Is this tantrum concerning

[Anonymous]

Daughter is 3 years and 2 months. She had a 25 minute tantrum yesterday which included ripping off all her clothes, scratching at her body (once she noticed I didn't like that), pulling her hair (once I tried to pull it up out of her face), wrecking her room by throwing books, stuffies, anything she could get her hands on. The reason was very normal toddler, she didn't like the pre-dinner snack I offered. We've had phases where she does stuff like this multiple times a week, often day after day. We have been in a low phase for a few weeks but this one cropped up. Does this sound like familiar toddler behavior or more extreme?

And yes, we are working with our pediatrician who recommended an assessment. Which we got but turns out was not covered by our insurance so we paid out of pocket but can't afford the $165 per session fee. So we are in this multi-month process working with our insurance company to find someone who treats 3 year olds and is on our insurance. In the meantime, we just find ourselves questioning if these tantrums are truly bad or just normal. It's upsetting to me that we have to wait so long for help so curious what others think.

[Anonymous]

This sounds like my daughter who has autism.

NOT dxing your kid, but affirming that those type of tantrums multiple times per week are outside of the typical toddler behavior.

Did you try your local child find? You shouldn't have to pay for services if she's found elibigle.

[Anonymous]

We have three kids and none of mine have ever had a tantrum to that extreme - either in length or destruction.

Generally tantrums are about two minutes - a long one might be five? Four or five?

[Anonymous]

Go through the school system to get an evaluation if you cannot afford one. www.wrightslaw.com

Find a free advocate to assist

[Anonymous]

I’ve encountered tantrums like this regularly in my professional career working with children with autism. I don’t know what normal is, that varies greatly by child. I would focus more on whether your child’s tantrums are disruptive to their ability to learn and function and interact with people or the environment. If the answer to that is yes then I’d be concerned and seek an evaluation.

[Anonymous]

Sounds extreme to me.

BTW, full neuropsychological evaluations cost 5K now - we'd paid $3K in 2010 (pre-test appointment with psychologist, 8 hours of testing over 2 days, post-test debrief and written report). This is for older kids, of course, who can tolerate such long hours of testing. Not reimbursed, usually. When DS was little, we saw a development pediatrician (covered under our insurance), and paid out of pocket for a narrowly-focused, $700 eval (in 2005, so now probably much more expensive).

What exactly is covered for $168?
You're looking at an evaluation, not a session or treatment.

[Anonymous]

It could be concerning and it might not be. To share my own experience:

When my DD was 3, she had one extremely disturbing and upsetting tantrum that lasted a long time and where she simply could not calm down essentially until she had exhausted herself. It happened on vacation and the trigger involved potty training, which was a really challenging event for this particular child. I was convinced that she had autism that was causing both the potty training issues and the tantrum. This was the only tantrum she had like that but it was really, really intense and I was certain something was wrong.

However, while we were waiting on an assessment (waiting lists can take months), we worked with another specialist on the potty training and finally resolved that, plus we did some reading on parenting techniques for highly emotional children (the book The Explosive Child was useful, as was How to Talk so Kids Will Listen and Listen So Kids Will Talk) and started using some different tactics that helped a lot to avoid tantrums. We also started more intentionally teaching her emotional regulation via modeling techniques, creating a "quiet calm corner" in our house that we also sometimes used during conflicts to calm down, and utilizing some of the tools from the reading we were doing to give her other ways of expressing her emotions and resolving situations.

By the time the assessment came around, she was 4 and basically a different kid. Fully potty trained, actually pretty emotionally mature (like could identify emotions, including mixed emotions, that she was feeling and speak intelligently about them with the therapist who she had just meant -- the therapist said that she was among the most articular kids that age she'd met regarding emotional expression). We had a bunch of good systems in place at home that had eliminated a lot of our conflicts that had previously given rise to tantrums. Just all around better place.

She didn't get an autism diagnosis. They think it's possible she might have ADHD but she isn't scoring within the range for that yet (it's been a couple years and we may get her tested again soon because we are seeing some signs of inattention and hyper focus since she started school). She's just a pretty emotional kid for whom age 3, which is hard for many kids, was extra difficult.

