Advice for managing possible SEN-related behaviour in my four-year-old

[Newbie234561]

I have posted in parents and was told to post here. This may be a long and confusing post but I hope someone has some advice. I recently spoke to my health visitor regarding my 3rd child who is 4 years old, his behaviour has worsened over the last year and I am finding it difficult to handle. It’s started with what I thought was just normal toddler frustrations and paddies and is now extreme tantrums, hitting throwing things and hiding in very unsafe spaces. I reached out as I’ve dealt with a lot of different things with him being my 3rd, my second was diagnosed with asd when she was 6 she is now 12. So I’ve handled quite a bit as a parent. His pre school also has mentioned a few things when I have gone to them and I hoped it may just be age related however they too have noticed the frustration, hyperactivity and one mentioned him being difficult with change in routines, she also said she feels there may be more to it with him (I know they tread lightly with these things) the morning I spoke to my health visitor was due to one of the more frightening behaviours. He had gone out of my front door, whilst getting shoes on to leave and hid under my car, me and my older children had been calling his name searched the car and the house I then walked up the road to see if he had ran and whilst walking back I saw him laying under my car with absolutely no emotion on his face still as I called his name to come out and asked why he did that he said he liked it I explained (not the first time) that it’s dangerous and that when I call his name he must answer as it is worrying. I did explain to the health visitor i am not looking for assessments and or labels simply advice on how to manage, she said she feels it’s sensory based and gave me some links to look up however she also said she feels what I am doing is primarily what they would advise and to get back to her in a month after trying. The issue I have is just like everything else it’s works for a short time span (4 days) I just increase the things I was doing and tried more patience and understanding, I say it worked I mean for the most part of the day I could see he was trying his best to behave and ignore impulses, that did just lead to a larger explosion later in the day, day 5 comes around and each thing I was doing seems to make no difference and he is now hitting more and lashing out more. I feel he understand this is wrong as he does apologise and I can see the regret. But in the moment it’s as though the consequence does not matter. I would rather avoid the lengthy heart breaking assessments and skip to how best help him- and myself so I don’t lose my mind 😂 if anyone has any advice and has dealt with this I would hugely appreciate it. Thank you

Tantrums or meltdowns?

Personally, I would request a referral to paeds.

Request a home OT assessment to look at making the home safer and better meet DS’s needs. They can help with equipment, aids and adaptations. For example, they can look at specialist locks on the door DS cannot open and if you have a driveway, they can look at helping make that secure so DS can’t get out.

For outside the home, do you use reins &/or a pushchair when needed?

Not all ICBs commission sensory OT on the NHS, but if your area does, it is worth a referral for that too. You might find the book the Out of Sync Child helpful. There is a ‘has fun’ version too. Also this booklet and some of the Occupational Therapist’s resources.

What support is the preschool providing? Does DS have a support plan (called different things in different places but a plan that sets out DS’s needs and the support he needs)? Have they asked any outside agencies for advice? Has an EHCNA been requested? Is DS starting school in September?

The explosion you mention is known as the coke bottle effect. It is often used to when talking about school, but it can apply to other circumstances too. It signifies unmet needs. If the ‘most of the day’ part you mention was easier, home life would improve too. This could also explain why the initial days are easier but day 5 is not. DS can appear to manage to contain everything until, well, he can’t and it explodes. Think of a glass topped up throughout the first 4 days and then spills over when you continue adding to it.

Honestly I’m not sure, with my older child it was very clear to see and only took place just after school.

Thank you, a few people have mentioned OT so I feel this is probably a good route to try. I do have a door latch high up and keep it on at all times it’s just happened to be a very warm day and I had gone out to the car to open windows. He has hidden behind bins, in the car and different places previously but this the most dangerous.

I typically drive everywhere and on the occasion we go out it’s a short trip and in shops he will run but with the right encouragement (helping me with putting shopping in the trolley) he can behave well but again once we are at the till it becomes an issue of hiding under tills and climbing on things.

activities we do I tend to make it so it’s open fields, parks or water play as he can run free and safely.

As far as I am aware they have a type of plan but more based on helping him with communication and speech, I’ve only recently spoke to them about my concerns so now is when they are mentioning things to me.

