Behavior Problems - What Do We Do?

mha3484

Mon, Jan 11 2021, 2:42 pm

When my son was just around 5 and in 4 year old nursery he really started to struggle socially and behaviorally. We started with talk therapy because my son was really struggling with social skills. The therapist suggested that we may want to look into deeper issues such as ADHD/ASD. He was extremely impulsive and it was impacting all areas of his functioning. Towards the end of the school year, we went to see a neurologist for meds and did not like her at all. The following year, we went to see a developmental pediatrician instead and thought she was great. It was a comprehensive 90 minute appointment with the MD and the social worker she worked with. She agreed ADHD and gave us clarity on meds and different therapies he may benefit from.

We did the neuro psych the next year after that because the school really pressured us to. They felt he was on the spectrum we did not agree. We found the eval to be extremely helpful and we learned a lot about how our son functions.

We also did one school year in a special program for kids with behavioral needs it was mixed. Some good and some bad.

Finding the right medications was a huge help. We also found that parenting using a method in the book the explosive child was extremely beneficial. Our yeshiva over the years has also embraced this style of discipline which I really appreciate. My son is in 4th grade now and doing great bli ayin hara.

mha3484

Mon, Jan 11 2021, 5:21 pm

A developmental pediatrician is an MD who did extra training in child development. They work with kids with a myriad of issues from ADHD, Learning Disabilities, Autisim etc. They can prescribe meds like a psychiatrist or neurologist but I find they focus more on the whole child and not just here are meds come back next month.

Has your son always struggled behaviorally or is this sudden? If its sudden, I would start with regular old therapy because it could be his way of communicating that he is struggling with school, friends, teachers anything really. Behavior is communication. If he has always had a hard time and its just getting worse as he gets older thats totally normal at this age.

I think this age for boys is really hard. School expectations ratchet up significantly and the social expectations change a lot too. The psych who did my sons eval said they get a huge number of referrals in 3rd grade because the social gap really starts to widen and you see issue with your kid you didnt see before and the academic expectations increase significantly so a kid that could coast a bit now gets challenged and cant keep up.

amother

Peach

Tue, Jan 12 2021, 9:30 am

We had a very good experience having our child evaluated by a clinical psychologist with a PhD, who is on staff at the Children's Hospital in our city (not NY or NJ, sorry).

After giving our child's diagnosis, he did not push medicine. Instead, medicine was only one of the measures offered and he was very encouraging when we wanted to start without it. My husband and I took a 6-week class with other parents where we learned a lot about how to more effectively communicate with our child, measures we could implement at home to help our child succeed in specific areas of difficulty, and measure that school could implement if necessary. At this time, we are not medicating and our child is doing well.

Like yours, our child does very well academically, and I think the school has been a big factor in mitigating what could have been behavioral issues. As I mentioned in another thread, the school provides a lot of time to work independently or in pairs, with children permitted to work on the floor or at a desk and to walk around to get things or use the restroom as necessary. There is not much sit-down lecture time. When our child finishes the assigned work, there is more advanced work available and any remaining time is allowed to be spent drawing, reading, or doing crafts or other projects. I think our child would have a lot more behavioral issues in a more "traditional" classroom.

FranticFrummie

Tue, Jan 12 2021, 11:35 am

amother [ Yellow ] wrote:

You don’t give too many details. To me, the basics to start with are diet (remove dairy, gluten, dyes, limit sugar), sleep hygiene, some calming anti inflammatory and neurotransmitter supporting supplements and amino acids, exercise. Treat yeast, look for chronic infections.

Totally agree! Most kids that age live on bread, pasta, and Bamba. It's the absolute worst thing to get them addicted to heavy, starchy, empty calories. I do mean addicted in the classical sense of the word. The insulin reaction feedback loop really wrecks their blood sugar levels, and causes extreme high and low mood swings and meltdowns.

Also, check for strep. It could be PANDAS.

I find that more and more boys' schools are pushing to get kids on ADD meds, instead of working on classroom behavior and better teaching skills. If the teacher is young, the class is overcrowded, and there's a lot of pressure to sit and learn all day long - it's easier to just tell the parent to medicate the child.

If your child has a through evaluation, and meds are truly the right thing to help him be happier and more successful, then fine. If not, then the school is being just plain lazy.

amother

Wed, Jan 13 2021, 1:07 am

Quote:

If he has always had a hard time and its just getting worse as he gets older thats totally normal at this age.

