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Behavioral specialist, anyone?



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amother


 

Post Wed, Nov 12 2014, 12:11 am
I don't know if this is normal or if I should have ds evaluated and by whom.

Ds is 3 and although quite bright he has a really hard time following directions.
Mostly he either ignores or says I don't want to.
This plays out in every aspect of the day from getting dressed or using the bathroom to eating, cleaning, even pulling up his pants after the bathroom etc. He will just stand there and ignore me or say I don't want to.
I try to be firm but loving but he seriously has no interest in following what he has to do and at times all to often it can lead to a tantrum.

I generally have to physically (as gentle as possible) manipulate him into the action (like pulling up his pants carrying him to bathroom or bed and putting his clothes on in morning while holding him down from leaping out of my hands. While I know he is a 3 year old and I can't expect much I'm really starting to get not only worn out but a bit worried about this behavior. It doesn't strike me as normal functional.
We are late to playgroup every day because of this and I can only imagine how much harder it will be when we have to deal with real school.

I've tried to use incentives and charts and minimal treats but it doesnt help much and just gets him to demand treats (which I dont give in to unless its a reward for following a direction and he asks nicely.)


Do I need to get him evaluated? Who would I need to bring hom to? A doc? A therapist? Etc?
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MaBelleVie




 
 
    
 

Post Wed, Nov 12 2014, 12:17 am
Does he do this with everyone, or just with you? What happens at school?
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moshiachnow




 
 
    
 

Post Wed, Nov 12 2014, 12:39 am
I dont use any incentive, treat or chart for getting dressed. I have to leave an hour before drop off time for his prep. All clothes are within reach in pull out boxes. I give him the power. Do u want to pick out a shirt, do you want me to help you get dressed, he likes me there and he likes me to help him. I think you just have to let him be a decision maker for control and self esteem. For example, if he wants me to dress him I will, if he wants to put something on himself he can. I often have to remind him that they will be upset, he is also 3 if he is late, but they now have a 25 min. window for the kids to arrive, that is practical. If he is more tired he needs more help. Little ones are teenagers in miniature. It is best to put him in the assistant drivers seat and you take the cues from him as to how it is that day. We may have to have breakfast first, I'll even ask him what he wants to do first, get dressed or have breakfast for example. He needs oomph. Also, I may give one eenie meenie two eenie meenie three eenie meenie or he can't do or have something and that gets him going, he knows I act on that consistantly and mean it. He is a strong willed guy so I do that, not the incentive thing, but sometimes I do incentive...mostly not but eenie meenie gives time for the behavior to go nicely. Ignore tantrums, up to a half hour is normal. I may say when you are quiet I will do blinkity blank behavior that he wants me to do....I may say you can't go to school if you don't have socks on and I explain why, he may be plead, everymorning it is different, just let him be the controller or the yetzer you have to trick in a nice way.
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amother


 

Post Wed, Nov 12 2014, 1:50 am
moshiachnow wrote:
I dont use any incentive, treat or chart for getting dressed. I have to leave an hour before drop off time for his prep. All clothes are within reach in pull out boxes. I give him the power. Do u want to pick out a shirt, do you want me to help you get dressed, he likes me there and he likes me to help him. I think you just have to let him be a decision maker for control and self esteem. For example, if he wants me to dress him I will, if he wants to put something on himself he can. I often have to remind him that they will be upset, he is also 3 if he is late, but they now have a 25 min. window for the kids to arrive, that is practical. If he is more tired he needs more help. Little ones are teenagers in miniature. It is best to put him in the assistant drivers seat and you take the cues from him as to how it is that day. We may have to have breakfast first, I'll even ask him what he wants to do first, get dressed or have breakfast for example. He needs oomph. Also, I may give one eenie meenie two eenie meenie three eenie meenie or he can't do or have something and that gets him going, he knows I act on that consistantly and mean it. He is a strong willed guy so I do that, not the incentive thing, but sometimes I do incentive...mostly not but eenie meenie gives time for the behavior to go nicely. Ignore tantrums, up to a half hour is normal. I may say when you are quiet I will do blinkity blank behavior that he wants me to do....I may say you can't go to school if you don't have socks on and I explain why, he may be plead, everymorning it is different, just let him be the controller or the yetzer you have to trick in a nice way.


