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Avatar universal

Help "diagnosing" a student

Hello, I am currently working as a teacher in an Asian country where mental health issues are extremely taboo. In fact, all professional jobs require applicants/employees to include their medical records and those with any history of mental health tend to not get hired. Therefore, many people do not get diagnosed in fear of social stigma.

I have a student (11 years old) who is obviously suffering from some issues and even after our staff has talked to his mother about his behavior and offered to help, she refuses to have him diagnosed.

I am hoping for some help in finding what disorder this child has in order to help him more in the classroom. His homeroom teacher believes that it's ADHD, but I'm not so sure. I know it would be ideal take him to a professional, but his family refuses to do so and I am trying my best to help him and I think the best way would be to identify what his problems are.

One of my main concerns is his extreme angry outbursts. Sometimes, he would get extremely angry and would ball up his fists. His body would shake in anger and he would stare at the ground. Sometimes some tears would come out. This happens when teachers, female students, or students older than him make him angry.
In other times of anger, he would hit another student. This happens usually with students his own age or younger. Most of the times of angry outbursts are unprovoked. For example, I once saw him wandering around and I told him his class is doing extra practice for a performance and they're in the auditorium and he only caught the last part of what I said since I spoke fast. Another student who was with me repeated what I said to him and he got extremely angry and tried to hit him.


Another main concern of mine is that sometimes his behavior would be completely opposite! He would burst into uncontrollable tears. This usually happens when he is surprised or scared. Students like to hide and jump out and scare their classmates and this is extremely playful and normal but when this happens to him, he would cry uncontrollably. This also happens when there is a sudden loud and long-lasting noise. For example, the PA system at the school is loud and screechy, so whenever there is an announcement, he would burst into tears and a teacher would have to take him outside, away from the noise and calm him down.

He is of average intelligence but he has a problem with trying and failing. He would rather not try and fail (because his excuse would be he didn't want to do it) instead of trying and failing (because then he would be "stupid"). He gets angry and refuses to do assignments and we teachers have to do a lot to get him to complete the tests. He actually scores at acceptable levels.
If he isn't able to complete a task right away or do it correctly right away he would quickly push the worksheet/test/game/whatever away and physically move away from it and show at least slight anger or annoyance. It is because of this, some other teachers think he has ADHD, but to my knowledge, children with ADHD can't control themselves from being distracted. To my observation, he doesn't get distracted easily, he just doesn't want to do his work in fear of failure.

Sometimes, he would make random noises and open/close his mouth as if doing jaw exercises. Sometimes he would get up and jump in circles as if he was trying to flip his body around (the best example I can think of is when dogs try and catch their tail by trying to jump around themselves) and make random noises while doing so. Sometimes he would hit his desk and make yelping sounds.

He appears to get extremely disturbed by things out of the ordinary. For example, I was watching a Hong Kong show about lawyers during my lunch break and like British lawyers, Hong Kong lawyers wear white wigs. My students dropped by my office and I showed them what I was watching and he completely freaked out over their "weird hair" and started jumping around. He pulled his forearm up close to his body but his hands were flapping around and he avoided eye contact and keep yelping about the weird hair. The other students thought the wigs were weird too but they simply laughed and even called their friends into my office to check it out. I explained why lawyers in Hong Kong wore wigs and black gowns and they were fine with it but he needed to be taken out of the room and calmed down.

Thankfully, he is not bullied by the other students. In fact, he is extremely babied by his classmates! That's actually a problem too, because he has started taking advantage of that and doesn't even bother getting his textbooks out because his classmates do it for him to avoid confrontation/another angry outburst.


17 Responses
973741 tn?1342346373
If he lives in a culture where it is taboo to diagnose him, then I would respect that.  If he has a diagnosis on his record in that country and it would hinder him in the future, then I too would not want that in my child's record.

