Monday, June 11, 2012

5 year old with developmental delays and anger overload

My 5.5 year old son is developmentally delayed closer to age 3, including language. He also has  ADHD. He is always easily distracted, impulsive, and has short attention span. He also seeks adult attention, both positive and negative. He is a child that has a difficult time with transitions, but has not been found to be on the spectrum thus far. He has a divorced family, so transitions can be very hard, especially for sleep. He has never been a good sleeper. He is usually very sweet and loving, but whenever he gets congested from a cold (and he gets recurrent sinus infections, in the past with recurrent febrile seizures) or seasonal allergies....transitions and asking him to do something or stop something he doesn't want to...he suddenly starts throwing, spitting, hitting, etc over and over....telling us he is doing this but as if he cannot stop. If we ignore during these heightened times, these behaviors escalate. He has had a good preschool year overall, with these behaviors appearing whenever congested, along with heightened sensory seeking, less able to calm asleep, and potty regression to diapers. This May he slid back hard with these behaviors at the start of pollen in all home and school settings. He has missed a couple weeks of school and ot, pt, and speech services because of this. He started 10mg of Ritalin LA on Friday and so far, though meltdowns are shorter, they are still appearing. I am very concerned. I also know that his father has an up and down explosive personality. Any thoughts/tips?
P.S. Also, I meant to mention that he does not always appear angry during these moments and will sometimes giggle like it is a game, especially at school.

With developmental delays, sinus infections, and sensory integration issues, it is good you have a team of professionals helping.  With development and with control of his sinus infections and allergies, you will likely see an improvement in your son's ability to deal with frustration.  In the short term, what I would suggest are trying to adjust the sequence of activities when possible to limit the number of difficult transitions, as well as developing a "go to" soothing place in the house for when your son is getting frustrated.  The tough part is going to be to try to catch his frustration early, before he is totally out of control.  The OT may be able to help you develop a soothing place in the house--maybe with a mat, blankets, soft object to hold, soothing music and possibly soothing smells.  You would go with your son to this place and help him soothe, because ignoring does not work well if a child is frustrated and has significant developmental delays.  You would practice for a few weeks when your son is not upset, and make this space in your house a calming and enjoyable space.

At the same time you would try to anticipate your son's frustrations and re-arrange the schedule where possible to have something fun follow something difficult.  Also, if your son cannot stop an activity, you may have to hold off and only allow this activity when there is plenty of time (on weekends for example).  Sometimes advance notice of a transition helps, or sometimes it helps to let your son know something fun that is going to begin in a short while, but sometimes the transition is still difficult.  Brainstorm with your professionals what cues might help, or if it is best to avoid certain fun activities when there is limited time.  You may have to alter your expectations about transitions, i.e. expect it will be difficult and schedule fewer transitions.

In my anger manual I also describe a process in which the parent verbally labels a child's level of anger in a calm and non-critical way--you may need to wait until his language skills are at a kindergarten or first grade level.  At some point when your son's language skills allow, you may be able to help him recognize his moods; if he can recognize a change in his mood, he will be ready to be a more active participant in using calming techniques, techniques that are best employed when he is just starting to get angry.  In the meantime, you and other adults will need to "catch" the frustration and re-direct your child to a soothing place or to another activity.

Your last comment about the giggling suggests there are times he is not in full anger overload.  That is a good sign because the above strategies will work better if he is not in full overload.  You might also want to use humor (or silly comments) to engage him and thereby distract him when he is having trouble with a transition in school or at home.  All the best, Dr. Dave Gottlieb

No comments:

Post a Comment