First steps for 3.5 year old

[Anonymous]

My son is 3.5 and in preschool. He has always had some quirks but through parenting and his hard work, many have already subsided. So here's what we are left with: at home, he is a typically energetic boy (on the more energetic end of the spectrum, but has friends who are worse), very happy, no tantrums ever, no crying, helpful, etc. So long as he has something to focus on, he actually stops bouncing around so much and can stay focused for a really long time with limited parental involvement (maybe an hour?) -- trains, trucks, being read to, puzzles, crafts, bath, eating.... He loves the park and playing outside. Also loves tv (duh) but we are pretty good at limiting it. Speech is okay - similar to several other boys in his preschool who aren't too chatty. As an aside, we're doing speech to resolve some articulation issues stemming from years of fluid in his ears.

Things change at school: louder environment seems to directly correlate with "ants in his pants", for lack of a technical term. If I were going to try and do a laymans diagnosis, I would say that he has auditory overstimulation issues, that exasperate his movement and touch understimulation issues. The morning starts great when there are only a couple kids at school. Craft time and small groups are great, as is open play at the park. When they shift to circle time, class singing and dancing, etc, he loses all body regulation -- steam rolls, overhugs, kicks the floor and others, knocks down other kids' block construction, and if he's not touching others, just has zero ability to sit still - feet shaking, hands squeezing, rolling etc. These are self-control and body regulation issues. (as an aside, he's freakishly large and strong for his age, so really has the capacity for hurting inadvertently). During all this, he is exceptionally happy. He loves school, loves the kids. His physicality is not anger or aggression, so much as a need for movement and touch. But for obvious reasons, others aren't sure of what to make of him. He's been improving and working SO hard to better his behavior. But it's just not where it needs to be and I know he is a challenge for his teachers (who love him and are so supportive, but feel like their ability to help is limited).

I have googled this to death. ADHD seems likely down the road, though he has exceptional focus when he's not around a lot of noise - so I'm not really convinced. I know sensory processing isn't a diagnosis, but if it were, it's the only one that makes sense to me.

When he started the school year we did an OT screening, and no surprise they found sensory issues. We did a couple months of therapy in the classroom and privately, and even the OT acknowledged that his behavior in private was great and he just lost control despite best intentions in class - and therapy wasn't going to help a whole lot. As mentioned above, he's doing speech.

So what's next? Developmmental pediatrician? Neuropsych? Group behavior classes? Other? Also, I work full time and his behavior is not such a problem (his preschool wants him to stay on rather than go to public PK, and when I asked, they said they don't think it's at the level where they'd request we get outside help) so I am not interested in making his diagnosis and treatment a full time job.

Can you provide names and whether they take insurance? We are in Dupont Circle area.

[Anonymous]

My son was like this, though not as extreme as it sounds like yours is, and he is also not physically large. That said, he started around 2 hating loud noises/overstimulation. That turned into over-physicality - pushed a table into a wall with a kid stuck behind it, pushed a friend (ie not out of anger) through a playhouse window and he hurt his arm, etc. We did do OT for about 6 months - it helped, I guess, but what really seemed to help is time. My son is now 4y3m and hasn't had one issue for about 4-5 months.

We used Canyon Kids in Bethesda, but I'm honestly not sure if he just outgrew it or if the OT helped. It was a lot of swinging (which he used to hate because he felt out of control), movement games etc.

[Anonymous]

My son is the EXACT same way but with fine motor issues. I too have concluded that ADHD is down the road. We do OT twice a week and I think it is helping some.

[Anonymous]

Apologies if this is too obvious, but since you didn't mention: This is exactly the kind of guidance you should be getting from your primary care pediatrician, who should have the expertise, the contacts, and the knowledge of your son to screen him, advise you, and direct you to specific sources of treatment as needed. If you don't feel comfortable asking your pediatrician, you should probably get a new pediatrician.