Instead, I'd look and do your own research on ways to help him and have the other teachers he is with do so also.  My son has sensory integration disorder which can look like what you describe.  One thing that really helped my son was a plan for anger.  Here's what you CAN do spoken about ahead of time and here is what you can't do.  A place for him to go when upset set up ahead of time should be made.  Strategies for decreasing the anger need to be explored with him whether it is using his words and telling an adult what is wrong before it escalates or after if he is able (but that is often too late), deep breathing, counting, headphones with soothing music while sitting in a rocking chair, opening and closing fists firmly, etc.  We also used a stress thermometer with my son that helped us at first but them HIM to recognizing when he is angry.  It is something this boy could benefit from----  

Stress thermometer:
sit down with him and talk about this ---  have a picture of a thermometer drawn.  He colors in the bottom part (the ball at the end) a color--  we used green.  This is the 'just right' spot where someone (him) feels good. Not upset, not agitated, calm.  Talk about how he feels when he is 'green'.  Talk about what his body looks like, smile or relaxed face, relaxed hands, voice nice and steady, not loud, eyes bright, breathing normal, etc.  Then color the section above the green yellow.  This is the area where he is beginning to just start to feel agitated or upset or angry.  talk about how his body feels when he is yellow.  Talk about what his body may look like such as smile faded, lips together, face tensing, hands not relaxed, voice getting louder, shakier, heart rate picking up, etc.  Then talk about what he could do at THAT stage to bring himself BACK to green. This is where you talk about strategies he can use that are time tested anger management strategies (the cool down spot, the counting, using words, etc.)  Then have him color the next section above the yellow orange.  This is where he is clearly upset.  He is talking very loud, he is breathing hard, his hands are in fists, his eyes are squinting, his lips are pursed, etc.  Talk about how his body feels.  Then again talk about strategies that might help calm him down so that he can go back to green.  After the orange section, have h im color red.  This is where he NEVER wants to go. This is the meltdown.  This is where he is yelling, making a scene, out of control.  it is very hard to calm someone down once here.  So the goal is to never go red.  (by the way, a piece of chewing gum does slow the nervous system in these instances),

So, you introduce that and then start using it.  First, you help him see when he is changing from green to another color.  It can seem like it is happening fast but there are usually signs and you just keep your eye on him.  Perhaps an aid in the classroom would be a great idea for him.  You can give this information for his parents to use at home as well and they just may do it as no one wants there child to have this issue.  Then the real goal is for him to become so familiar with what his body is doing that HE can pick up on changing from green to yellow to orange and stop it before it happens.  

So, that is just an example but since you seem like a kind and caring person---  I'd try to help him wit these life long strategies.

Also, kids like this often do well with lots of movement during their day.  Give him jobs--- running something to the office, passing papers, and better something that involves some lifting to it like moving books, etc.  

good luck
973741 tn?1342346373
Oh, and by the way, bursting into tears and anger are very similar in terms of what is going on inside.  Treat them as the same in terms of the stress thermometer.  

Fear of failure is perfectionism and is part of anxiety.  Do story telling in class about failures and how it is no big deal. Everyone makes mistakes.  Make some mistakes in class on purpose around him and self talk outloud about "oh well.  Not a big deal.  We just fix it or move on . . ."  Things like that.
13167 tn?1327197724
I agree with everything SpecialMom said.

Only thing I have to offer is the kids needs to be made to stop jumping out from hiding to scare other kids.  Interesting,  we talked about that at lunch with friends the other day, and how NOT funny that behavior is.  It's aggressive and cruel,  like adults who like to tickle children until they are screaming and crying.

