Have Mental Health Questions? Ask a Psychiatrist Online
Welcome, I am a professional counselor, Behavioral-Consultant and relationship expert.
It's outside of my scope of practice to prescribe or advise around medications but I have a lot of experience working as a program developer for high emotional and behavioral needs kids and teens in residential treatment settings....
I've also worked as a behavior consultant for a major school board.
Do you mind If I ask a few questions to better understand your situation and what your grandson is facing?
Thank you. Anything you want to add here first?
What are your grandson's top 2 or 3 behaviors of concern at school? You also mentioned that he's good at home. Any behaviors of concern at home or in any other settings outside of school?
Hard to cope with change,from playing to putting toys away, meltdowns with crying, sucking his thumb, and rolling in a ball on the floor in school. He is best at home whrn given a chore, eg. shoveling snow with his Dad, helping to clean the car, etc.
If things don't go his way, he has difficulty just "sucking it up" and going with the flow.
Have you seen his meltdowns? Would you mind thinking of what triggers these most often and giving an example or two of these common triggers for him?
For example, he can do a chore ok, but what other tasks, events, people or situations set him off most of the time, when he has meltdowns?
Are there common triggers at home and at school?
When he isn't able to do what he wants at a certain time, kids don't want to play with him, he hardly knows the names of the kids in the class, and at a birthday party, he "melted" when he didn't get the chair that he wanted.
Thank you for the information. As a behavioral consultant I think the most important thing you can do for your grandson is get a real evidence-based behavioral intervention for him. This is particularity true if a good neurologist has indicated ADHD.
At justanswer.com we sadly can't do a comprehensive evaluation and guide an intervention, we just answer single questions....
With the behaviors you've described...
It's very important to intervene early and to find out what part of the behavior can be positively changed by making supportive changes in the environment at school and at home....
What is critical here is really knowing and understanding what triggers the meltdowns. For example, with ADHD, it's very normal for a child to feel frustrated and to compare himself to other kids who don't have difficulty in certain areas...
I have ADD, myself. I remember feeling very sad and frustrated when I couldn't write as fast as my peers in school and get to the rewarding free time activities the teacher set out for fast, good writers.
Many kids with ADHD learn how to type and can out perform their peers at school on writing tasks. And that's just one example out of hundreds.
The best thing to do I think is work with a Board Certified Behavior Analyst (a hidden gold mine for behavioral intervention).
A BCBA can work with your family and grandson to set up some basic data collection to see what is really triggering and maintaining the meltdowns and other behavioral issues.
The neurologist says ADHD, the phychiatrist says Anxiety, Should he be on Prozac or Ritilan?
Often teachers are to busy to really help kids and they don't understand the behavioral science of proper supports. They can easily get frustrated and contribute to the problem with out knowing it.
Is this something that he will outgrow? What about his says that "I hate myself, I'm Stupid"?
In my experience and training we should always work with the least intrusive intervention first. Medications in my view should not be brought into play unless there is a real risk of harm, and until a proper behavioral intervention is done to see if there aren't very simple interventions that can be done to help change behavior first.
My daughter lives in New Jersey and is a speech pathologist and covered by the NJ teachers health insurance. She says that many therapists don't return her calls. Only one did and he does group therapy, not individual therapy. Do you thin he need one on one?
Like I was saying above, if your grandson does have ADHD, or if he there are problems in the environment at school or both, it's important to get the behavioral supports he needs so that his self-esteem isn't negatively impacted over time. A proper behavior intervention will provide a very clear picture of what needs to be done to help your grandson. If he doesn't respond to parts of an environmental intervention than you know more clearly what to focus on medically, and psychologically.
In my experience therapy is not indicated for a 6 year old if ADHD and related behaviors are the problem. It's more about making changes in the enthronement, and gradually teaching your grandson skills and strategies to help him better cope with his symptoms. I'll provide links for your further research before we finish here today.? In some cases there may be abuse or trauma and then therapy is indicated. A behavioral intervention with an BCBA will provide very good insight into none-behavioral factors, indicative of alternative forms of treatment or support. There is nothing in the information you've provided to indicate trauma or abuse.
The psychiaatrist said that when the third child was born, the six yr old was the second child, that he felt distant from his Mom, and need more attention from her. I don't agree with the "poor forgotten second child" syndrom. He was in day care from 3 months , and always did pretty good. He always had a lot of energy, but he is a boy! He was a good baby, with no problems.
Well, the reason I'm behaviorally oriented is because it answers these questions for us. For example with good behavioral observation and data collection at home and school you'll see if some of the behavior is related to attention seeking or task avoidance because certain things are too hard etc. Good data collection will also show a trend if common triggers involved low attention conditions with mom and or competitive attention conditions with siblings. In all of these cases there are hundreds of science proven ways to help a child learn and adapt.
Just getting teachers to collect data strategically can transform their attitude and get them to pay attention to things they haven't been paying attention to. Same at home. BCBA's can tailor data collection tools and strategies that don't take to much time. You can start to get a picture of what's really maintaining behavior in a week or 2.
Everyone wants him to be happy dn function in life. Nothing is perfect, we all have to adapt and go with our strengths.
So you feel that behavorial therapy is the way to go? What about the so-called anxiety?
You know, one of the secrets I share with my clients is to work with a Master's level clinician who is working towards full BCBA certification. This way you are working with the certificant and the clinical supervisor. BCBA certificants will often work very well for free or at a reduce rate because they are getting supervised hours towards full certification.
It's not behavior therapy necessarily but applied behavior analysis. It's the same approach they use to academically and socially "normalize" seriously autistic kids. This approach is used in many clinical settings including behavior therapy as you mentioned but usually with adults.
Where do we find someone who is working on a Masters?
Actually they will already have their Master's but be working towards board certification and applied behavior analysts. What city and state are you in, if it's ok to ask?
Westfield, New Jersey 07090
Ok. Thank you. Let me take a look I'll be back in a second with a few links...
Thanks for everything. I there anything else?
Here are some BCBA's in your area:
I would contact a few them by e-mail or phone and let them know that you are looking to work with a certificant. I would let them know the basics of what you're grandson is experiencing at home and at school and what the professionals have said so far..........
Let them know that you want a behavior analytic intervention to target the meltdowns and other sources of some of the negative things your grandson has said about himself. Let them know you want to have strong data collection/observation tools for family members and ("teacher friendly") school observation/data collection tools for teachers to use, so you can understand what's really going on with your grandson.....
Make sure to ask for a certifcant or BCBA who is familiar with and has experience working with ADHD....
Tell them that you also want to know about weather or not there are behavioral interventions that would be less intrusive then medication etc...
They may want to come and do some observation themselves, which is a very good idea, at school and at home. Again if you can work with a certificant this would be great. School boards will often allow a professional BCBA to come in and do behavioral observation. The BCBA's in your area will know all about the school issues and resources, as many of them are employed by major school boards....
Finally, let them know you'd like to see if you can't find some real answers and strategies that would work for your grandson without having him formally identified at school unless that would be truly helpful to him in your area and given what emerges from the data and observation. Ask them if they think a "functional analysis" is indicated. They can explain this procedure and many others from which they will selected the most appropriate tools for your grandson based on the research.
Does that make sense?
Yes, thanks again. I have to go babysit now, so if there is anything else, can you sent it on my E'mail?
I think that's if for now.The BCBA's will be in a better position to answer more questions. I wish you and your family all the best!