Bad couple of weeks - advice?

[Anonymous]

My 4yo son has ADHD combined and ASD. He gets along well in a normal preschool classroom with supports, and receives speech and OT outside of school. He's a generally sweet, passive child who has lots of friends and isn't horribly difficult to manage. However, the last few weeks have been AWFUL. His defiance is at an all time high. Fighting with us constantly over everything. Won't eat. Won't listen at all. When told to do something (or stop doing something), he either is non-responsive or says no. If you tell him he can't have something, he will ask for it over and over and start getting pushy if rejected. His obsessions are also getting stronger and it's more difficult to turn his attention elsewhere. If I tell him to go to his room, he'll refuse to go and I have to chase him down to take him, where he will then throw his belongings. His energy is constant and his sensory-seeker behavior is off the charts. He's had brief periods like this, but never for this long or this bad. And he's only doing this at home.

So those who have experience - what's going on here? He is not medicated for the ADHD, although we see it in the future. He gets some AA, but only in school and not at home. He eats well (what little he'll eat), sleeps okay, and gets a ton of activity. He's driving us nuts. Any advice, or just a pep talk, would be appreciated!

[Anonymous]

Be careful about setting a precedent where you send him to his room or take him there. One day soon you won't be able to physically make him go and then what do you do? Speaking as a parent of a defiant MS kid, thinking you can control a child is somewhat of an allusion.

[Anonymous]

Anonymous wrote:My 4yo son has ADHD combined and ASD. He gets along well in a normal preschool classroom with supports, and receives speech and OT outside of school. He's a generally sweet, passive child who has lots of friends and isn't horribly difficult to manage. However, the last few weeks have been AWFUL. His defiance is at an all time high. Fighting with us constantly over everything. Won't eat. Won't listen at all. When told to do something (or stop doing something), he either is non-responsive or says no. If you tell him he can't have something, he will ask for it over and over and start getting pushy if rejected. His obsessions are also getting stronger and it's more difficult to turn his attention elsewhere. If I tell him to go to his room, he'll refuse to go and I have to chase him down to take him, where he will then throw his belongings. His energy is constant and his sensory-seeker behavior is off the charts. He's had brief periods like this, but never for this long or this bad. And he's only doing this at home.

So those who have experience - what's going on here? He is not medicated for the ADHD, although we see it in the future. He gets some AA, but only in school and not at home. He eats well (what little he'll eat), sleeps okay, and gets a ton of activity. He's driving us nuts. Any advice, or just a pep talk, would be appreciated!

OP here - I meant ABA, not AA. I might need AA

[Anonymous]

I don't know why but May is a horrible month. I don't know if the kids are anticipating the change to the end of the year/summer... schedule change.

But I remember May, September (that makes sense) and December (winter break).... were bad, the anticipation of change maybe.

[Anonymous]

Any recent changes in his life? Anything going on with siblings, grandparents, you or your partner? If you had to throw out three possible reasons, what would they be?

[Anonymous]

Anonymous wrote:Any recent changes in his life? Anything going on with siblings, grandparents, you or your partner? If you had to throw out three possible reasons, what would they be?

OP here - this is hard, because there really haven't been any shifts. He's nearing the end of his school year and due to start camp in a couple of weeks, but the camp is at a place and with people he knows well. Nothing weird at home. His younger brother is becoming more chatty and assertive. He's taking fewer naps and I'm afraid he might not be getting enough sleep overall. We put him to bed early every night, and some nights he'll just stay up and read.

[Anonymous]

I have a similar type of child and i know this type of kid takes a lot of parental energy. Here are some things that work in my home:

1. Using a timer. For just about everything. If my child doesn't know a transition is coming, it's going to be hell... for me!

2. Incentive chart. DC gets rewarded for good behavior at the end of the week. Some kids can't wait till end of week so you will have to play with what works... but DC gets to watch a movie at the end of the week for good behavior.

3. Discussing expectations. Before we start our day, we talk about the schedule and expected behavior. We also discuss how to handle frustration, how to handle upset feelings before we start an activity.

