"discipline" for 4 y/o w/adhd, comm challenges

[Anonymous]

My DS is 4 years old, diagnosed with ADHD and communication delays. He is an awesome, funny, loving smart kid. However, he can be very challenging and we honestly don't know whether it is because he is 4, or because he has ADHD, or because he doesn't always "get" what we are telling him, or a combination. And as such, we don't quite know what to do re: discipline. This is a problem both at home and when we go places, but more troubling when we go somewhere..because we don't want him to get hurt. Because we don't want to lose him...and lastly because we don't want to have the "one bad kid" everywhere we go.

For instance, we took a short weekend trip as a family this past weekend. He kept wanting to run away from us, even after we told him that he doesn't run away from mommy and daddy. He wanted to go into a body of water that we were close to, even though we told him not to (we were afraid he was going to jump in). We asked him to sit, he would not. We asked him to walk, he wouldn't. We go into a restaurant, he runs around the restaurant. We go into a shopping center, he decided that it is time to play chase. However (as is often the case), when we tried to talk to him about why he needs to stay with us, etc., he just doesn't seem to follow/care what we are telling him (we can't decide which it is). We brought plenty of toys with us for him to play with (we let him pack a small suitcase full of toys for he and his sibling). We went out of our way to find a place where we could find a place to run around after breakfast to get extra energy out. So we weren't trying to make him act like a grown up or anything else developmentally inappropriate.

What can we do to make our family time together less challenging? We dont want to always be yelling/telling him no/upset. However that is the road that we are going down.
Where do we start?

[Anonymous]

My son has ADHD. Just diagnosed this year at age 10. But he was a lot like that at 4. 1,2,3 Magic was really helpful for that. The countdown lets him focus on his behavior and therefore modify it. As honestly it was good for me, too, so I could at times manage my anger.

His consequence was losing TV. "If I get to 3, you lose TV."'a great deterrent for him.

And as a rule of thumb for my son, he needs twice as much physical exercise as what I would think, to help keep him calmer the rest of the day.

[Anonymous]

We have the same issues and it got quite a bit worse before it got better. Is there a receptive delay? If not, use Kadzin. If so, still do positive reinforcement and ignore negative, but we had to do a lot of other things too and it is brutally hard, kid is now 5.5 and things are a bit better. Note, he actually has tested as normal range receptively since around 4, but the delays lasted much longer in actual real life.

what we had to do: shadow him, use visual cues, redirect endlessly, ABA therapy which costs us arms and legs, which incorporates motivators. You have to be incredibly clear, consistent, and simple. These kids don't get nuances. No I can run and jump in at this pool, but not here. It has to be the same all the time.

We just started medication and things are so, so much better, but there are still issues like this. I will note that part of the reason we started it is because all of his interactions started to be like this. What is in the realm of normal at 3, a little off at 4, is suddenly just not acceptable at all at 5, and we had to help him. A lot of these are impassivity of course. But if he lacks receptive language he is also not understanding what he can and can't do let alone why. So figure that out. Most kids with receptive delays are strong visually, so you can do things like hold up a stop sign.

[Anonymous]

Sorry - above is impulsivity. But what you are describing sounds more like a receptive delay/cognitive issue (not that he is not smart, just not getting what you are saying). Those have to be dealt with differently. You aren't going to like this either, and neither did I - I am incredibly busy and social - but we had to cut way, way back. Sometimes we needed one parent to stay behind. There starts to be too many opportunities for conflict and bad behavior and its not fun for anyone. We also learned that my son needed to be completely under control at home and on small excursions before we could handle bigger things.

[Anonymous]

Anonymous wrote:Sorry - above is impulsivity. But what you are describing sounds more like a receptive delay/cognitive issue (not that he is not smart, just not getting what you are saying). Those have to be dealt with differently. You aren't going to like this either, and neither did I - I am incredibly busy and social - but we had to cut way, way back. Sometimes we needed one parent to stay behind. There starts to be too many opportunities for conflict and bad behavior and its not fun for anyone. We also learned that my son needed to be completely under control at home and on small excursions before we could handle bigger things.

OP here. Thanks. He does have a receptive delay. Sometimes he gets what we are saying, but sometimes it is like talking to a brick wall! However when we can carry on a conversation, it is the most awesome thing ever. This morning, we were talking about what we did over the weekend, and the fact that we were discussing things that we did, and what he liked and didnt like, and he actually remembered and could say, it made my morning.

