My son has always been strong willed and agressive, but lately the aggression has been getting worse. I have been trying to figure out how to deal with that, and since a lot of his aggression happens during a meltdown (what I have always called them because they are clearly beyond a normal temper tantrum) I did a search for how to control meltdowns. Every single page the search brought up was about kids on the spectrum having meltdowns, so I did a search to see what the difference is between meltdowns and tantrums, and what he has sometimes every other day, sometimes 3 or 4 times a day, for anywhere from 15 minutes to over an hour, fit with meltdowns.

What usually sets him off is when he can't have or do something he wants or when he has to do something he doesn't want to, but once the meltdown starts, nothing matters anymore, there is nothing anybody can do to stop it except try to keep him from destroying the house and hurting himself or the rest of the family until it is over. He is big and strong for a 4 year old, so I have a very hard time holding him and have to put him in his room. He will scream hysterically and hit and kick the walls hard enough that things hanging on the other side of the wall fall off, he screams names at me, he throws things at the walls and door, most recently a musical chair that weighs 15 or 20 pounds, repeatedly. If my husband gives in to whatever the meltdown was about in the first place, it still doesn't stop, he's just completely lost it and nothing but time will fix it. When the meltdown is finally over, we all have to walk on eggshells around him for 15-30 minutes or any little thing will set him off again.

I have had some concerns that he may be on the spectrum for a few years now. His speech was a little delayed when he was a baby, but he had caught up by the time he was 2 1/2. We went through a few months of playing with his ears whenever he was upset when he was 1, then a few months of head banging, then crawling around with his head pressed on the carpet, then when he got upset over something and knew he wasn't going to get his way sometimes he would blink repeatedly for a minute or two and that seemed to calm him down.

He also has poor eye contact. If you are just talking to him he will sometimes look at you, but if you tell or ask him to look at you, he faces to the side and looks at you out of the corner of his eyes. I'm not sure if that is a developmental problem or just attitude since he only does it when he is asked to look. He doesn't do it as much anymore, but he has a simple puzzle, about 8 pieces that fit into a form that it took him maybe 2 tries to figure out, but he would sit and do that puzzle over and over, one day i timed him at over an hour. He had to take all the pieces out one at a time before he started over, if anybody dumped the puzzle when he was done or tried to help him he lost it. He also likes to line up his toys. Again, he hasn't done this as much in the last 6 months, but he will take a bunch of little cars or little people and put them in a container then take them out one at a time and line them up, when he has them just right he will put them back in the container one at a time and start over. Interrupting him when he is doing this usually ends in a tantrum or meltdown.

He also has this little ritual when he goes to bed. After I get him tucked in and do kisses and hugs and love yous, he says "Where are we going tomorrow?" and I say "I don't know, where do you want to go?" and he says "The beach" and I say "We'll see" and then he lets me turn out the light and he goes to sleep, even though he knows we probably aren't going to the beach. If he thinks of something else he needs to tell me or ask me after this, when he is done we have to start over again. If I walk out of the room before he goes through this or I don't say exactly what I'm supposed to word for word he looses it and starts screaming, but if I go back in and "fix" it, he calms right down and goes to sleep.

I talked to his pediatrician about a year ago about some of my concerns, but between both kids acting up and distracting me and my husband interrupting me and downplaying everything I said, I don't think the doctor got a very good idea of what is going on. He suspects that my son has mild hyperactivity, but my 7 year old daughter has serious ADHD-combined type, and the things that I am seeing in my son just don't match up to me. I plan to talk to his doctor again, but I'm not sure how much good it will do me. His insurance plan doesn't cover any psychiatrists or psychologists or developmental peds in the area (just the community mental health center, been there with my daughter, not going back again) so to get him into anybody, I would have to drive at least an hour, and even then I don't think there are any developmental peds in the state that they cover. Right now my main problem is that he isn't in school (we can't afford private preschool and we make too much to qualify for the free preschool) so I am the only one that is really seeing what is going on with him, and it is hard to put everything I am feeling into words to try to explain it to a doctor.

So I guess I'm just asking if this sounds like it could be ASD or if I'm just worrying too much and if anybody has any suggestions about how to deal with his behavior or if a psychologist or psychiatrist would be better to take him to to try to figure out what is going on. I appreciate any help.

Thank You