Monday, March 23, 2015

3 yr old kicks and scratches at preschool

Our three year old son is very sweet and calm most of the time but he has a hard time coping when he feels left out, or is told no and doesn't get his way. He was just recently kicked out of his 3rd preschool for his behavioral issues. He only made about 2 days at this last place. Day 1 he hit 2 kids, said No to a teacher and scratched the teacher. Day 2 he kicked a teacher and his last day he was climbing up the slide and was told not to climb up the slide; this made him mad and he started throwing wood bark at the other kids and screaming. His fit was so bad that he had to be put in a separate room where he proceeded to destroy art work, and throw stuff, just very destructive. It was so bad that security had to escort my son and husband out of the facility. 

We have good routines at home:  we do time outs and we have worked with a therapy program to help our son. They introduced some relaxation techniques and games to help our son with self regulation.  He seemed to like the breathing exercises but they only work some of the time.  Our son was in a smaller in-home daycare with a small ratio only 4 children to a teacher and this helped. He had far less episodes and in the 9 months that he was there he only experienced 3 incidents of hitting and/or screaming where we were called to pick him up early. 

When we give our son 3 minute time outs he destroys his room and/or bangs on his door the whole time.  He has stopped throwing his stuff around after I brought a trash bag into his room and said I would throw his stuff away. He has an older sister who is 5 and they fight but they also play well together.  When they do fight it is normal sibling stuff, nothing out of the ordinary. We go on family outings and I take my son with me on errands and to work etc. He has always done fine 1:1. He is articulate, loving, kind and affectionate most of the time. He recognizes when he has done something wrong and he says sorry but he has zero coping when he feels hurt, ignored or left out.  

Last summer, we went to fireworks and it was scary for our son.  We were fairly close to where they were going off and the sound was scary for him.  When we left he started screaming and didn't want to get on the shuttle back to our car.  I held him tightly and we sat in the very back.  It was packed full of people and my son proceeded to scream let me go.  He was scratching me and kicking and screaming and his fit was so severe that other kids on the shuttle started to cry and everyone was staring at us. This went on for the entire shuttle ride 15 minutes.  Once we got to the car we could not buckle his seat belt and his fit continued for another 10 minutes at least. Now on that particular day we had been up early for an annual Fun Run and we had been on the go all day and he had not had a nap but he had been fine. Until the fireworks started he had been playing with the kids sitting next to us. The fireworks were what set him off. He hasn't had an episode like that since but it was very scary for my husband and I, and traumatic for all of us. Our son will be 4 in June and we are concerned that he will not be ready for public school when the time comes. Any suggestions you might have for helping him with his aggression would be greatly appreciated.

Hi, your email points to several precipitants that I often find with young children:  tiredness, loud noises, and not getting to do what they want to do.  Children's reserves get depleted if they are tired or frightened.  You learn what a child's limits are, and then you would try to avoid those triggers in the future, when possible.  

For the times he explodes when he does not get his way, like at preschool, it will be important to have a very predictable routine especially with a larger group of children.  With smaller in home daycare, there is more flexibility, and your child probably does not have to stop what he is doing so frequently.  I would recommend keeping him in daycare for another year.  During that time his brain will develop, and you can practice keeping to a schedule at home part of the day in order to prepare him for kindergarten.   When you are ready to practice for part of a day, explain ahead of time what the schedule will be.  Come up with cue words (and have him draw a picture with you of switching activities) that will remind him that it is important to go with the flow.  And have a fairly immediate reward ready for him when he is flexible and stops what he is doing and gets ready for the next activity.  For example, you could have play time and then lunch time.  If he stops playing when asked, he gets a special treat after lunch.  Be sure to remind him of the cue words before the first activity starts, and then repeat the cue words when it is almost time to switch. I explain more about this in volume two of my parenting books on anger overload in children.  

For other triggers, you would try to anticipate and use one of the strategies I outline in my first parent's manual or in my second volume of strategies for home and school.  Your use of relaxation is a good idea.  You will want to try to catch his frustration at an early stage when you can, and re-direct him to a relaxation station in your house that is fun and relaxing.  I write about this and other techniques such as emotional distraction, re-arranging the sequence, and changing a child's expectations.

Once a child loses it, there is not much you can do but hold him if he is being physically destructive.  What you did on the shuttle bus sounds right on, even though it is hard on everyone.  You have little choice at that point but to restrain him.  Children in the overload phase are not rational, and talking to them usually does not work.  I would explain to him later on when he is calm that it is important not to hurt people when he is angry.  You might say it is okay to scream for now, but if you hit, kick, scratch, or throw things, he would lose some of his toys for a few days (however long a period of time would motivate him in the future, and you don't know this until you try a certain amount of time, and see if the frequency of physical acting out diminishes over the next few weeks).  The fact that he stopped destroying his room when you took out the trash bag is a sign that he will try not to destroy things if he might lose them.

When he does return to school, it will be important to coordinate with the teacher:  introduce him to the routine ahead of time, and have a behavioral plan in place that includes cuing him, emotional distraction, relaxation stations, and potential rewards.  Depending on how much he grows emotionally in the next year, you would target specific behaviors that are disruptive or hurtful, such as throwing and kicking (if that is still going on in a year).  You could adjust the behavioral expectations depending on his progress, but be very specific about what you expect, and do it one step at a time.  In other words don't expect he will use exactly the right words to express his frustration from the get go.  As you probably recognize, change is gradual, and you want to set mini-goals for your son, and then you can change your expectations over time.

Best, Dr. Dave Gottlieb  

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