We are getting an ABA evaluation this week, after being referred by our dev ped.

[Anonymous]

Anonymous wrote:My son has ADHD. Just diagnosed this year at age 10. But he was a lot like that at 4. 1,2,3 Magic was really helpful for that. The countdown lets him focus on his behavior and therefore modify it. As honestly it was good for me, too, so I could at times manage my anger.

His consequence was losing TV. "If I get to 3, you lose TV."'a great deterrent for him.

And as a rule of thumb for my son, he needs twice as much physical exercise as what I would think, to help keep him calmer the rest of the day.

OP here, thanks. We tried 1,2,3 magic when he was younger, but that didn't work so well. However we have realized that if we tell him that we are going to take away something that he likes, that is a good motivator. Especially when it comes to a fun toy or his leapfrog tablet. It might be more "fair" to him to give him the 1,2,3 warning before doing so. Thanks. Also, thanks for the input re: physical exercise...

[Anonymous]

Also - sorry - but I have BTDT and so want to help as much as I can - if your child was diagnosed at 4, the ADHD is severe. You need an IEP, so start that process.

Also, and this is controversial, but start OT and behavioral therapy, if you are going to do them, and think about medicating at 5. There are so many opportunities for learning all things, but especially behaviors, at this age, that kids with severe ADHD just miss. Thousands of missed cues every hour. We got push back from everyone and people are still like, OMG, a diagnosis and medicating at 5.5 for ADHD? I never! Those people have never had a child they can't take into starbucks or to the park or on a walk around the block. They can leave their 4 year old unattended to pee. Ignore those people. You are in a different lane, and they should stay in theirs. Just my position, obviously.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sorry - above is impulsivity. But what you are describing sounds more like a receptive delay/cognitive issue (not that he is not smart, just not getting what you are saying). Those have to be dealt with differently. You aren't going to like this either, and neither did I - I am incredibly busy and social - but we had to cut way, way back. Sometimes we needed one parent to stay behind. There starts to be too many opportunities for conflict and bad behavior and its not fun for anyone. We also learned that my son needed to be completely under control at home and on small excursions before we could handle bigger things.

OP here. Thanks. He does have a receptive delay. Sometimes he gets what we are saying, but sometimes it is like talking to a brick wall! However when we can carry on a conversation, it is the most awesome thing ever. This morning, we were talking about what we did over the weekend, and the fact that we were discussing things that we did, and what he liked and didnt like, and he actually remembered and could say, it made my morning.

We are getting an ABA evaluation this week, after being referred by our dev ped.

This is your issue. ADHD + receptive delay = disaster with behavior and chicken or egg issues. ABA is going to be huge for him. It made all the difference for my son at this age. Receptive delays look like terrible behavior - and are, of course, really - because the kids just don't get it. They just don't understand, and it makes no sense, so there is no motivation. Something we have worked on a lot that has really helped that will help your son more at say 5 and 6 - understanding his own emotions. My son could point to them in pictures - that is happy, sad, what have you - but could nto recognize them in himself or others in practice. Helping him get, hey, when we are making this face, we are disappointed or worried you will get hurt, or what have you - priceless for a kid with a receptive delay.

[Anonymous]

Anonymous wrote:Also - sorry - but I have BTDT and so want to help as much as I can - if your child was diagnosed at 4, the ADHD is severe. You need an IEP, so start that process.

Also, and this is controversial, but start OT and behavioral therapy, if you are going to do them, and think about medicating at 5. There are so many opportunities for learning all things, but especially behaviors, at this age, that kids with severe ADHD just miss. Thousands of missed cues every hour. We got push back from everyone and people are still like, OMG, a diagnosis and medicating at 5.5 for ADHD? I never! Those people have never had a child they can't take into starbucks or to the park or on a walk around the block. They can leave their 4 year old unattended to pee. Ignore those people. You are in a different lane, and they should stay in theirs. Just my position, obviously.

OP here again. We are in the IEP process as well.

Hear you re: a different lane. We went to a baseball game yesterday, and I saw two kids, about the same age as mine, sitting on a set of steps, outside of the ballpark, without a parent hovering over them. Just sitting there. Patiently waiting. I couldn't even imagine leaving my child on steps in a busy place like that.

However, when we got home last night, he listened to me and didn't stand up in the bath tub when I had to step out to get his shampoo!!!!!!! Which, to be honest, is a huge win for bath time.

