My son, 4-years-old, has been having problems for years. My husband stayed at home with him for 18 months, and it was probably the best time of all. Once he started daycare... In daycare #1, he started biting the other kids. Now, he got bit, too, but we were told that DS bit harder than the others. So, at age 2, he was kicked out. His speech was delayed, so we started therapy. The belief was that chronic ear infections had caused the speech delay, and the frustration with being unable to communicate caused the biting. In daycare #2, with therapy the biting stopped. but we heard rumors of fighting, hitting, etc. But, they only really complained that DS never listened. We felt that DS wasn't ready for such formal teaching at age 3, so we tried a more relaxed daycare. In daycare #3, the lack of structure was disasterous!! Biting returned - and hitting, punching, spitting, ...
We went to so many therapists. First they said sensory integration disorder, but that didn't help. He had a neurodevelopmental exam in December, and the doctor said it wasn't ADHD. Essentially, it was bad parenting - we were too unstructured and inconsistent. She referred us to a behavioral therapist and early intervention preschool. The behavioral therapist said he was borderline ADHD - if he was in school, she wouldn't hesitate to diagnosis him as ADHD combined, and possibly ODD. But, at age 4, it was too early.
The early intervention staff interviewed the teachers and observed DS in the classroom. They didn't see the problems - only a fidgety, bored little boy. But, based on the ADHD assessment the teachers returned, they were convinced it was ADHD. (On many questions, he scored 4 deviations off the norm.)
Well, daycare #3 changed teachers, and DS decided it was intolerable. He began biting every day within an hour of being dropped off. He made it clear that being at home, knowing Mom and Dad were hurt and angry, unable to play with his toys (per therapists advice), was still preferable than staying at the daycare more than one hour.
So, we tried in-home child care. We hoped in a smaller, more home-like setting, DS would do better. And, he has! But, not good enough. He still hits/pushes when he's mad, doesn't listen, forgets the rules, and impulsively breaks toys. The child care worker is afraid to leave him alone - just in case. After all, she's responsible for the other children's safety.
On the positive side, he is actually making friends. He shares his toys, and does much better socially.
The therapist, although still uncertain of ADHD or ODD, believes that the medicine can help DS. She thinks we need to help him suppress the impulses and focus so that the behavioral therapy can make a difference.
He's been on Focalin XR for 2 weeks. I don't see any difference, but the child care provider thinks he's a little better.
I'm so lost. Are we doing the right thing? My mother is furious; she says we should have tried another daycare provider or a nanny before giving into medicine. But, DS is so happy there! He actually begs to go there over the weekend. If he can't behave in an environment that makes him happy - after 7 months of behavioral therapy - how can we not try the medicine when both the therapist and the pediatrician tell us it's best for DS?
How long has be in the new day care? Behavior therapy takes a long time and if he is happy and improving I would go with that. If day care and home is consistent he will continue to improve. 4 year olds are really, really difficult. My daughter (NT) made a complete turnaround after age 5. We also had her evaluated at age 4 becasue she was still having horrible tantrums and very very defiant. She is very different now.
You cant start worrying what other people think. You are going to always be judged. Just go with your gut. If you feel medication is the right choice at this time and so does his docotr, then that is what you should do. If you dont though, it doesnt make it the right choice because the doctor and therapist say so. My daughter who has ADHD was diagnosed at 5 and her pediatrician recommended meds. We did not do it. She was not having those behaviors of hurting others though. This was all for focus and at age 5 with her other issues we chose not to. We did end up going with medication at age 9 though as things continued to get harder fro her at school.
DS has been with this child care provider for about 2 1/2 months. His behavior has significantly improved over daycare #3, but we haven't seen much improvement since we switched. He's still averaging at least one pushing/hitting incident each week. And, he still doesn't listen.
The child care provider is working with us to ensure it's consistent. When he does something wrong, he gets a time out for it, just like home. And, he gets stickers for good behavior, just like home. In addition, she helps with the behavioral therapy. For instance, he has a "deal" with his therapist. When he manages to control his impulses for an entire day (no hitting, pushing, etc.), then he gets a treat - such as renting a movie, eating at a favorite restaurant, or swimming with Mom and Dad. She reminds DS of that treat throughout the day to help motivate him.