I think I'd make that punishable by missing recess for a couple days.  No hiding and jumping out.
973741 tn?1342346373
I agree with rockrose.  I do think that this could be part of this child trying to be social and  not knowing how. Ugh, my own son has done something similar when a child comes over and he is all excited.  It took me a while to understand he was trying to make his friend laugh and it took him a while to realize this wasn't funny.   better to pair him up with another child on projects to help me acclimate to socializing better.  
5914096 tn?1399922587
The sudden shifts of affect and behavior that you describe points to bipolar disorder. Unfortunately, if this is the diagnose, there is little that you could do to help him as those living with bipolar disorder often need anti-psychotic meds to lead a normal life.
189897 tn?1441130118
COMMUNITY LEADER
    All of the points above will help.  The problem is that they don't deal with the cause.  And it really does sound like ADHD or more probably ADD.  
    As a fifth grade teacher (long time ago), one of the best signs to me of a child with possible AD/HD was frustration and anxiety.  If it had been undiagnosed to that point, they were a mess.  They knew they should have been doing better - yet they couldn't.
    You said, "children with ADHD can't control themselves from being distracted. To my observation, he doesn't get distracted easily, he just doesn't want to do his work in fear of failure."   Trouble is you can't tell what he is thinking.  I have had kids in class looking right at me and were a million miles away.  That was one reason I moved a lot and used there names all the time as I was talking - just to try and pull them back.  
   What you need to ask yourself is why the fear of failure.  You said he has average intelligence, but has a fear of failure.  Kids with average intelligence should not be failing unless something is getting in the way.  And I can guarantee you that after failing for 2 or 3 years, you will start to compensate.   I really feel for the little guy.
   I do understand the culture as I also had to deal with that as a principal and a teacher in the US.  About the only thing I can offer is that in that culture, education is very important.  Unless, he can get help - he won't make it.  If his parents want him to go to college - they need to help him now!   Chances are his parents are not going to realize this until he hits middle school and the work becomes so difficult for him that he self destructs - unless he can learn coping skills.
    That is why Specialmoms suggestions are so good.  He needs to learn how to deal with his anger.   His actions are so typical of a culture that believes you don't show emotion.  You just have to hold it in.  Showing him how to deal with it before it gets to that breaking point is really important.  This is an excellent link to what is called "anger overload" - it is worth your time to read.    http://www.chadd.org/Portals/0/AM/Images/Understading/AUG01AngerOverloadinChildren-DiagnosticandTreatmentIssues.pdf
    As the CL on the ADHD forum too, I have come across ideas that also will help you help him in class and maybe to study at home.
     Here are 3 or 4 links that will prove helpful.  Even if he does not have ADD (and you are right - they need to figure out what is going on) these will be helpful.
          http://www.additudemag.com/adhd/article/8394.html  
          http://www.onhealth.com/tips_for_parenting_a_child_with_adhd/page6.htm#develop_organizational_aids
          http://www.pediatricneurology.com/schoolrx.htm

       Hope these help.  Please post if you have any questions.
Avatar universal
Thank you for your suggestions.

One thing I forgot to mention is that he's not very talkative no matter what mood he is in. When he is in one of his bad moods (extreme anger/rage) he refuses to speak. I am a subject teacher and I go to his homeroom when I teach and his homeroom teacher is usually in the class and he's extremely helpful. He always pulls him aside and tries to talk to him but he refuses to speak. When he's extremely angry he refuses to move, which is a problem because we can't continue with the class (the homeroom teacher tries to remove him from the room to speak to him privately while I continue with the lesson, but since he doesn't move it causes an extremely awkward atmosphere). There were instances where he seemed to be a physical threat to other students so he had to be moved physically but he refuses to move and the homeroom teacher doesn't want to forcibly remove him since he resists so much.
When he's upset with uncontrollable tears, however, he is fine with being moved.

I will read up on sensory integration disorder, thank you again!
Avatar universal
In my school, this appears to be fun, normal behavior and kids don't appear to see it as cruel, but I can see your point of view. From now on, I will be more strict about this behavior just in case.

As I have said, his classmates aren't cruel to him and they specifically make sure not to jump out and scare him after the first incident.. When they see something interesting, I always notice that they discuss if it will scare him or not before deciding to show him. They are good kids and care about his well-being.
Avatar universal
I have considered bi-polar disorder but I am unsure if that is the case... I googled a bit but there doesn't seem to be much information about it relating to young children. This boy is 11 years old. If anyone could give me more list of symptoms, that would be great. I see a lot of symptoms online for teens about insomnia and increased sexual desire, which I would have no idea about! To my knowledge, he is not yet interested in girls/dating/etc.

