Need help with school Behavior

[MomtoCade]

I have a 5 year old son who was diagnosed with PDD/ADHD at the age of 1.  He has been in OT and Speech since then. Last year as a Pre-K student he was non-verbal (although he talked at home) with his teachers adn other students.  He did talk to his OT and Speech therapists.  This year he went from a very shy, non-talking, introvert to a very loud disruptive and abusive child towards his peers and teachers.  As a Kindergartner he has gone to a new school which is much larger than his Pre-K school but the class size is smaller.  He continously makes loud noises, speaks loudly, burps and makes funny noises throughout the day thinking its' funny.  When the teacher asks him to be quite he just laughs and gets louder.  He has been hitting his peers, spitting at them, tearing up their papers, stomping in the halls and throwing his chair across the room. I'm at a total loss as what to do.  We have been very strict with him at home, taking away his favorite toys and making him earn them back.  Putting him on time-outs.  It's just so hard to tell if he really understands his behavior and actions.  He is currenlty taking a high doss of Concerta and it's alwasy worked very well up until this point.  But honestly I don't think it's the medicine but more of a behavior issue.  Does anyone have any suggestions, advice or anything that we can do?  both my husband and I are Active Duty military and its hard to constantly run to the school because of his actions.  We are on a waiting list to see a behavior therapist (social worker ) unfortunately in the area we live that is about the best we can get.  There is no ABA available within hundreds of miles.  Any help would be greatly appreciated.  Thank you

[Sally44]

Like all children they do change and develop.  Sometimes they seem to be at the same stage for ages, then suddenly they start doing new things.
As a toddler my son used to tell me he was tired and off to bed!  I couldn't believe my luck.  He never used to come into our bed.  Then once he was very sick, and for ease I kept him in bed with me.  He's never slept on his own since!
He also didn't used to be afraid of the dark etc.  Now he won't go upstairs without me.  He needs all the lights on in the house all the time and recently he started being scared to go upstairs during the daytime as well.  But I think this is a stage that all children go through, but ours may take longer to get through it.  But it will happen.  To be honest I'm not really stressed out about him sleeping in my bed because he will cuddle up to me and we will have a chat about something, which is nice as it doesn't happen very often.
I try not to give in completely to his fear.  So, if he wants the toilet I will turn on all the lights and wait for him at the bottom of the stairs.  Sometimes he is too upset and I do go up with him.  I don't know what, if anything, triggered this fear, but it is very common and I think it is part of normal development.  As a toddler you have no knowledge of potential danger and therefore don't feel fear.  
Just try to do what works for your family and child regarding schooling.  I am reasonably happy with the school my son is at for the time being.  It is much better than his previous one that had no idea of how to teach him and they were making him more and more dependent rather than introducing enough structure and routine so that he could be independent.  But sometimes I think it is such a struggle for him, would it be better to get in a camper van and travel the world??  For some home schooling works.  I have found that my son responds best in one to one situations.  So, he's been having drum lessons.  The tutor isn't following the normal curriculum, she is really teaching him the basics but at his pace and with structure.  But in situations like this it can help them to learn to listen and follow instructions and to take turns etc.  Other children like things like martial arts because of all the ritualised movements.  
It would be really useful for you to get in touch with a parent support group because you will get lots of information and advice from them.  
Regarding the fear of the dark/being alone - have you tried getting him a cuddly toy that he would like to have with him at times like this.  Let him choose what it is.  It doesn't have to be big, it can be small enough to put in his pocket if he wants one that small.  But try to let him choose an animal that represents being big and strong such as an elephant etc.  My son has a toy shark and it does help alot.  I tried the toy after I went to a seminar by Olga Bogdashina and she told of how her son used to be terrified of the dark, new places etc etc.  He chose a toy elephant and she said that that toy had saved the day on many occasions.  I tried it and it worked.
If your son tends to be full of energy and bouncing around all the time, you could try getting in an exercise trampette.  I put one up in my living room and my son uses it frequently.  He's never on it for a long time.  He tends to be doing something eg. playing with his toys or watching TV, then he'll come over and bounce on the trampette for 5-10 bounces and then he's off it again.  The OT explained that he is using the trampette to regulate his sensory system to help his focus and attention.  It is similar to how we feel when we have been sitting for a long time and we need to get up and walk around a bit and then we feel okay to sit down again.
Just try to do a bit of detective work and analyse his behaviours.  There is a reason why he does the things he does.
I just remembered another thing.  Do you suspect your child has delayed processing?  Does he suddenly say things out of the blue, or ask you things that you remember saying to him hours, days weeks before?  Today my son asked me 'Mum, is it true that if I watch TV all day long I will get a jelly belly and die?'  I found out my daughter had said that to him about two weeks ago!  She'd said it because she wanted him to stop watching TV and come and play with her.  But it had taken two weeks for him to process this statement and get round to asking me whether it was true.  But if anyone's processing is so delayed, then it is going to be very hard for them to make sense of 'what is happening now' because they cannot process the information and understand what it means whilst they are 'in the moment'.  That could be the case with language or with social interactions.  So they end up being totally out of synch with everyone around them.  I remember another occasion when we had gone to a childrens animal farm and as we got to each pen I asked him 'Do you want to feed the animal'.  I would get no answer and so we'd move off to the next pen.  But about 50 yards away he would say 'yes I want to feed the animal'.  So we'd have to go back and feed it.  Again that took him a long time to process.  Of course it depends on the environment and what else he is trying to process or focus on as well.  At other times he is sharp as a pin and replies immediately.  But again it is the enormous variation in performance.

