Concerned about a child, might be wrong, what do you think?

[SloanyPony]

I'm close with a group of about 9 parents, and their children, they were my antenatal group so I've known their first babies and subsequent children since they were born.

The children have been close and have grown into preschoolers together, well, they are approaching their 3rd birthday. Many now have younger siblings.

One of the children started hitting a lot soon after his first birthday. It started with his parents, but soon moved on to other children. He bites and pinches/scratches as well. He doesnt appear angry as such, and doesn't just do it out of anger - he can do it unprovoked for any or no reason. A few days ago he managed to scratch every bare surface of his baby sister when his mother was briefly out the room. She saw him doing it, directed him to stop, and he just looked at her and continued doing it. He didn't seem angry at the time, she said - very calm and calculated.

His parents have tried just about everything to get it to stop, all the usual time out and telling off, making a fuss of the injured party, nothing seems to work. He gets a glazed expression on his face when being told off. It seems not to bother him in the slightest. He doesn't try and cover it up either - if you say "did you hit Ruby" he'll just say "yeah" and look vacantly in the other direction. There is no emotion about it.

His non-violent behaviour is very antagonistic. The only time he seems to interact with other children is to ruin a game - like take a piece of track away from the train track so they can't play with it, take toys of children, not for the purpose of playing with them himself, but to hide them and then watch them be upset. I believe this is also why he hits - he seems to like to watch other people be upset. He likes to goad other children too by screaming in their face (there is a lot of screaming) or taunting them, though he doesn't really have the speech so it just comes across as a sequence of taunting sounds and tends to be delivered in the face of another child.

What concerns his parents also is this child has considerable speech delay - he has an unusual tone of voice, very poor diction and very limited vocab. He sounds more like the average 18 month than 3 year old and his mother is concerned about this too.

Yesterday, we followed him round very closely as it struck me that when he is not able to be antagonistic or hit due to super-close supervision, he doesn't really know how to play with other children, or even alongside them - so he'd play alone with his back to everyone else. If we wandered off and he noticed that we had backed off or were involved in conversation, he'd see it as an opportunity to go and antagonise or hit, but then we'd be straight on to him so he wouldnt' get away with it so he'd go back to doing something on his own.

The other children in the group (3 years old) are playing nicely together now - games involving chasing, passing cushions to each other and making stacks of them, one on a bike while the other pushes them, that kind of thing. He seems unable to interact in this benign way - the only interaction he seeks or seems to know how to do is antagonistic.

Does this sound familiar to anyone? Is it a set of behaviours that has a name to it? If so, how is it best tackled? How would you deal with it? Do you think it indicates a special need or just some difficult behaviour? I know the behaviours in themselves could be considered "normal" for the age, but I have not observed any other child who displays them all the time, to the exclusion of other more sociable behaviours, and so consistently so they become known as the child who does that all the time, if that makes sense.

His mother has not had him seen by any health care professionals and he doesn't have a health visitor. He hasn't had hearing checked, or anything like that, I dont think he's really been seen by anyone at all for quite some time as there hasn't been a need but his mother is now at the point where she is considering getting him seen but doesn't quite know where to start or if its simply that she is to blame, she's at that point. She wants some other perspectives before she goes down this route.

Thanks for reading that! I hope this is the right place to post it.

tell her to call the HV or go to GP. She needs some help and advice. It could be signs of a SN or just a very frustarded child who cant get himself heard with Speech delay. Either way he needs to be seen. Tell her to start a diary of his behaviours, its always helpful to have examples handy.
HTH

He should be seen yes, although knwoing that and being able to broach with the Mum is another thing entirely and you should proceed with caution.

Start with hearing / vision as hearing esp. can be very related to this.

I have to say thought that IME (which is fairly ameked, 2 kids with it and working at an MA in the subject) it may be that this child needs assessing for an ASD (autistic spectrum disorder). The hittingc ertainly presents like my ds1, although a speech delay would be huge red flag in itself in any professionals were invcolved I would think.

