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Child Behavior (Expert Forum)
Should I be concerned about autism or pdd-nos?
Answered by
Kevin Kennedy, Ph.D. - Child and Adolescent Psychotherapy, Family Therapy, Crisis Intervention
Harvard Vanguard Medical Associates
This forum is for questions and support regarding child behavior issues such: Child Discipline (behavior management), Normal Child Development, Parent-Child Communications, Social Development
Should I be concerned about autism or pdd-nos?
by Patsygrl, Nov 18, 2005 12:00AM
My four year old son (will turn 5 in January) participates in an early childhood program in our local school system. He has a speech delay--uses some short sentences but has good receptive language--and is having some problem behaviors. He has been very active since he was about 18months old. Despite his behavioral challenges and speech problems, he is very bright--knows his alphabet, and can count to 10. He does play appropriately with cars and blocks and will maintain eye-contact for short periods of time when prompted. He likes to play rough and will give hugs. He smiles a lot but does respond adversely to loud sounds. His PCP referred us to our local MHMR provider due to his hyperactivity and my inability to manage his behavior well in new environments. I have observed that my son is very resistent to change, tantrums often, can be aggressive--although he is usually only aggressive towards me--, and is reluctant to play with other children. He insists, for example, on removing his shirt or pants if they become wet regardless of where he might be--on playground or in the cafeteria. He resists any redirection and will tantrum if anyone tries to stop him. He will interact with adults but prefers to play along side other children than with them. Our homelife is very structured, necessarily. My son will fill downtime with loud vocalizations, darting to and fro. He needs lots of praise and positive reinforcements. I use time out for inappropriate behavior and taking away of priviledges as consequences for inappropriate behavior. I use immediate positive feedback for appropriate behavior at home. He sees a psychiatrist who has prescribed Seroquel for his hyperactivity. The meds help him to sleep but he is gaining weight and his negative behaviors at school--tantruming, non-compliance have worsened. The psychiatrist has refered him to a pediatric neurologist for further evaluation. My son's teacher believes, that although he does have some difficulties with speech, his behavioral challenges are typical of his age and that his problems stem from poor social skills training. I agree--I'm a single, working mom with limited family support. He is strongwilled and raising him has been difficult, although I am trying to do my best for him. My son has been enrolled in structured, registered day care settings since he was 6wks old and I have tried to provide stimulating social experiences for him. My question is, should I continue to seek medical advice regarding this situation or continue to address parenting and social skills training for my son. Thank You!
Doctor's Answer
by Kevin Kennedy, Ph.D., Nov 20, 2005 12:00AM
, Nov 20, 2005 12:00AM
Your son's emotional and behavioral responses indicate that lack of social skills is not the area of primary concern. You are on the right track with the sorts of intervention you are using and seeking. Your description of his behavior does not rule out that he might display a condition along the Pervasive Developmental Disorder spectrum, but it is also not at all clear that he does. What is clear is that his overactive, sometimes disorganized and aggressive behavior need to be managed. Seroquel is not typically used to treat symptoms of ADHD, but it may well be that the doctor is addressing your son'e agitated, aggressive tendencies. One question to ask is this: might he benefit from a small does of psychostimulant medication, even at his young age? Another medication that might deserve some attention is Tenex (or Clonidine). These are antihypertensive medications that can help children be more calm, less aggressive.
tracey
thanks again,
Patsygrl
tami