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Parenting K-6 Kids/Kindergarten Behavior Problems

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My son turns 6 in November and just started kindergarten. He did not attend daycare or pre-k prior. He has only been to school two days but both days he has had a bad note sent home. Both days he came home crying saying he don't want to go back to school. He does not have the verbal skills to tell me why but it is pretty obvious he hates school. The first note was the teacher stating she had serious concerns because he cries instead of using words to express feelings, acts out, does not follow directions, and does not hold still. The next note was basically the same only this time she suggested we get him tested.
I trust the teachers judgement on this, before he even went into kindergarten I questioned his maturity level but everyone said I was wrong, he is fine and it was time he started school so I registered him. My son has always been behind verbally. Not just a little behind either. Speaking and possibly understanding wise he is on the level of about a three year old and he is extremely soft spoken. He is a very solitary child, normally secluding himself at birthday parties and such. He is a very active child and when he gets excited he shakes his hands violently. We have tried to break him of this habit and it has calmed down but he still continues to do it on occasion. He really does not understand social norms, such as he does not seem to take lead from the other children in class and he seems to lack common sense I guess you could say. He acts like a 3 year honestly. He is academically smart, he knows his alphabet, numbers, can read a few words. He does NOT enjoy arts and crafts but knows his colors and shapes and he does not play properly. Example, he has matchbox cars and would rather organize them by color than drive them around. He was very hard to potty train, he was about four when he finally got the hang of it. We had him tested for autism when he was about two but they said he was fine. When we got a new pediatrician they said that we may need to take another test. Then we had to get another pediatrician because of a change in insurance and she said he was fine. I know when he was younger something about his head circumference was said, it being too small for his age but that was only mentioned once. I have always known my son was different, but now it is painfully obvious and I feel like a failure as a parent. Do you have any suggestions as to what can be wrong with him, what we should have him tested for or what steps I should take to help him perform better in school.
I would like to thank you in advance for all of your help.

Answer
Dear Blandy;

We might begin with the idea that all "normal" children (and adults, too) must be able to perform 3 tasks. Anyone who cannot perform even 1 of the tasks has a "disorder". All normal people must be able to 1) get their work done at a level consistent with their ability 2)follow reasonable rules so they're not getting in trouble routinely and 3) get along with others such that others are not routinely complaining about them.

By your description, your son isn't performing at age level in any of these areas. Thus he does have a disorder of some type. To discover which disorder(s) a child has, it's best for parents to begin with an assessment of the child's physical condition. Then, mental health conditions are checked, then educational issues are investigated.

Possible physical disorders capable of causing behaviors you describe include microcephaly (small head size), often related to inherited conditions, exposure to toxins during the pregnancy, birth trauma, and many more), gene and chromosome disorders, and others. A Behavioral-Developmental Pediatrician or Pediatric Neurologist can diagnose and treat these. Mental health disorders include, Reactive Attachment Disorder, Autistic Disorders and Mental Retardation. A Child Psychologist or Child Psychiatrist can diagnose these disorders and the latter  professional can treat them. Educational issues include Learning Disabilities (like Auditory Processing Deficits and Visual-Perceptual Deficits). These are diagnosed by Child Psychologists and "treated" with Special Education programs.

Since several disorders may coexist, the order in which professionals check out the possibilities is important. Physical (Medical Doctor) comes before mental health (Psychologist/Psychiatrist) and educational assessment and services, based on the first 2, is last.

Hope this is helpful.

AMD

Parenting K-6 Kids

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Alan M. Davick, M.D.

Expertise

As a Johns Hopkins trained Developmental-Behavioral Pediatrician with 40 years experience, I have focused on distinguishing underlying willful, poor choice-making (like Oppositional-Defiant Disorder)from innate "conditions" masquerading as willful misbehavior (like ADHD, Autistic Spectrum Disorders, Bipolar Disorders, Cerebral Palsy, Developmental Delay, Epilepsy and "Behavioral" Seizures). Though I cannot act as a formal medical or psychiatric consultant, I will answer queries with generic information and suggestions for discussion readers may direct to their own professional advisers, including physicians, psychologists and educators.

Experience

I trained at the Johns Hopkins Medical Institutions in Pediatrics, Child Psychiatry and Behavioral-Developmental Pediatrics. Thereafter, I've continuously practiced Behavioral-Developmental Pediatrics and have taught the principles mentioned above to parents, colleagues and professional groups.

Organizations
American Academy of Pediatrics SW Florida Sportsman's Association Florida Writers Association

Publications
First Travel Meds - 1987; Managing Misbehavior in Kids: The Mis/Kidding Process; Bullying: Rarely Travels Alone; Discipline Your Child (without going to jail); AD(H)D: What Every Parent Needs to Know

Education/Credentials
Undergraduate - NY University WSC Arts & Science, NYC 1959-63 - B.A. Medical Degree- State University of NY, Upstate Med Ctr, Syracuse 1963-67 - M.D. Internship/Residency - Johns Hopkins Hosp/University - Baltimore, MD 1967-70 Major, US Army Medical Corps, Chief Pediatric Section, Savannah, GA - 1970-72 Sp. Fellow, Dept Child Psychiatry - Johns Hopkins Hospital/University - 1972-73 Practicing Behavioral-Developmental Pediatrician, lecturer, author - to date Currently practicing Child Psychiatry - SalusCareFlorida, Fort Myers, FL.

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