[MomtoCade]

WOW, can you move here?!  :-)  You have given me soooo much information and I don't even know how to answer your questions.  I live in the US in a very rural area that does not offer any resources to ASD.  Thus the reason why we are asking the Air Force to move us to a  much larger city with resources.  One of the things I would love to do is get him in a school like the one you described.  Unfortunatley, there is not one here.  I am having a problem with the school in that they don't have much experience either but are trying to be very helpful.  They just dont' know how.  My son takes language literally too.  We went to a childrens' museum that was literally built upside down.  When you went inside the ceiling was on the floor and vice versa.  As we where going in my son said, "I can't go in there, it'll hurt my head."    That's when i realized that he didn't understand.
When you spoke about his speech...as below:  Honestly, I have no idea and I plan to print this and bring it to his Speech Therapist to find out.  Currently it is still difficult to understand what he is saying.  I sometimes have to ask him to repeat things numerous times until i can figure it out. Of course that can frustrate him as well.  He loves superheroes and use to call superman, bitaman, but has since changed it to superman.

What is the diagnosis of the SALT regarding your son's speech.
Does he have Semantic Pragmatic Disorder - google that to see what it is.
Does he have delayed echolalia - google that to see what that is.
Does he have auditory processing disorder - google that too.
Also google Executive Function Disorder as alot of those on the spectrum have these difficulties.

As far as his attention span, it is very short.   I have yet to find anything that will keep his interest.  Computers are about the only thing that he enjoys doing as well as puzzles but he tires of them very easily.
The passed couple of weeks he has gotten very scared of being in rooms alone.  Even during the day.  If he is left in the living room alone he screams over and over.  I ran back in to see what happened and he had this very scared look on his face.  I asked him what happened and he told me his brother had left him alone and he was scared.  It was the middle of the day.  Every night he comes screaming into my room because he is scared adn tells me he see's bad pictures in his eyes.  Another words he is having night mares.  We had to move him into his older brothers room because he hates being alone.  I also have to escort him to the bathrooms now becuase he's rather pee his pants then go into the bathroom alone.  Just a month ago he was all over the house.  Now, he's at my feet.  I don't mind but he is truly scared to death.  I've told him that monster's don't exist but he says they do. Now my oldest son went through a scared of the dark stage too but he soon got over it.  Hopefully we can work through this quickly as it started to carry over into school as well.  

[Sally44]

From a sensory point of view, any or all of the senses can be under or over sensitive day to day or throughout the day.  So a child may react to one type of sound by covering their ears, at another time appear deaf, at another time be shouting or banging on things to make noise.  This means their auditory sense isn't or can't modulate itself.  A book that I found was the most helpful to me understanding my son's autistic behaviours was Sensory and Perceptual Differences in Autism and Aspergers by Olga Bogdashina.  She is a linguist from the Ukraine.  She has a daughter with Aspergers and a son with Autism.  Her book explains how if you receive sensory information differently, then the information you have about your environment is different to the one we have.  So we are living in separate sensory worlds.  When you understand that and see the 'reason' behind the behaviours, then it does make sense and you can start to adjust their environment.  If you google her name you will find an article by her printed in Autism Today.  Read it and see if it sounds like something that might be relevent.  This book also has a sensory questionnaire at the back of it that you can complete to get a sensory profile of your child.  This is very useful because every child has a different sensory response.  One child might be touch sensitive, whilst another may not even feel when they are in pain.  Temple Grandin said that she believed that all those with autism had some sensory difficulties ranging from mild to severe.
Regarding the sinus problems your son had.  It is interesting to think that he must have been in alot of discomfort and pain and not said anything to anyone?  My son did the same with an ear infection.  I took him to the doctors when half of his face swelled up!  When I asked my son 'Does your ear hurt you?', he said 'Yes, I can't get to sleep'.  But he didn't volunteer that information.  I had to ask him the specific question.  
What is the diagnosis of the SALT regarding your son's speech.
Does he have Semantic Pragmatic Disorder - google that to see what it is.
Does he have delayed echolalia - google that to see what that is.
Does he have auditory processing disorder - google that too.
Also google Executive Function Disorder as alot of those on the spectrum have these difficulties.



He most likely has focus and attention difficulties which are common in autism.  He will have lots of time for the things that interest him, but will not be able to 'force himself' to pay attention in class.  Usually this would entail not expecting him to sit still and listen to whole class instructions etc.  All activites should be geared towards his attention span eg. if it is 10 minutes then that is what it is, there is no point trying to press him to stay focused for a further 20 minute lesson!

