Expert: Ettina - 9/13/2008

Question
Hi

My 7 year old son was diagnosed with PDD at age 3 and a half.  He developed normally until 3, when within a week he lost all his speech. He started getting night terrors, became anxious, clingy and he use to scream nearly non-stop.

Six months he was also diagnosed with Bipolar and OCD.  He is on Risperdal and Neurontin.

For the last 3 months his little life has been hell.  He is so aggresive, hitting me, and everyone else. He is also throwing things, breaking everything and hitting his head against the walls. The school even asked me to keep him at home until i sort out the agression.  The doctor just increases the meds..

His teacher does not believe he is on the autistic spectrum, he doesn't have problems with eye contact, forming relationships - he even holds grudges.

What else can it be?  

Please I feel so desperate for him - I can't even take him to the shops anymore - he will also hit strangers.

Thank you
Lindy  

Answer
Sounds like a difficult situation.
One thing I'd like to ask is if Heller Syndrome (also called Childhood Disintegrative Disorder) has been considered. Regression at 3 years is typical of Heller Syndrome, as are mood problems (a good source of information is the book When Autism Strikes). He does sound more mildly affected than typical for Heller Syndrome, however, since he's not completely aloof.
A child doesn't need to avoid eye contact and not form relationships to be diagnosed as autistic. They do need to be socially impaired relative to their overall cognitive functioning, but they can be sociable but clueless about people, or socially immature, rather than actually aloof. Lorna Wing, an expert in autism, described three categories of social interaction in autistic kids - aloof, passive (accept interaction but don't initiate) and active-but-odd (initiate interaction in an odd or immature way). The last category of kids do form relationships readily and some make eye contact normally.
As for his behavior issues...
Do the medications seem to be helping, but not enough? If that's so, then increasing the dosage (provided the side effects are worth it) or trying additional treatments is best. However, it may be that the medications are not helping or even making his problems worse, in which case he should probably be tapered off of them. But you should not modify his medication on your own - talk to his doctor about it, and if you're not satisfied with the treatment he's getting, consult another doctor.
Did anything change in his life 3 months ago? If so, that might explain his behavior and give you clues about how to solve it.
When he's having a meltdown, try to keep calm as much as possible (I know it's not easy!). Restrain him the minimum you need to ensure his and other people's safety, and try singing softly, reassuring him, or doing strange things to distract him. If something works once, remember that and keep trying it (unless it's bad in some other way, such as giving him a treat and possibly rewarding his behavior). If he's getting upset in a public place, you should take him out of there if you can, for two reasons - you're less embarrassed and better able to deal with his behavior, and there's less to overload him.
I also recommend keeping a diary of his behavior, what the situation was that he started acting up in, and how you dealt with the behavior. That sort of thing can be a big help in determining patterns that explain the behavior. For example, one boy I worked with always had a meltdown when we were removing shoes for gymnastics. I realized it was because there was a whole bunch of kids in a small space and he was overloaded, so I started taking his shoes off somewhere else and bringing him in to gymnastics after everyone else had gone in.
Lastly, his behavior sounds quite stressful for you. I suggest you look into whether there is a respite care program in your area for him. Respite care is basically babysitting for disabled people, with caregivers who are knowledgable about disabilities. The way it works in my area is that the caregiver fills out a form stating things like what ages, kinds of disabilities, etc they are willing to work with, what times (emergencies, holidays, etc), whether they'll look after the child in their home or yours, etc. (I know because I've just recently applied to be a respite care provider.) And then the parent/caregiver can ask to see forms of a certain type (eg 'people willing to look after a school-aged child with challenging behavior') and contact the caregivers to negotiate the care. It might be different in your area, just ask around.