At breaking point

[Strawberrymoon98]

I’m at breaking point with my 4yo DS. He will be 5 in September and starting school. Showing almost all traits of adhd. Most noticeable are hyperactivity and extreme impulsivity. He cannot control himself. He isn’t violent but does impulsive things like throwing stuff he shouldn’t, putting things where he shouldn’t (i.e. throwing a bottle of suncream in the bath I am running for him.) Unkind impulsive behaviour such as destroying children’s sandcastles, taking off his cousin’s hat and repeatedly throwing it on the floor.
I need advice on what to do now. He has been at preschool for the past two years and when he transitioned to upper preschool (it’s a preschool attached to a private school) they flagged be was having trouble listening, with instructions, transitions etc and I mentioned adhd and they said possibly. He has improved at preschool over the year and actually had a good end of term report saying he’d made great strides however as he is going into a different school (state) for reception part of me thinks they are less invested.
I just need to know what to do to get support. We can afford private if necessary. I imagine they will flag something when he starts reception but I need immediate help now to manage at home as I feel like I’m not coping or managing it correctly and I don’t know where to go for advice. Is it GP, health visitor, do I need an occupational therapist, play therapist?
and before anyone mentions it, he is given firm boundaries, removed from situations and given consequences. He is upset and sorry in the moment but then the behaviour starts up again soon after.
i am frequently losing my temper and honestly not liking him or being a mother. I recognise I need help as much as him in how I should be dealing with it to give him the best support I can. Please help

In the time it’s taken to write this message, he’s thrown his favourite cuddly over the side of the balcony (we are currently on holiday). Eaten something he found ‘under the mattress’ - came to tell me his mouth tasted funny. No idea what can only hope not poisonous. And now just banged his head messing about on his bunk bed. Im at my wits end.
He is constantly injuring himself through this behaviour.

It really sounds like you're doing your best, even if it doesn't feel that way. I'd start with your GP and the school once he starts, and keep a note of the behaviours you're seeing. I also found ADHD Certify helpful for understanding ADHD and what the assessment process involves. You're not alone in this.

@Wajeehakamran thank you for your reply at a time when I’m feeling desperate. I don’t think they will actually diagnose adhd at this age will they? But I just need to get some support in place mainly so that my husband and I can understand how to manage it and help him at home.
I’m guessing reception will flag something but so far preschool have just said it’s a listening issue. Nothing has been escalated to the point of needing an ehcp or send support or anything. They just say to me there are quite a few boys like it in the preschool. And whilst I recognise many of these behaviours are common in four year olds, I really feel it’s gone beyond that now. I thought last summer was bad but his behaviour is noticeably worse this summer and seemingly getting harder to manage month on month.

@Wajeehakamran also possibly a silly question, but with the GP do I book the initial appointment without him? Obviously we will be talking about his behaviour and I don’t think it would be appropriate for him to be present for a lot of it?

I would start by speaking to the GP. You can book an appointment alone or if you have someone with you so DS is only present for part of the appointment you can do that or you can write some notes to give to the GP if you don’t want to speak in front of DS.

In the UK, it is very, very unusual to get an assessment for ADHD at 4. You could request a referral to a neurodevelopmental paed though for a wider more general overview.

In some areas there are drop in sessions with OT and/or SALT. If your area has them, it is worth attending.

OT will help. Not all ICBs commission sensory OT on the NHS, but either way I think a referral it is a good idea.

What support did the preschool provide? Did they refer to &/or consult any outside agencies?

Have you spoken to the SENCO at the school DS will be attending? Has he had an enhanced transition?

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

When you say DS is given consequences, what do you mean? I’m not asking in a way to say you need to give consequences/more consequences and criticise you. I’m asking because some DC with additional needs need a different approach and typical consequences can backfire and ramp up behaviour.

Some people find the Out of Sync Child book helpful. There is a ‘has fun’ version too. You might also want to try some of the ideas in this booklet. The Occuplaytional Therapist has some useful resources too.

How are DS’s sleep and eating?

@inthequietofdawn thank you for your detailed reply. I will definitely be booking an appointment with a GP as the first step. I’m not sure about any drop ins, I haven’t heard of anything but then I’m new to this. Could the GP advise? I am happy to pay and see an OT privately if that is the best course of action at this stage.
I’m aware they won’t diagnose at this age but I do need some sort of help as does DS. We’re all miserable currently. I had one meeting with his key person at preschool last October, which I requested, after getting continuous feedback at pick up about listening (and noticing behaviour issues at home too). At this point I did ask whether he would qualify for an ehcp for transition to reception as I’d heard about it and she basically said no it’s very hard to get but she’d have a word with their Sendco (I think for the main prep school not just the nursery) - nothing came of it. I get the impression they don’t think his behaviour is that severe to require it? Or that because we aren’t staying on at the private school that they have washed their hands of it so to speak and think they will deal with it when he starts reception at new school?
Consequences- a range of things depending on circumstances. I will remove him from the situation if I can, if not I will give time out where he has to come and sit with me or hold my hand (e.g. if we are out with friends for the day and I can’t leave). At home, we will put toys in ‘toy jail’, or send him to bedroom for time out. We try positive reinforcement too and sticker chart but probably need to do more positive reinforcement. Please let me know if there’s anything else/different I should be doing?
Eating is generally fine, but he struggles to sit still at table. He eats a fairly wide range of foods for a four year old (i.e. not all beige!). At parties he refuses to eat as he’s just too busy having a good time (not sure if relevant).
Sleep is ok on average 10-11 hours. He does wake though with nightmares and will often have night terrors at start of night (another issue!). Seems to come and go. He doesn’t take hours to fall asleep though but I do feel he wakes often for nearly five .

The GP may be aware of drop in sessions but equally they may not know. The 0-19 nursing service should know. The local offer might include them if your area has them.

If you want to pay privately for an OT make sure you go with someone who has the training, qualifications and experience in the sensory side of things. Not all do. If you want to post roughly what area of the country you are in, someone may have suggestions. If you apply for an EHCNA and the LA agrees to assess, an OT assessment can be part of the needs assessment. If you want to go private now but may apply for an EHCP either now or in the not too distant future, make sure whatever OT you use has experience of writing Tribunal standard reports.

Don’t base your decision on whether to request an EHCNA on the preschool or school. Unfortunately, some incorrectly tell parents their DC don’t need or won’t get an EHCP.

Sending DS to his bedroom may not help. Similarly, for some, sticker charts can actually make things worse. In some DC, they can feed into the feelings of failure and rejection. I would try stopping those.

@inthequietofdawn thank you. We are based in South West near Bristol.
So I can apply for an EHCNA and then they will assess those details to see if he qualifies for an EHCP or any additional support? My feeling is that he won’t, only because a friend’s son who also has suspected adhd has one and I would say his behaviour is much more extreme. However I am hoping the school will be able to provide more guidance once he starts fully in September and they can see him in the classroom environment.
Do you have any consequences that do tend to work with young children with adhd please?

You can request an EHCNA yourself. You can use IPSEA’s model letter. Then the LA decide whether to assess or not. If they refuse to assess, you can appeal. If they assess, they will undertake a needs assessment. This includes seeking advice and information from various people. That can include an OT. Then they decide whether to issue an EHCP or not. If they refuse to issue, you can appeal.

Request a meeting with the school’s SENCO. Even without an EHCP, they should provide support.

For OT you could look at Donna Podesta. There is also Ann-Marie Baker but she only has sensory integration module 1. Many travel for sensory OT, if you are willing to travel within the SW you could look at sensory footsteps, Nikki White or Rosie Gibbons in Cornwall.

I would avoid traditional consequences. Traditional consequences rely on skills (e.g. executive functioning, emotional regulation, being able to think of the future and link actions to consequence) young DC with ADHD don’t yet have or have in theory but can’t put into practice in the moment.

Some people find non-violent resistance methods helpful. Some find logical natural consequences, such as when you remove toys which have been thrown (and maybe replacing with other sensory activities that give the same sensory feedback), work. Not immediately but over time when couple with supporting things like emotional regulation. They need to be immediate and clearly linked to the action. Ignoring the lower level stuff will help. Otherwise you get into a negative cycle with few positives. Reduce your use of language. Short simple sentences/instructions rather than detailed sentences work best. They may appear blunt to you, but cutting out the filler words means it is easier for DC to take it. As well as this, thinking about triggers and working to deescalate before DC reach the point of no return is more helpful. You might find keeping a detailed diary helps.

@inthequietofdawn i have been looking at the company Now Next and Then I wondered if they could help.
my plan for now will be to see GP, implement what you have advised above in terms of trying to manage the behaviour, settle him into school and then speak to their Sendco about whether he needs additional support. Is there any reason the school wouldn’t support an EHCP or further support? Does it look bad on them or anything. Also what does an EHCP actually mean? What will having it enable us to do?
thank you again for your help I am new to this and it is very overwhelming

You can apply for an EHCP yourself but, the chances of them knocking you back and telling you to reapply once he’s had time at school are pretty high.
I would use the first few months at school gathering as much evidence as you can.

school can refer to the early help team, and also an EP to observe (this can be done prior to EHCP application) to gather their thoughts.

ask for a meeting with teacher and senco but give it afew weeks for them to see your DS and how he is.

My DS is ADHD and autistic.
he’s only recently been diagnosed at 7.
EHCP applied for term after Xmas in reception, finalised Xmas term year 2.
it’s a long hard road but, the change in him has been fantastic.

school put him on the SEN register in Jan - reception. They then get funding which can help til an EHCP is in place.
things that help at school;
ear defenders (noise wasn’t an issue until school)
chewy necklace
low demands before and after school
sensory toys in class
movement breaks

He does thrive off praise.
I praise him for things that are an everyday thing for an NT child to give him ‘the hit’ and let him know he’s doing well.
when a consequence is needed, I sometimes remove things from him and it’s a 5/10 minute ‘ban’. I put a timer on.
in that time we work on breathing exercises, tracing round his hand, a tight pressure hug.

it’s all a learning curve tbh; what works for one child doesn’t work for another.

