Normal naughtiness, sensory issues, something else?

[systemsaddict]

Hi, I posted this in behaviour and a couple of people advised I try it in SN as well, thanks oddgirl, coppertop. I'm concerned about my son, who started Reception in September just turned 4. We've struggled with his behaviour at home for a long time but starting school seems to have made it a lot worse. I don't know if it's normal exhaustion / immaturity, or whether assessment from a health professional is in order and if it is, how to start that process. Teacher is clearly very frustrated with his lack of co-operation.

The main issue is that he is incredibly resistant to most everyday activities, including:

• getting dressed, every item of clothing causes a battle / running away / hiding behind the sofa;
• going to the loo, he always holds on till too late, has wet pants, refuses to go if I suggest it, and we have only just cracked poos in the potty with the help of Lactulose and long potty-sits after breakfast and dinner;
• sitting at the dinner table;
• eating a lot of foods, particularly anything at all that is mixed or at all slimy in texture;
• getting into the bath, and then, once he's in, getting out of the bath;
• having cream on his eczema;
• pretty much doing anything when he's asked to.

At school, he doesn't line up outside school, or sit quietly on the carpet for the little time they have to, or do anything he is asked to without being constantly pushed. He's bright, reading already and working at the top of the class apparently, despite being the youngest. The teacher didn't seem to think this was such a good thing though, it seemed more that it highlighted his behaviour. OK working one-to-one at school but can't work in groups.

He alternates between being incredibly silly and being incredibly frustrated, at which point he gets really worked up, lashes out, scratches us, kicks, screams, sulks, and can get really hysterical - sobbing on the floor in a foetal position. He gets SO angry. The only way I can get him to do anything is to threaten to delete his favourite TV, Sarah Jane Adventures or Dr Who, about 500 times a day. Home life is a constant battle. He can get really worked up if I try and talk or get him to talk, and shouts furiously 'Stop it with all those words mummy!!'

As a baby, he was very quiet, still and observant - much more so than the other babies his age - but could also get very worked up, especially if tired, when he would bite and headbang. Needs loads of sleep. Has always hated getting dressed / undressed, screamed and fought for every nappy change, bath, cream. Walked late, potty trained late, talked early. Has had some strange phobias - sloped streets, hand driers. Absolutely has to win at every game or there is a very dramatic meltdown. Is affectionate, makes eye contact. Sometimes can't bear to be touched, other times he's all over me and completely over-the-top in my space. Spends half his life hanging upside-down.

Sorry this is so long! Does this sound like normal not adjusting to school very well, or does it warrant further exploration - and if so how? SIL is a paediatric occupational therapist and has suggested we get him assessed for sensory processing issues, but I wouldn't even know where to start in doing that, or whether she's just seeing that because, well, it's what she's trained in.

I would ask your GP to refer you to a development paedetrician.

Tell her everything you've told us.

Good luck. It's all a bit scary. But you certainly won't regret being seen by a paed.

If they say there is nothing wrong you'll be thrilled, and if they say the opposite you'll be very glad you went.

The paed will refer you to an OT.

I do think your SIL is right, definitely sounds like some sensory processing issues. But could also be something else as well....

Thanks Indigobell. I have to ask, did you have something specific in mind when you said the 'something else' it could be? (Don't worry I'm not looking for an online diagnosis here!)

Could be ASD. Most kids with ASD also have Sensory Processing Disorder (SPD). Also dyspraxia can be very similar to ASD.

The thing about him being very bright and an early reader, and also a very quiet baby, makes me think ASD.

(Although obviously those aren't the diagnostic criteria for ASD)

My DS has ASD, Dyspraxia and SPD. He was diagnosed a year ago when he was 8 - and since then we have made so much progress with him. So please don't panic or worry (too much). Once you have a dx there is heaps and heaps and heaps you can do for him.

I would ask for a referal to see a paed. GP would be a good starting point. Write all your concerns down.

I'm not going to say your DS may have this or that, but all i can say is that a lot of what you have written strikes a cord with some of the behaviours my own DS (nearly 5) did have or still has. He has autism (high-fonctioning) but my DS also has moderate speech and lang.delays, but on the other hand he isn't agressive usually when he gets worked up he gets himself into a panic screams, throws himself on the floor if it's bad, but really lashes out.