You son't say what country you are in.  My son is also high functioning autistic and has (according to non-verbal testing), at least high average intelligence.  But when they are finding it hard to read, write or basic numeracy, it is hard to find a school that can differentiate the classwork to something they can attempt and achieve, whilst also keeping their attention and keeping them motivated.  I moved my son from a mainstream school to another school called Enhance Resource.  I am in the UK.  This type of school is also mainstream but specialises in autism.  So each class is streamlined according to literacy ability and each class has around 5 children with autism or ADHD.  Then there is one class for those struggling with the academic work and my son is in that class.  There are a total of 18 children, 9 of which are on the spectrum.  There is one teacher and 2.5 teaching assistants.  My son receives 1-1 teaching so that he knows what he should be doing, then he goes to his work station and finishes his work independently using the visual instructions.
My son is doing alot better there, but he is still struggling academically.  He was recently assessed by a private SALT who diagnosed Semantic Pragamtic Disorder (the schools SALT did not even test for this), as well as saying he has traits of Dyslexia and Dyscalculia.  

A SALT who specialises in ASDs should be able to tell you what he understands by the assessments he/she carries out.  If you are asking the question yourself, then it needs checking out because you have that 'hunch' for a reason.  The types of things my son does are:-
He uses alot of phrases from TV and DVDs in his speech.
He has set phrases such as 'by the way' or 'just a minute' .
He sometimes gives a totally unrelated answer to my question.
He mispronounces alot of words eg nap or map, bokano for volcano.
He takes language literally and doesn't understand the 'meaning' behind sayings such as 'You've turned the house upside down'.  He would reply 'Upside down! How did I turn it upside down?'
He can't always find the words he wants to say and gives up.
If he heard a joke on TV he would tell me just the punchline and expect me to laugh.
If he is trying to tell me something he doesn't give me enough information to understand what he is talking about.

[MomtoCade]

Thank Sally44!!
Currently his is in a public mainstream classroom environment.  He has a speech therapist at the school along with OT.  He is also getting private OT and Speech.  He was in the special needs class for Pre-K but they considered him and still do to be too high functioning for the class.  Currently we are working with the Special Needs teacher, who goes in to the class room once every day, and his mainstream teacher and parapro to work on the behavior.  They do as much visual cues as they can.  We are adding to the visual almost every week to help him with the schedule. I almost feel as if he's trying to get as much attention as possible whether it's negative or positive.  He will yell out poop and butt because he knows they are words we don't approve of such as butthead or poophead.  He yells them louder when he gets no reaction or when the teachers are trying to discipline him and then he laughs.  But, I am having difficulty discerning what he understands and what he can't understand.  I do feel he cannot put himself in other peoples position.  I think the special needs coordinator has some experience but not alot with children on the spectrum.  We are in a semi-rual area with almost no Autism support what so ever.  Thus the reason we are asking for a transfer to a new location, larger city, with more support.  Thanks for the heads up on Theory of the Mind.  I had not heard of that and it looks like i'll be doing some reading.  I feel the school is trying to be as helpful as possible I just don't think they have the experience needed.  I do think the sensory issue have come in to play for one reason.   One month ago he had his adnoids removed, his tonsils removed due to sleep apnea and severe sinusitis which was chronic.  His doc said that it was one of the worst sinus infections he had  ever seen.  From that day forward it has been night and day.  He went from a very quiet shy little boy to this new loud, obstrutive child.  Its almost like once the sinusitis went away he was able to smell better, hear better and breath better and it "woke him up."  I'm not sure if it's sensory overload or what.  I appreciate your help and comments.  If you have anything else I would love to hear about it. THANK YOU

[Sally44]

Is a SALT involved and also what kind of school is he going to.  Does it have experience of children on the spectrum and with ADHD?
Regarding his behaviour.  If, because of the autism, your son cannot recognise emotions in other people by their faces or tone of voice, then he isn't going to be able to understand that people are getting angry with him.  This sounds plausible especially as he talks loud.  If he understand voice volume etc and what it represented that he would bring his own volume down.  But he doesn't.
It could also suggest a difficulty with Theory of Mind.  If you google that it will give a good explanation of what that is, and it is typical of those on the spectrum to have difficulties with this.  But basically it means he cannot put himself in anothers situation and understand what they may be feeling, thinking etc.  He can just react in the here and now with how he is feeling.  You can help by reading stories and asking him to predict 'what happens next'.  Use books he will be interested in.  At school the SALT should put together a social communication programme, this will involve whatever they need to work on first.  He may respond better to visual symbols rather than the spoken word so all instructions should be backed up with a visual symbol such as 'wait' 'stop' etc.  He can be taught a visual signal to show him he needs to be quieter.  My son picked up this visual clue within a day.
As he is very active, do you think he has any sensory issues ie. is he under or over sensitive in any of his senses (this includes the senses of balance and co-ordination?).
But the behaviour is probably down to autism or ADHD, and therefore the supports, structures and teaching strategies need to be in place, rather than medication to reduce the behaviour, because you will get all the side effects from the medication as well.  I am not being judgemental as I know in some circumstances it is necessary.  But the balance should be that he is in the correct school environment with medication on top if necessary, rather than medicated to remain within a school that both he and the teachers cannot cope.
If you think the school is an issue please post back.