4 year old with disruptive behavior disorder-nos

My 4 year old daughter was diagnosed as Disruptive Behavior Disorder-NOS about this time last year.  My husband and I have followed all the directions from her behavioralist and her thereputic staff support person.  We implimented time outs (not just giving them but recording her behavior that led to the time out, how long it took her to calm down and be quiet so time out could start, the intensity of her anger, how long she sat in time out and how long she kept herself in time out after she was told "Time out is over, you may get up now.").  We took priveges away (if she was "grounded" from a specific toy, we would remove that toy from her bedroom completely).  We did a reward system (a sticker each time she completed a task that she was asked to do, one for each time she redirected herself from a tantrum, a small prize out of the treasure chest if she went the whole day without a tantrum, ect.).  

In August, she became very angry (we still do not know what about) and stomped on a small animal causing it's death.  Later that day she basically threatened to kill her brother who is 6.  We IMMEDIATELY paged her behavioralist who set up an appointment for her with the doctor at the counceling center that day.  At the appointment we were told that it would be best for her to go to a psychiatric hospital and have her admitted.  We did out of pure desperation....a week later, she came home.  We were told that she had absolutely no temper tantrums while there, she was a normal 4 year old with nothing wrong.  I once again called her behavioralist and changed from his services with thereputic staff support to family counceling (it's my understanding that the family route would help us more) after her throwing a tantrum in the car not 5 miles away from the hospital.  

What are we doing wrong?  At preschool, we are told what an absolute angel she is and at home we don't see any part of that child.  She screams, yells, breaks things, attacks other people and animals (all the pets are gone now), attacks herself......We are just at a complete loss!  Is DBD-NOS even a possibility of what is going on with her???  Our whole family needs advice.  Please help us!

[margypops]

If there is no problem at school I suggest you look at the dynamics at home ,how do her siblings behave towards her, I feel more is going on this child sounds upset, getting some further counselling would be a good thing.What happens prior to the tantrums you describe could anyone be teasing her,she sems angry from frustration .  There is a lot of punishment here perhaps it would be good to focus on her postive side and praise her when you see her doing something right, be aware of anything to upset her like teasing going on .

[ladeanjanel]

She just started at this new school so we will have to wait and see how things work out for her there.  She was expelled from her last preschool after she got up and dumped her lunch over another girls head.  No one had said/did anything to her before that episode.

There is alot of positive reenforcement at home.  She has her sticker chart to track progress throughout the day and the treasure chest to pick from when she reaches that level.  She also gets treats like going out for ice cream, skating with mom, ect.

She has 2 older siblings who are grown and out on thier own.  She has another older sibling who is terrified of her after she stabbed him in the nose with a fork (we were sitting at the table eating dinner....it was completely unprovoked).  She acts out even without being provoked or being upset.

Prior to the tantrums, she becomes extremely quiet and then just explodes.  No one teases her (mainly because we are all afraid of her.....yes, her father and I are also both afraid of her.).

She gets alot of praise for doing things right.  This is why we are so lost.

This morning, she wanted chocolate cake for breakfast.  I made a deal with her to eat her egg and toast first, if she was still hungry, she could have a small piece of cake (pick and choose your battles, right?).  She got up and went into the living room....she came back out, screamed at me that she hates me and stabbed me in the leg with a pencil.  2 stitches in the ER.  This is why we are all afraid of her.

[margypops]

I still think that the Issue comes from home as she is no problem at school, maybe check out what upsets her as I said it does sound as if some further counselling is in order because something is going on to upset a 4 year old like this .Good Luck

[vcj363]

How many family members live in the home? Maybe there is one particular member that she gets frustrated with and takes it out on everyone. Try one on one with her per family member and see what happens. Also what about a neurologist? Maybe you could call one and ask questions on the phone. My nephew has behavorial problems but his is because he can not communicate well with others due to a syndrome he has. I know how frustrating it can be from watching what my sisters family goes through. Good luck to you and to her.

[margypops]

Sorry but I did not put up the post ladyjaneal did , I think you made a mistake ..all is cool