Good luck. x

system what has the teacher said? You say that his knowledge based activities highlight the behavioural ones. Has the teacher made any suggestions? are they advocating a 1-1 approach with your DS to help him? What else are they doing at the moment to help him? It might give you some idea as to whether they think his behaviour is in a normal range for children just starting in a new and challenging/scary environment or whether his behaviour is extreme.
Definitely take your concerns to the GP who should be referring you to a paediatrician preferably a developmental one, but in some systems they have to be seen by a general paediatrician first - if that's the case see if the GP can request a general paediatrician with a specialism in developmental issues
Had to lol at the hanging upside down. I have a DS like that [hgrin]

Thanks, I have seen the teacher twice so far, once to discuss the poo issue early on when she was very understanding, helpful, kept saying 'well he's very young, we understand that, we'll work out strategies together' (27 Aug birthday); then at the parents' evening last week, so a couple of months into it, when she seemed, to be honest, pretty frustrated with him and was saying yes he is young, but seemed to feel that didn't excuse or explain his behaviour. She seemed, if anything, really frustrated and maybe a bit confused by him, and her plan was more to tighten up and expect more from him - her phrase was, 'he's not going to like us much I'm afraid' . I did ask if she thought there might be anything else underlying his behaviour (and ASD has crossed my mind, though I think nursery would probably have picked up on that), and there was a long pause before she suggested I discuss it with the school nurse if I was concerned. But I couldn't work out if she thought I was just being neurotic middle-class mum. She certainly didn't suggest it.

I would ask to speak to the school SENCo as well. You could sound as though you are trying to be sympathetic to the teacher who obviously is finding it a bit of a puzzle. Being young doesn't really account for all of the things you mention.
She should be able to suggest some kind of behaviour programme for him. Fairly typical at this age would be some kind of reward chart for sitting on the carpet for three or four minutes or some other small target.Not everyone likes behaviour charts and they don't always work but it is a starting point.

Hiya!! and welcome to SN board-as I said before, I would strongly suggest you get him seen simply because if there is something like sensory processing problems which explain his behaviour, you have far more ammunition with the school to provide appropriate support. Behaviour charts do have their place but when the cause of the problem may not be behavioural but sensory/neuro, they are of limited value. Whilst we do emphasise appropriate behaviour to DS, as I said before understanding the organic reason behind his behaviour has been invaluable in helping him to find his way. IF your DS has sensory issues, reception classes are a nightmare...lots of noise/children pushing past each other/visual and auditory stimuli from all directions/posters on the walls etc etc...my poor DS used to just shut down completely he had so much sensory overload.

Now of course this could all be about immaturity but my DS was ayounger child and I just knew his behaviour could not be just put down to unreadiness for school (although I do think he would have coped far better if he had started school when he was 7+ purely because motor and reflex issues-another story!!-would have been sorted).

Anyway keep posting and do read The Out of Sync Child-can help with lots of tips...one thing that really helped DS is his positioning in class-at the front with as little visual distraction as poss...otherwise he just lies on the floor!!

HTH

Thanks! Yes I was thinking that it might be more strategic to get a paed referral first, and then speak to the SENCo if / when there is any sort of dx. He has seen paeds before for allergies (and also when he was hospitalised with tonsillitis - because he refused to communicate to us that he was in pain - sigh).

He seemed to cope much better at nursery, but I think the stimulation there was different - fewer children in the space for a start, and then he could always take himself off to a quiet corner any time he felt overwhelmed, which he can't do at school.

Teacher is already onto positioning, she showed me his named 'spot' on the carpet, right at the front next to her! though again she seemed a bit bemused that even this didn't stop him jiggling up and down and making 'silly noises' all the time.

I second not using reward charts.

If it's (for example) physically painful for him to sit still on the carpet - do you really want to reward him for sitting still?

Absolutely...if a child was blind for example you wouldnt dream of setting up a behaviour chart to make him "see better"

SA - I'm sorry, but it definitely sounds like SN to me. As soon as the teacher says 'but this works with all the other kids'....

Normal behaviour management tricks often don't work at all with ASD kids.

For example my DSs teacher said 'he does not seem to understand the link between behaviour and consequences' - I loved that one :)

You know I think I agree. I think I have a pretty good understanding of behavioural techniques - I have literally written books on learning! - and yet we have never really got any of the things that are 'supposed' to work to work with him consistently. Reward charts etc just seem to make it worse, and it is only the ultimate sanction of losing one of his recorded TV programmes that has any effect. (His obsession with Dr Who since the age of 2 has always struck me as a little unusual.)

I looked at some websites on ASD yesterday and was again thinking, but this really doesn't fit him; he has normal if not good speech development, he seems to have a good understanding of other people's reactions and feelings. And then I got to a page on something called Pathological Demand Avoidance and it could have been a description of him from birth; this is what I was groping towards when I said the problems arise whenever he is asked to do anything. I know it's not a fully accepted dx yet but I have never read anything that described him as well as this, from the passive baby to the collapsing on the floor when you try to get him dressed, to the panic-attack lashing out when he's pushed, even to the teacher-y role play. I think I am going to talk to the GP, and see how we go on; nothing to lose after all.

