I suspect my girlfriend's five-year-old son may have ADHD. I'm not sure what to do about it.
My girlfriend and I have been together for 8 months. We each bring two children to the relationship (a girl and boy each). All our children are under the age of 11. The behavior of the five-year-old is really wearing on both of us and our family. I have long suspected that he might suffer from ADHD or some other disorder, but my girlfriend kept saying, "He's five." Well, yesterday was particularly difficult day, as many of them have been, and it seemed like my girlfriend was finally coming to the realization that maybe there is more to his behavior than being five. After the chilren were put to bed she asked me if I thought something was wrong with her son. I said, "It's possible". We started talking about Bipolar Disease and ADHD. My girlfriend is adamant about one thing - she doens't want him taking medication. But I think we're too far away from knowing anything to make judgment call like that yet.
This morning I got up and read the criteria for hyperactive-impulsive type ADHD. I can answer a very strong 'yes' to every question about the boy.
Fidget and squirm in their seats: yes
Talk nonstop: yes
Dash around, touching or playing with anything and everything in sight: yes, particular at stores when we are shopping
Have trouble sitting still during dinner, school, and story time: yes.
Be constantly in motion: yes
Have difficulty doing quiet tasks or activities: yes
Be very impatient:Yes. Everything has to be RIGHT NOW
Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences: yes
Have difficulty waiting for things they want or waiting their turns in games: yes
Mealtimes are some of the worst. The other three children will focus on eating and may talk amongst themselves. He, however, constantly gets out of his chair, won't eat, will complain non-stop about having to eat, etc. When he does eat, it's usually at a glacial pace and he throws fits about having to eat. If the other kids get raucous with their chatter then it really blows up, as it overstimulates him to the point where there is nothing we can do but remove him from the table.
Meltdowns are common. I mean, full-on bawling, sobbing, crocodile-tears, end-of-the-world meltdown. The meltdowns are often the result of not getting his way, being told something he doesn't like, being directed to do something he doesn't want to do, or something not being a particular way.
Example: he couldn't get the zipper on his coat to go "all the way" to the top. He had zipped it as far as the zipper would physically go. When we informed him that was as far as the zipper would go, he had a meltdown.
He has a really hard time taking turns with anything and sharing anything with other kids. He will take toys right out of the hands of other kids. If there's something special to do, he has to be the one to do it. If he has to share, he pouts and cries and sometimes melts down. He hates other kid's birthdays because it's not his birthday.
He's incredibly impatient. If we take a photo on our phone or with a camera, before we can even blink he's yelling at us, "I wanna see!" If we don't immediately show him the image on the camera, he repeats his cry louder, with more whining, and starts crying. This happens with a lot of things - if his command isn't obeyed instantly, he repeats louder, more forceful, more whiny and eventually with tears.
We try not to take him to sporting events that his big sister is involved in because he will spend the entire time melting down, pointing at the basketball court, wanting to do whatever it is she is doing, and sobbing that we're not letting him do it. We can explain to him all day that it's basketball for 11-year old girls and he's not a girl and not old enough, and he doesn't care. We've learned that if we have to take him to one of these events, we have to distract him the entire time so he doesn't pay attention to what's going on.
He often says he "hates" things. We can hear this phrase ten times in five minutes. If the family is watching a movie he doesn't like, he'll say, "I hate that movie." This happens with a lot of things.
If we direct him not to do something, he will get very angry and stand there with his fists to his side, his brow furrowed, leaning toward us and will make a very angry noise, essentially suppressing a yell, in his throat. His face will turn red and he looks like he's going to pop. Occassionally, when in a disagreement with his 11-year-old sister, he will hit her.
He will hold on to emotions for a very long time. For instance, if we don't allow him to do something, like open a particular door, or whatever, he may start crying FOUR DAYS LATER and blurt out, "But I wanted to open the door!" We parents will then stare at each other, recall the event from days ago, roll our eyes and each other, and then tell him to let that go, because we're not discussing it anymore.
He's a loving kid. He tells both of us, "I love you" a lot. He's very affectionate. I don't want him to seem like a monster. He doesn't have problems making eye contact or talking (in fact, he can't be quiet) and I don't suspect anything like PDD. When it's just his mom and I in the car, for instance, driving to town, he can sometimes be quiet and will just sit there staring off into space making no noise. But most of the time he's a constant stream of verbal diarrhea and physical motion.
