[katie_25]

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

[SilverNeurotic]

I would talk to his doctor again, preferably when you know you aren't going to be distracted or interrupted. Why not copy what you've written hear into word doc and print it so when you talk to the pediatrician you have this in front of you so you stay organized and on point.

If it is ASD it's important to get a diagnosis early and hopefully get some early interventions in place.

If he if doing this, and you have trouble with keeping him from destroying the house or hurting himself or others at four, you have to think about what the situation might look like when he is eight or twelve or older.

These are likely signs of poor frustration tolerance, perseveration, and difficulty with change- which are all signs of being on the autism spectrum, but maybe not.

If you are on a position where you don't actually need a referral from your GP for a pediatric neuropsych OR just plain old pediatric psych, to be honest I would just go straight on and make the appointment around the GP.

These kinds of behaviors at four, to this severity, are rarely about manipulation but more about a child pretty much losing it and having no clue what to do with what they are feeling. It kind of sounds like you know that, but sometimes we need to hear these things? I don't know.

But also- this really shouldn't wait. I know you don't want to go to the mhc and its very expensive to see a psychologist. In some states now a dx of an asd afford certain state benefits including state paid services but I don't know if you are one of those states.

I speak as a person who used to be that child,who would not have tantrums, but meltdowns of frustration to the point of passing out- literal physical exhaustion.
This is really important to address asap.

You are on the right track thinking that.
-Josie

[yellowted]

write down all the things your son is doing, that is date time what happened immediately before, describe the action/melt down - how long it lasted, what he did and how he was after it. for actions also include his reaction to interruptions. once you have a good list of things add a note about your concerns and what you would like them to look into then at the next meeting hand it to his paediatrician. that way your concerns and his actions will be there in black and white for the pedi to see even if you are distracted at the time.

[katie_25]

Thank you all so much. I think it's a relief just to have people not try to tell me it's a phase or he's just being a boy. I am going to be writing all of this down and either taking it to his pediatrician next month or to a psychologist (if I can find one that's not too far that will take a 4 year old and accepts his insurance.) The closest neuropsych they cover is about 2 1/2 hours away, closest child psych is over an hour, so I may end up having to take him to just a regular psychologist if any of them will see him, but I will find some way to get somebody to listen to me. I also have to add his self-imposed carb diet to the list. He eats breads and pasta and potatoes, but other than that he is mostly limited to hot dogs, bananas, chicken nuggets, and junk food that I try to limit. He can be very picky about texture too. He will not touch smarties or sprees or any kind of chewable medicine like tylenol or vitamins. He got a chocolate no-bake cookie the other day and it took one bite to figure out that wasn't going to happen.

I remembered about his eating when I found a PDD assessment on Childbrain, I'm not sure how accurate that is, but he scored 74 and the site says that anything between 50 and 100 suggests mild PDD. Should I print this out and take it to the doctor too?

[yellowted]

great to hear you are going to write it all down to show his doc, Don't be too worried about what he chooses to eat, children have a knack of getting all they need from what seems like junk to adults... take chicken nuggets, they often are fortified with milk, have egg to stick the coating on or in the batter, and can actually be pretty healthy if made with breast meat and are oven cooked. Bananas are packed with potassium. even ketchup has goodies in it!
Many spectrum children have funny eating, but so too do many non spectrum kids too! look at what he eats over a week or so and you will find he probably has quite a balanced diet if a bit high in carbs and fats.
if you are still concerned there are ways of hiding goodies in junk food... sweet potato makes great fries, make your own burgers with a little pure carrot in it, pasta sauce can hide puree veg too and coloured pasta can be made using spinach or tomato. ice cream can hide fruit puree in the swirls or sauce. hey I even convinced one child that sweet corn was yellow peas and broccoli was mini trees! if he does not like chewable food then puree veg or make smooth soups. if it is a colour thing then add his favourite colour food colouring to the water when boiling eggs, their shells are porous so the colour actually soaks through and colours the egg white as it cooks! ok some people will be all oh no not colourings but if it get him to eat eggs then once in a while will not hurt!

