5 year old boy social issues

I have a 5 year old boy.  We noticed at 3 that he was having problems with his speech and went through the school system to get him evaluated.  They put him in a pre-school class at the local elementary school to help improve his speech and comprehension skills.  That first year he was suspended three times mainly because of behavior issues.  This is his second year and he is doing much better but everything has to stay on the same routine at school.  If they have a sub or if they switch rooms he gets very disruptive and does not follow directions.  After one thing disrupts his routine the rest of the day is normally rough.  They switched rooms in daycare (his after school program) and they told me when I went to pick him up that he set in the floor and was pinching and hitting himself.  This is the first time that this happened.  As far as book smarts he is very smart but I feel he still has problems understanding simple questions like if you ask him why he did something we will only tell you the reasons he should not do it.  The school feels he has behavior issues but I took him to the military Dr. who observed him in a room by himself playing and feels he may be a little immature but within normal levels.  Does anybody have any suggestions???

[Kevin Kennedy, Ph.D.]

Try not to judge much by your son's reply when you ask him 'why' he did something. To be frank, that question with young children is not very useful. They do not have the cognitive skills to answer in a revealing fashion. It's clear that your son requires, as all young children do, a good amount of structure and routine. When he does not have the benefit of such structure, he behaves in a more disorganized manner than he does in the face of structure. Observing a child playing alone may not be particularly instructive. Observing him in social situations, and speaking with the people (parents, teachers) who are with him in those situations, tend to be more useful ways of figuring out what is occurring. For now, be sure he receives a good amount of structure and routine, and be sure the limit setting is clear. Classroom rules should be clear and straightforward, and violations should be met with time out.