Expert: Jene Aviram - 2/4/2009

Question
hello there, i am in need of some help. i have a now 4 year old who has had what i call issues her whole life. from the day she was born always cried never happy no matter what i did, and through the years would through some major fits about nothing most of the time, always screaming. at one time she screamed for over an hour and she gave herself a headache and instead of stopping she covered her ears and continued. she would not act like that in front of anyone else in the family until she turned 3 then some family members witnessed it. she will not do it in front of eveyone though. she actually has people that she acts like an angel in front of,also i had her going through counsoling which they told me was great so she could get some help, and that started in may and they have done nothing except get her in preschool, they could not even help give any assistance in diagnosing her, i feel like every looks at me like i am making this up she just became potty tried ( i tried for over a year) but she does thing the way she wants or no way. i started the counsoling because she started to become very violent to others ( her brother, sister and myself) she says she loves me, and i know she does and she is always attached to my hip never leaves me alone, although if i leave she is ok with it. also ever so often she will be just sitting around and come out of nowhere and scream at someone but there is no one there, at first i thought maybe an imaginary friend but it is only once in awhile, in fact it has happened 4 times in 1 year and thats all.. i am truly concerned for her , also she is a very smart child in fact she is a quick learner at alot, she colors great exspecially for her age and when she plays with block and other things she lines them up.  i want some help so that she can get the help she needs. at her preschool she is perfect never acts up or anything but it is because she likes her teacher. i don't know what to do because even though they have not been diagnosed i believe my husband and his father and sister have bipolar, and they say she acts just like how she did when she was younger and they didn't do nothing about it never even brought it up, well i'm sorry i want to make sure my child does not have to feel alone i want to help her, i want to be able to talk to someone who understands this and can help me help her, i also what to know so if she needs medication she will get on it, i am afraid she will get older and hurt herself or otheres and that is what i want to prevent, i want her to feel oved and wanted and she always thinks no one wants to play with her so she automatically cries, she is always hungry and will even say she didn't just eat even though she did, also her sleeping habits are horrible, she will stay up until between 10pm and 2am and then start her day at 7:30am and act like it all over again(and no she does not get a nap) i am starting to thing she may be autistic or something else, it has to be more then one thing.. everyday (yes everyday) she troughs at least 3 of those fits not a day goes by without them. this has been emotially hard for me because i feel like it is because of me.  thank you for your time:)

Answer
Hi Tracy,

Firstly let me say you are doing a wonderful job!  Your love and caring for your daughter shines through.  People don't realize what an emotional toll it takes on parents when their children display behaviors they don't understand.  But I do.  Dealing with tantrums and outbursts is draining because you love your child and don't know what to do to help.

Let's take one step at a time.  Your daughter might have tantrums and violent behavior now but it doesn't mean she'll have them when she grows up.  Try not to worry about the future.  Let's deal with the present and get you the help you need.

I agree that your daughter has some concerning behaviors but it doesn't mean that she has autism.  You certainly didn't mention many of the "stereotype" characteristics of autism.  There is no way to be sure until you get a thorough evaluation.  In your case, I would sincerely recommend going to a pediatric neurologist.  They will have the experience you require for a thorough evaluation.

Tantrums and outbursts typically come from two things.  The first is if a child is unable to express themselves.  This leads to frustration and loss of control.  How is your daughter's speech?  Is she able to communicate and get her point across?  The second reason a lot of children display outbursts is from sensory issues.  This is when a child is over sensitive to the environment around them.  Noises can be too loud, textures too rough etc.  They might not be able to filter out all the sounds around them.  This can feel very overwhelming and being that children still need to learn coping skills, they often react with outbursts.  Part of sensory issues is not being able to self calm.  I think your daughter would benefit greatly with some help from an OT.  Depending on her speech, she might require services too.  The sooner you're able to get an evaluation, the better.  

When a child feels overwhelmed, they try and gain control of their world.  One of the ways they do this is by trying to control every situation.  This certainly sounds very much like your daughter.  They tend to thrive on structure.  I found it interesting that your daughter is like an angel in preschool.  I wonder if the structured environment helps calm her down.  I would try making her routine at home more structured if possible.  Easier said than done, I know.  Some suggestions are to draw a schedule and stick it on the wall.  Start with her routine before school.  Pictures that depict waking up, getting dressed, eating breakfast and leaving for school.  Direct her attention to the schedule frequently.  Praise her and reward her for completing each task.  As she begins to respond, you can add more items to the schedule.  This might help her feel more secure and in control of her world as she will know what's coming next.

I recommend you go to http://www.nlconcepts.com
On the right hand side you will see a column that says "How do you know if your child has autism?"  
Download this article and read it.  It gives you a really good description of common behaviors associated with autism.

Last but not least.  Go easy on yourself.  You're doing a wonderful job and it sounds like helping your daughter is mainly on your shoulders.  Do you have a babysitter you can rely on so that you can get some time for yourself?  It will do you wonders.  Try and get that evaluation as soon as possible.  

Please let me know if I can be of any further help.

Jene Aviram
http://www.nlconcepts.com