[katie_25]

By junk food I mean chips and cookies and candy lol. I wouldn't be too worried except that he is starting to loose weight. If I don't let him have any of his junk food and we are eating things that he doesn't like, he just won't eat. I have tried chopping veggies up into tiny pieces and sneaking them into hamburgers and things like that, but he will literally pull the whole thing apart and take out what he doesn't like. He has been doing this for 2 years now with no change except for whether or not he likes bananas from one week to the next, but his ped. is still telling me it's a phase. I love his pediatrician, he is great with my daughter and always listens to what I have to say, but for whatever reason, he just isn't listening with my son. But, he has a lot of patients with ADHD, so maybe he is just more comfortable with that.

[katie_25]

Well, closest psychiatrist insurance will cover that will take a 4 year old is an hour and a half away, so it looks like I'm going to have to take him to the community mental health center and hope they work with him better than they did with my daughter. Should I mention to them that I suspect he might be on the spectrum or just tell them what is going on and let them take it from there?

[rosska]

Originally Posted by katie_25

By junk food I mean chips and cookies and candy lol. I wouldn't be too worried except that he is starting to loose weight. If I don't let him have any of his junk food and we are eating things that he doesn't like, he just won't eat. I have tried chopping veggies up into tiny pieces and sneaking them into hamburgers and things like that, but he will literally pull the whole thing apart and take out what he doesn't like. He has been doing this for 2 years now with no change except for whether or not he likes bananas from one week to the next, but his ped. is still telling me it's a phase. I love his pediatrician, he is great with my daughter and always listens to what I have to say, but for whatever reason, he just isn't listening with my son. But, he has a lot of patients with ADHD, so maybe he is just more comfortable with that.

I was a pretty fussy eater as a child, I hated textures and tastes. Even now I have a pretty structured diet and tend to eat the same meals on repeat over the course of the week because they are what I like and things I don't like I just have no interest in eating. It must be hard for you though, I know looking back my mum had a very hard time with me growing up (heck she still does since I live with her and she has to deal with all of my meltdowns and anxiety attacks).

Sadly, you may be right about the paediatrician, I was only recently diagnosed (I'm 27) and I've been seeing therapists since I was 12. Not one of them caught that I have AS, or that I have OCD and DID until my most recent one who happened to have a special interest with ASDs so she was probably more aware of what to look for. All the others had ever diagnosed me with was depression, so I never got the help I needed and it's seriously stunted my ability to cope with the world.

I wish you luck.

[katie_25]

Wow, that had to have been hard knowing something was going on but not knowing what. My son's pediatrician seemed to blow off my concerns because he doesn't have the classic signs of autism and even though he had a speech delay when he was younger, it was just a slight one and he caught up by the time he was 2 1/2.

[rosska]

Originally Posted by katie_25

Wow, that had to have been hard knowing something was going on but not knowing what. My son's pediatrician seemed to blow off my concerns because he doesn't have the classic signs of autism and even though he had a speech delay when he was younger, it was just a slight one and he caught up by the time he was 2 1/2.

Yeah it wasn't easy, but at least now I know so hopefully my new PDoc can help me get some sense of self and help me deal with things better.

That sounds very similar to what happened with me, I had brought up the thought of DID to one of my old PDocs and he actually laughed at me and said "No no no, not DID, you just have a very active imagination which is nothing to worry about"... That was the last time I bothered to go see him. The new PDoc saw me for an hour and had already decided without me saying anything that I had AS, DID and OCD. It's slightly disconcerting that two different Docs can have such varying abilities to diagnose.

I had a very short period of speech therapy around the same age as your son, I had problems with some words and sounds, most notably was 'f' sounds I always pronounced like 'th', and I had problems rolling my 'r's, which with being Scottish was fairly noticeable. But it wasn't enough to set off any warnings as a kid.

Your son is lucky to have a parent who cares so much about him. I can never repay my mum for all she's done for me, but it doesn't make me any less grateful.

