Expert: Catherine Ridenour - 7/7/2008

Question
My son is 4 almost five.He was diagnosed with PDDNOS when he was 3. We have had him in an early intervention program in the school district, which he no longer qualifies for because of his improvememnt. However, since he still has a year before kindergarden he sill be attending an autism preschool until then.

This summer has been very tough for us. Our son speech is pretty good since he has been in speech therapy, we can pretty much understand everything he says even though he still has problems. He seems to be getting worse in some ways. He says awful things to me and his dad. Very disrespectful and will not listen to anything we say. He has become more physical with his little brother who is 3, and throwing things when he is angry. We can't get him to mind. When he does things he shouldn't we take him by the hand and make him lay on his bed for a time out. He will stay in time out but as soon as we let him out, its back to the bad behavior. He is destructive to our home and things, he seems really angry and defiant. Its like someone else has taken over his body. He acts like he could care less if he hurts anyones feelings or if he gets punished. He will lay down at my feet and kick and scream and cry. He was doing so well, but lately has gotten much worse. However his speech is still goign good, but he behavior is worse. He is such a sweet little boy and even though he has this challenge has always been really sweet and loving. What am I doing wrong? He has been in soccer this summer and take karate twice a week. We spend time with him, read to him and introduce him to new things. We have a reward chart for doing chores and I have talked to him about doing a treasure jar where he gets rewarded with good behavior.
We live in Utah. I sometimes still have a hard time getting people to believe me that he has this even though I have a diagnosis, except anyone who has spent alot of time with him.

Sorry this is so long but I am at my wits end. I am sure it will get better once he starts that school at the end of summer. Part of the program is a parenting class for that the parents must attend. But, what do I do till then?

Thanks for the help,
Sara

Answer
Hello Sara,

You are not doing anything wrong! Don't guilt trip yourself or let anyone else do so.

Your son is probably autistic. PDD/NOS is the catch-all used for very young children who have not begun to display the behavioral symptoms fully. Language problems are often the first thing to show up.

Contact his doctor or the psychiatrist who did the original diagnosis and bring these new symptoms to her/his attention. You need help, now, not a year from now. This is not the "terrible twos or threes".

Here is what is at the root of your son's behavior. He lacks what is called "theory of mind." That means he has no instinctive understanding that other people have thoughts and feelings. Nor does he recognize the rise of his own feelings until they overwhelm him. He is not able to control the impulse to lash out. He cannot foresee the consequences of his actions.

He CAN learn all these things but it requires intense, direct teaching. Social skills will not be learned by mere exposure as we normally learn them. He has to memorize rules of conduct. Each new situation requires new learning. Just because he learns to share his shovel in the sand box does not mean he knows to share his truck on driveway. Over time, he will build a repertoire of appropriate behaviors. However, novel situations will always challenge him.

Time out can be effective but usually the child has to be a bit older to care. Removing him from an over-stimulating situation before an outburst occurs is the best prevention. It requires constant vigilance on the part of his parents and teachers. Never leave him alone with a younger child, he has no concept of how he can hurt others. He's not evil, just totally "socially deaf." Your tone of voice and facial expressions are not useful information for him. He doesn't get it.

I am glad to hear he will be in a specialized pre-school. His teachers should be a good resource for discipline techniques.

I have to mention that bi-polar disorder is also a possibility but I would hold back on nailing down that diagnosis until they are certain it is not autism. The medications for bi-polar disorder are heavy duty stuff with many side effects. The only medication used for autism is Risperdol. It also has nasty side effects including huge weight gain. It is only effective in some children and people who have taken it tell me it makes them "feel stupid". It can be very sedating.

Children with autism can also have attention deficit/hyperactivity disorder (ADD or ADHD). I would not hesitate to medicate that. It helps a lot and the side effects are very mild or non-existant. Ritalin, Adderall and such are not sedatives that "zombie" the child. They are stimulants that kick in the attention part of the brain which lets the child process information at a normal pace instead of being overwhelmed by too many incoming messages.

I know this is a hard thing to face. Find a support group of other parents. Resist the temptation to find a "cure". Some kids benefit from chelation if they have heavy metal poisoning but a blood test can tell you if lead or other toxins are involved.

Best wishes,
Catherine