Google the triad of impairments and see if that fits. I have to pop out but will look back later. good luck.

Oh and remember an ASD does not necessarily mean severe impairment, it can be quite mild. but long term prognosis better with early input.

Thanks for this. I think she's at the point that she will get him seen, she doesn't know where to begin, but I've said, begin with the GP if you are unsure!

Sorry to dripfeed but he had measles but wasn't checked for hearing loss.

See its tricky because many children hit - but I've not seen one hit like this. Usually they are antagonised or angry or there is a "justifiable" reason (for want of a better word)

The antagnoistic stuff bothers me more than the hitting, I think, personally, this need to wreck things for others - its so antisocial and one wonders where it will lead. This bit sometimes goes over the head of the mother - if he takes a toy she convinces herself its because he wants it and all kids do that - but he then goes and hides it and basks in the fall out from the other children - which is an entirely different thing altogether.

Mother is swinging from burying her head in the sand and making jokes about it (like "anyone know any good adoption agencies" etc) and wanting to tackle it now as she's back at work soon.

I don't think the mother's concerns are unfounded. Individually my DS1's difficulties aren't especially severe but put them together and it changes the story IYKWIM.

The mother can self-refer to Speech and Language Therapy - I would suggest she rings then follows up the conclusion of the conversation in writing e.g. appt schedule for xx date. SALT isn't just about no of words spoken, it is about how the child communicates and understands language too.

If her GP is helpful I would suggest going and asking for a referral to a paediatrician (pref. one who specialises in development issues).

It may also be worth her getting in touch with the local sure start centre if there is one in your area. I've had some great support from a Family Support Worker. You don't need a dx or anything like that. Also consider Homestart referral, I have no doubt she is coping well but it must be fairly full-on to deal with and a couple of hours support at home could really help.

Is he at preschool/nursery yet? May also be worth speaking to the SENCo as may be able to access an Educational Psychologist referral.

Not suggesting she does all these things at once, just giving an idea of what services are normally available.

sorry crossed-posts.

Hearing test wise, but the standard ones will require a certain level of understanding and compliance from the child. So she may end up being referred on/have to go back again.

There can be lots of reasons for the hitting, one could be sensory-related. My DS1's pushing can get out of hand v quickly, he is under-sensitive so really seeks out rough and tumble (slamming into us/walls/furniture). Could also be because his social skills are under-developed he has got into the habit for hitting as it will yield an interaction (though obviously not one the other party is keen on).

Agree with justa, downplaying the difficulties to the GP etc will likely result in them saying wait and see 6 months and as waiting lists can be v long it is best to get on them asap.

If he's got significant speech delay (whether it's related to ASD or not) it will almost certainly affect his ability to interact properly with his peers. At the age of 3, as you say, most children start playing together, in a more sophisticated way. If he has language delay (particularly receptive language - what's his understanding like?) he may feel out of his depth and a bit lost. The behaviour you describe (eg hiding toys, shouting in faces) suggests more to me that he wants to join in but doesn't really know how - if he's not equipped with the same skills as everyone else he'll struggle.

DS shows inappropriate social behaviour to a certain extent - he wants to play with other children (sometimes) but will sometimes push them to get their attention - he doesn't have the social skills to approach them 'normally'. We've been working on strategies such as patting another child on the shoulder to initiate play.

Would definitely suggest starting off with HV/GP for speech delay if nothing else.

agree with bialystok. try not to see the behaviour as deliberately antagonistic or taunting - it may be frustration due to difficulty communication or it may be that the child doesn't know how to interact and/or is misreading reactions - i.e. if a child responds by crying, that he doesn't realise it's because the child is sad.

There are eharing tests theyc an do at this age; at that point they semed to think that was ds1's issue (the other stuff came later, lost speech at three) adn they ahd all kinds of wonderful tests they could do.

WRT to antogonistic hitting so many things that could be- simple frustration at hspeech delay is quite usual; ASD social issues; sensory; hearing loss frustrations- so many things.

Good luck