[Yoda]

My son has ADHD but we didn't know that until he started school. He is my only child and I thought he was just energetic. My son had delayed speech and didn't potty train until he was four years old. He never had melt downs to the level that you describe. When you put your son in his room during a melt down do you put him by himself? I would think it a good idea if you or your husband were in the room with him if only to speak calmly and repeat that when he is calm he can leave his room to do a desired activity. My son's pdoc said don't ever restrain him when he is upset. We did have success with time outs although he would often be upside down in the chair during the time out but in the chair in any position was okay.

Do you have a routine for meals, baths, bedtime? Routine is very important. Also let your son know before an activity changes that it will end in ten minutes so he can mentally prepare.

Will he drink smoothies? You can sneak lots of fruits and vegis in them.

[katie_25]

Yoda, that is what I go through with my 7 year old daughter to some extent, but she has severe ADHD to the point that you just knew by the time she was 2, and she was diagnosed just before she turned 4. We have the same rule with her about time outs, as long as she is in the chair one way or another, it counts. With my son, I stand outside his door (so he can't hurt me) and remind him that he can come out as soon as he can be calm for 4 minutes, but the thing with him is once he gets to that point, nothing matters, nothing gets through to him, so I try not to talk to him except when he gets too violent because it tends to set him off more. And sometimes I have to restrain him, just hold him in a really tight hug if I can, because he is so out of control that he will hurt himself throwing himself around or smacking/punching/pinching his legs or arms. Last year his pediatrician said he suspected mild hyperactivity, and he can be hyper, but it's only once or twice a day for maybe half an hour, most of the time (when he's not having a meltdown) he is extremely calm for his age and the way he can focus on things is unbelievable. I have tried smoothies, but my blender is getting a little old and if there are any chunks that don't get broken up, even what we would think of as tiny peices, he won't drink it. Even when I can get it really smooth, it just depends on his mood that day.

[rosska]

Chiming in again, sorry.
Just thought I should probably mention that with ASD related meltdowns, when we're in one, nothing can stop them. Also, it's actually highly inadvisable to touch or talk to the person having a meltdown simply because our brain goes 'haywire' for lack of a better term. Senses can become hyper stimulated, our fight or flight system is triggered and it becomes instinctive to lash out at anybody in range or to simply run away and hide in a dark corner somewhere.

Growing up I tended to favour the latter, but on my way to my room I would generally hit/punch/throw any person or object in my path. Upon reaching my room and slamming the door behind me I would scream. Nothing coherent just loud screaming like I had to get something, anything, out. Then I'd usually fall into a slump on my bed and shake/rock/cry for a while and then I'd return to normal.

It's hard to explain the feeling. From the outside it really does look like a temper tantrum but on the inside it's like your body is on fire and everybody around you is going to try and kill you, the world is suddenly against you and the noises and sensations just wont stop. Nothing makes sense. You can't process anything because your brain is too busy overloading to actually take in what's happening.

I know that can sound horrific to people but it really isn't something we can control once it starts and that's been proven, the only thing we can do is try to stop it before it starts. Sadly though with children as young as your son that can be difficult because he's too young to understand it himself or to know the feelings as they come on and take action to prevent it.

For me, I can feel my anxiety increasing, my heart beats faster and I get a sensation like ants crawling over my brain. I know at that point if I don't get out from where I am and go somewhere quiet/dark/alone, then I'm going to go into meltdown. Now that I'm an adult and know what I'm dealing with I can at least spot those signs. This may sound strange, but I have a little empty space at the bottom of my wardrobe and if I feel one coming on I go and sit in the wardrobe and close the door. The dark and silence really help.

The upside I guess (if you can call it that) is that it's not motivated by anger or rage. It's a neurological overload, and afterwards I personally feel awful. I get extremely embarrassed if anybody has witnessed my meltdowns and I feel a horrendous shame for my actions, even though I now know it's not my fault.

Anyway, sorry I'll leave you to it now, just thought the meltdown perspective from someone on the spectrum may be handy.