Hi its op thanks for response.
I've tried this.
This child has choosing power, yet I find he either says no I don't want to do any of the choices or just takes ages to choose.
For example:
Me: which outfit are we putting on today? A or B?
Him: not any. I want to play.
Me: so let's get dressed quickly so you can have lots of time to play before school.
Him: (either ignores or) no. I don't wanna get dressed.
Me: that's silly, nobody can go to Morah in pajamas. Which outfit? A or B. You can even choose C if you want.
Him: no. I don't wanna.
Me; that's not one of the choices. We don't say no to a mommy. Sometimes we need to do things even when we don't want to. Now please pick which outfit you want.
Him: (either says no or ignore)
Eventually I just choose one and try to help him pull off his PJs while he resists or tries to run away and try to get him to be active in putting on the clothes but its mainly me just putting it on him.
Bathroom example:
Me: you look like you need to use the bathroom, run run run, so u can make a splash!
Him: no. I don't need to.
Me: mommy knows that you need to cuz you are doing the bathroom dance. Please go now. When you're done you're going to help me put a sticker on the bathroom chart.
Him: no I don't wanna go. (Or ignoresme or runs away)
Me: when you need to go it can make a boo boo to hold it in
Let's go now together. You ate gonna be like a tarty (If I have time I offer to read a book and sometimes that works but often mornings are such a struggle I don't have time to offer that)
I even give him choice to sit or stand.
Him: no. I don't wanna.
Me (lift him up and bring him to toilet. Try to get him to undress to make but he just stand there so I do it. And oh boy- he makes. And I'm wiped. Then comes the time to wipe flush pull up pants etc and he won't budge. I end up just dragging up his pants, dragging him to sink. Sometimes he will grab something by the sink and throw it down. Grrrrrr.)
I tell him I'm so proud he made and he tells me he needs a treat cuz he made.... Omg! I started now telling him he gets a small treat only if he goes on his own.
But these are just 2 examples.
I find that there is some sort of click missing to follow authoritative commands or requirements. His Morah claims he is a good boy but when she says to take out lunch he ignores and she has to do it for him or he won't eat. She said all the other kids do it on command. When she asks if he needs to make he says no.
Its a bit crazy I think that the even understands its an option to say no to a mother. Its not like he sees older siblings doing it as he is an oldest.
For goodness sake I don't think I realized I could technically negate my parents commands till I was about 11 or 12.

I just hate that I often only get him to do anything by physically guiding him.

Forget it, getting him to eat supper and do bedtime routine is impossible and takes way too long. Ds baby starts getting super impatient waiting for mama as I spend mosty energy trying to get ds 3 to accomplish his tasks.

No wonder I'm exhausted.
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FranticFrummie




 
 
    
 

Post Wed, Nov 12 2014, 2:21 am
I hate to tell you this, but he sounds perfectly normal. The good news is that he will eventually grow out of it.

DD was the sweetest, most delightful 2yo you could imagine. There were no "terrible twos" at our house. I thought I had gotten off easy. HA!

I could not have been more wrong. 3 1/2 to 4 1/2 were the worst years of our life. Honestly, I don't know how either of us survived intact. I cried, I prayed, I negotiated and pleaded and bribed and cried some more, and she did the same. It was one long year of power struggles and misery.

Then one day, it was like a switch was flipped, and she was my sunny little sweetheart again. Go figure.

I can tell you that the one thing that got me through that period was to try and look at everything from her point of view. Imagine being that small, so smart and so frustrated, and having so many rules that don't make any sense to you. It must be awful! If you can channel an "empathy mode" and really understand where all these tantrums are coming from, it makes riding them out a lot easier.

Do a lot of reflective listening, that helps a lot. "I understand that you don't want to do this right now, and that you'd rather play." If you keep it up, he may decide to cooperate on his own terms, just because you backed off and validated his frustration.

Best of luck!
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amother


 

Post Wed, Nov 12 2014, 2:53 am
Honestly, your son sounds like a normal defiant 3 year old. I say this as the parent of a child with autism. He isn't locking you out of his world. He just wants to do his own thing.

It isn't realistic to expect him to listen to you just because you are the parent. You need to incentivize the behavior that you want to elicit. If it was me, I wouldn't fight him so much. If he wants to wear pajamas to play group, let him. Nobody got expelled from playgroup for showing up in pajamas. Eventually, he'll feel embarrassed and get dressed voluntarily. If he refuses to use the toilet, make sure he knows that if he uses his underwear instead of the toilet he's spending the day in the bathtub so that your home doesn't get dirty because it's not your job to make him toilet or change him. (This is assuming that he is fully trained and can actually control himself.) He may be acting this way simply because he knows that he can get away with it. Show him that he can't, and that he isn't going to enjoy life without behaving appropriately.

If he is interacting in a healthy, age-appropriate way with his peers in playgroup you probably don't have to worry about an autism diagnosis.
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amother


 

Post Thu, Nov 13 2014, 12:08 am
Op here. I know its borderline normal but I feel like its also borderline need some help.
I feel like a "click" is missing in following commands.
He throws tantrums from as much as needing me to reach a straw to his spoon fell on the floor.
I do not tolerate screaming tantrums and calmly tell him as soon as he calms down and talks nicely I'll be happy to help him.
But his initial scream and cry reaction concerns me. His pediatrician saw it too and said to keep an eye on it as he was concerned as well.
I dont think its a heavy duty case but I honestly feel like I'd feel a lot better raising him if he had a specialist with behavior teach him how to feel safe and not need to tantrum for everything and also to help him learn how to follow commands.
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5*Mom




 
 
    
 

Post Thu, Nov 13 2014, 1:41 am
How is your relationship with your ds in general? Do you spend unstressed, unhurried, unstructured time just hanging out with each other? Reading to him with no time pressure? Listening to him talk to you about whatever? If not I would definitely work on this first.
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seeker




 
 
    
 

Post Thu, Nov 13 2014, 1:41 am
If his pediatrician shares your concern, ask him for a referral. He should be able to direct you somewhere.
In addition you said his morah too says he needs more help to get going. So you can have her write up these concerns and seek help from the dept of ed. Request psychological, speech/language, and OT evaluations. Note this can sometimes take a while to happen.

