Is this normal aggression in a preschool boy?

[Concernedmom4C]

Background: My son is 3.4 years old. I would describe him as a very active, bright, happy, cooperative, social, sweet, sensitive and VERY gentle boy. He has asthma and is on Symbicort and Singulair daily. We are VERY attentive, loving, gentle and sensitive parents. We use a firm voice and time-outs when needed-balanced with tons of encouragement and praise. I am pregnant and due in January-he has no other siblings. He went to a preschool camp in the summer and was very gentle and happy.

Problem: This year, he started a new preschool for the first time about 6 weeks ago (5 mornings a week ). Since this time, he has been quite aggressive at school with his peers and at home too. At home, he is defianty and always seems to be testing limits. He will hit my husband and I and pulled hair once (most often unprovoked). He will hit my pregnant stomach and say "I'm hitting baby brother" or "Can I hit squeeze baby brother when he is born?"

The teachers at school report his aggression is almost always out of the blue and not triggered by anything obvious.  He has kicked a boy in the head (did it three times repeatedly until a teacher intervened), pushed, hit, punched, tried to bite. Every day there are about 3 aggressive acts lately. He also has a reported lack of personal space/boundaries at school with peers-he will sit on a child or hug a child until they fall and do it three times in a row. He continues to do the same behavior within the same day and the next.  Although he is very verbal and social at home, his teachers have noted that he is not verbal or playing interactively with his friends.

I observed him in class and he seemed a bit bored by the activities and it is quite structured in nature. The aggression often occurs during unstructured moments after he had been required to sit and focus on things.. He is now being sent home from school and it looks like he is heading towards being kicked out. Thanks for any help

[Rebecca Resnik, PsyD]

Hello,
    Your son is going through a period of escalating stress for a young child, and he sounds very overwhelmed. These behaviors are likely his way of coping with intense feelings like frustration, jealously, anger or loneliness. While situational stress could be the explanation, your son is displaying some symptoms consistent with ADHD as well. I often hear parents describe problems such as difficulty with impulse control, aggression, violating other people's personal space and trouble with unstructured time.

I would visit the pediatrician to rule-out any medical issues that could be impacting your son's behavior. Ask for a referral to a psychologist who specializes in young children. It sounds like your son would benefit from having a psychological assessment to rule out ADHD and to learn more about his emotional functioning. The assessment data can be used to create an effective treatment plan for home and school. In my experience, schools are sometimes willing to give a child a little more time if they know the parents are trying to get help. Make sure to put the psychologist in touch with the school to foster collaboration.

Psychotherapy will be very useful to you and your son. The therapist will teach you to manage his behavior in positive ways (both at home and school) and can help him learn better ways to cope with his stress. It seems that a combination of parent work and individual child therapy would be indicated for your family. It would be best to start all of this now, before the baby comes. You want to make sure to have a plan in place so that you do not have to worry about the baby's safety!

Finally, with respect to the issue of your son's difficulty adjusting to the upcoming sibling, here are some terrific books that can help. It is very important that yoru son be able to express his negative feelings without becoming aggressive, and important for you to let him know that he will still be loved and valued. I recommend Siblings Without Rivalry by Adele Faber and Elaine Mazlish and The Kazdin Method by Alan Kazdin for you and the following children's books for him:  I'm a Big Brother (there are two different books by this title, both are excellent), and The New Baby at Your House.

Best Wishes
Rebecca Resnik