I think this age for boys is really hard. School expectations ratchet up significantly and the social expectations change a lot too. The psych who did my sons eval said they get a huge number of referrals in 3rd grade because the social gap really starts to widen and you see issue with your kid you didnt see before and the academic expectations increase significantly so a kid that could coast a bit now gets challenged and cant keep up.

Pretty much this. He was never an "easy" kid but B"H over the years I've been able to learn what works with him and at home I have pretty good disciplinary techniques in place to manage his behavior successfully most of the time. But at home we obviously don't need to make the same types of demands as the school, so we don't have the same types and severity of issues they experience. The older he gets, the bigger the gap becomes between him and the other kids - and the more frustrated he gets.

Quote:

What types of details do you refer to? I'm glad to provide them if it can help me help him.
I will admit that the limited research I've done, mostly anecdotal, both online and in-person, indicates that diet change rarely has a drastic effect on behavior issues. I used to work in a special-ed related field, and feedback from both parents and teachers is almost unanimous - many have started out on these types of special diets with high hopes, only to be disappointed. Do you have information to the contrary?
In any case, we are a mostly natural/homemade food household, and I limit processed foods and avoid sugar in my cooking. Sweet treats once a week for a (small) Shabbos party, none any other time. Dyes are almost never in his diet, but being a kid, he will have the occasional french toast/pancake with maple syrup once a week or so. They also give sweetened yogurts once a week at school lunch, which ds loves and wouldn't give up. Still, I would say his sugar intake is quite low.
Dairy is also limited, as too much makes him constipated. I'm hesitant to remove it completely because it would be hard for him to get adequate protein. We avoid soy and the only other proteins he will eat are tuna fish and eggs, but tuna needs to be limited because of mercury content.
Removing gluten is a hard one. He would miss his normal foods terribly and I'm pretty sure he'd have an awful time adapting to the change. Pesach he refuses baked items and lives on eggs, fruit/veg, and whole wheat matza. He is very skinny and a bit on the short side, I would hate to risk limiting his growth.
We have a consistent bedtime routine, he typically gets between 10 and 11 hours of sleep a night and wakes up on his own easily.
Can you share info abt these anti inflammatory/neurotransmitter supporting supplements and amino acids?
If it matters, he already takes a probiotic supplement.
I have tried implementing a consistent daily vigorous exercise period, but it seems to me that it serves only to get him revved up and increase hyper behavior. Counterintuitive, I know, I was surprised by this, too, but that's been our experience.
Treat yeast - what would indicate an overgrowth? And how to test or treat?
Chronic infection - more detail please?
TIA

Quote:

Also, check for strep. It could be PANDAS.

I find that more and more boys' schools are pushing to get kids on ADD meds, instead of working on classroom behavior and better teaching skills. If the teacher is young, the class is overcrowded, and there's a lot of pressure to sit and learn all day long - it's easier to just tell the parent to medicate the child.

Good insight, but I doubt it's PANDAS if he has always been this way, right? Also, he has never tested positive for strep in his entire life, B"H B"H.

The teacher has many years of experience. The school actually places great emphasis on retaining experienced staff and ds has actually had an inexperienced teacher only once in his entire school career from age 3 to present. Class size is 21 kids, not small but not overcrowded by NY standards. But a kid like mine would probably do best with his own personal teacher, lol.

Kids get two breaks during the day when they can choose to play outdoors or indoors with games/toys/books/art supplies supplied by the school, but yes, it's a more traditional learning style and they are expected to sit and learn the rest of the day. Sometimes it's as a class, sometimes paired up for reviewing material. Sadly, ds enjoys the secular studies portion much more than the Jewish ones and behaves a lot better during that part of the day. Which is especially interesting to all of us because it happens during the last portion of the school day where one would think after a long day of learning he would be much more likely to be at the end of his rope behavior-wise. Davening time is probably his least favorite and tends to elicit the most outrageous behavior. He also often acts up during the bus rides, which I've tried to mitigate by sending him with a little activity book of brain teasers and art activities to keep him busy. He enjoys art and also written work, fun sheets, even worksheets, but results depend on the day - he will do some of the pages every day, but some days will keep at it for the whole bus ride and others quit after a little bit and go back to acting crazy.

Whew, sorry for the book. I appreciate the advice and support you've all shared. Still trying to figure out what angle to attack this from.

amother

Yellow

Thu, Jan 14 2021, 6:34 pm

amother [ OP ] wrote:

Yellow, I wish you'd come back and share more details. You sound like you know a lot and I'm intrigued by your approach.