I understand the coke bottle effect however I don’t believe it was called that when my daughter was younger, I thought that may be the reason for this and just hoped there was a better way of managing so this didn’t happen but it seems he tries his very best and just can not anymore, and it’s heart breaking as it’s as though he really does not want to behave this way but even with me using different oulets, encouraging positive behaviour, taking extra time and understanding he still struggles.

You might have heard it called after school restraint collapse with your DD.

You can request an EHCNA yourself. On their website, IPSEA has a model letter you can use.

If you feel you can’t keep DS safe in some situations out of the house, I would look at reins/harness for places where DS’s running away is a danger.

would this not be jumping ahead? Is it possible that the structure of school could improve behaviour maybe? That might seem silly or that I am in denial but I wouldn’t want to use resources needed by other children.

I have requested more info from the pre school so I can fully understand how things are there too. And his reception teacher is going to visit him at the pre school soon, maybe I could ask if it is worth doing. Thank you

Personally, no, I don’t think it is jumping ahead. I would make the request. I wouldn’t let the preschool or school put you off. Unfortunately, some incorrectly tell parents their DC doesn’t need or won’t get an EHCP, but the parents go on to successfully make the request themselves, even if they have to appeal. It isn’t about what other DC also need. If DS is starting school in September, you won’t have one by then, anyway.

Is DS receiving an enhanced transition?

I think maybe I wonder if he could settle and it wouldn’t be necessary however I guess it would be better to start the process just in case. I heard from the health visiting team today and they said although it was suggested to wait the month she anticipated they would need to get involved again, she has referred a team to get in touch and do some assessments to see how best to support him and I, do you know what this may include?

Not as yet but his teacher is going to visit the nursery and I guess that would be something they suggest if feel needed? Or am I putting too much faith in them?

I wouldn’t rely on the school raising it. I would request a meeting with the SENCO and take it from there.

It depends on what team the HV has referred to. If they mean a team within the health visiting team it will probably looking at taking a history looking at pregnancy, birth, and development to date. Looking at things like sleep, hearing, vision, eating, motor skills, communication, nursery, play outside of nursery. They may ask you to complete questionnaires such as the Ages and Stages questionnaire and the Ages and Stages Social-Emotional questionnaire. They may observe DS while he is playing and doing some activities/tasks.

My DS was referred for an ASD assessment via our health visiting team, age 3. If we had let it continue into school before trying to get a referral we wouldn't have had a chance.
My DS masks so well at school (and he does have an amazing school, very relaxed and have been super accommodating anyway) plus the much higher child to adults ratio they wouldn't have had chance to pick up on the behaviours my DS carries out. I want to stress that particularly at this age my DS did very much seem NT to everyday people, just extremely shy.
We were advised to refer before he got put into the education system and if we felt it wasn't required as he got older we could just have him removed.
Our health visiting team were an absolute backbone for us in the transition to school, and I wish they could still work with us now because as soon as he came off their books we had nobody to replace that support.

Sorry I know that doesn't quite answer your post, but if you can access any support via the health visiting team before the end of August it may well be worth it.

@Iknowthatfeeling it isn’t quite the same as the traditional HV role, but if there is something specific you want to discuss, you could contact the 0-19 nurses/school nursing service.

I’m sorry it has not just emailed me a reply. Thank you, you have been very helpful in all of this. I will be calling the school today to see if I can get in for a chat, when viewing the school and doing the picnic I found them to be very helpful and said to reach out if I needed to.

yes it’s the health visiting team so I imagine it will be what you have said

Thank you, my dd’s nursery were great but when she went into reception they said she didn’t exhibit any behaviours, then near the end of the year when it was more “structured” they noticed and her year 1 teacher actually pushed for the referral so I thought it would be the same but maybe not the case. I hope your little one is doing ok now

@Newbie234561 is your DS going to the same school as DD?
I would definitely get in front of the SENCo so he's on their radar, highlight any specific concerns you have as he doesn't need to have any kind of referral in place in order to be on the school SEN register. They can offer enhanced transition (my DS went in a couple afternoons for 20/30 minutes with us) however you are quite short of time with the term about to end, so I'd call them today.
It may be a watch and wait situation with school to begin with, as they get to know him but you can always flag new things with them.
Your local SENDIAS can also provide impartial information for you as well, they'll give you a call back and let you know your rights and what school should be doing.
Also does the school have locked gates during the day or are they open? They need to ensure he can't or won't have opportunities to escape/hide unseen if that's something he may do to regulate himself.