Thanks for all your advice everyone.

Luckily I know nothing about Pathological Demand Avoidance,

But doesn't sound to me like you can rule out ASD yet....

Aspergers is basically Autism without any language difficulties, plus an obssesion with Dr Who sounds like ASD obsessive behaviour...

Anyway, good luck. Hopefully a paed will be able to get to the bottom of this.

ROFL that you have written a book on learning. I too have written a book - and the chapters I wish I could undo now that I've learnt more

Lots of things you've said sound like ds who has sensory processory disorder and aspergers traits. However, I would suggest that Sarah Jayne adventures and Dr who might not be suitable viewing - ds gets very over-the-top with any slightly scary programme.

Thanks SBUE. Weirdly ds finds them calming, and doesn't seem to find them scary at all. I know, I know - doesn't make much sense, and we do try and limit them when we can, but as one thing guaranteed to return the house to sanity they are a bit of a coping strategy too!

systems - I've just been onto the website for PDA - fascinating stuff. It's made me wonder, not that DS2 is PDA - but maybe he objects to the very direct approach i have to take with DS1 as far as instructions. DS1 is so disorganised i have to be very deliberate and simplify instructions so there is no room for dithering. Maybe DS2 is reacting badly to this and i should try - when it is not a family instruction - to be more indirect with him. It could be why a lot of the behavioural techniques don't work with him. Perhaps he just doesn't want the good behaviour - star on chart predictability. Maybe i just need to be more cunning and devious?
Mind now working on overdrive - away for some diet coke to relax! [hgrin]

I know, it's really thought-provoking isn't it? A lot of things I've tried with ds already have been to be more explicit, direct, 'in 5 minutes we will do x' etc, one very clear instruction at a time, set very clear boundaries - 'we expect this behaviour and then this will happen' - and it all just seemed to make it worse!

Well that was easy, just spoke to GP and been referred to specialist child development centre in the local area. Likely to be about a month he thinks, but that's OK - it'll give us a bit longer to work out what's going on at school, and I will keep a log of behaviour in that time too I think. Thanks again for all the advice, will report back once he's seen someone.

well done.

It was all 'that easy' for us as well. Took about a year to get a dx - but that was because they wanted to see him 6 months apart. At no stage was it 'hard' or 'scary'.

Good luck.

Good luck! He sounds a lot like DS1, right down to the DW obsession (which I share, but am allegedly a fully functioning member of society. ) DS1 is the oldest in his year, 5 in August (I'm in NI so the cut off is different) and he has come on in leaps and bounds since he was 4. His initial DX was Sensory Processing Disorder, aged 2, which was then revised this year - because he had a speech delay and disorder, his "official" DX is High Functioning Autism, but the paed said he has pretty typical Aspergers aside from the talking.

I hope things are resolved quickly for you - IK would highly recommend a trip to a Sensory Integration trained OT if you can, we have been waiting nearly a year, but have had two sessions now, and she is BRILLIANT.

xx

Thanks again to all for advice on this. Quick update, we have a home visit booked for next week so the assessment process is starting.

I have since posting this had another meeting with his teacher which was much more positive, she is on board with sensory issues as there are several children in the class who they think have some sensory issues, to the extent that they had already had an OT in the class to advise. So we could already start talking constructively about strategies and she will be informed and involved through the whole assessment process.

Have also met a local mum of a child with autism, same age, and GOD it was a relief to talk to someone who didn't just say "he's young, it'll pass, they all do this"! She had some very sensible advice too about not trying to solve it all myself and end up getting burned out. And says the local child development centre are absolutely fantastic.

I've been reading more about pathological demand avoidance and trying some of the strategies, which seem to work much better than other things we've tried. Also keeping a log of his behaviours. Though trying really hard not to fixate on this as a diagnosis, as I don't have enough experience of other children to judge the degree of severity of his behaviour if you see what I mean.

So, feeling more positive and we will see how it goes. Dp very reluctant to have ds 'labelled' but on the other hand realises that there are definitely issues there; one step at a time with him. (Have to say, dp often displays PDA behaviours too which makes life a little bit more tricky!)

Will update thread next time we have any news.

COming to this late but some of the things you describe are very like my DS who has dx sensory processing disorder but is not autistic. Glad you're making progress. If it hasn't been mentioned before read The Out of SYnc child www.amazon.co.uk/-Sync-Child-Carol-Stock-Kranowitz/dp/0399531653/ref=sr_1_1?ie=UTF8&qid=1290010930&sr=8-1
you may find what is describes is all too familiar.