Advice re 5yo DS behaviour/social communication disorder/CAMHS referral

[IsItMeOr]

DS is just 5, and has been having behaviour problems in school pretty much since he started, and in nursery before that.

He lashes out and hurts the other DCs. School have been trying hard to figure out what is going on and how to help him. They're being supported by the council behaviour, language and learning team. The team seem to think that there is a language issue - while DS's language is pretty sophisticated, he doesn't express his feelings and desires much with words.

He's had a paediatric assessment, which seemed to rule out most things, but referred for a further assessment for possible social communication disorder.

School have now asked for a CAMHS referral, because his behaviour has got worse again - he's just had his birthday, plus paediatric assessment - both of which unsettled him a fair bit - and school were trying to reintegrate him into the normal school routines. They're also concerned that he talks a lot about fighting and hurting people.

We desperately want to figure out how to help DS, but at a loss as what to do for the best. Should we simply wait for the social communication disorder assessment (c9 months) and CAMHS referral (timescale unknown) to come through? Or is there anything else we could/should be trying now?

Thanks for reading this long OP!

Speak to CAMHS and ask them what they do. Ask what disabilities they can diagnose there.

Usually for the younger children the diagnosis and assessments are done by the paediatric assessment unless the family are suspected of being dysfunctional.

Perhaps you can ask CAMHS to support an application for a shorter wait for your paediatric appointment?

You could read The Explosive Child and attempt to use the strategy in there?

He sounds very much like my son at that age. I would start keeping a diary of behaviours and triggers. It will help you work out what helps and will also be useful in getting a clear picture if what's going in when you do get to dx. The explosive child is a book that is definitely worth getting hold of, some of his aggressive behaviors may well be due to anxiety, stress, a noisy environment.....it could be anything but the key thing is that he probably can't control his outbursts

Cross post!

Thanks for helping, everybody.

We have (partly) read The Explosive Child (after seeing it recommended on here loads), and had begun trying out the technique before the school put the new behaviour things in place.

We then had a steer from the behaviour team that structure and limiting choices were really important for DS, so we've dropped the EC approach for now. Us being more "in charge" does seem to have helped DS a lot at home. Everything is a lot less stressful for all of us.

I've googled our local CAMHS - there are two options as school is in one borough and GP in another. But I think it goes by GP...

For the one our GP is in, the services offered include "Specialist assessments for neurodevelopmental disorders e.g. social and communication difficulties, ASD and ADHD".

That sounds quite helpful, I think?

Levantine out of interest, what has happened with your son as he's grown?

We've had real problems identifying specific triggers - possibly linked to his lack of communication about things that are bothering him. So our most recent conversations with the school have featured the observation that he is resistant to time out and that it seems to escalate his behaviour. So he gets a 1 minute time out for e.g. saying "you're stupid", then refuses to do the time out, hits someone and ends up with a 5 minute time out - which he still doesn't want to do. I'm not sure what that tells us though?

Well time outs don't seem to be working in the way they are implementing them.

Do you do time outs at home? Have you tried it with the glitter bottle (you fill a bottle with water and some glitter, you shake the bottle and ask them to sit and watch it until it settles)? I'm going to try it with my older DD, as it might help her calm down.

Are the school keeping records of the circumstances in which the events take place? Does it happen more frequently there?

I would see your GP, as well as asking about CAMHS (which can be quicker from a GP than a school I've heard), they might be able to give you advice or direct you to a parent support group.

Well, you can sort of understand how confusing it might be for your son. He says something which he believes is factually correct (probably doesn't recognize it is rude) and then gets punished for it. Not surprising it then escalates - injustice is a guaranteed trigger for my sons.

The message to get through to school is that if the punishments are making the situation worse then there is absolutely no point them following this strategy & they need to do something different like be aware for signs of stress & do something about it before the explosion. Or perhaps use social stories to teach the child that saying someone is "stupid" is not appropriate behaviour.

The school may also say that timeouts are the strategy we use for all pupils so we HAVE to do it this way. It took a long time for my sons school to realise that actually they could treat them differently without detriment to the other pupils.

Thanks OneInEight

We do broadly the same system of time outs at home. They certainly don't "work" in the way that you see on super nanny, where they have a few and then never again...!

Part of the problem is that he appears so bright in general conversation that it is very hard to believe that he does't understand - DH and I certainly have that problem.

School have been doing social stories, so that sounds good.

It feels like there's stress at two levels for DS. A sort of underlying level (more like a mood), and then top level (e.g. somebody hits him).

The underlying level seems to build up over a while - if he's relaxed, he's pretty good at dealing with top level stresses. If he's stressed at the underlying level, he can just randomly hit out or name call. E.g. on school outing yesterday he didn't want to stroke the animals (no problem), then was saying he was bored and wanted to go and play somewhere else away from the group. I thought we had to stick together, so insisted, and then noticed that he was starting to whisper to the other children (Stupid, shut up). So it could have been that he was anxious about the animals or just bored because he didn't want to join in with that activity?

Yes, we see very similar with the ds's that when they are stressed it takes very little to push them over the edge. Again, really difficult for the teachers to understand that sometimes they can cope with changes in routine etc but when they are stressed they absolutely can not.

The goal has to be therefore to try and reduce the underlying stress level - easier said than done of course - but there are things that have helped my two e.g. visual timetables, advance warning of changes, lots of reassurance that they are doing the correct thing. ds1 is in an EBD school and the small class sizes and the high staff ratio have really helped but many of the things they do could be done in mainstream with the flexibility and willingness of the teacher.

Wasn't sure whether to revive this thread or start a new one.

Mainly just needing to vent because DS's referral for an assessment seems to have got stuck because we live in one local authority/NHS area, but are registered with a GP in the neighbouring area. So he's not eligible to go to the single multi-disciplinary assessment team in the area where our GP is, because we're not resident in that area. So we're stuck. ARGGGGGHHHHHH.

Hoping that the consultant paediatrician will be able to sort this out so that we get somewhere soon.