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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
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Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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My 3 1/2 yr old is very articulate and intelligent (Between

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My 3 1/2 yr old is very articulate and intelligent (Between Kindergarden-1st grade level in academics). When he was 2, he did punch me a great deal. He no longer hits me now and he is calm at home. However, the issue is at pre-school. When they are not playing a certain way or if they are using a toy he was just playing with, he will say “No, No, No, No!” and get very angry. He may then push, punches, grab their hair. It is now an every day thing and the school sends him to the office. There are other children there that are very active but he is the only one that hits. Additional facts: - Knows and tells everyone else to share. - Allergic to soy. - Had a lot of ear infections when he was younger (about 8 or so) that caused pain at night. - We ask him why and he says he doesn’t know. He feels really bad about it and says he wants to stop but doesn’t know how. - When a bad day happens, he wants to read “Hands are not for hitting” at night. - He gets 5-8 hrs of sleep at night as he wakes up in the middle of the night several times. - Hasn’t been evaluated if he is having an allergic reaction to gluten. - No psych evaluation. - He went through a divorce and his dad just calls in for 5 minutes every other day (I’m the step father). - Cries sometimes when I drop him off. Councilors say this is because of separation anxiety because of the divorce. - The school now has a 6:1 ratio for students:teachers. They love him but they are getting fed up with his anger and are calling for him to be picked up more. Questions: 1) Is he not emotionally ready for day care? 2) Could it be diet? 3) His uncle was diagnosed schizophrenic. His father shows signs of paranoia (Not saying that to be mean e.g., He think people are after him). Could it be herediary? Thank you so much. Any help you give will be beneficial. He’s a young boy that is going to make a difference someday.
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 2 years ago.
Hello. I believe I can be of help to you with this issue.

It sounds as though you are doing many things quite correctly to build a relationship with this boy and compensate for the loss of presence of his father. I'm wondering if you could comment on the nature and quality of relationship he has with his mother. Specifically, how much one-on-one time is she spending with him each day e.g., play sessions, reading, exercising. Day care of course is no substitute for having an adult attachment WITH the child during the course of the day so many kids don't do very well in day care, especially if a divorce has occurred.

Every hypothesis I come up with based on your post suggests that this boy would be helped by one-on-one time and attention in activities that would provide social reinforcement and rewards, but would introduce elements of gradual frustration that he would have to learn to deal with, in small doses, then somewhat larger doses, etc. So building things that can fall over and 'break down', working hard on tasks that sometimes succeed and sometimes do not, will help. When is not feeling stressed, purposefully setting up situations that require him to delay gratification is important. His mother should do this with him at least a few times each day. When he asks you to play a game while you're you or his mother are the middle of a task, have him wait for a short period of time. Praise him for being patient, and gradually work on increasing the time he has to wait. For instance, if he is hungry you can decide to bake a half-dozen cookies from pre-made cookie dough you buy in grocery stores. He can help put out the cookie dough onto cookie sheets and then back them. When they come out of the oven, he will have to delay the urge to eat one because they are hot, but this is an opportunity to use the cookies further to help delay gratification. For example, "We need to clean up the kitchen counter before we eat a cookie" or, "lets put the cookie on a plate here and watch it for minutes before eating it"; let's stack up the cookies and so they can wait a few minutes before we eat one.

If he is dealing with a frustrating situation, alway be sure to empathize verbally, "You worked so hard on that building and it keeps falling over," validates his feelings. Verbalizing the prob­lem can also help pull for possible solutions. After empathizing about the building, saying something like "How can you make it stronger so that it will stay up?" gives your child a cue about solving the problem.

 

Start to brainstorm other opportunities to require gratification delay and consideration of alternatives. For example, you can purposefully set up situations in which you want to say 'no' to this boy about something; for instance, say 'no' to one request, say, for a toy or object, and then, provide an alternative for your child when he can't have a desired object. When your child asks for candy in the grocery store, suggest another, more acceptable alternative. For other children, however, the alternative choice may be reasonable. If your child is engaged in an activity that is causing frustration, suggest that he walk away for a few minutes or try to engage him in a different activity for a period of time.

 

All in all, this boys sounds somewhat developmentally or 'learning' delayed in both his emotion regulation skills and some socialization skills. This typically means that parents haven't really spent enough time with the child doing the sorts of things I mention above. Some kids need more of the kinds of training activities I mention above than others. The above activities can be built into play sessions with friends i.e., invite another child over and play with the two of them and monitor, coach and direct their sharing behavior; verbally praise and reward episodes of reciprocating and sharing. This is the part of the one-on-one stuff I mentioned at the beginning of this post.

 

I'm going to pause here and solicit your reaction. My point is that it doesn't matter what this kid's history is, whether he has biological deficits or problems, or learned misbehavior. The only way to remedy any of these is through more intensive parent or adult child training and exposure to repetitive situations that can help build emotion regulation, frustration tolerance, and delay of gratification, as well as sharing skills. Now his biological father needs to be doing some of this stuff with him as well; most men though, don't have a clue about exactly what to do to be helpful to their child so some coaching is necessary e.g., from a child behavior therapist or someone known as an applied behavior analyst----they understand the sorts of things I'm mentioning above and can coach parents. What do you think?