[Anonymous]

Anonymous wrote:Apologies if this is too obvious, but since you didn't mention: This is exactly the kind of guidance you should be getting from your primary care pediatrician, who should have the expertise, the contacts, and the knowledge of your son to screen him, advise you, and direct you to specific sources of treatment as needed. If you don't feel comfortable asking your pediatrician, you should probably get a new pediatrician.

OP here. I find pediatricians aren't particularly helpful for anything beyond the basics. I have no problem asking, and even mentioned my son's hyper behavior when he was younger, and my ped chuckled and gave a bit of "boys will be boys response". I don't think the two minutes you get with a pediatrician to try and explain an issue are enough for the pediatrician to give advice. There are a lot of parents who have tried so many things with their kids and I'd rather hear their successes or ideas. My experience has been that this is more helpful.

[Anonymous]

OP,

I think you need to consult a developmental pediatrician. Some kids are sensitive and will eventually grow into themselves, quirks and all. But sometimes not.

Get on the wait list at KKI or Children's and take whichever appointment comes up first.

[Anonymous]

OP, I just responded to your dev ped question--the one whose DS was diagnosed with ADHD at 5--but hadn't read your post from yesterday. I think you already know that a dev ped is where you need to go, but I just wanted to throw out there that your DS may have anxiety issues (particularly in the settings you describe) and they are manifesting in this way. Anxiety and ADHD often go together, although he could be dealing with anxiety without ADHD and his anxiety just manifests in this way. My DS has both, and his ADHD-type behavior significantly ramps up when he is anxious (and he is often appears happy or to enjoy these situations). The jumping around, acting over-the-top silly (beyond just acting like a little boy), stomping his feet all around, making weird faces, unable to control his hands/body, running into his friends, etc. all ramp up a bunch when he's anxious. Just something else to consider.

[Anonymous]

Op this sounds a lot like my son. I would suggest taking yours to a developmental pediatrician. My son has similar sensory issues, and his dev pediatrician has indicated he might get a adhd diagnosis as well. He also gave my son a dx of dsypraxia - basically because he is not aware of his body in space and his coordination is sometimes off.

Because of his issues we had to pull him from a regular daycare/preschool and put him in a therapeutic one - we were getting to the point where the daycare was ready to ask us to leave - our son was hitting, pushing, not sitting for circle time....basically because his body was so disregulated and his teachers had no understanding of what was happening. Instead they would punish him and send him to the office. It was horrible. He is so much better off where he is now. (he is 4.5 by the way).

The therapeutic preschool has much smaller class sizes, more teachers and one on one attention - he is also getting speech and OT while there. I am not in the DC area, FYI, so I can't make recommendations, but I would be surprised if there aren't any near where you live. This kind of environment sounds much more suited to your son.

If you have not read it yet, get Raising a Sensory Smart Child. It well help a lot. To echo what PP said, I would not be surprised if our son has anxiety as well. I hope you find the answers and help you need.

[Anonymous]

Is the school giving him some sensory stuff that could help him? Wobble chair, fidget toys, etc.? At this age, kids are going to start noticing if your kid is always trying to touch them, especially if it hurts. The physical issue can become a social issue if not dealt with.

[Anonymous]

You should go to a dev ped. I also had a private pre-k tell me that I could keep sending my son to their school. But, if he's not fitting in bc he can't sit still for lessons... why would you send him back. You need to separate how much the school loves your child from how well they can educate your child and give him what he needs.

You should also contact your county Child Find office and have your son evaluated for pre-k services on the county level while he's still in pre-k.

My highly verbal child with sensory issues did the same as yours in school but at home, where we controlled the environment, he was focused and we got along just fine. At school, he couldn't sit still, couldn't follow instructions, couldn't sit for circle time.

He received county pre-k and is now entering K with an IEP. Doing worlds better than if I left him in private where they "loved" him but couldn't educate him.

[Anonymous]

He sounds like a great kid, good luck op!