4. Praise. We have to give lots of positive reinforcement for every small good behavior so he knows that this is what makes us happy and allows him to be praised. He likes praise, stickers, etc... we are lucky with that!

5. If things go south and we are having conflict with my ASD/ADHD child, I walk away. I tell him to sit quietly and have some thinking time. I really have meant to get a beanbag chair. It's on my list. But having a time out spot (don't call it that) with a comfy, sensory-pleasing item is nice for these types of kids.

[Anonymous]

I have a kid with ASD/ADHD combined type but older turning 9 over the summer and according to our psychiatrist, the ADHD behaviors evolve and change as the child gets older.

The defiance is classic ADHD behavior. If I were you, I'll think about medicating now rather than later. Sounds like your DS is out of control and unhappy due to his ADHD.

[Anonymous]

14:25, those all sound like great ideas! We definitely need to get better about enforcement in our house. I feel like I'm always the one trying to create discipline and structure, and then my husband shows up and just blows it all up.

Re: medication - I have been suspecting that it may be time to talk to our doc about meds. Right now his therapies are working great and he's making a ton of progress, but they seem to be focused much more on his autism versus his ADHD. The ADHD gives us way more trouble, IMHO. I am pro-meds, but I wanted to feel like we'd tried everything else and didn't start him too soon. Yet, I see just as much hazard in not starting him soon enough and denying him an opportunity to be more present and engaged. How have you all handled the medication issue?

[Anonymous]

Meds are so tricky to get right and can help, but won't fix everything (I would pay anything if they did). Some meds have more side effects than others. ADHD meds can make your kid not eat, whereas your anxiety meds can make your kid eat too much. Both can reduce anger and frustration and both can increase it. At the same time, it's hard to know if their working because environmental factors influence our kids so much, like transition to end of school and start of summer. That really throws off even typical kids. I'm not saying all this to be snarky because our family is in hell trying to figure it out, so I'm just saying be patient as it's a lot of trial and error. Some people get lucky the first time, but I think more are struggling in the other boat.

[Anonymous]

Sleep is critical for my DD functioning. At 4, I would lay with her until she fell asleep and constantly redirect her to be still and quiet for up to 30 minutes. She still needs me to lay with her that at age 10, but seems to be able to self-soothe a bit more as she's gotten older. I can leave now after 10 minutes and she will go to sleep. I wonder if his defiance could be mainly due to tiredness.

[Anonymous]

My DS with ASD is close to the same age and every single time we see a spike in behaviors or defiance we take him to the doctor and he is sick.

You may want to make sure there is nothing physically wrong to cause the change in behavior.

Hope things get better

[Anonymous]

Op, when did you get diagnosed? If it is before 4, the ADHD is usually severe right? Hmmm. My son with severe ADHD has gone through lots of phases like this, he's 4 too. Sometimes they signal a major cognitive break through, like he just stared telling stories and jokes and I tell you, the past few weeks were hell on earth. He had a receptive language delay and that is resolving - a bit, now normal range - and that was also proceeded by abysmal behavior. I think all that brain stuff is tiring. How's his speech now?

[Anonymous]

Sometimes when the behavior is bad at home, the problem is actually at school. Are you allowed to observe or have someone else observe his preschool? Good luck OP.

[Anonymous]

14:28 again. My DS had major behavioral issues in 2nd grade. It was caused by a variety of things but most of it was due to his undiagnosed and untreated ADHD. He already had a ton of supports and services for the ASD but all his problematic behaviors was at school, at home he was fine, ate well, slept well, as sweet as can be.

Also, he was just very unhappy. I would say depressed except the 2 psychiatrists who evaluated him for depression said the sadness was due to the ADHD not depression. Once he was medicated for the ADHD, DS became a much happier child. The problematic behaviors at school all disappeared combined with a functional behavior assessment and behavioral plan. These were not needed after 6 months.

DS never had academic issues so we primarily medicate the ADHD for his mood and general sense of well being.