About Michelle Fattig Expertise I can answer questions about educational testing, autism, Asperger's Syndrome, ADD/ADHD, Special Education, IEP, Learning Disabilities, Sensory Processing, Parent Advocacy, Response to Intervention, living and parenting with disabilities, parent rights in special education, school psychology, and more. I cannot provide a medical diagnosis.
Experience I am a school psychologist, medical technologist, author of the Annie Books series: Experience Aspeger's Syndrome and Attention Deficits Through the Eyes of a Child, RTI facilitator, ILCD facilitator, parent advocate, presenter, and researcher. My children and I have Asperger's, ADD/ADHD, and learning disabilities.
Organizations National Association of School Pyschologists, American Medical Technologists, Learning Disabilities Association of Nebraska
Education/Credentials Ed.S. in School Psychology, doctoral studies in SPED Law, SPED Systems Enhancement Leadership, and doctoral candidate Education Leadership. MT(AMT) and MLT(ASCP)
Question My son is 11 yrs. old and has been diagnosed with ADHD, Sensory Dysfunction - mainly Audiological Processing, Vestibular Dysfunction and Bilateral Coordination Dysfunction - as well as Oppositional Defiance Disorder.
I need guidance on aggression-reducing medications, such as Risperdal, Paxil, or Lamictal. These have been recommended by a neurologist but not yet tried. His aggression leveled out, but now has increased.
He becomes very aggressive, physically and verbally, when given limits he does not like, or told to do things he does not like.
This centers mainly around his favorite computer game "Roblox", which is about the only bargaining chip my ex. and I have with him.
For example, last summer he went through a period around our divorce of hitting the walls with objects and knocking holes in them. While we were in a Sam's store during a 2 week Social Skills Camp in Atlanta, he hit me several times on the back (and it hurt!) because he did not want to be shopping at Sam's (I know the underlying emotion was fear, because the clouds were getting dark, it was starting to thunder, and a homeless man was walking around in the parking lot). It was almost the same reinforcer which led him to hit me again last week - he put his foot on the cart wheels so I could not move it. After the usual warning of the consequence and description of what he SHOULD be doing, I quickly brought the cart backwards, then forwards around his foot. This caused him to stumble and fall into a rack of clothes. At this point he was quite angry, and, I believe, embarrassed. This is when he started hitting me on my back, almost uncontrolably. We left the cart where it was, went straight to the car and hotel.
He has not hit me since then until last week-end, May 15, 2008. I told him it was time to get off "Roblox" - he knew it would be time to get off. He yelled at me, so I told him to go to his room, the usual consequence for yelling at me. He refused. I ended up physically removing him from the computer and lugging him into his room. He was crying and intentionally blowing his nose so mucus would drip down his face...a trick he likes... I held him in front of the mirror, my voice still calm, non-angry, and told him to look at himself and see what he was making himself look like. He was pulling away from me the entire time, but he did see himself in the mirror in his room.
When I thought I'd made my point, I let go of him and he stumbled backwards, just as had happened in Sam's. At this point he hit me once, with a flat hand on my arm. I was wearing a sweatshirt, but a red mark stayed for about an hour.
He's gotten in trouble at school all his life for not following directions, but he's never been a fighter. A lot of the Sensory Dysfunction seems to be smoothing out, after a year with Neuro-net and Occupational Therapy.
But the aggression remains. I'm glad he's still little (not really, since he's underweight). Of course, at Dad's house the aggression is not brought out as much. Dad is not involved in any kind of therapy.
He's on 10 mg Vynase - any more upsets his stomach and he won't eat. He could use the weight gain from the Risperdal.
Bigger problem is I come from a physically abusive home and freak out when I get hit. I don't think I can be his parent if I have to be afraid of his hitting me. He is also quite verbally abusive with a generally negative mind set. He'll say obviously inappropriate things to teachers, such as "Your're starting to piss me off."
He will tell me its my fault he gets angry because I "annoy" him. This sounds like its coming straight from his dad - other people control their feelings and therefore, actions.
Please help me. Like every probably every parent who writes you, I'm just devastated.
Also, he's adopted from Russia at 6 mos. APGAR's all 8. He weigh @ 8 lbs. and stayed at 50th %ile in height & weight till he started ADHD meds in third grade.
Now he's 48 inches and 63 lbs. at 11.6 years.
He sees a Psychologist every week - he mainly talks to me re: setting boundaries; everything I already know, but this kid is, according to the Psychologist, "the most manipulative child I've met in 30 years of practice." Everything is just so hard! His intelligence is superior, so I feel like I'm living with a lawyer.
Is he too young for Paxil? I know that has a weight gaining effect and makes people really "nice" - my ex. was on it for a while, but didn't like the sexual side effects.
Answer Your son's diagnoses are an overlap of "symptoms" typically present in children with autism, high functioning autism, or Asperger's Syndrome. I wrote the book Taming Tommy's Tantrums specifically for a child similar to your son. An excerpt which may be helpful:
Hyper-reactive or Hypo-reactive to Stimuli
We need to understand and manage sensory overload and “under-load.”
We can’t be cured, but we can learn to cope!
By Michelle Fattig
What is fair?
Fair is not equal.
Fair is not treating everyone the same.
Fair is doing what needs to be done,
so that everyone gets what he or she needs.
