Help - 4 year old keeps hitting.

[Worriedmotheroftwo]

I just don't know what to do. My 4 year old (almost 5) is suspected ASD/ADHD. He stims and has trouble with transitions, as well as behavioural issues. We manage him well at home, but at nursery he is becoming increasingly challenging. He is getting angry and hitting other children. I just don't know what to do.

We have an ASD assessment for him in a few weeks. They won't assess for ADHD until he is 6 (is it correct that the earliest ADHD can be assessed is 6?).

But a diagnosis will only be a diagnosis anyway. I need to know how to help him. I've tried everything I can think of. We've gone through strategies (breathing, counting etc) to do when he's angry, nursery have done an ABC chart, we give consequences for hitting, we talk about it, we've read books about emotions, we've cut out almost all sugar, doing early bedtimes, lots of exercise, we've even tried probiotics (I read a research article on this). I just don't know where to go from here - nothing is working and it is getting worse. When he's not angry, he's an absolute champ, and a lovely well behaved little boy. But he has outbursts and lashes out.

He starts school in a fortnight. School is aware of his issues and I am being very open with them. However, I'm terrified he's going to hit other kids, parents will complain and he'll be asked to leave. Weve got him into a lovely private school with a very small class (fewer than 15 kids) which I think will really suit he. He is very very clever and brilliant at maths. But he won't last long if he hits kids.

What else can I try that I'm not already doing?!

I'm looking into seeing if I can get an EHCP as maybe 1:1 support would make the difference. Is there anything else at all I can do? I'd be so grateful for any help. I will do absolutely anything but I have no idea what the best thing to do is. Is there any sort of therapist that deals with this sort of behaviour with SEN children Thanks? Thanks so much.

You don’t need to wait for a diagnosis for support.

What did the nursery’s ABC chart show? Have you kept a detailed diary to try to spot the triggers and prevent/reduce them or if that isn’t possible improve the handling of those situations/deescalation?

What support was DS receiving at nursery? You could ask the school if they have anyone who can support Zones of Regulation work. Some find nurture group helpful, if they offer that. Play therapy or OT may help. SALT can support interaction, too. Some people find Ross Greene’s book The Explosive Child helpful.

Thanks. I know, but I literally don't know what support would be useful - that's what I'm asking.

I'm reading The Explosive Child at the moment - it's very good. The ABC chart at nursery shows that triggers are when he mostly gets annoyed by other children knocking down his towers, or getting in his way, or with transitions. We manage that fine at home as we can give him close attention and can help him calm down if he gets upset, but obviously it's not 1:1 at nursery. We don't keep a diary at home as we manage him fine and actually he's really easy most of the time when he's with us. Much easier than his toddler brother! It's specifically the nursery setting that he struggles with, with other children around.

He hasn't been receiving any formal support at nursery, although I know that staff do keep a closer eye on him than others.

Is SALT useful if his communication is excellent- I thought that was for speech and language? He chatters away confidently when he's happy and has plenty of rambunctious friends (when he doesn't hit them!).

Play therapy and OT (occupational therapy) - what is the difference and how to I go about getting this therapy? Happy to go privately if necessary but I don't know who is good etc or exactly what I'm looking for!

Will ask the school about Zones of Regulation when the summer holidays are over, thanks.

Really appreciate your advice. If anyone has anything else, I'd be so grateful. Really desperate to help him but just overwhelmed by the whole system!

I know you are asking about types of support, my first sentence was in response to reading your post on the other thread you posted on where you wrote “Should I was for his ASD assessment/diagnosis first or not?”

Nursery should have been providing support. Did the nursery try a visual timetable? Doesn’t help all DC, but it does help some. If they didn’t you could try that with the school. SALT can help with interaction. It isn’t just about the physical ability to speak. OT and play therapy can look at different things, e.g. OT can also look at sensory needs, but both can support DC with emotional regulation and interaction. If you secure an EHCP, therapies can be part of that. Otherwise you could look at an NHS referral (in some areas you can self refer - although sensory OT isn’t provided on the NHS in all ICBs) or private.

Nursery should have been providing support

He's only just started there. He got excluded from his previous nursery for his aggression. He's only there for a couple more weeks and I'm grateful to them for taking him.

Thanks for the info. Trying to unpick it. Where would you recommend we start - there's a lot there? Do I simply try to find an occupational therapist as first step?

I would start by requesting an EHCNA using the model letter on IPSEA’s website. It is a shame the previous nursery excluded before they exhausted avenues of support such as requesting an EHCNA. I would also request a meeting with the school to discuss how they can support DS.

I think I would wait for therapy for a few weeks. Starting school is a big transition for all DC, lots of new people, tiring etc. on its own without adding therapy sessions to the mix which can be tiring for DC in their own right. Then when you do look at therapy I would probably start with play therapy although it is difficult to say for certain without knowing DS.

would start by requesting an EHCNA using the model letter on IPSEA’s website

Thanks so much. I have no idea what this means, but will look it up!

Yes, I will never forgive the previous nursery but nothing I can do about that now.

I know play therapy is something the school can offer or arrange so that's good.

Thanks again- hugely appreciate the replies.

An EHCNA is a needs assessment you first request as part of the EHCP process. If the LA agrees to assess can include various assessments such as from an ed psych, SALT, OT etc.

IPSEA is a charity that supports parents with SEN matters. They have lots of helpful information on their website, including some model letters, and a helpline.

Amazing, thanks. This looks great.

Hi @Worriedmotheroftwo this sounds just like my son at that age, and unfortunately fixed term exclusions continued into primary school.

We too have tried a whole host of approaches like you but nothing has helped. Our son is likely high functioning autistic (still waiting on formal dx) and has severe sensory processing issues. The sensory processing issues are what is believed to trigger much of the anxiety/aggression that our son presents with. Like yours, only at school, where there are lots of sounds, smells, interruptions etc..

You may find an OT assessment helpful, and maybe get one organised so that your son can be observed in class. This would tell you about sensory issues. We found this, and the strategies recommended, helpful.

Can you meet with the school Senco and head of early years/ class teacher ASAP and put in place a transition plan, and possibly create an Individual Education Plan (IEP) for your son? This would be reviewed every three months and outlines easily-met, additional support your child will receive.

One of our greatest challenges for us was that school always said they couldn’t ascertain what the triggers to our son’s challenging behaviour was, so early communication and plans with school about this could help.

I wish you luck - I know just how you’re feeling. If you want to PM me, am happy to chat.

Can you meet with the school Senco and head of early years/ class teacher ASAP and put in place a transition plan, and possibly create an Individual Education Plan (IEP) for your son?

Thanks, I definitely will do... as soon as school holidays are over. Thank you. I will pm you if that's okay - really grateful.

It would be worth making a SAR to the previous nursery so you have evidence for making an EHCNA and should you need it for anything else at a later date.

Although independent schools must make reasonable adjustments in line with the Equality Act, they don’t have to abide by the SENCOP, so they may not follow the assess, plan, do, review cycle in the same way.

Thanks. We did put in a GDPR request but they didn't give us anything at all. It all got quite nasty actually. I reported them to Ofstsd and the ICO (I think that's what it's called? Who deal with GDPR) but nothing came of it.

I would chase it up with the ICO.