It does sound like you could benefit from a behavior specialist. Maybe if you post your location someone can make a more specific recommendation. You sound like a great mom who's trying hard but I do see where you could try things differently, however I am nowhere near in a position to actually advise especially without ever having seen you/DS personally (though for starters it seems you're doing waaaaay too much talking and attention, if this is an ongoing scenario.)

Also I would strongly caution against letting these power struggles into the bathroom. Bathroom power struggles never end well in the long term, they go under the surface and re-emerge as relationship issues, IMO. Maybe a few accidents will do him good. Maybe if he likes being a big boy you can tell him that if he doesn't go to the bathroom then he will have to wear diapers (no fight; simply remove the underpants from his wardrobe if he doesn't comply.) My DD does the "I don't have to make" bathroom dance; I never want to tell her that I know better than she does what her body needs (though I'm sure I sometimes give that message inadvertently anyway!) so instead I'll tell her "It's OK if you don't need to, it's bathroom time anyway. You'll sit for a minute and if nothing comes then you'll just go back to playing. No problem." Of course she fights this too but we are no longer arguing over whether or not she needs to go - this is an argument the parent can never win (and you certainly don't want them holding it in to prove their point.) We have rules about visiting the bathroom at certain times (after coming home from school/trip/park, before leaving to store/trip/etc, before bed) whether you "need to" or not; having these steady routines helps reduce the individual struggles.

So there are little things you can try that should make some difference, but what you are describing does sound worrisome to me as well and I do think you should look into this. I wonder if there could be a physical explanation. PANDAS for example classically presents more as anxiety but I wonder if it could do this as well. Couldn't hurt to rule out possible physical factors because it seems like something is going on and that would be a shame to overlook.

Go with your gut. Your mothering instinct tells you something is not "clicking." Even if 20 amothers come here and tell you you just need to be more firm and stop letting him get away with things, you are the one living with him and raising him and if you think a "click" is missing then GO FIND IT! I know, easier said than done. Hugs. Good luck. But don't let anyone tell you you're making something out of nothing. If mom feels it's something, she's often right and at least deserves to be checked out.
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amother


 

Post Thu, Nov 13 2014, 4:15 am
I am the "autism" amother above. In my opinion, if your pediatrician shares your concerns then they should have already given you a referral to a developmental pediatrician for evaluation. I would ask for one immediately, as the wait can be several months.

I wish you both lots of hatzlacha.
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amother


 

Post Thu, Nov 13 2014, 6:06 am
Listen the seeker, ESP the last paragraph. Even if the paed does not agree with you. Mommy knows best.
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imasinger




 
 
    
 

Post Thu, Nov 13 2014, 6:12 am
I have a kid with autism, my oldest is a BCBA (behavior specialist), and I have taught in preschools for decades.

While any parent who is worried should always have her concerns taken seriously, my hunch is that testing will show that your DS doesn't have autism, and may not qualify for a specialist.

Ask anyway. He is clearly not an easy kid. You are trying hard.

While you are waiting, a faster route to sanity might be a really good parenting course, especially one geared towards parents of challenging children.

I also highly recommend you run out right away and get the book, "Parenting the difficult child: the nurtured heart approach." It will take you step by step through a more effective way to get cooperation.

Hatzlacha!
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seeker




 
 
    
 

Post Thu, Nov 13 2014, 9:01 am
Why is everyone suddenly talking autism/not autism? Nothing here sounded like an autism concern to me. However, lots of things sounded concerning. We are not qualified and don't have enough information to label it, but kids can refuse to listen for many reasons ranging from processing ("missing a click?") to clinical depression. These warrant attention.

I have heard Tzipora Koslowitz's phone parenting advice is very helpful for kids with specific difficulties. I think that was the name, at least. I hope I'm not mixing up with someone else.
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imasinger




 
 
    
 

Post Thu, Nov 13 2014, 9:44 am
seeker wrote:
Why is everyone suddenly talking autism/not autism? Nothing here sounded like an autism concern to me.


Because the thread is titled "behavior specialist, amyone", and behavior specialists primarily treat children with autism.

That's pretty much what insurance covers them to do. Maybe not true in 100% of cases, but that's how the system was set up.

Other issues of processing or psychological concerns would more likely be handled in other ways.
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MaBelleVie




 
 
    
 

Post Thu, Nov 13 2014, 9:51 am
IME this is not typical behavior, nor is it necessarily a huge red flag. Typical three year olds are defiant sometimes, not always, and don't tend to be that way with all authority figures. That's why I asked whether this is occurring across multiple settings or only at home. I would go for a couple of sessions with a child psychologist who can help determine what's going on and how to manage the behaviors. I don't love the idea of a behavior specialist because often they don't have a broad enough general background and are more limited in their knowledge base.
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