An EHCP is a legal document setting out a child’s needs, the provision they need to meet those needs and (in most cases) the placement they will attend. An EHCP enables someone to enforce provision. It also enables DC to receive support they wouldn’t otherwise receive.

Unfortunately, schools aren’t always supportive. For a multitude of reasons, some don’t support an EHCNA request even when the child meets the legal test. The only lawful test for an EHCNA is a) has or may have SEN, and b) may need special educational provision to be made via an EHCP. Anything else is unlawful. Similarly, for a multitude of reasons, some schools aren’t forthcoming with SEN support.

In the current climate, an ed psych assessment via the school &/or LA outwith the EHCNA process is unlikely unless there are significant issues such as very challenging behaviour. And I wouldn’t wait for a ed psych assessment before requesting an EHCNA either.

It is only personal opinion but I’m not keen on Now, Next and Then.

An EP assessment prior to an EHCP application are actually very useful.
the school can make some adjustments to support the child before the long road of the application.
you don’t have to wait to see them before starting an application either.

it may be in areas but there’s never been an issue with seeing an EP before starting the process. It is not unusual or unlikely.

In many, many LAs it is unlikely. Many LAs are struggling to keep on top of statutory work, not that a lack of staffing is a lawful excuse for breaches, before getting to non-statutory work. Many schools have very limited EP time that they use to prioritise certain types of pupils such as those displaying very challenging behaviour.

I didn’t say you had to wait. I wasn’t saying I wouldn’t wait in response to you saying an EP assessment can be done prior to the EHCNA request. Yes, it can, but personally I wouldn’t wait. That isn’t the same as saying it isn’t useful, either.

It doesn’t have to be a long road to application. That is a myth some LAs and schools like to perpetuate.

The school should be making adjustments even without an EP assessment.

I wouldn’t let it put you off speaking to the school about an EP assessment prior OP as they can happen.

Me saying it’s a long is in how long it can take to get an EHCP.
It took us years due to how long tribunal wait times are.

of course they should but an EP can give alot more detail in what can help etc as that is what they are trained to do.

I feel like your trying to turn everything round that I’ve said as advise to OP when this is what my experience has been, so I’ve shared it.
not everything is a No.

I wish you the best of luck OP

I haven’t turned anything around. I have commented on posts. That is how a forum works. I haven’t said you can’t share your experience either.

The length of time to get an EHCP isn’t the same as a long road of the application. That is why I said it doesn’t have to be a long road to application because it sounded like you meant a long road to apply for/request an EHCNA.

No a long road to having it finalised. From start to finish

Then I’m sorry for misinterpreting ‘before the long road of the application.’

Yes I said that in terms of the whole application, not just the initial requesting of one

As I said, to me it came across of you meaning before applying, and I apologise for misunderstanding what you meant.

Thank you for replies. I can see this is a very emotive topic. We all just want the best for our children when little support is readily available.
Do you know if a private school is more likely to be able to support with SEN? We toyed with keeping DS at the private school he has been at the preschool for due to smaller class size (17 vs 30), but in the end it would have stretched us a lot financially.
I must admit I’m still feeling quite overwhelmed at what to do for the best. I think for now I will book a GP appointment and wait for him to settle into reception and see what happens. I’ll give it to October half-term and if no one at school bas raised anything with me I will ask for a meeting.

In the meantime I can try and find an OT. Do you have any recommendations in Bath which is where DS will be at school.

It depends on the individual school. Some independent mainstream schools are supportive of (certain types of) SEN. Some are very much not. Some of those schools who are welcoming charge extra for special educational provision.

If the fees would be a stretch financially, in reception, I would think very carefully before going down the route of paying for an independent school. Is it really affordable? Fees and the extras will only increase.

Micah Law is Bath way. However she was on maternity leave. I don’t know if she still is. I have only seen a couple of her reports so it may not be representative, but I don’t think they were the most comprehensive I have seen so if you may apply for an EHCNA at some point she may not be the best person to use.

@inthequietofdawn We aren’t paying for independent school for the time being. If things become very problematic at the state school we are going into then we may consider it, if anything for the smaller class sizes.

Sorry I wasn’t meaning to imply you were going down that route now. I meant that if going down that route would be a stretch now, I would think carefully about whether it is, at whatever point in time in the future, truly affordable before changing your mind and going down that route later because fees and extras will only increase with age.

If you go down the EHCP route, if an independent school is required, an EHCP can fund independent schools.

@inthequietofdawn we are in a fortunate position that my husband’s salary will likely double in the next 10-15 years so our circumstances will mean we can afford it.
i’ll update once I’ve spoken to a GP. Thanks again for all your advice so far