Expert: Dr. Sharon A. Mitchell - 8/31/2010

Question
Hello. I am a very distraught mother who is at the end of her ropes. I don't know what to do from here.
My son is six years old and has been exhibiting extreme behaviors since he was two years old. He has always been "too young" to diagnose. I need some answers from somewhere.
He started extreme behaviors at two years of age. He stopped talking for 9 months in which time he only screamed and threw things, hit, bit, spit on people, and seemed to not have any care as to who it was. Now at 6 years of age he still screams even when he's talking, he still hits but he has became more violent like talking about shooting people, he loves guns, knives, etc. He is now more destructive but seems to only focus on things that are glass. Windows in our home, car windows, windows on the school bus. He tries to punch or kick them out never with an object. He is very intelligent and aware. He also is unable to be in large crowds or away from home. I can't take him to the store, to fairs or carnivals. He hates to be away from home. These are only a few of his behaviors the list is so long. Please HELP

Answer
Oh, Angela. What a lot you and your son have been through these past years.

At age six, he is not too young to diagnose if it was felt he had something on the autism spectrum. Have you taken him to a physician recently or was the "too young" what you were told a number of years ago?

The behaviors you describe could be those of a child on the autism spectrum but they could also describe kids who do not have autism. You mention ADHD and yes, there are six year olds who attentional difficulties. But the incidents you mention sound extreme, both for kids with ADHD and for children with autism.

The behaviors sound uncomfortable both for you and for your child. He cannot be a very happy boy with this level of tension in his body.

You talk about the screaming. Does he speak well? Do you think the screaming is due to frustration and a way of making himself heard? Some children who have expressive language disorders can be very frustrated at their inability to make their wants and needs known and resort to screaming or acting-out behaviors. Has your son seen a speech-language therapist for an assessment? If you are unsure how to contact one, this link will tell you of qualified speech-language pathologists near you http://www.asha.org/proserv/  

Sometimes it is difficult to pinpoint one exact cause of what you are seeing. Although I know you would like to know the "why", perhaps the label is not the most important issue. What is most needed are the strategies that will work for him.

Tantrums can be difficult to live through. Even though to you they may seem unpredictable, there actually are reasons behind them that may be difficult to see.

One of the first reasons I like to check for when such behaviors occur is the sensory area. Many kids who have autism spectrum disorders as well as kids without such diagnoses have bodies with sensory systems are not quite wired like yours. They may be either over or under sensitive and react to things that you hardly notice. Whether or not your grandson has a formal diagnosis, here's a couple books you may find useful:

- Asperger's Syndrome and Difficult Moments: Practical Solutions for Rages, Meltdowns and Tantrums (http://www.amazon.com/Asperger-Syndrome-Difficult-Moments-Practical/dp/193128270)

- Asperger Syndrome and Sensory Issues: Practical Solutions for Making Sense of the World (http://www.amazon.com/Aspergers-Syndrome-Sensory-Issues-Practical/dp/0967251486/)

- The Out-of-Sync Child (http://www.amazon.com/Out-Sync-Child-Recognizing-Processing/dp/0399531653/ref=pd)

When kids who don’t have autism are upset, we try to talk to them to calm them. Often it works. But with autistic students, those very same words may escalate the situation. It’s not that you’re saying anything wrong; it’s that they have a hard time making sense of your words, causing even more anxiety.

Reducing his current anxiety is likely your primary concern right now. What sensory input has a calming effect for him? Do weights work? Pressure? Vestibular stimulation? Proprioceptive?
There are a couple ways of trying to help. One is through a sensory diet where at regular intervals throughout the day you give him short periods of the type of stimulation his body craves to feel calmer.

The other approach is to provide the needed stimulation at times when you think he may become upset. For example, if his hearing sensitivity is increased in noisy, crowded situations, have him wear a weighted vest when he goes to the mall with you.
Here are some common things that you could try:

• Swinging
• Using a rocking chair
• Playing on a teeter totter
• Jumping on a trampoline or rebounder (mini-trampoline)
• Sitting on a therapy ball
• Rolling a therapy ball over his body
• Sitting in a bean bag chair
• Being sandwiched in between two large cushions (or under your couch cushions)
• Laying under heavy blankets
• Wearing a weighted vest
• Wearing a pressure vest (sometimes called bear hug vests – often made of neoprene)
• Wearing ankle weights
• Placing a weighted pillow on his lap
• Playing with fidget toys (scraps of fabric or ribbon, squeeze balls, etc.)
• Doing push-ups against a wall
• Carrying or lifting something heavy

Another reason for his tantrumming may be related to difficulties he has in processing and knowing how to respond to what he hears. Although many of us as adults are comfortable with words and talk a lot, not everyone learns best by listening. Some people are better at taking in information through their eyes or through their sense of touch. If your son has a weakness in auditory processing, then when he's upset, the more you talk at him, the less information he'll receive and the more upset he may become.

It may help to couple your words with visuals, or better yet, reduce your talking to a minimum and use visuals or pictures instead to get your meaning across. The following website will give you several hundred free pictures as samples to use as well as information on why using visuals can be so helpful: http://www.do2learn.com

Author and speaker Linda Hodgdon has written an excellent, user-friendly book that may help you, called "Visual Strategies for Improving Communication : Practical Supports for School & Home" (http://www.amazon.com/dp/0961678615?tag=autismhelpf0e-20&camp=14573&creative=327)

You are wondering about the possibility of autism. There are specific symptoms associated with the various autism spectrum disorders. You can read about them and diagnosis here:

http://www.psychiatry.emory.edu/PROGRAMS/autism/pdd.html

And in more medical detail here:

http://www.nichcy.org/pubs/factshe/fs20txt.htm

Here is a short, free, online checklist your could look at to see if you think your son is showing characteristics of Asperger's Syndrome:

http://www.udel.edu/bkirby/asperger/aspergerscaleAttwood.html

Here's a checklist on characteristics of autism:

http://www.hmc.psu.edu/psychiatryservices/child/outpatient/autism/Revised%20Auti

These checklists are not definitive and do not mean that your child has or does not have autism. They may provide you with some information that you can take to your doctor, though.

If he is six, I presume that your child is now in school. School personnel may be your greatest allies and work with you to get at the root of your little boy's difficulties. They can work with you to get the behaviors under better control so that he is able to learn and progress. Talk to the special education people at your school or at the head office in your school district.

All the best to you and your little guy,

Dr. Sharon A. Mitchell
www.autismsite.ca