Customer: replied 2 years ago.

 

Excellent feedback!

 

They don't spend a large amount of time and she isn't happy about it.

 

She is going through clinicals and working 30 hrs, some at 2nd shift. She teaches him, makes him laugh, and they interact very, very well. He seems to be more articulate after a few hours with her.

 

When they play with blocks and they break apart, he'll say "Looks like we have to build a stronger tower". But if a child comes and takes a block, he either cries a lot or becomes very angry. But if a child is standing there, looking at him, he will say "You can have all these blocks here and we can be neighbors".

 

Around us and at the school, he actually has a lot of patience. He tells the other children how to play games and the order of turns. He passed the "one cookie now or 3 cookies later" test and reminded them when they forgot to give him the three.

 

However, this patience isn't all the time, especially at transition. If its cleanup time at school, he's upset.

 

We're pretty routine in the mornings and night. He says the routing when he gets into the door.

 

When we're doing a task and he asks to play, we will say wait until we're done with this. He then repeats "Ok, after you put up the clothes, then we can play with the legos." He's never gotten upset over this unless we ask him to pause what he's doing something he likes.

 

I sat on a day care session in the morning and noticed the following:

 

  • - A child didn't play a "Man on the ice" block game well and he became frustrated.
  • - When someone took a toy away, he became very upset and pulled her hair.
  • - When someone got to close to him and kept touching him, he pushed his face.

 

I may be beating a "dead horse" but here are some other facts:

 

  • - He's good at puzzles and doesn't give up on them. However, he hasn't played much with them lately as we haven't provided them to him.
  • - He's in day care from 9am to 5:30 pm, which is akin to what you mentioned before about low parental time.
  • - He did watch a lot of TV (3 hrs), especially on the weekends (5+ hours) for about a year. For the past2 months its now 0-1 hr a day, 3 hrs on the weeks. He's 100% ok with this and he repeats the rules to us.
  • - We don't praise him as much as we should.
  • - We tried rewarding him with one 30 minute show and toys if he's good the day but that doesn't work.

 

She has recently suggested removing him from daycare. Her time with him will not increase much because of job+clinicals but it will increase a day.

 

I've added additional info to help with the hypothesis. I hope I provided good feedback based on your reply. Could this be a "power" issue?

Expert:  Dr. Michael replied 2 years ago.
I think you see (as I do) that there is something about the impersonal social situation and context of the day care situation that has a big effect on his behavior. The problems you see there, would be less severe or would not happen if he was doing the very same things (e.g., playing with a playmate) with his mother nearby. I do think he is distress about not being with his mother and you suggest this is a 'power' issue; I would rather think of it as his way of objecting and protesting his situation.

I would like to suggest an experiment in which his mother keeps him at home for the additional day or time that she can, instead of daycare, but without notifying the daycare center about what her plans are, she should ask the daycare person specific questions about his behavior on the TWO DAYS before she keeps him at home; and then the ONE DAY AFTER he returns. Mom would call in at the end of the day again and ask the very same questions. If his social behavior problems are related to the protest or power issue we are discussing here, then there should be a change that would be correlated with the extra time with and then without, his mother---at least a very temporary one. This would give you some hard data to show whether the day care context is a significant emotional and developmental issue for him. You'd only have to do this experiment 3-4 times, on consecutive weeks to find out. Also, if this boy is attached to his father calls in or visits for 5 minutes at a time---what is this about? I'm assuming this is in addition to a visitation schedule of some kind; but anyway---dad should be doing some of the things I mentioned in my first response with his son.

You idea of trying to reward him for having a good day at day care is right on target , but unfortunately, the task demand (9-5:30 for good behavior) is too high relative to the reward. After all, he is just 3 1/2, and can't sustain intent for more than a few minutes at a time---surely not self-remind all day for 8 hours, that he has to act 'well'----too many cues to frustrate, distract etc. So the task demand here is too high.

Your level of knowledge about him and the things you are trying to do as a step dad are frankly, unusual and remarkable and quite positive. You are doing many things right.

Let me know if I have overlooked any aspect of your original question. You may want to think about the concepts and suggestions I've outlined and then see what you can do to implement them---you are actually doing quite a number already--or close variants of them. And, knowing that you want to reinforce and shape the behaviors mentioned above (e.g., delay of gratification, patience, etc), you can talk to an applied behavior analyst (get a referral from your local public school district, or talk to some school psychologists in the public schools where you live) for more ideas and coaching. I think this kid is brighter than average from what you describe but I suspect his problems are primarily emotional, relating to the divorce, feelings of insecurity, displacement from his mom, etc. Please click on the green Accept button at the bottom of the screen. THANKS.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and other Mental Health Specialists are ready to help you
Expert:  Dr. Michael replied 2 years ago.
I see you've read my last post. Feel free to respond and comment. If you have no further comments, please click on the green Accept button at the bottom of the screen. THANKS

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