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3 1/2 year old with ADHD and impulsivity
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3 1/2 year old with ADHD and impulsivity

My 3 1/2 year old son was born full-term, started walking at 10 months, and was developing normally until at 18 months I noticed his speech wasn't progressing.  I had him evaluated by early intervention and they said his verbal skills were those of a 10 month old and receptive language was a 12 month old.  We had someone come to the house from 2 -3 years old once a week for speech and he improved alot. During this time, I had concerns with his hearing because he wouldn't turn when I talked to him.  He had an ABR with sedation and we were told he has normal hearing.   He had been enrolled in daycare from 3 months until 18 months and then was home with my husband for 2 years (from June 09 until early May 11) while he was out of work.  When he was 2 1/2, I enrolled him 2x a week in a daycare program for socialization and after 2 months, they told me that they didn't want him coming back the following month because he was too much to handle and they couldn't put another teacher in the room.  He would often run out of the classroom (so they had to put a bell on the door), climb on furniture, disrupt the class during naptime and not socialize with other kids or participate in circle time or reading activities.  

Around the time, I was told that he was no longer welcome at that daycare, he had and evaulation in my school district for their special needs pre-school program.  He was accepted into this program, with speech therapy 3x a week and started attending in Nov 2010 and continues to attend there until the end of this month when school ends.  He was put in the afternoon class at the pre-school so, since my husband was home, he would put him on the bus and take him off each day.  

In the meantime, I discussed his behavior with his pediatrician and they recommended me bringing him to a neurodevelopmental pediatrician.  I did this in Feb 2011 and she diagnosed him with ADHD with impulsivity.  She recommended that they add Occupational Therapy to his IEP at school for self control due to his impuslive behavior.  I discussed this with the school district and they said they didn't feel he needed it and has been doing well in school.  She also recommended a medication, however, this isn't something I would consider for him at this young age.

In early May 2011, my husband got a job and returned to work so I had to enroll him in the full-time daycare my 5 year old is in and have them put him on and off the bus each day.  The first week went well but then the second week, had 4 incident reports written up about him and then another 3 the next week and so far 3 this week.  They are very concerned for his safety due to his impuslive behavior.  Some of the instances are:

- running out of the classroom and them not being able to find him because he hides.  They use the pager system in the school to alert everyone that he has left the room.  teachers and the director have to stop everything they are doing and find him
- he climbs on tables and the support beams in the room with no regard for what the teacher says or what the class is doing
- he runs out of the play area they have by unlatching the gate and trying to get back in the building

I now have almost daily calls with the director at the school about his behavior and what could be causing it.  I am very concerned because I am the primary source of income for my family and need to work full-time. I am worried that they will tell me that they cannot care for him anymore and I will have nowhere to put him during the day.  The class sizes are large with 2 teachers and within the acceptable range for this age group.  I think he may need 1 on 1 supervision during the day and am struggling with resources for this in my area.  I don't feel comfortable having someone I don't know come to my house all day to watch him.  I would much prefer a childcare setting where he can socialize and be carefully supervised.  

He has also had instances of dangerous impulsive behavior at home when my husband was home watching him.  Once, when my husband was using the bathroom, he piled up toys and opened the sliding glass doors to the backyard, proceeded to unlatch the gate from the fenced in yard and run to the neighbor's yard to play on their swingset.  I never could have imagined him being able to get out of the house this way since we have a special reinforcement on the sliding glass door, including the lock for both the glass door and screen door that he somehow figured out how to open.  He also never wants to hold hands and will run away any chance he can so I never take my eyes off of him and always hold his hand. I talk to him over and over again about being safe and not running away and when I ask if he understands, he says yes, but then continues the same behavior seconds later.

Even though he is very active during the day, when it comes to naptime or nighttime, he sleeps amazingly well and never wakes up during the night.  I have explored sensory integration techniques to help him release some of his energy but I feel that he needs more assistance with this. He is very loving at home and is always cuddling and lets me read to him and we make up fun games to play and he interacts great with his brother.  He doesn't do these impulsive behaviors, that the school sees, at home.

Any advice on the following things would be greatly appreciated:

- what are the reasons for this impulsive behavior and can it be controlled without medication?
- has anyone heard of full-time daycare like programs that are geared towards children that need extra attention and smaller classrooms.  I am located in central NJ.
- any advice on what I could be doing to help him would be greatly appreciated.  I am very concerned for his safety and ability to integrate into a mainstream school environment in a few years.
- the cord was 3x around his neck when he was born and I worry if that has caused any of these issues.  they didn't say anything about there being a problem when he was born.
- do you think that if I would have kept him in the daycare program he was in from 3 months to 18 months, he would not have these issues now?  I feel alot of guilt for taking him out of the program and wonder if he would be different if he had stayed in a social environment.  
- any other thoughts on anything else I have written here would be greatly appreciated



This discussion is related to Active 3 1/2 year old.
Tags: impulsive, 3 years old, ADHD, 3 1/2
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8 Comments Post a Comment
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Avatar_m_tn
   It is interesting that the special needs pre-kindergarten did not seem to see the problems the day care is having now.  I think that part of the problem with the daycare is that he is the new kid on the block, is uncomfortable, and reacting.  And its gotta be stressfull for a almost 4 year old to be hoping on a bus and heading off to a new place.  Is your son on the bus with him?   Any chance when he goes running off, he is looking for your son?  I know I would sure be trying to find my buddy in that situation.   The other problem would be in their supervision - gotta feeling its kind of lax.  I doubt that he had 1 on 1 in the public school setting.  Wonder what the difference is.  I think that you need to take an afternoon off and see this daycare yourself.  It may well be that they are just not able to handle him - wonder how the public school does?  
     Before, I forget, when posting on the ADHD forum, I recommend,"The ADD/ ADHD Answer book," by Susan Ashley a lot.  Its worth your time to buy it.  Amazon carries it.  and it will help you with integrating him into the mainstream classrooms.
      your other questions.  
      The reason for his impulsive behavior is his ADHD.  Unfortunately, at his age, controlling impulsive behaviors (if he has ADHD is very difficult).  They don't have the maturity to do so.  Ashley has a full section on Parenting which deals with this issue (pgs. 123-144). and the problems it causes in terms of disciplining your child, etc.  The sad thing is that many parents try all kinds of punishment to change a behavior that the child has no control over.  That can be a disaster for both the child and the parent.
     The only problem with the cord would have been if it had cut off oxygen for a long enough period of time to cause brain damage.  And you would know that by now.
     I doubt that taking him out of the day care caused him to have ADHD.  Its mainly genetic.  Ever notice any signs of this in your husband?
     I do think that you may have to start a serious look for daycare around you.  Ask at the public school where he has been going.  They are used to working with special kids and may have some ideas.  
     You saw a neurodevelopmental pediatrician.  Might be interesting to see a pediatric psychiatrist who specializes in ADHD and get their feelings.  The main thing that you would want is how to work with him.  Which leads me to the final point.  There is a  lot that you can do for him in the future.  But to do so you really need to become an expert in ADHD.  The book I recommended will help.  You might want to check out my post here - http://www.medhelp.org/posts/Child-Behavior/10yo-boy-not-sure-whats-going-on-anymore/show/1531336#post_6957831    for other resources and a look at what other parents are going through.  And, of course, feel free to look at any of the posts on the ADHD web site.  I can recommend other web sites too, but honestly I haven't seem much aimed at this age group, but they will become important very soon.  Hope some of this helps.  best wishes!!!
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Avatar_f_tn
if he's dangerous impulsive take him to his room. because you want to undo his anger once his calm put him to a time out.
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Avatar_n_tn
Thank you so much for the response!  It is extremely helpful and I just purchased that book you suggested.  The special needs pre-k did see some of these impulsive behaviors (running away when getting off the bus, running out of the classroom, climbing) when but they seem to have gotten better.  The class size there is only 8 with a special ed teacher and 2 assistants.  The daycare has 15 kids with 2 teachers that aren't certified and many of the kids have been there since they were infants so know the routine. It has only been 3 weeks for my son and I do think it is alot with him going there in the morning, getting on the bus and then going back there without napping. He still naps on the weekends for 2 - 3 hours so I think that he is overly tired, too.  My other son isn't on the bus with him and stays at the daycare all day. Next year, they will both be in the morning class, so I will put them both on separate buses at 8am and then planned to have them dropped off at the daycare. This way, they are only going to two places a day and not back and forth.  He will have a better routine since he will get off the bus. have lunch, have naptime and then it will be more of a normal schedule.  

One thing he likes to do is play with these little beads and put them on these boards to make shapes and animals so I brought a box of them into the daycare for him if they notice him getting distracted and he really enjoys this. He will sit and play with the beads for an hour and be completely content.  I do think that they are overreacting with some of the things they have written incident reports about.  I have been there and see alot of the kids running around and trying to run off the playground but I don't know if these were written up.  On friday, when I picked him up, there wasn't an incident report but his teacher told me he wasn't listening well and they were playing with paper rockets and he was throwing it at the teacher. I asked if he thought they were playing catch or a game and she said he wouldn't stop so she took it away from him.  I can't imagine he is the first 3 1/2 year old that would do this.  

It is funny you mention about my husband, when we got married, almost all of his relatives said how he was uncontrollable with his energy level, etc.  The neurodevelopmental pediatrician asked the same thing and the answer is yes, I believe he probably would have been diagnosed with adhd.  

Regarding the impulsivity, the only punishment I have ever used is putting him in time out.  One of the challenges is getting him to look at me and listening to what I am saying when I tell him that he will get hurt, etc. He always says yes, he understands.  At our house, there really isn't anything he can hurt himself on and in his bedroom, there is his car bed that he can't fall out of and no dresser or table since he would climb on it and most likely get hurt.  I have to be very vigilant when we go out because he always wants to run so I always make sure to hold his hand.  Sometimes now he will say "i am being a good boy" and that means that i can let go of his hand and not run away.  He sees his brother staying close-by and I think he is learning from him.  He rarely gets angry or upset about things.  The only times is if someone takes a toy from him and that, I think, is pretty normal for the age.  I have noticed at the daycare, he doesn't have friends to play with becaue he has difficulty communicating and the tend to walk away when he is trying to say something, which I feel bad about.  

He was invited to his first birthday party today for one of the boys his special ed class and he had a great time so it was nice to see he had formed some relationships with those kids.  I was talking to one of the mom's and she was insisting that I put him on medication so he is better in school.  I would rather leave my job for one that lets me work from home some days than put him on medication at this age.

I did call his case manager at school to see if she has any recommendations.  I also have his end of year IEP meeting on the 14th and will discuss this further then.  I will also look into the pediatric psychologist.  He is a very happy child, very loving and wants to hug everyone.  I am grateful for the time you took to post the response.  
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Avatar_m_tn
   Glad I could help.  
I would check into both a pediatric psychologist and psychiatrist.  There are some advantageous to the psychiatrist, but essentially you want to find one that is experienced in working with ADHD kids, and more importantly one that will spend time with you.
   The book I mentioned will help you a lot I think.  Another thing that will help over time is to start buying a series of books in the "learning to get along", and "Way I feel" that are aimed at the 4 to 7 year old child and are meant to be read aloud to them.  You can find out more here, http://www.amazon.com/Share-Take-Turns-Learning-Along/dp/1575421240/ref=pd_sim_b_4
    One of the things that you can do with ADHD kids is to work (it takes repetition) on doing things at home that will carry over to school.  With enough practice, it will become second nature and that is what will happen when the filters aren't working.  When you have a very loving child, that is wonderful and something to expand on.
    Loved your story about the teacher and him throwing the paper rockets at the teacher.  I would have been throwing them back at him and showing him how to make the rockets more accurate.  The school doesn't have a clue.
   And yes, I do think a lot of the problem is in his routine, lack of nap, etc.  I have seen lots of studies that show that a lack of sleep really accelerates ADHD behavior.  Anything that you can do to make the school situation more comfortable, more familiar to him will help.
   Be proactive about next years classes.  Try and meet the teacher early (both at daycare and school).  visit the areas before school starts so he is really familiar with them.   Establish a relationship.  Let the teachers know what he is like - no surprises.  The book will give lots of ways to work with him which you can share.  I can also recommend very detailed books for the teacher if the need is there.
   Punishment wise, you are doing the right thing.  The book will fine tune it for you.
    Best wishes!
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973741_tn?1342346373
Hi.  I will come back and read your post thoroughly in a minute but I will tell you that there is something that rings a huge bell for me.  My son ran as well.  It is a base level "flight or fight" response.  My son was diagnosed with sensory integration disorder at three.  He had issues with speech as well as motor planning which is part of the sensory system can interfere.  Sensory involves the nervous system and can look a lot like adhd at times.  

Please google it and see what you think.  My son is now 7 and going into the 2nd grade.  He has no IEP at school and does really well.  We've done what they recommend for sensory integration disorder like maniacs.  "Heavy work" and coping skills are the predominent course of therapy.  It got my son through and he is doing great.  I'd be happy to share the activities that I found most effective for calming my son's nervous system and things we did in the classroom (preschool and now) that helped him along.  