Very hard to say if this is true for your kid or not, and go ahead and pursue the assessment because I think it's useful information no matter what. But in the meantime, maybe my experience can offer you some other tools to help. It's tough and it can be hard to just have no idea what is causing the behavior -- maybe autism, maybe something else, maybe just being three. It really could be any (or all) of the above. But there are things you can do to help get through it. Good luck! My kid is wonderful and while I wouldn't say tantrums are totally behind us, I feel like I have a lot more resources for dealing with them now and I can't remember the last time we had one that felt out of control like that since the big scary one.

[Anonymous]

Anonymous wrote:Sounds extreme to me.

BTW, full neuropsychological evaluations cost 5K now - we'd paid $3K in 2010 (pre-test appointment with psychologist, 8 hours of testing over 2 days, post-test debrief and written report). This is for older kids, of course, who can tolerate such long hours of testing. Not reimbursed, usually. When DS was little, we saw a development pediatrician (covered under our insurance), and paid out of pocket for a narrowly-focused, $700 eval (in 2005, so now probably much more expensive).

What exactly is covered for $168?
You're looking at an evaluation, not a session or treatment.

We got the assessment from Skills on the Hill, pediatric OT. Recommended by our pediatrician. The assessment cost us cost $775. The insurance situation is one for another thread but we found out after the fact that we only had out of network coverage which is minimal. The evaluation was not super intense or specific, but they did note that she was oppositional and didn't want to try things in the way they suggest. They recommended sessions that would cost $165 per session. I'm just trying to find something that is covered by our insurance for a co-pay.

[Anonymous]

I would definitely get an evaluation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sounds extreme to me.

BTW, full neuropsychological evaluations cost 5K now - we'd paid $3K in 2010 (pre-test appointment with psychologist, 8 hours of testing over 2 days, post-test debrief and written report). This is for older kids, of course, who can tolerate such long hours of testing. Not reimbursed, usually. When DS was little, we saw a development pediatrician (covered under our insurance), and paid out of pocket for a narrowly-focused, $700 eval (in 2005, so now probably much more expensive).

What exactly is covered for $168?
You're looking at an evaluation, not a session or treatment.

We got the assessment from Skills on the Hill, pediatric OT. Recommended by our pediatrician. The assessment cost us cost $775. The insurance situation is one for another thread but we found out after the fact that we only had out of network coverage which is minimal. The evaluation was not super intense or specific, but they did note that she was oppositional and didn't want to try things in the way they suggest. They recommended sessions that would cost $165 per session. I'm just trying to find something that is covered by our insurance for a co-pay.

You had her evaluated by an occupational therapist?

That is not acceptable, and your ped is incompetent for suggesting this. Physical/occupation/speech therapists are not trained, at all, to diagnose psychiatric disorders - they treat the symptoms, AFTER a diagnosis has been made. Obviously in the course of their work they can sometimes tell what's going on big picture wise, but again, that is not what they are trained to do. They don't have the academic background for that. You should have gone to a reputable psychologist (PhD and years of practice), or given your child's young age, a developmental pediatrician (MD).

[Anonymous]

Contact your county’s Child Find.

[Anonymous]

Anonymous wrote:I would definitely get an evaluation.

People say this like it’s easy.

[Anonymous]

Anonymous wrote:Contact your county’s Child Find.

This, they will help you find someone in your insurance and if you have to pay out of pocket, they will help you depending on your salary and how many people are in your house.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Contact your county’s Child Find.

This, they will help you find someone in your insurance and if you have to pay out of pocket, they will help you depending on your salary and how many people are in your house.

This is true under 3. But OP's kid is 3 so all services would be through the public schools and free.

OP, is your kid in public school?

[Anonymous]

I agree with everyone else saying to get in contact with your local child find program. You can sometimes find them on the county website. The duration and intensity + the fact they occur on a regular basis are concerning. Frankly, the pediatrician should have recommended this rather than an OT consult. They should have provided information on local resources and programs for you to look into. We often place our trust in these pediatricians that they are experienced and will be able to help guide us as new/inexperienced parents but they are not subject matter experts on the DSM and are often just as clueless as us. We need to listen to our gut when it tells us something isn't quite right because it's usually correct. I say this as someone whose former pediatrician told us to "buy a helmet because it's normal for some kids" after we raised concerns about headbanging at age 2.5. Guess what, based on old assumptions they made about what autism looked like and our ignorance on how to proceed, our kid wasn't diagnosed with autism until age 6. Not saying your child has autism just saying keep trusting your gut and look at the local resources for help. They can and will do evaluations to help you and your child. The sooner the better.