But, she's still nervous of his inabiliity to obey her and his impulsivity. Without the medication to give him that extra control, we do not believe she will continue to watch him.
If the problem was just listening, I would not be considering the medication, and I doubt it would be an issue with the child care provider. But, right now, our choices seem to be the medicine (and pray it helps with the impulsivity) or keeping him away from other children. But, DS really wants to play with other children. He will leave the playground if he's the only one there!
That only leaves one option, I guess.
I know I shouldn't worry about what other people think. But, I need someone to talk to that won't judge me. The medication frightens me, but so many people believe it's a cop out for poor parenting skills. When I talk to my friends, I find myself editing the conversation when it gets close to DS. I'm ashamed that I can't keep DS from hurting other children.
How do you manage it? Have you found friends you can really talk to?
I have a great support system. My friends and family. If they dont approve, they dont tell me.
People dont understnad and dont expect them to. Everyone has opinions and advice, just take it all in and sort through what you can use and discard whats meaningless. If you and you childs physician feel medication is the route to take, then you should take it. NO one has to even know about it.
Sounds liek the otehr things you are doing are great. Keep plugging away...........most everyone here will understand for whne you need to vent or get advice from parents of kids who are going through the same things.
If the behaviors place your son or others in danger, then medication can be a helpful part of treatment. If he is not having any side effects on the focalin, yet some posible benefit, it would be worth continuing the med trial and try to find an effective dose.I would recommend re-evaluating him. He can be diagnosed adhd at his age. Before you medicate, you want to make sure you have the correct diagnosis. It could be adhd or something else totally. He sounds overstimulated at times and acts out from it. He is too young to control his impulsive behavior. My son does impulsive things that get him in trouble but he thinks he is being fun
If he does have ADHD, then I would see a specialist for medication, a psychopharmacologist. Mine prescribes his meds and is also a psychiatrist. He knows these kids, as well as other disorders.
It sounds like your son really likes where he is now and I agree with you to keep him there. A lot of us talk about guanfacine, it really helps with overstimulation, which your son sounds like he has.
Keep us posted!
IMHO, this whole hurting other children thing is an impulse issue, and it usually goes away. It is really hard for the parent to deal with though because it is so socially unacceptable. Hitting/pushing once a week for a four year old ADHD boy seems right in normal ADHD range to me. I found the in home daycare setting to be the best fit. I would use behavioral techniques to focus on the hitting/pushing. I understand your stress on this topic. Set up an INSTANT reward for not hitting pushing. Everyone in the daycare gets one candy after lunch if he did not hit/push all morning. And he gets another candy as soon as he gets home if he does not hit from lunch to pick up time. If that does not work, make it every two hours or change the reward. Reel him into the reward system. I also drew a picture ( I had this problem at age four). A road divided into two, one with a happy face and one with a sad face. It was on my frig. Every morning I would ask, what road will you be taking today? The sad road where you play all alone? This is the road you take when you hit. Or the happy road where you have lots of friends to play with? This visual really worked. You'll feel so silly, but do give it a try.
And, last but not least, homeopathic treatment helps with the impulse issue. Didn't do much for the focus but it definately got rid of the most extreme impulse issues, the ridiculous silly behavior, and the failure to respect personal boundaries. Of course, this is not good enough improvement in a school setting, but it sure helped elsewhere--if you have the patience.
NoTellin39287.8778819444 Pebble,Pebble
What I present is my opinion. Others will differ which is good as it can give you different viewpoints to consider.
Be aware that Play Therapy alone can do nothing about ADHD itself as
it is a neurological disorder. It cannot do anything about your height either. What Play Therapy does is deal with the emotional issues that can result from being ADHD such as frustration, peer issues, anger, etc). These kids are always in trouble and don't really know why.
What a Play Therapist who is good with ADHD can do for you is to first
teach you behavior management methods specifically designed for ADHD
kids. This is of utmost importance. They can be helped. Then the
therapist works with the child in the play therapy setting to help them
develop the tools to deal with their issues. The therapist's job, in
my mind, is to help you develop ways of helping your child and to help
the child develop ways of helping himself. It should be a team effort.