I'm at a loss what to do next. His behavior really wears on my girlfriend (both of us really, but it's extra hard on her because it's her child). I don't know what steps to take or if this is just behavior he will grow out of.
Hi there, Well, I'll be perfectly honest with you. Your girlfriends son sounds a LOT like my own. He does NOT have add/adhd but instead has something called sensory integration disorder also called sensory processing disorder. He was diagnosed at 4 and we see an occupational therapist for this which I can't tell you how much has helped.
Does he attend any type of preschool program or has he been in daycare and what do they say, first of all?? This is really important and a big key to things.
Because two things are true before you start thinking of what might be 'wrong' with him. First, many boys have tons and tons of excess energy. I have two boys, one with sensory and another without. Both can run around like mad men at times, climb, jump, wiggle and talk a lot. Both can become upset at times. All of this is variable as to how a child of 5 is by demeanor and there is a VERY wide range of normal. Some kids really are just chatter boxes and full of energy and more sensitive without a diagnosis of anything at all. You manage through the problems with these kids and work on giving them coping skills and outlets for the energy. The second thing that is very true is that this boy is in a transitional state with his life. Kids sometimes take time to adjust to mom and dad not together, mom has new boyfriend, boyfriend has kids that mom is paying attention to, etc. That can cause a lot of emotional insecurity and outbursts. VERY common and something that you kind of expect. Kids of 5 aren't emotionally mature and the way they handle things can make them seem difficult when in reaction, they are anxious or stressed about new situations and people in their lives. Much patience, reassurance, quality one on one time with bio parent (minus new boyfriend and their kids), and a good dose of empathy help them come through.
So, I want you to take that into consideration regarding this child.
If he has a diagnosis of anything, his mother's life is about to change dramatically. My son functions great and has many coping skills but it has taken great time and effort on my part (sometimes at the expense of other things) to get things that way.
I would google sensory integration disorder or sensory processing disorder. SPD is a great web site. They talk about varous symptoms for you to look at.
Examples of my son------- super picky eater and doesn't want to sit down during dinner. Will try to walk in a circle around the table instead. Also flat out refuses certain foods and will gag if forced. Or spit it out.
Constant motion and driven in a way that seems intense.
Very volatile over things that make no sense, often around the area of clothing (among other things)
lacking in social skills, has a hard time taking turns, being flexible.
plays too rough, touches too hard, doesn't know personal space or voice volume
Among other things.
A healthy plan of what they call 'heavy work' is really helpful and causes his nervous system to calm down. I can give you a full list of ideas if you like. Those activities mixed with some behavioral strategies really have helped my son conquer many of his challenges.
What has his mom tried to help him handle the outbursts better? You can teach a child how to handle distress as some kids really need this instruction.
So, those are some of my thoughts and I could go on and on--
I would, to be totally honest, look into sensory prior to add/adhd as the symptoms often overlap and the therapy/treatment is different. However, sensory strategies do often benefit an add/adhd kid. Sandman will tell you all about add/adhd and recommends a book that helps one understand more about it. Knowing about both sensory and add/adhd will help you when it comes time to add intervention if deemed necessary. I steal from other disorders all the time to help my son and often a child that has add/adhd has comorbid sensory issues.
good luck and let me know if anything I said didn't make sense or did make sense and you'd like more information.
Specialmom makes some good points.
My now 11 year old son starting showing signs of a problem by the age of 4. Probably earlier if I think back and he has a range of issues, though he does have ADHD. He has executive function problems, sensory problems ( not too far away from Asperger syndrome, though apparently he's too high functioning) He has emotional and behavioral too, which added together makes life interesting if nothing else.
Your girlfriend's son sounds like he's had a lot of changes to contend with, which though this doesn't excuse or explain all his behaviour, you do have to take that into consideration too.
That said, only your girlfriend knows his usual behaviour and if this was an issue before all the recent changes then there could be an underlying problem there.
Though my son was first seen at 4 yrs, they assured us he was fine. We had to be re-referred at 7 and it still took us a couple of years of testing and persistence before we finally received a diagnosis and help. Though his doctor is specifically useless and we are in The process of applying to change doctors now.
The best advice I can give is your girlfriend knows her son and if she is concerned then she should follow it up with a doctor and be persistent until you are satisfied that all avenues have been considered and looked at thoroughly. Good luck.
Really good ideas by both posters I do think that you want to check out SPD as I definitely see some signs of that too. A good site to check out is here - http://www.sensory-processing-disorder.com/index.html
I can't remember if this is the one that specialmom recommends, but you will find it very helpful.