Again, google sensory integration disorder.  I'll get back to this post in a bit and read it carefully.  BTW---------- my son walked at 10 months as well.  It was a predictor of sensory.  
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Avatar_m_tn
Hi,

My son is 4 years old as of February 2011.  Right before his birthday, my wife gave birth to twins, we had to switch his daycare/preschool to Goddard.  He began exhibiting aggression, biting returned, and general disobedience.  He began to exhibit the behaviors at home and in school.  We took him out of Goddard, right before they kicked us out, and enrolled him in a local Catholic school.  He still aggressive, pulled other childrens hair, spit at the teachers, and threw things in the classroom.  We had an IEP done and they indicated a social delay.  The catholic school teacher kept saying ADHD.  We scheduled an appointment with a developmental pediatrician at Children's Hospital of Philadelphia.  Prior to seeing the developmental pediatrician, they required he have a hearing test.  We did so, and it showed a mild hearing loss.  We took him to a CHOP ENT and he had an enlarged adenoid and large tonsils.  They recommended removal.  It's now three weeks post op, he has started talking more, listening, aggression is almost non-existent, no more tantrums.  He sleeps like without snoring anymore and is no longer mouth breathing.  The catholic school told us he had a great week last week and now he's under a microscope.

I know my wife and I felt hopeless, but definitely work with the experts, rule out the medical before you jump into the psychological.

MJG
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Avatar_n_tn
Hello:  Thank you so much for the post and that is wonderful that your son doesn't need an IEP and is doing so well!  I would really appreciate any activities you wouldn't mind sharing with me to help him.  I will read about sensory integration disorder and will discuss with his case manager at our meeting on the 14th.  Someone at my job said to me today about some links they heard about kids that never crawled having learning/reading issues.  I thought that was interesting if it is true.  Thank you!

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973741_tn?1342346373
Yes, I have learned many things over the last few years that are very interesting regarding development.  Crawling is actually harder than walking!  Who knew?  One thing that they often do for kids that didn't crawl is go back and play games with them in which they have to crawl.  It is very good for the nervous system.  They have to have to hold their body weight up with their core muscles which is part of the "heavy work" that helps the nervous system stay calm.  So, maybe get some cars or trains or trucks and have him on all fours crawling around pushing them.  You play with him too (ah, we mom's get our exercise, don't we?).  

You can also try to have tummy time with him.  When he is playing something--------  have him lay on his stomach.  Don't know if he likes this or not but my son hated it.  I'd put a pillow under his belly/chest to make it easier at first.  Again, this involves core muscles.  

A good website for sensory is simply named "Sensory Processing Disorder/ spd".  Google that and you should get to the website.  I think it does a nice job of going through all the different parts of sensory.  But most importantly----------- when there or google in general "sensory processing/ integration disorder and heavy work".  You'll get lists of things that are known to calm the nervous system.  Whether he has sensory or adhd--------  they are really helpful.  Michael Phelps has adhd and found swimming soothing to his nervous system-----------  obviously he did a LOT of it!  I've had my boy in pools several times a week for years.  It provides both hard muscle work and resistence, making it an excellent calming activity.  Jumping on anything is great.  If you have access to a trampoline, great.  We got one of those little mini ones and my son would bounce away on it.  Before school this is good because it wakes up the nervous system and calms it at the same time.  My boy use to jump for at least 5 minutes before school.  You can even put a mattress on the floor and have him jump on that.  When at the park, pay attention to what he does and try to get him to do some muscle work.  Climbing up an play structure walls is excellent.  Hanging on monkey bars is great---------  even just straight down hanging for a few seconds at first is calming.  Swinging is a go to calming activity (I'm sure you've seen a lot of little ones fall asleep doing it!).  We have hills around us.  I have my son roll down them and then run up.  I make it fun by playing chase games with him or calling it the Olympic Challenges.  So make it all into a game.  

Oral soothing is excellent as well.  Old fashion bubble blowing is great.  Have him drink something thick through a straw----- apple sauce, milkshake, thick smoothie.  Chew a thick piece of gum.  Play a game of blowing a cotton ball across the table with a straw cut in half.

He'd probably love an obstacle course.  Have in it things like crawling under a table, jumping over some pillows, etc.  Make it one that works out the nervous system.  

Learning issues do often come with adhd/sensory/etc.  But not always.  My son has not shown any signs of a learning or reading issue.  He reads above his grade level and had a 'perfect' report card--------- meaning he got the highest marks in every category.  I don't say that to brag but to say that IQ and developmental delays do not always go hand in hand.  So you do not have to assume that your son will have issues in this area.  And with adhd/add it is often difficult to figure out if it is a learning disability or the focus issue itself that causes the problem.  Ha--------- my son is just going into 2nd grade and it is amazing how serious academics get right from the start!  Enjoy your LITTLE guy!

So, I'm happy to provide more activities----------  look at that site and see what you think!
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