Behavior modification helped my youngest quite a bit prior to meds. Meds helped make the behavior modification "stick". We use our version of ogram's marble system (top stickied post) and incorporate school and home behaviors. We were working with a psychologist (prior to med treatment by the psychiatrist) who reviewed everything we were doing. Once meds were on board and effective, we no longer needed the psychologist (but we can go back anytime an issue comes up in the future).
We also worked at giving her space (we made her bedroom a safe place for her to be angry and get it under control-not for punishment); staying calm and leaving her alone (so we would not escalate it); and coaching her on the appropriate ways to express anger (giving her the right words "I am angry with you" not "I want you to die"). We would give heavy praise the minute she would calm down and for any small positive step. She went from full violent rages to expressing the anger appropriately (although she is still stubborn as can be ).
My 5 1/2 year old son was diagnosed with ADHD recently and started on 18 mg of Concerta about 11 days ago (I have an appointment with his doctor this Friday to see how he's doing on it). He took about a two month break from pre-school while were figuring out what was going on with him/getting his anxiety level from school back down - my parents alternated watching him and he will be starting back to pre-k next Monday. We also are trying to employ behavioral management techniques that me and my husband met with the psychologist about (a slooowww process) employing positive reinforcement and time-out methods, etc. to try to get him to be more in control of his emotions, etc. I think there might be a slight improvement on Concerta with the hyperactivity part/focusing, etc. but not really a big improvement on his meltdowns and how he handles those. Normally, he gets over a tantrum fairly quickly but sometimes they can be the intense screaming at us kind that can kind of come out of nowhere which I haven't seen a significant decline on the Concerta. Does anyone think increasing the dose of Concerta would help him with that? Is this purely something that only behavioral modification will help him with or does anyone think a different type of med will help him with the tantrum issues (along with the behavioral modification)?. My cousin's almost 6 year old son is on a higher dosage of Concerta and he has ODD and she said they have helped his blow-ups/meltdowns tremendously (he used to have blow-ups in school so bad that he would throw chairs, knock over things, etc. and get very angry and would have to be picked up from school because he would not calm down). Justin has never done all that, he just gets very demanding (sometimes crying and whiny sometimes not) and sometimes as mentioned it will involve screaming at us but normally can be calmed down in a 5-15 minute time period. I don't want to seem like I'm trying to dope up my kid just to calm down the tantrums, but if the Concerta (at a possibly higher dose) or another kind of medication (instead of a stimulant) would help him, I'd like to be as educated as possible on it. Thanks to anyone for any insight/opinions.
-Heather
Thanks for your response. At least now he's moving away from "I don't like you...go be someone else's mommy/daddy" as he's calming down to, I'm sorry mommy - I love you so much" (sometimes "I'm so so sorry" mommy) and giving me kisses (though he's almost pitiful to watch because I know he is truly sorry but it's like he just can't control himself in the middle of the tantrum). I'll go check out the marble system you spoke of. Thanks again!We're in North Carolina (right outside of Raleigh). The owner of the school told this to me. Perhaps I should try to contact the proper channels and find out if this is a load of bull or what? Not sure where I'd find that out though.
I would definately look into this. In NY there aren't regs that specific to follow for a preschool. Call another preschool and ask them, or ask your own preschool to see the state regulations on this or who they should contact to find out more information about this. You also have a child with Special Needs. That falls into a different catagory and special modifications/accomodations typically need to be followed for them.Behavior modification will always be important. It is important to remember, though, that some things may be too far out of grasp for him if he has ADHD tendencies. I remember asking my son when he was five, and in kindergarten, and he had been sent home once again for his explosive behavior, "Why can't you just sit and do what your told. Stop being so naughty." His response, that I can remember like it was yesterday..."mommy, sometimes I tell myself to stop in my head but my body wont stop." Needless to say, that is when I realized that behavior modification alone wasn't going to do it. You don't need to think of it as "doping" up your child, but providing them with a fair playing field. My son, who is also a Justin, started on the 18 of Concerta as well, and in a very short period of time needed 36. The improvement was overnight with the 36. Never give up on finding new behavior mod tecniques, but if you feel some of this is beyond his reach, don't be afraid to work with a psychiatrist on medication. Removing him from preschool makes his days easier, however, he isn't seeing the modeling of other behaviors. Is it possible for him to go for a couple of hours a day or a shorter portion of the day? It sounds like you are on the right path. You are on top of it and are providing him with the support he needs. I am also a special education teacher in a behavior adjustment primary class. So many of these children don't have this kind of support. This will help him dramatically! Good luck and keep us up to date!
Iganio, thanks so much for your response and I appreciate you letting me know I'm on the right path. He'll be back in school on Mondays, Wednesdays and Fridays for hopefully at least a month (maybe longer if my parents can watch him on T/Th for a while) my hours at work are 8:00-4:00 so for those 3 days each week, he'd be dropped off at 7:45 and picked up around 4:30 (maybe earlier if my husband finishes work early or my dad can get him a little earlier). I would have done half days if I could have, but with my parent's schedule this is the only part-time schedule that will work right now. I think one of the biggest challenges will be the MANDATORY 2 hour nap each day at his school (he has always fought taking naps). While obviously they can't make him go to sleep - according to a supposed state mandated rule he has to stay on the mat the entire 2 hours even if not sleeping. Let's hope his medication relaxes him enough to think to himself, hey...maybe it would make me feel better if I took a nap...but I'm not holding my breath. Thanks again! :)
What state are you in? Two hours seems like a long time! My son stopped napping at age 3. In preschool they had to lay on their mat for an hour. WE used a tape player with headphones for him to listen to books on tape. He would pick the books out the night before and I would read them into a tape recorder or my husband would. He got to hear our voice and we would leave little positive messages throughout the tape. It took a lot of time but we also had a lot of books on tape that we would intermix with our voices. After a month, the school had quite a library from us and he could just pick one for nap time. He earned a prize for staying on his mat for the entire hour!! (and lots of praise.) Just a suggestion. It is hard to believe that any preschooler who doesn't sleep during nap time would stay still and quiet on a mat for that long. Timers also worked well for my son. Now they have the new ones that don't make noise but you see the red disappear. The teacher would set them for the amount of time of the activity and if he made it cooperatively until the timer ended he got a check on his chart. So many checks equaled a special treat. The teacher said that even when he wasn't focused on the lesson at hand, he would watch the timer so he wasn't disrupting the others. (Of course now, at the age of 11, he hates it when we use a timer for anything!!) lganio39146.7274652778I agree that 2 hours is long time....for a 5 1/2 year old...in the preschool/daycare that I worked for (in Ohio), the 4 and 5 year old room didn't even have to lie down...we would dim the lights, put in a Disney movie and have quiet time for the duration of the movie. Most 5 year olds don't nap anymore....
I like the books on tape suggestion....sounds like a good idea!
Thanks again for all your help :)