I've got several/many things to get back to you with. Just don't have the time right now. Should be able to do so later on tonight. By the way, when is his birthday? (just trying to figure out if he will be in public school next year)
Well, you are at the start of a journey that should wind up making life better for all involved. The most important part of this journey is information. The more information you acquire now and in the future, the easier the journey will be.
Your first concern seemed to be "medication". The newly released clinical practice guidelines for ADHD specifically state, "For preschool-aged children, evidence-based behavioral therapy alone is recommended as the first step toward treating ADHD symptoms and associated impairment. Behavioral treatments may include behavioral parent training, classroom management, and/or peer interventions. These behavioral treatments represent a set of behavior-modification techniques that are provided to parents for implementation in the home, at school, or through group-based training sessions and are often delivered by clinical psychologists.
After behavioral therapy has been delivered to preschool patients, significant impairment may persist. If moderate-to-severe dysfunction at home and in other settings persists and has lasted for at least 9 months, medication with methylphenidate may be considered. However, AAP strongly recommends that the treating clinician first consult with an experienced mental health specialist, assesses the child's developmental impairment, and considers both the safety risks of medicating a young child and the potential risks to school and social participation if medication is not initiated."
Thus, there is no way that medication would be initialed if the doctor is following the new guidelines. Having said this - most pediatricians don't have the time to do behavioral therapy and consequently many take the easy way out and medicate if they don't do referrals or if the parents want instant (temporary) fixes.
So my first point is that you need information. Is it ADHD or SPD or some combination of both. I think to get that answer you will have to go to a professional that specializes in those fields. That alone is going to take some research on your parts to find the right person. And really - outside of learning all you can about SPD and ADHD - that research is the most important.
Some thing else to think about. At least some of his behaviors are probably due to family dynamics. I get the feeling that he is the youngest with two older sisters and a brother? Got a feeling that if this is so, that the older brothers and sisters (perhaps more the sisters) have perhaps treated him like the baby in the family and quickly given into his demands - which kind of reinforces his behavior. Now this has nothing to do with his ADHD/SPD, but it shows how important a whole family approach to working with him will be. And this is not a criticism of the kids or you. If an adult is missing in the household, the older kids will pick up the slack - so to speak - in helping out with the younger child. Unfortunately, its very hard for them to say no.
Now, kids with ADHD - heck kids in general have to be taught how to deal with their emotions. Its just that if the child does have ADHD, they don't have the filters to think twice. Actually, 5 year olds aren't known for this ability anyway. Point being they really do need to know other ways to express them selves.
There are several great sets of books aimed at this age group. The books are meant to be read aloud. And to a certain extent, the whole family needs to be included because it sets up a set of expectations and a vocabulary that the whole family should use to reinforce the ideas in the books.
I would probably start with the Learning to get along series by Meiners with "Cool down and work through anger" found here - http://www.amazon.com/Cool-Through-Anger-Learning-Along/dp/1575423464/ref=pd_sim_b_2 and you can find other good books by her. You might also want to look at the Way I Feel books by Spelman. Start with "When I Feel Angry" found here - http://www.amazon.com/When-Feel-Angry-Way-Books/dp/0807588970/ref=pd_sim_b_2
Once again these books are to give him and your family ways to work with him. It will take practice and role play. Actually play out the parts in the books. Its got to be repeated enough so that it becomes second nature.
I also highly suggest you get the book, "The ADD/ ADHD Answer book," by Susan Ashley. It covers everything from medication to school to home discipline to self concept. In fact, it probably is the book you want to get first (about 10 bucks on Amazon), because it will help you with the doctors appointments that you are going to need to make.
Summing up - I can tell from the length of your post that you are very concerned about this. This can be channeled into making things a lot better. I get the feeling (and thank you for the extensive posts - normally, it takes a lot of questions to pull out this much information) that there are two things going on. One is him being the youngest kid and learning how to get his wishes granted. He also sounds like he is pretty intelligent which means (if true) that he has learned the fastest way to get results. All of the above can be dealt with by a immediate, consistent reinforcement of proper behavior. What throws all of this off though is the possibility of ADHD or an ADHD/SIDS combination. It just makes things a lot tougher to deal with. But, if you know what you are dealing with - it makes it much easier to deal with it!
I do worry a bit about him holding on to his emotions. It sounds like anxiety. Which would be understandable at his age since his family has changed. Anxiety adds another dimension to the problem which definitely needs to be discussed with the doc.
