Behavioral problems with ~3 year old

[Anonymous]

(splitting off from: https://www.dcurbanmom.com/jforum/posts/list/15/915408.page)

I have a child who is almost 3 who is an incredible challenge. Everything is a (losing) battle with him. While he scores high on the autism screen questionnaires at the pediatrician's office, he's very social so they assume it's more sensory-based rather than ASD. We've been enrolled in early intervention and speech/occupational therapy for a year now, but we're certainly not seeing dramatic improvements, particularly around behavior. He's mostly non-verbal, although he speaks enough that I'm pretty sure he understands a lot of what we say.

What caught my attention in the other thread was the OP saying they have to scream to get their kid to react. That's our situation as well. Talking to him about dangers and consequences up-front doesn't help. Putting him in time-outs (which, we have to do with him, because if we don't hold him down he'll run away) doesn't help. Redirecting him to other activities doesn't help. That is, if we move him from climbing on furniture to climbing on a real climbing apparatus, he goes right back to the furniture.

Roughly speaking, rewards don't work for him, because everything he likes to do is bad. Taking him away from activities doesn't help either (e.g., bringing him inside if he runs outside our yard) because he doesn't seem to mind- he just finds new trouble to get in.

Even basic tasks, like brushing teeth, are a challenge. We've tried every strategy we and the therapists can come up with. Different tooth brushes. Different tooth paste. Songs. Books. Posters. Nothing helps. Everyone has always told us that it is important to follow through with tooth-brushing, so we do. But it's getting harder and harder as he gets older. It now takes two of us to hold him down, force open his mouth, and brush his teeth. Everyone we've talked to has always said if you just keep it up, he'll get used to it, but that absolutely isn't happening.

[Anonymous]

In the other thread, another poster seemed concerned by the pediatricians and therapists mostly writing off ASD. I figured I should expand on that.

We haven't pushed for a ASD diagnosis. Basically, I've just asking them what it would do. As far as I can tell, it wouldn't really change anything. We're already seeing a speech pathologist and occupational therapist to deal with the speech delay, sensory issues, and to get advice on general behavioral issues.

Is there something more that would happen? I have a friend in New England with an autistic toddler. They're getting a lot more services from the toddler there (daily in-person visits, even through the pandemic) , but it doesn't seem like that they do that here.

I'm not afraid of labels. I'm just not interested in labels for label's sake.

[Anonymous]

Oh pp, I replied before and did not realize you are the same poster.

Has he been evaluated by a developmental pediatrician? He is too young for a neuropsych.

You only mentioned autism screening questionnaire at ped.

Do you sign with him? I think you should work on signing with him too.

I do know a child who was like this and it really was just sensory integration dysfuction. But OT worked to help him. He was released before kinder and is a calm kid.

But realistically I think you need an evaluation with a developmental pediatrician.

[Anonymous]

You may get more responses if you ask Jeff to move your thread to the kids with special needs forum.

[Anonymous]

Yes, I recommended you start your own thread but I didn't realize you were the same poster as the ASD questionaire post. Special needs forum would be better.

[Anonymous]

Anonymous wrote:In the other thread, another poster seemed concerned by the pediatricians and therapists mostly writing off ASD. I figured I should expand on that.

We haven't pushed for a ASD diagnosis. Basically, I've just asking them what it would do. As far as I can tell, it wouldn't really change anything. We're already seeing a speech pathologist and occupational therapist to deal with the speech delay, sensory issues, and to get advice on general behavioral issues.

Is there something more that would happen? I have a friend in New England with an autistic toddler. They're getting a lot more services from the toddler there (daily in-person visits, even through the pandemic) , but it doesn't seem like that they do that here.

I'm not afraid of labels. I'm just not interested in labels for label's sake.

Let's talk about this. "labels for label's sake" is only a thing with parents who are afraid to get their kid dxed. I am not saying this is you, I'm saying this is where it shows up in the s/n community.

The truth about the vast majority of parents whose kids have s/n is that having a name for what is going on is incredibly helpful. It is helpful for the parents and the kids. There is so much pain and struggle and finally having a name for why the things that work for other parents to do with their kids doesn't work for your kid is a relief. The only guilt is not pushing to find a dx sooner.

Having a name means you can look to the future and hear about older kids and adults and have hope. Because sometimes hope is in short supply. It lets you find out ideas that other parents with kids with that dx or similar have done that worked for their kids.

BTDT relief and guilt and everything

[Anonymous]

Read the kazdin method

[Anonymous]

OP here.

He hasn't seen a developmental pediatrician. We were trying to find one before the pandemic hit, and then that basically took a back burner. We haven't wanted to bring him anywhere since he won't wear a mask, but I've since been told against and again that doctor's offices don't really expect kids his age to wear a mask.

We are now planning to get him in somewhere, although I've been told it takes a very long time to get in. I think we should, but I still get the impression that nothing would really change. What would a developmental pediatrician change beyond what we're already doing with speech and occupational therapy?

We didn't sign. We kind of wanted to, but didn't follow-through. He has a twin brother, and raising twins in pretty hard. When his daycare wouldn't strongly commit to signing, we pretty much dropped it.

His basic vocabulary is pretty good. He definitely knows the words for basic foods and drinks. And I think he knows if he comes up to us and says "apple," we'll give him an "apple." He just, in general, doesn't ask for things. If the apples are out, he'll grab one. If we hide them, then he doesn't care. We've tried intermediate things, like having a picture of an apple out, but he ignores those.

One of the more troubling developments recently is that he has started hitting us. Pretty hard, too. He went through a phase a while ago where he did that. At that point, crying after he hit us was a pretty effective way to get him to stop. But now he's so worked up when he hits us that it doesn't seem to phase him in the same way.

[Anonymous]

Anonymous wrote:OP here.

He hasn't seen a developmental pediatrician. We were trying to find one before the pandemic hit, and then that basically took a back burner. We haven't wanted to bring him anywhere since he won't wear a mask, but I've since been told against and again that doctor's offices don't really expect kids his age to wear a mask.

We are now planning to get him in somewhere, although I've been told it takes a very long time to get in. I think we should, but I still get the impression that nothing would really change. What would a developmental pediatrician change beyond what we're already doing with speech and occupational therapy?

We didn't sign. We kind of wanted to, but didn't follow-through. He has a twin brother, and raising twins in pretty hard. When his daycare wouldn't strongly commit to signing, we pretty much dropped it.

His basic vocabulary is pretty good. He definitely knows the words for basic foods and drinks. And I think he knows if he comes up to us and says "apple," we'll give him an "apple." He just, in general, doesn't ask for things. If the apples are out, he'll grab one. If we hide them, then he doesn't care. We've tried intermediate things, like having a picture of an apple out, but he ignores those.

One of the more troubling developments recently is that he has started hitting us. Pretty hard, too. He went through a phase a while ago where he did that. At that point, crying after he hit us was a pretty effective way to get him to stop. But now he's so worked up when he hits us that it doesn't seem to phase him in the same way.

Well, there is ABA therapy for one. You really need to call around and get on waitlists for developmental peds, like TODAY. Who knows if your child has autism, but your child definitely has additional challenges that he is dealing with. You need all the information you can get to be able to help him best.

Don't cut to what you think the dx might be, that does not help your child.

[Anonymous]

Anonymous wrote:

Anonymous wrote:In the other thread, another poster seemed concerned by the pediatricians and therapists mostly writing off ASD. I figured I should expand on that.

We haven't pushed for a ASD diagnosis. Basically, I've just asking them what it would do. As far as I can tell, it wouldn't really change anything. We're already seeing a speech pathologist and occupational therapist to deal with the speech delay, sensory issues, and to get advice on general behavioral issues.

Is there something more that would happen? I have a friend in New England with an autistic toddler. They're getting a lot more services from the toddler there (daily in-person visits, even through the pandemic) , but it doesn't seem like that they do that here.

I'm not afraid of labels. I'm just not interested in labels for label's sake.

Let's talk about this. "labels for label's sake" is only a thing with parents who are afraid to get their kid dxed. I am not saying this is you, I'm saying this is where it shows up in the s/n community.

The truth about the vast majority of parents whose kids have s/n is that having a name for what is going on is incredibly helpful. It is helpful for the parents and the kids. There is so much pain and struggle and finally having a name for why the things that work for other parents to do with their kids doesn't work for your kid is a relief. The only guilt is not pushing to find a dx sooner.

Having a name means you can look to the future and hear about older kids and adults and have hope. Because sometimes hope is in short supply. It lets you find out ideas that other parents with kids with that dx or similar have done that worked for their kids.

BTDT relief and guilt and everything

I'm really not afraid of a diagnosis. Honestly, the developmental pediatrician thing is more logistical than anything. It's tough when my spouse can't really help with these visits due to work. His visit schedule is already quite disruptive, and I'm not particularly inclined to prioritize something without a clear value proposition. Would anything the developmental pediatrician say or do identify or lead to other resources/therapies? So far I've basically been told "no" by his regular pediatricians and therapists.

Getting some sort of diagnosis might make me feel less like a failed parent, but I have no expectation that it will change anything with my kid, other than perhaps provide me some peace of mind. We're going to do it, but honestly I've been more focused on finding better therapists than getting into a developmental pediatrician. The county's early intervention program is pretty useless when it is all-virtual, but the private therapists are doing in-person appoinments.

