today doesn't have close relationships with them as she sometimes pushes them away and sometimes will invite them close.

At nursery she is not popular. She wants to bring in an object from home every day ( I think as a comfort and to cling to familiarity) and yet she will not show it to the other children or share it. Neither will she join in their games or give to them in the sense of listening to their stories and joining in play but will occasionally hog the show by talking non stop and most times just stay near the nursery teachers.

I almost feel as if she is trapped in a prison as very very occasionally ( say once per month) she is in a fantastic mood and chats animatedly and says she'd like a playdate and eats well and generally behaves herself very well and then suddenly its like the shutters are down again and she is back to her normal self.

In terms of behaviour she is extremely difficult and I am exhuasted. By that I mean that she will not allow anyone else to pour her a drink or do up her zip except me. She sleeps next to me at night in her cot and wakes numerous times sometimes asking to come innto bed with me and sometimes just screaming.

we did have her in her room for a while but she constantly woke up my dd3 aged 10 whose school work then began to suffer. We tried everything - stairgates/sticker charts but she still woke up at night. Surprisingly apart from seeming a bit tired she copes magnificently with her night disturbances. I only moved in her with us out of desperation as i couldn't stand the nightly screaming and having to get up and do the shush shush routine or cc or whatever we were currently trying.

The sleepless nights are just one more facet of her behavior however.

On top of this she seems to get ill quite often - fevers and coughs. I have taken her to a pead about this and results are back tomorrow for a battery of blood tests. However I really need her referred for her behaviors - something is definitely amiss and the thought of continuing for too much longer like this is enough to make me want to leave home!!!

Is it a child psychologist I want or what type of practitioner?

Can you make a proper appointment to see the health visitor (as in ring and ask for one, as opposed to a drop in appointment). They should be able to support you/refer you on, although they may start by looking at parenting strategies first.

Have you spoken to her nursery worker? Do they have any concerns?

I think you need to see your GP and ask for a referral to a developmental paediatrician to discuss your worries.

Have you spoken to the nurset about your concerns

Are you seeing the paed again about the blood results? Could you flag up the behaviour issues too?

Thanks all . yes seeing paed tomorrow and will flag up concerns but i am the kind of person that i like to know who I should be aiming to see rather than just accept whatever he says I shoudl do. So for eg if I should be aiming for therapist ( play therapist type person) or psychologist ( which sounds a bit heavy). Re health visitor - round here they are not that good but I could try. Ditto GP really.

Nursery staff do see my concerns and think things are not optimum but just put it down to shyness. They were supposed to be getting an ed psych to assess her but the lady never seems to be there to do so. Would an ed psych be right do you think or wrong focus?

I think you should ask nursery to do you a written report of their concerns and I think you should write down your concerns and examples for the paed. I think it is too early to be thinking about specific therapists until you know what the actual issue is (if that makes sense?)

When I had concerns regarding ds we saw the paediatrician who referred us to an assessment at the child development centre, who did a two day assessment and ds was diagnosed with autism (not trying to diagnose you dd here just explaining the process we went through) once he had his diagnosis he was directed to the relevant professionals eg speech therapist, ed psych etc.

thank you - that is very helpful. I will speak to paed tomorrow.

Good luck, don't be afraid to be pushy about it! You're an experienced mum and you know something isn't right so don't be brushed off.

Ed psych should be able to asses and nursery could sort this for you. Would hive you a starting point. She is still quite little, can be lots of change in the next few years as you know. One of mine was worrying, mute in public, aggressive to strangers/friends, hostile to everyone other than me and his dad, no eye contact with anyone else, uninvolved at school, slept in our bed out of necessity, huge violent tantrums... Now he is entirely ordinary. Hope your dd evens out too.

Ah didn't see that you were seeing a paed tomorrow. Definitely speak to him and ask who he thinks you should be referred onto.

I agree you need some idea of diagnosis before you can look at particular therapies.

If nursery have said they were looking for an ed psych to report DO chase them on it as well as above. A report will help you build a picture of what/if there are issues and help as you progress onto school etc.

(IANAD etc)

I also think you need to push nursery to start making more formal observations of your dd so you have some other supportive evidence, ask again about the ed psych. Perhaps suggest a meeting with nursery rather than informal chat that will make people more "focused". You could also ask for them to arrange for a meeting with the LEA's early years area SENCO. I met quite regularly with ours right up until ds started reception and he/she should be able to get the ball rolling quicker with the ed psych.