By the way, I do think that some of his behaviors can be changed now. Just don't try and change all of them at once. Pick one thing and work on that. Experts say it takes 3 weeks of consistent, immediate reinforcement to effect a change. And that change should involve something that SPD or ADHD does not have an effect on - like when his commands are not instantly obeyed and he gets all whinney.
So lots to think about here. Take some time to digest it and get back to us for more specific help. Best wishes!!!!
I'm doing my best to just research as much as possible right now. So many of his "symptoms" overlap between potential diagnoses. Only a professional will tell us, of course, what is really happening, but it doesn't appear as if my partner or her ex-husband are ready to take that first step yet.
@Sandman2 - he is second youngest.
Re: The changing family dynamics. It is my understanding, from talking to my partner, that his behaviors have existed prior to my and my children's arrival. If he were just acting out to get attention due to changing family dynamics, I'd understand. But I think it would feel a bit different from this.
This is a wide range of persistent, day-to-day behaviors that are not normal and are destructive to the harmony of our daily lives. He's impulsive. Exceedingly and unbelievably impatient. Angry. Gets frustrated very easily. Has anxiety about a lot of different things and hangs on to his emotions for a long time. Constant meltdowns. Disagreeable. Eating is a hue ordeal every time. Confrontational. Can't wait for anything. Doesn't take turns. Is physically pushy/grabby with the other kids. Hits and kicks; physical hitting and kicking is his go-to retaliation if he isn't getting his way. Doesn't recognize that he has to pee until the last possible moment, then argues and cries when we instruct him to go potty.
If we were dealing with just one of these behaviors, I'd say, "Okay, we can manage this." But all of this stuff together? It's a nightmare.
I appreciate the answers though. I had not even heard of Sensory Processing Disorder before. I'm not sure that's what this is, but some of the symptoms fit.
The problem we found when trying to get help was the range of issues to be taken into account when trying to get a diagnosis and treatment. Some conditions can present with identical symptoms, this can make an already difficult task seem impossible. Obviously getting the correct diagnosis and resulting treatment is paramount to your girlfriend's sons future so doing research is always a good place to start I think.
My son can suffer with aggression, impulse issues, has problems with social relationships, he reads any form of accidental physical contact as intentional and will attack and affection is on his terms. Certain things have to be in order or he can have a complete melt down. He has difficulty understanding the rules of a game which makes any game played difficult.
I have, when he has been in a rage dragged from one side of the kitchen to the other by my top. He is a highly intelligent boy who has great difficulty dealing with conflict and reading facial expressions are also an issue for him. He seems to interpret all facial expressions as being angry so he automatically goes on alert.
I posted his diagnosis on an earlier post but what I just wanted to add is that we are still trying to get him referred for a specific and specialised test for Aspergers syndrome which we have had real difficulty in getting. His school is now trying to refer him to another paediatric doctor who will look at the facts and hopefully refer him to be tested as his school feel he certainly falls in this spectrum and has grounds for being assessed if only to eliminate this condition. I guess my point is be open to all possibilities, be prepared to stand by your observations of his behaviour and be patient.
With regards to your girlfriend's and his dads reluctance to acknowledge there could be a problem, unfortunately accepting that your child needs help can be very difficult and I'm afraid is something that you can't help them with. Accepting my 2 children, my eldest also being diagnosed with bi-polar disorder and both of them receiving medication but also therapy was maybe easier for me to accept with having rapid cycling bi-polar disorder and ADHD myself.
My advice is stay supportive and give your girlfriend the space and time to accept he may need more specialised help than she can provide.
Hope the research helps give you some ideas but your girlfriend isn't going to accept there is a problem until she's ready too.
Take care and update us.
Nice suggestions by helplogan.
I do think that family dynamics play a role here (but a small role). The eating part is bothering me. Does make it sound like it good have some SID overtones. And yes, a ton of his actions sound like ADHD. And yes, I think there is some good anxiety mixed in there.
Point being is that what he is going through is not normal. Nor do I think that it is something that can be corrected through "good parenting". He needs professional help. And I don't mean pediatrician kind of help. Find a psychiatrist that specializes in kids and make an appointment. I really feel that without professional help, that based on the symptoms you have related - this will only get worse.
Another option is your local school district. I believe he will be in public school next year. Many schools offer early help due to federal laws. Make an appointment with your special education department and see if they can help. From what you have said - he won't last long in a public school setting. Best wishes.
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