To some, we appear to be odd, difficult to read, aloof, or unique, but we are really foundering in a world of unwritten rules in social interactions. We sometimes ‘make up our mind’ and it is almost impossible to sway us, or ‘get us to understand’ another’s perspective. We may abruptly leave a conversation, sometimes in the middle of a sentence, and we may announce that we are ‘never coming back!’
We are almost constantly at the mercy of our ever-fluctuating sensory reactions, with our emotional valve systems either fully open, or fully closed. We are rarely at an emotional calm, within our own person. We tend to have delayed response times, while we process information, and can have some difficulty organizing and retrieving thoughts, words, answers, or responses.
Emotions are a sensory issue, as much as taste, touch, sound, light, proprioception, or other more commonly included sensory issue. Emotions hit us like a sack of potatoes, we are able to relive memories in context with vivid mental images of acute detail, and usually those memories are distinctly negative in nature, a failure of some kind. We know we will ‘fail’ on any given day; it is simply a matter of when and how bad. All emotions are treated with some suspicion, with the distinct exception of anger. Anger we know, anger we can see, anger we can trust. Joy is fleeting, and can be too overwhelming. Sadness is all encompassing and almost unbearable. When the valve is wide open, emotionally, sadness can be catatonic. When the valve is fully shut, emotionally, sadness is: numbness, hollowness, head pressure, and avoidance.
Compliments are a double-edged sword. Briefly, it leads to a warm feeling in our chest, and our faces feel flushed. Embarrassment is an enormous sensory overload issue, and we can become embarrassed at a comment, glance, or shrug. Embarrassment can sneak in through a compliment, correction, look, or other seemly innocuous gesture, leading us to a valve wide-open systems overload. It is acutely uncomfortable, and as we experience this, we tend to look for the emotion we can trust: anger. What this may look like to those who are not on our team:
· Walking away in the middle of a conversation
· Storming off to our room
· Quitting a job, or being unable to go back
· Refusing to answer the phone or open the door
· Getting mad at a compliment, or shutting down and refusing to work or interact
· Tears or tantrums with little or no provocation
· Multiple moves or job changes
· Physical violence
· Avoidance
· Abruptly changing behavior
· Picking, tattling, arguing
Individually, if someone on our team is acting out, being difficult, having a tantrum, or becoming avoidant, rest assured that something in his or her environment, job, social interaction, classroom, or home is not meeting the definition of fair. Something is not being presented in such a way that he or she can understand, some trust issue has been broken, or other sensory overload is occurring.
Routine
If you change our routine unexpectedly, you will fling the emotional valve wide open or fully shut! Change is overwhelming to our sensory systems, and can be devastating. Change in the home, school, workplace, dinnertime, teachers, level of noise, crowded spaces, or invasion of personal space leads to high anxiety, frustration, and acting out or acting in.
Acting in: withdrawal, quiet, stomachache, headache, crying, masking, etc.
Acter-outers tend to appear to be more defiant, difficult, oppositional, and take more risks
Acter-inners tend to have more physical symptoms, eating disorders, anxiety disorders, obsessive-compulsive issues, depression, and tend to be more vulnerable to abusive relationships
We have difficulty understanding or trusting facial expressions, body language, and social cues. Sometimes we have difficulty following a conversation or directions, give us prompts and visual cues. We have difficulty ‘getting’ jokes, sarcasm, or multiple meanings, explain it to us simply and with concrete examples.
Avoid abstracts! Saying, “Be nice,” is too vague. Saying, “Listen to what the other person is saying, make one comment that is of a similar nature, and then you can talk about…” is concrete, we get the rules, and we can follow them! We have a distinct difficulty with reciprocal language. It might not occur to us that we should ask how someone’s day is, or how his or her family is, because it isn’t a functional part of our day. Understand that we don’t often hang out in the break room, because we can’t be social creatures, not because we don’t want to be social creatures! As children, we want to make and keep friends; it is just that we don’t know how!
What can you do?
As much as possible, ‘listen’ to the behavior. What is causing her to avoid school, friends, or food? What is causing him to fight at recess? Why does he get a stomachache everyday at lunchtime?
Interventions:
· Try to manage external levels of stimuli as much as possible (low levels of noise, movement, change, or other ‘trigger’)
· Try to ignore acting out unless specifically harmful to self, others, or property
· Consider a cuing system to identify and avoid ‘triggers’ before overload occurs
· Sensory outlets such as quiet, safe area (never use as a punishment)
· Fidgets, squishy toys, heavy blanket or vest, gum, chewies, crunchy or chewy foods, a tub of white rice, core strengthening seats, or other, which helps to calm psychomotor agitation or anxiety
· Break down tasks literally, visually, verbally, physically, realistically, and simply
· Remain calm and consistent
· Use schedules, journals, planners, and calendars
· Be aware of change in routine and prepare, practice and role play
· Create a crisis plan, in the event that sensory overload cannot be avoided, and stick to it
· Clothes, toothpaste, paper grain, Popsicle sticks, pencils, socks, tags, tastes, touch, smells can all cause sensory overload, be aware of needs, and address accordingly
· Teach, model, and practice social skills
· When all else fails, find humor in the situation and downplay and social blunder
I would suggest trying omega-3 supplements, which can dramatically reduce sensory overload. Vyvanse is actually what my children and I take, and is a good combination for us with the omega-3. However, check with your physician before adding any supplement or vitamin of course. I would recommend addressing his behaviors with social skills and requesting a sensory diet from a qualified occupational therapist. Some websites:
