Expert: James Michael Roan - 4/19/2007

Question
My 3yr old son was adopted. He was placed with us at 15 months old. He had been in a Spanish speaking foster home from 7-15 months. He had been neglected, so when we got him we really spoiled him with love and attention. I noticed that he wouldn't make eye contact when I sat across from him while he ate in his high chair. Eventually that stopped. he acted like he didn't understand us when we spoke to him and we realized that maybe he only understood spanish. Our spanish was poor but we tried. He was non verbal untill about 2 yrs and then it was only a few one syllable words, he mostly grunted and whined. His speach has gotten much better now, but he doesn't stop!!! He repeats himself over and over to the point of making me tell him "I heard you ask for the juice" I am getting it that second and yet he still keeps saying "Juice Mommy, juice"  Sometimes I think he does that just to bug me! The constant whining is going to make my head explode one day! Another issue is he intentionally tries to hurt our new son who is 19 months old. We brought him home at 7 months old and the 3 yr old has to be watched like a hawk. He tries to slam his hands in doors and drawers, he pushes him off toys shoves him to the floor and one day I caught him sitting on him hitting him. When we put him in the naughty corner He cries so loud, one might thing we had just beat him, and he throws himself to the floor. He used to hit his head on the tile floor in frustration or excitement. He refuses to make poo in the toilet but will pee in it. I had to take him out of pre-school because of it. His teacher said that during story time he would not sit on the floor with the other children and listen, but would go to the tables and put puzzles together, alone. He was the only child out of 24 that could do the entire alphabet puzzle. He is very social and outgoing and does play well with most other kids but doen't share his toys well.When we ask him to pick up his toys, sometimes he will and other times we have to tell him as many as ten times and then he will just look at you like you're from another planet. While we are standing there angry for his defiance he will look up at you and smile the sweetest smile. He seems to have no remorse or empathy for injuring his brother. Transitions are a nightmare...he loves to have fun but when the fun needs to end for something such as dinner, it is a huge ordeal. I found that if I tell him what will be happening before it happens,he seems to do better about transitioning from one thing to another. He has no fear of anything, and scares us half to death sometimes. His attention span is short for things that he wants to do like coloring...I'll get everything out and set it all up and 5 minutes later he's running off to something else and of course, he refuses to help put the crayons away. These are the most prominent issues, what do you think...is he just a spoiled brat, or is it something bigger. the symptoms of ADD don't seem to compltely apply, so when I learned about PDD, it seemed to make more sense, and the fact that his birth mother did abuse drugs early in her pregnancy struck a nerve too.

Answer
Hi Leslie;

This does not sound like PDD-NOS based on your description of his social interaction with peers. Transition problems are most likely due to an "executive dysfunction." Many children are misdiagnosed as having attention deficit hyperactivity disorder (ADHD) or attention deficit disorder (ADD) when, in fact, they are experiencing some degree of executive dysfunction. The executive functions are a collection of cognitive processes that are responsible for guiding, directing, and managing intellectual, emotional, and behavioral functions, particularly during active, novel problem-solving. Executive functions are responsible for planning, organizing, and executing a sequence of goal-directed behaviors. Children with executive functioning problems are often misinterpreted as having an inability to focus and may not be able to independently initiate activities. Transition should be announced in advance several times as the the transition time approaches.

As for the aggressive behavior, I am not sure what to make of it. I have heard of this on many occasions and in most cases the behavior disappeared with intervention from the parents. If you suspect fetal alcohol syndrome (FAS) or other related condition, you should these concerns with your pediatrician. Drugs and alcohol during pregnancy often result in social, behavioral, and learning problems but not always.

In any case, if you live in the U.S., call your school district for information on their Early Intervention program for children 0-3 years of age. Make a referral for a thorough assessment at county or school district expense.

Kind regards,
James