[Anonymous]

Yes, different lanes. I went to two fancy restaurants for dinner last week - really fancy, like $45 cheapest entree - and there were kids there! Ha ha! Never! Also I see kids at brunch! And kids at the mall just walking and holding their parents' hands and kids that can go to the daycare at the gym and walk beside their parents calmly at target and ... you get the point.

I will say post medication I can take my similar sounding kid to the store and for coffee. I took him to a BBQ yesterday and it wasn't horrible!!! It's huge for me. Having these kids is so humbling. It makes you really grateful for progress.

[Anonymous]

Anonymous wrote:Also - sorry - but I have BTDT and so want to help as much as I can - if your child was diagnosed at 4, the ADHD is severe. You need an IEP, so start that process.

Also, and this is controversial, but start OT and behavioral therapy, if you are going to do them, and think about medicating at 5. There are so many opportunities for learning all things, but especially behaviors, at this age, that kids with severe ADHD just miss. Thousands of missed cues every hour. We got push back from everyone and people are still like, OMG, a diagnosis and medicating at 5.5 for ADHD? I never! Those people have never had a child they can't take into starbucks or to the park or on a walk around the block. They can leave their 4 year old unattended to pee. Ignore those people. You are in a different lane, and they should stay in theirs. Just my position, obviously.

What is the difference btw OT and behavioral therapy?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Also - sorry - but I have BTDT and so want to help as much as I can - if your child was diagnosed at 4, the ADHD is severe. You need an IEP, so start that process.

Also, and this is controversial, but start OT and behavioral therapy, if you are going to do them, and think about medicating at 5. There are so many opportunities for learning all things, but especially behaviors, at this age, that kids with severe ADHD just miss. Thousands of missed cues every hour. We got push back from everyone and people are still like, OMG, a diagnosis and medicating at 5.5 for ADHD? I never! Those people have never had a child they can't take into starbucks or to the park or on a walk around the block. They can leave their 4 year old unattended to pee. Ignore those people. You are in a different lane, and they should stay in theirs. Just my position, obviously.

What is the difference btw OT and behavioral therapy?

Both can work on self regulation, but that's not going to work well for a 4 YO with a receptive delay. I would do OT because I would bet there are some sensory issues, and how is his fine motor? Almost all kids with these challenges have fine motor issues. For behavioral, I would do RDI or ABA, the more RDI version. They will modify it based on your kid's needs. My kid does not have ASD - and yes we have done the ADOS and I would have no issue, at all, with an ASD diagnosis, meaning nobody is avoiding one here - so the ABA is not quite the same as it would be if you were encouraging say social interactions.

[Anonymous]

OP, who is your dev ped? Is it Belsito, per chance?

Ous is and she was hopeless referring us to appropriate behavioral support. I had to do it myself. I know that KKI has a clinic also, depending on where you are.

[Anonymous]

Anonymous wrote:Yes, different lanes. I went to two fancy restaurants for dinner last week - really fancy, like $45 cheapest entree - and there were kids there! Ha ha! Never! Also I see kids at brunch! And kids at the mall just walking and holding their parents' hands and kids that can go to the daycare at the gym and walk beside their parents calmly at target and ... you get the point.

I will say post medication I can take my similar sounding kid to the store and for coffee. I took him to a BBQ yesterday and it wasn't horrible!!! It's huge for me. Having these kids is so humbling. It makes you really grateful for progress.

OP here.... Can you take your kid to a story time now? For me, that is the gold standard of what we just can't do at this time, no matter how fun the event sounds in theory.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Yes, different lanes. I went to two fancy restaurants for dinner last week - really fancy, like $45 cheapest entree - and there were kids there! Ha ha! Never! Also I see kids at brunch! And kids at the mall just walking and holding their parents' hands and kids that can go to the daycare at the gym and walk beside their parents calmly at target and ... you get the point.

I will say post medication I can take my similar sounding kid to the store and for coffee. I took him to a BBQ yesterday and it wasn't horrible!!! It's huge for me. Having these kids is so humbling. It makes you really grateful for progress.

OP here.... Can you take your kid to a story time now? For me, that is the gold standard of what we just can't do at this time, no matter how fun the event sounds in theory.

We have not, but he has let me read him the entire set of the Captain Underapants books and has understood them. Things like story time are hard for him because of the sensory stuff. Too much input. He could sit, that's not the hard part, it would be all the other kids/parents in the room, the noise, what have you.

I will tell you that I have so much more insight into what is up now that he is 5.5 - I can finally tease out the issues, and we have been on this "journey" since he was 2.5.