Another thing is that he is quite thin and doesn't seem to eat as much as the other kids. I'm not sure if this is significant since he's not EXTREMELY thin or malnourished but at 11 years old, he should have a bigger appetite since he should be growing, right? He's at an average height compared to his classmates.
Avatar universal
Thank you for your reply.

To my knowledge, he hasn't failed any classes.... if that's what you mean? I think maybe I should have said he's afraid he won't get things 100% perfect. I don't know what he's thinking of course, but from what I have observed, he seems to be afraid of not doing something fast enough with 100% perfection.

The homeroom teacher has attempted to get his mother involved and invited her to ADHD conferences with him and things like that but she's always "busy". We both believe she isn't really busy (she is a housewife, not that housewives aren't busy! I'm just saying she is able to set her own schedule) and is just embarrassed.
According to the boy's grandmother, he started exhibiting this behavior at around age 3~4.
I met him when he was about 8/9  and he showed all the behavior he does now EXCEPT extreme anger and uncontrollable tears (is there a term for this?) which started last year at age 10/11. I don't know how he is at home, if it's better or worse but I know his grandmother is extremely exasperated about this.
There is one female student who takes care of him a lot and his grandmother actually relies on her to handle him!!! She once show up with him in tears and desperately asked where that female student was because she couldn't stop him from crying. That student wasn't there that day and the grandmother just left me to console him.  

From what I have read, being distracted is the key point of ADHD, but is it possible to have ADHD without being distracted easily? I have two other students who have ADHD (one is actually diagnosed and went to treatment before) and they clearly get distracted and drift off into space. This boy, doesn't seem to get distracted in the same or similar way they do if at all. Could it be a mix of ADHD and something else?
The homeroom teacher went to many ADHD conferences/seminars and has tried techniques but I haven't seen much improvements that came from those techniques.
ADHD is actually becoming more recognized here and is being seen as a more "acceptable" disorder compared to other mental disorders so I'm afraid that most teachers here would jump to the conclusion that every "problem" student has ADHD. I think that's why I'm afraid just "brush it off" as ADHD.

Thank you all again for all your helpful responses. As a subject teacher, it's difficult for me to try and identify this student's issues since I teach him for approximately 4 hours a week. I see him for maybe another additional 4 hours a week as I interact with him at lunch and he and his friends like to visit my office during breaks and I see him in the hallways. I'm so, so glad he has such a good homeroom teacher who goes to ADHD seminars in his free time and he even spoke to a specialist. I'm also so glad that his classmates are so kind to him, although the extreme babying has become a problem and may enable bad behavior. But at least it's better than bullying or isolation.
189897 tn?1441130118
COMMUNITY LEADER
   No, there is no one key point of ADHD.  There are 9 different symptoms for "inattention" or ADD and 9 different ones for the hyper type of ADHD.  Frankly, I could add a few more from personal observation that would include anxiety and frustration and depression.  
    Here is a list of the symptoms for Inattention (ADD) -      
             http://www.help4adhd.org/en/about/what/WWK8
   When I talked about fear of failure, I meant exactly what you said.  Its not failing a class - its about failing to do as well as either he expects himself to do or his parents, etc. expect him to do.
    I doubt that he is bipolar.  The link I sent you on anger overload talks about the difference.  I do urge you to read that link.  I have worked with Asian children who did just what he does.  And, I would call it more extreme frustration and not a clue how to deal with it.   That is why the techniques that specialmom mentioned as well as the ones in the "anger overload " article are important.  He will likely only get worse if things are allowed to continue exactly the same way.
   Curious about his not speaking.  Are the classes in English or Chinese?  Is this an American school in China?
189897 tn?1441130118
COMMUNITY LEADER
      By the way a child who does not get enough sleep at night or one who is malnourished will have symptoms like ADHD or will have their ADHD symptoms worsen.  But, if he started exhibiting this behavior around 3 or 4, that is probably not the case.
      Oh, thats a good point.  What behavior was his grandmother talking about that he started showing at 3 or 4?
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