[Anonymous]

Anonymous wrote:

Anonymous wrote:In the other thread, another poster seemed concerned by the pediatricians and therapists mostly writing off ASD. I figured I should expand on that.

We haven't pushed for a ASD diagnosis. Basically, I've just asking them what it would do. As far as I can tell, it wouldn't really change anything. We're already seeing a speech pathologist and occupational therapist to deal with the speech delay, sensory issues, and to get advice on general behavioral issues.

Is there something more that would happen? I have a friend in New England with an autistic toddler. They're getting a lot more services from the toddler there (daily in-person visits, even through the pandemic) , but it doesn't seem like that they do that here.

I'm not afraid of labels. I'm just not interested in labels for label's sake.

Let's talk about this. "labels for label's sake" is only a thing with parents who are afraid to get their kid dxed. I am not saying this is you, I'm saying this is where it shows up in the s/n community.

The truth about the vast majority of parents whose kids have s/n is that having a name for what is going on is incredibly helpful. It is helpful for the parents and the kids. There is so much pain and struggle and finally having a name for why the things that work for other parents to do with their kids doesn't work for your kid is a relief. The only guilt is not pushing to find a dx sooner.

Having a name means you can look to the future and hear about older kids and adults and have hope. Because sometimes hope is in short supply. It lets you find out ideas that other parents with kids with that dx or similar have done that worked for their kids.

BTDT relief and guilt and everything

Sorry for the re-post. I just wanted to fix the quote problem for future replies.

I'm really not afraid of a diagnosis. Honestly, the developmental pediatrician thing is more logistical than anything. It's tough when my spouse can't really help with these visits due to work. His visit schedule is already quite disruptive, and I'm not particularly inclined to prioritize something without a clear value proposition. Would anything the developmental pediatrician say or do identify or lead to other resources/therapies? So far I've basically been told "no" by his regular pediatricians and therapists.

Getting some sort of diagnosis might make me feel less like a failed parent, but I have no expectation that it will change anything with my kid, other than perhaps provide me some peace of mind. We're going to do it, but honestly I've been more focused on finding better therapists than getting into a developmental pediatrician. The county's early intervention program is pretty useless when it is all-virtual, but the private therapists are doing in-person appoinments.

[Anonymous]

You don't know if you are doing everything because you don't have a dx.

You are asking the wrong people if it would make a difference.

You are struggling to parent your child as he is now, with the non-typical struggles that he has. You need more information in order to make choices in how to proceed.

Put a fence around your yard. Forget about time out completely, that is not a discipline method that will work.

You, your ds and your family need real help. Getting a dx is step 1. I don't know if your ds has autism and I am not saying he does. I am saying that you need more information.

[Anonymous]

Op have you considered working in a therapist specializing in early childhood mental health? An LCSW (clinical social worker) or psychologist that could work with you on tools to respond to him. I know you said the OT and speech are helping with that but honestly that’s not really their specialty. I’m sorry, it sounds really hard. It might be helpful to work with a regular therapist for tools besides time out etc. I can’t say it will solve anything but gives you someone to run ideas by and try to get some feedback. Make sure they are really trained in this early age.

[Anonymous]

Anonymous wrote:You don't know if you are doing everything because you don't have a dx.

You are asking the wrong people if it would make a difference.

You are struggling to parent your child as he is now, with the non-typical struggles that he has. You need more information in order to make choices in how to proceed.

Put a fence around your yard. Forget about time out completely, that is not a discipline method that will work.

You, your ds and your family need real help. Getting a dx is step 1. I don't know if your ds has autism and I am not saying he does. I am saying that you need more information.

+1 I agree with this op (I’m the poster that just recommended a therapist to get you beyond time out). Punishments etc are not likely to be a good approach here (honestly they aren’t that effective with typically developing 3 year olds even). I’m not saying this is because you are doing something wrong - I’m sure you are trying so many different things, but maybe someone can help with more tools.

[Anonymous]

Anonymous wrote:Op have you considered working in a therapist specializing in early childhood mental health? An LCSW (clinical social worker) or psychologist that could work with you on tools to respond to him. I know you said the OT and speech are helping with that but honestly that’s not really their specialty. I’m sorry, it sounds really hard. It might be helpful to work with a regular therapist for tools besides time out etc. I can’t say it will solve anything but gives you someone to run ideas by and try to get some feedback. Make sure they are really trained in this early age.

And they will be much more effective if he either has a dx or certain dxes are excluded. This is a great suggestion for OP for while she is waiting to get in to a development ped and after he has been evaluated as well. She needs this kind of help.