To the issues in your original post, many here have give some good
ideas. I suggested a good therapist who works often and successfully
with ADHD. Your other choice is to become an expert yourself
by researching the subject. I suggest Russell Barkley's works. He has
a new website. Also you may wish to look into CHADD and the related
help4adhd site. All have good reliable data.
You may also with to buy the book Taking charge of ADHD: The
Complete, Authoritative Guide for Parents (2nd edition). Amazon has
it for a good price or you can usually find at least the first edition in most libraries
One of the most important principles for working with adhd children is strong structure. Gentle consequences but lots of them. Thumbs on loose or thumbs on tight as needed but never, never thumbs off. ADHD could be defined as a deficit of self control or self regulation. To regulate their behaviors, The child needs to have consequences in the environment. It is here where he can successfully manage his behaviors. You and the teachers at the school have to provide this. This is a skill set that can be learned.
Some ideas: Speed is the key. One warning if needed or none If it is an ongoing issue, the consequeces should then occur within 15 seconds after the event. I like shorter. If you use speed then severity is not required normally. Quite light consequences will suffice if they are done quickly. No second chances. You are just setting yourself up when you do this. Make the child responsible for their behaviors. You do not decide to put the child in time out, they decide to have time out by their behavior choices. Put the responsibility back on the child, not on you.
There are no solutions to ADHD. It is a chronic disorder and management is a journey, not a destination. If this child is truly ADHD it is a life long management issue.
There is much available for helping ADHD children. Good books are available. The people on this forum can help. Read their posts. They come from different approaches but they all care and are willing to share and help. Use them as a valuable tool.
I know that this does not address all of the issues of your original post. It is however the best advice I can give you.
Do try to practice forgiveness x3:
1. Forgive yourself. You have bad days and are not always at your best. Live with it.
2. Forgive your child. He is going to have bad days. He is not trying to ruin your life. If at times you have a hard time with this, sit beside his bed and watch him sleep. If you need a little extra help take a glass of wine with you. Carry nothing over to the next day except consequences. "Yesterday was not a good day, let's try to make today a better one." Apply this to both of you.
3. This is the most important one. Forgive those who judge. They do not know what you are going through. You know what you need to do. This is your kid, stay the course.
Diz
Thanks for the advice! I've tried investigating ADHD on my own, but there is so much contradictory information, I'm having a hard time determining the right information that fits my child.
I checked out Russell Barkley's web site, and it was very interesting. I like his cut and dried style of writing; I probably will invest in the book you recommend.
Thank you for your kind words.
Barkley is pretty much the top man in the field right now. The Chadd adn hdlp4adhd sites have good, research based information. There is more, depending on you technical level. If you of a more technical bent in these areas, let me know I will point you toward more sources of information and help You can email me if you wish.
GoodLuck. You cannot not have too much knowledge in trying to help you child.
Diz
Thanks for the suggestion! Our therapist is a play therapist who was recommended by our pediatrician, specifically by the child behavioral specialist. But, we've been considering another therapist. She seems to be helping, but, as she works in the office by herself, she often takes vacation (for several weeks) or attends a conference or something comes up and she has to cancel. We schedule twice a month, but more often than not we only see her once in the month.
Suggestion:
You may gain help from a child therapist who specializes in ADHD. This means some one who really knows how to work with this type kid. Check with several peds and family pracs. One good question to ask the doc "Which therapist would you send your kid to in a situation like this?" For mine, I would suggest finding a university trained play therapist who has a specialty in treating ADHD. Check out the Association for Play Therapy www.a4pt.org. They have a list of Registered Play Therapist by area. It is a place to start. You also might contact a university with this type of training. for recommendations. Then check them out for yourself. This is my best suggestion for a 5 year old child. It is not easy to find help who really know what they are doing but it is usually worth the search.
Good luck and keep on plugging. Helping you child is a journey, not a destination.
Diz
Thanks for all the suggestions!
We see the pediatrician and therapist soon (to evaluate DS on the meds), and we'll ask them about guanfacine and CAPD.