Aggressive 5 year old with ASD - what to do?

[Sunflower1650]

DS is 5 years old and is diagnosed autistic and dyspraxic. He has physio and OT. He’s got an appointment for an ADHD assessment in February but from the last appointment with the paediatrician she wasn’t convinced and potentially wants him to have a QBtest when he’s 6. He has very different behaviour to home than at school which I think is the issue.

DS’s behaviour at home is spiralling out of control. He doesn’t listen to anything we say, has meltdowns constantly, he is very defiant if he doesn’t get his own way, swears (he knows one swear word which he says repeatedly), constantly screaming, and over the last few weeks has started to hit, kick and push me and DH but me in particular. I’m very small and DS is a tall lad for his age. He has very little impulse control and can be fine one minute but then all of a sudden do something completely outrageous. For example he and his cousin spent a while building a track together then all of a sudden DS starts smashing it up and throwing it around the room. Last week he unwrapped all of my birthday presents despite us asking him not to. He can’t seem to sit still or relax ever. Tonight he was building with magnetic tiles, his tower fell down, he then starts screaming and throwing objects around the room out of anger despite me immediately offering to rebuild it with him.

At school he is quiet and mostly well behaved, there has been the occasional “naughty” incident which the school have described as out of character. His autism overrides and he doesn’t like to like to communicate with anyone. His teachers have said that he struggles to sit still, constantly walks off to the toilets, appears zoned out and struggles to follow instruction. He is on the SEND register, has a support plan for his gross/fine motor skills and is also in Lego therapy and a nurture group.

The SENCO at school has told me that unless he is diagnosed with ADHD there is no medication that the paediatrician can offer to him, is this correct? I am worried that he won’t get the diagnosis. I don’t really want to medicate him but his behaviour at home is awful and violent and I just don’t know what to do. It’s getting worse by the week. I have tried reward charts, ignoring bad behaviour and loads of praise for positive behaviour, punishments like removing screen time seem to make things worse because we massively rely on screen time to calm and regulate him. I physically cannot get him into another room when he’s hurting me and having a meltdown, he’s too big. I do think that the build up to Christmas and the changes to normal routines at school etc isn’t helping and this causes a decline in his behaviour but it’s definitely the worst it’s ever been. The main thing I want advice on is how to deal with his aggressive behaviour and who do I turn to if I’m in need of professional help? If it continues to get worse I’m just not going to cope. Sorry if this all sounds like daft questions, he was only diagnosed this year and I’m still learning as I go.

Presenting differently in different settings isn’t uncommon. The managing at school and exploding at home that you are seeing is called the coke bottle effect. It signifies there are unmet needs at school. If school life was easier, home life would improve too. Request a meeting with the SENCO. They need to provide more support. Does DS have an EHCP?

Did the OT assessment include a) a sensory OT assessment, and b) looking at the home environment to see how it can better meet DS’s needs and how home can be safer.

Do you have any sensory equipment or a trampoline or punchbag at home?

Has DS had a SALT assessment?

Some people find the books The Explosive Child and the Out of Sync Child helpful. Others find a NVR course/resources useful. Have you tried PDA strategies? Keeping a detailed diary to spot triggers can be helpful.

There is other medication that may be prescribed. For example, medication to help with sleep if that is a problem or when other strategies/support have been exhausted, sometimes a small dose of risperidone or similar is prescribed.

If it is something you would be interested in, Scope offer mentoring to parents of DC on the assessment pathway.

Most of it sounds like him having meltdowns and PDA, so more related to ASD. You say it happened when he built something with a cousin. With ASD, having another child and other people in one room, talking and doing stuff without a clear plan and structure, is something that would already massively stress my ASD dcs. Then he is planning to make something and his dyspraxia may make it harder, so he gets massively frustrated if it doesn't go to plan. From my experience, once they are in meltdown mode, it's really hard to calm them. The only thing that helps in my experience is identifying and eliminating as many stressors as possible beforehand, what of course is not always easy and might involve drastic changes (in our case we moved into the sticks, took our dcs out of school and hardly ever invite or visit family or friends).

Lots of good advice above and - please don't take this as a criticism because it's obvious you're a caring and competent parent - but praise, rewards, punishments, etc... can all really stress autistic kids out.

We've found the explosive child approach to be transformative (look up the Ross Greene podcast) because it helps us and DD understand what is actually causing the problem and have agency in fixing them. Often it's not what you think.

For example - she was bolting on school run recently. Adult assumption was that she was anxious. Explosive child approach helped elicit that she hated the sun shining into her eyes. 4.99 on a cap and that problem was solved, plus she learnt that people listen if you tell them what's wrong, and that it's up to you to find answers for problems.