Diet change: I know the medical and more medical minded special needs community will vehemently deny the effect of diet on behavior, but parents beg to differ. The gut is the seat of the nervous system, and directly related to brain function, so healing the gut is the path to healing the brain. One of the reasons people may not notice drastic effects, though many many do indeed, is because diet is just 1 piece of the puzzle. And if you’re not addressing any of the other pieces, the effect may not be noticeable, but that doesn’t mean it isn’t making a difference. Sounds like you got sugar and dye under control, unfortunately, dairy and gluten (and all their cross reactors soy and corn) are the biggest offenders, and if this is an approach you want to try, you’d have to eliminate them completely for at the very 6 weeks, with 3 months being even more reasonable.

As for the rest, my approach is really a functional medicine approach, looking for root causes and treating them. and supplements are most targeted If they are based off of functional testing. There are some basics you could try, but it’s a bit like shooting in the dark if you don’t really know what’s going on regarding neurotransmitters, pathogens, etc. But in general, magnesium and methylated b vitamins are the foundational supplements of nervous system health, and then you can try things like gaba, 5htp or tryptophan, l tyrosine, l theanine, taurine, glycine, for calming effect.

Pathogens are another piece, yeast overgrowth is hard to test for, you can just try treating and seeing if it makes a difference, chronic infections would include strep, which would affect behaviors via pandas, as FF mentioned, and lots of other infections can cause a similar constellation of symptoms due to brain inflammation. FWIW, many kids who eventually get diagnosed with pandas, often after years of misdiagnosis (adhd, odd, asd, ocd) think they never had strep in their life. WhT actually happened is that they never had typical strep symptoms, so their infections never got treated, and turned into pandas. So not having had strep, and always having been this way don’t actually rule anything out. The other infections to look for are lyme and co, ebv, cmv, hhv6, coxsackie, mycoplasma. These have all been shown to have the ability to access the central nervous system via different mechanisms and cause behavioral issues.

There’s so much more that’s beyond the scope of this post, but maybe some of this will be helpful.

amother

Thu, Jan 14 2021, 10:31 pm

Thanks so much for the informative response. You've given me a lot to think about.

amother [ Yellow ] wrote:

I'm not familiar with functional medicine/functional testing, and obviously shooting in the dark doesn't seem ideal. Can you elaborate on where/how I'd get this type of testing done? Is it a DIY thing or what?

amother [ Yellow ] wrote:

Pathogens are another piece, yeast overgrowth is hard to test for, you can just try treating and seeing if it makes a difference, chronic infections would include strep, which would affect behaviors via pandas, as FF mentioned, and lots of other infections can cause a similar constellation of symptoms due to brain inflammation. FWIW, many kids who eventually get diagnosed with pandas, often after years of misdiagnosis (adhd, odd, asd, ocd) think they never had strep in their life. WhT actually happened is that they never had typical strep symptoms, so their infections never got treated, and turned into pandas. So not having had strep, and always having been this way don’t actually rule anything out. The other infections to look for are lyme and co, ebv, cmv, hhv6, coxsackie, mycoplasma. These have all been shown to have the ability to access the central nervous system via different mechanisms and cause behavioral issues.

There’s so much more that’s beyond the scope of this post, but maybe some of this will be helpful.

Okay, lots to learn. Again, how do I proceed with trying this approach? How does one treat for yeast overgrowth? What about the other stuff you mentioned - can I just ask the regular pediatrician to test for everything?
Sorry, this is all completely new to me. Is there a type of professional I could consult for guidance/testing/diagnosis/treatment with this approach?

amother

Yellow

Thu, Jan 14 2021, 11:02 pm

amother [ Coffee ] wrote:

While I respect everyone's right to an opinion, I disagree strongly with the general anti - medication attitude. Of course a child shouldn't be placed on medication in a cavalier fashion. However, medication can be a game changer when appropriate. I was against giving my child medication many years ago, and that only prolonged the suffering. A healthy diet is a wonderful thing - but would you use diet alone to treat asthma? I am so grateful that these medications exist. I have the profound difference in my child on meds. My child would be unable to function well without it. I feel so bad for those not receiving the help that is available due to stigma and other factors. Medication is not like radical surgery. If a professional feels it is warranted you can try it and see if you achieve the desired results. If you're unhappy you can discontinue. Of course it's not a panacea, but it can be a life saver. Wishing you much luck.

My approach isn’t anti medication. It’s why not treat root causes if you can, instead of just bandaging them? And for what it’s worth, asthma can be vastly improved and possibly even cured with diet.