5 year old boy

My husband and I have been concerned with our son's behavior since age 2. Despite MANY time outs, charts, negative results, etc. he still uses aggression. Here are our concerns: inconsistent moods, unpredictable moods, trouble controlling his body impulses, some history of sensory difficulties (couldn't tolerate loud noises for a few months), recent concerns arising at his preschool regarding keeping his hands to himself. His temperament is anything but even. He is very bright. He enjoys challenges, mastering games of sorts. He is difficult to get going in the morning. Constant reminding to do things so we can get out the door. Overall, he has difficulty listening and following through. When he is motivated (or even bribed) he is much more able to follow through.
We have seen both a psychiatrist and a psychologist. My husband is a special ed teacher and I am an O.T. We try and stay on top of him but he has two younger siblings that also need attention. He is, by far, our most difficult child. We feel there is no rhyme or reason for his behaviors- it does not correlate with sleep, nor does it seem to correlate to nutrition. We are just worried about the future. He attends a Montessori preschool at present where they promote peaceful interaction, choosing your own "work", and operating in a quiet atmosphere. He's doing okay, but there are days, as stated above that he can't control his body and ends up in trouble. He kicked sand in a friend's eyes the other day when he was in a timeout, for example. When he is in a large, loud crowd, however, he shuts down a little, becomes shy. At church, for example, it took him 1 year of encouragement to go to the front of the church with the other kids to hear the children's sermon. Everyone felt like cheering.
Overall, his behaviors are not severe or life-threatening but they are certainly an ongoing concern of ours.
What are your thoughts? Possible diagnoses? Is medication even an option? We need help.
Thank you.

[Kevin Kennedy, Ph.D.]

Your son behaves in a way that is more impulsive and disorganized than a typical five-year-old. The symptoms you describe can result from emotional conditions such as mood disorder, impulse control disorder, disruptive behavior disorder. What feedback did you receive from the mental health professionals you consulted? We tend to refrain from employing medication with very young children, but if it is the sensible thing to do it shouldn't be ruled out. It's really a matter of determining the appropriate diagnosis and, if medication is part of a treatment plan, determining the goal(s) of the medication (e.g., to address aggression, impulsivity, uneven mood).

[mperez]

what do you mean by keeping his hands to him self and what did both of the doctors you took your son to say .what is it they think might be causing his behavior . i have a 6 yr old son how has been going through some hard times him self and just started looking for help for him just trying to stay positive for him i dont want him to think there is something wrong with him.

[sarahot]

What I mean is basic tapping, some pushing, things to antagonize others I guess. The psychologist focused on disciplining strategies with my husband and I. No talk of diagnosis with our son. The second Dr., a psychiatrist, wants to just monitor him.. he's not sure.. he looked at Aspergers, bipolar, and a nonverbal learning disability. We see him again soon. Thanks for commenting:)

[mperez]

thank you just need someone to talk to trying to keep my my busy and trying to look for help for my son to.

[avalongod]

From your description it doesn't sound like he has the speech delay you'd expect from autism, although Asperger's could still be a possibility.

A regimined behavioral intervention procedure could help.  Your son may need to start with very brief intervals of time in which he is rewarded (with something small but tangible) for "on task" or positive behavior (may need to start as small as a minute).  My guess is that at the moment, the time intervals in which he is being rewarded/punished for his behavior are too long to keep him "on task"...naturally this sort of intervention is exhausting and consuming for all involved, but the time lengths can be gradually lengthened.  

However my advice would be to seek out someone certified in this kind of intervention, a certified behavioral analyst or child psychologist, who may be able to guide you in implementing this kind of procedure.  

Keep in mind that some aggressive behavior is quite common in children, but excessive aggression is not.  It's also a "toughy" in terms of treatment, so hang in there.

Good luck.

[Kevin Kennedy, Ph.D.]

If the clinician recommended a systematic form of behavior management, which might well be the most sensible thing to do, it implies the clinician did not see the presence of a biologically-based emotional disorder (such as mood disorder). In Lynn Clark's book titled SOS: Help for Parents you will find a very effective form of systematic behavior management.

[sarahot]

Thank you all so much for the comments, all very helpful. He really has his good days and bad days. Still can't see a correlation. He is beginning to be aware of his impulses, however. For example, the other day he said "mommy, I was gonna kick J.P. but I didn't". I was happy that he could recognize this. His speech is great. Its just his overall internal control: running and crashing, screaming out of the blue, unable to stop what he is doing to listen, reacting very strongly with aggression: all making him a difficult kid.

[Bannett]

I just noticed your posting after posting mine today (4 yr old issues at preschool).  It is almost identical to mine and I feel your concern and frustration. My son is 4 1/2 and also goes to a Montessori preschool.  His behavior is starting to disrupt the class and he continues to be antsy and get into other kids "space".  Have you sought outside help and if so was it helpful?  Also, are you sending him to a public kindergarten or keeping him in the Montessori kindergarten (if they offer it).

[sarahot]

Hi, yes my son goes to a Mont. preschool, and he will go to a public kindergarten next year. He's actually had a good couple of weeks. No commments from the preschool or problems at home. I've discussed his issues with his pediatrician recently and he'd like to monitor him instead of us seeking outside help. If concerns persist, he would send him for neuropsychological testing. He feels some of these behaviors are consistent with ADHD. He also said behaviors can wax and wane. Right now I am very happy with his behavior but it could change. We'll see...

[Bannett]

I'm glad you've had a couple of good weeks.  We seem to be getting great improvements in behavior at home (he's actually playing and taking care of his little brother now instead of bopping him on the head all the time!) but still are struggling with his touchy and antsy behavior at school.  Luckily the Mont. teachers are very supportive and willing to help.  Good luck to you and I hope you update the forum as time goes on.

[mishu_jain]

A related discussion, 5 year old boy behaviour was started.