4 y/o and explosive temper, transition troubles, normal?

[Anonymous]

DS will be 4 next month and has always been difficult. He goes to a full-time daycare and does great there, but not without a lot of support from his teachers. No one at the school has ever suggested an evaluation, but we took him on our own to KKI (ASD eval) when he was almost 3. We ended up going home with zero diagnosis and a referral to a behavioral therapist. Our problem is DS' explosive temper. Any time he doesn't get what he wants, he'll throw something, or scream, or stomp his feet in anger. Almost anytime he transitions from one activity to another (e.g. end play to take a bath or turn off cartoon for dinner) he throws a fit. He doesn't seem to deal well with joining groups already in progress, such as a crowded playground full of kids, but he's wonderful in small groups or dealing with kids one-on-one. DS can be very sweet, but we've tried everything to help him deal with negative emotions. We've talked to him about using his words ad nauseum. It's to the point where I don't see the use of it anymore -- DS full understands what it means. He just chooses to cry and whine and get physical.

We have implemented the strategies we've learned in behavioral therapy, but that has only made a marginal difference. What seems to work best is to ignore DS' tantrum completely. But for us that means literally tuning out 20 minutes of DS' throwing whatever's in his reach.

Should we seek another evaluation? While the OT eval was strong, I was not particularly impressed with the SLP eval, and the MD spent about 45 minutes looking over DS, but mainly talking to us. We're just exhausted and not sure how to help DS anymore.

[Anonymous]

First, you have my sympathies, b/c it's hard. I would suggest revisiting behavioral therapy.

KKI's outpatient clinic in Colombia, MD, but you can probably find something closer in. They never train the parents to say "use your words." If you hit your finger with a hammer, and someone is telling you to "use your words" you would want to smack them, right? If your kid is having trouble regulating, implement the strategies in behavioral therapy.

He may get an actual diagnosis down the line, but you may want to consider a preschool like Maddux where they can provide the behavioral supports.

[Anonymous]

Listen, normal is a big country. So it could be totally within the realm of normal developmental behavior.

That said. For us, it wasn't. We got no dx at 4 either, but at 6 the ADHD was apparent.

[Anonymous]

Anonymous wrote:Listen, normal is a big country. So it could be totally within the realm of normal developmental behavior.

That said. For us, it wasn't. We got no dx at 4 either, but at 6 the ADHD was apparent.

Same with us. ADHD diagnosis at 5. Meds made a huge, huge difference in DS, and our entire family dynamic really. We used the KKI clinic in Columbia for behavioral therapy and found it very useful. DH and I (and DS) travelled once a week from Alexandria for about 6 months for behavioral therapy. We were obviously lucky to have the flexibility in our jobs at the time to do it. The behavioral therapy mostly targeted defiance, and, once that was under control using the techniques, they showed us, we could see what other impulse-control issues were left over. That's when we got the ADHD diagnosis from the dev ped.

As PP noted, it is very hard to deal with the constant explosiveness and negativity on a daily basis. I remember those days very well. My DS just looked for reasons to be negative and pissed off about everything. Now with meds, he's actually a very sweet, happy kid with a great personality and sense of humor under all of that negativity that was swirling in his brain.

[Anonymous]

This sounds a looooootttttt like my son before he went on Ritalin for ADHD at age 5. Much, much better now. You may consider seeing a devped or psychiatrist. Hang in there!

[Anonymous]

How often is he going to therapy?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Listen, normal is a big country. So it could be totally within the realm of normal developmental behavior.

That said. For us, it wasn't. We got no dx at 4 either, but at 6 the ADHD was apparent.

Same with us. ADHD diagnosis at 5. Meds made a huge, huge difference in DS, and our entire family dynamic really. We used the KKI clinic in Columbia for behavioral therapy and found it very useful. DH and I (and DS) travelled once a week from Alexandria for about 6 months for behavioral therapy. We were obviously lucky to have the flexibility in our jobs at the time to do it. The behavioral therapy mostly targeted defiance, and, once that was under control using the techniques, they showed us, we could see what other impulse-control issues were left over. That's when we got the ADHD diagnosis from the dev ped.

As PP noted, it is very hard to deal with the constant explosiveness and negativity on a daily basis. I remember those days very well. My DS just looked for reasons to be negative and pissed off about everything. Now with meds, he's actually a very sweet, happy kid with a great personality and sense of humor under all of that negativity that was swirling in his brain.

We are dealing with defiance as well. Any recommendations for a therapist or books or videos to help in these situations?

[Anonymous]

20 min tantrums are outside the range of normal I would say. At 4, that's too long. But it might not be a diagnosable thing, it might be him, he might be intense. If school is okay I would wait. Give him until 4.5.

[Anonymous]

not normal.