How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask David Akiva Your Own Question
David Akiva
David Akiva, BA, MA,
Category: Mental Health
Satisfied Customers: 167
Experience:  Counselor; Behavioral Consultant
57833540
Type Your Mental Health Question Here...
David Akiva is online now
A new question is answered every 9 seconds

My three year old is having a difficult time. He is having

This answer was rated:

My three year old is having a difficult time. He is having problems with ears which are manifesting in behavioral problems. A year and a half ago he started getting ear infections and, as expected, he became irritable and problematic. This happened at the same time as the arrival of a new baby sister, his first sibling. In December he got tubes in his ears and was soon back to his happy self.

A few weeks ago the tubes stopped working and his ears filled with fluid. We took him back to the ENT doctor who put him on antibiotics and ear drops. We went through the prescription, but the behavioral problems continued. He is destructive and says alarming things like "I'm going to kill you" and "I want to be alone forever". He has also started hitting and biting. He's been back to the ENT, who said he should have the tubes redone. That will be scheduled for 6 weeks time.

I expect that once the ears are fixed, his behavior will return to normal. However, I am concerned about the nature of his outbursts. It may be the ears causing the outbursts, but I'm worried about what is behind his disturbing statements. I'm debating getting him counseling. Do you think this sort of behavior is an early warning of underlying emotional problems? I worry that after the ears are fixed we'll forget about it because the behavior is more manageable. But if there is some turmoil that needs to be explored, I'd like to get therapy. What are your thoughts?

DuddyH :

Welcome, I'm a professional counselor and behavioral-consultant. I'd like to chat with you for a few moments to better understand your question and the situation you're describing. Are you available for chat right now?

DuddyH :

You show as "standing by" but you haven't responded for about 10 minutes to my chat request. That's ok, you must be very busy these days....

DuddyH :

Given the complexity of the situation you're describing, I need to ask a few questions to clarify. I'll check back shortly for your response. Please leave a time or 2 today that you may be available for live chat. Thank you.

Customer:

I will be available for the next hour.

DuddyH :

Hi. I just got a message that you returned to chat.

DuddyH :

Here are some questions to start off with"

Customer:

OK

DuddyH :

1) Are you seeing any positive, healthy and age appropriate behaviors right now? If so, what are the top 2 examples?

Customer:

1- he participates well in group activities when it appeals to him, although sometimes he his happy to sit on the sidelines and watch.

DuddyH :

2) Prior to the tubes, was behavior (i.e. social interaction etc) and development normal/neurotypical?

Customer:

yes. he can be a bit shy but once he's used to people is very engaging. His development has always been on track.

DuddyH :

How often are seeing the problem behaviors (times/day etc)?

Customer:

the second positive is that he has a great imagination and loves story telling

DuddyH :

Oh that's wonderful to hear!

Customer:

Every day there are fewer episodes. He really does seem to be learning to get things under control. Today there have been 2 so far. Yesterday I think there was just one all day.

DuddyH :

Thank you. What are the top 1-3 problem behaviors? Are you noticing any common triggers for each? Are you seeing a pattern?

Customer:

The top is hitting. One trigger is if his sister plays with one of his toys. He hits her gently. Another trigger is when I put him in time out. He hits me harder. Another trigger is if he's getting frustrated, but he's learning to ask for help when that happens

Customer:

Another trigger can be his father going out the door, or returning.

Customer:

That's a trigger to a tantrum

Customer:

What concerns me most are the things he says- like "I'm going to run away", or telling me to run away

DuddyH :

Thank you for the concise helpful responses. Very clear....

Customer:

Another behavioral problem is cooperation when it's time to go anywhere

DuddyH :

How often are you hearing those statements? Is it just those 2 or are there more?

Customer:

Probably once a day

Customer:

"I'm going to kill you." "I want to be alone forever", "Run away", "I'm going to run away", "I'm going to break something"

Customer:

"I'm going to smack myself in the face"

Customer:

re: the word smack...his grandmother was babysitting him the other day and was at a loss as to what to do, so she gave him a history lesson in corporal punishment..."you know, a long time ago when little boys didn't cooperate they got a smack on the bum"

Customer:

As soon as he got home he reiterated the lesson and has been using the word smack a lot (a new word for him)

DuddyH :

Wow, so he was able to apply the lesson to himself as an expression of ear pain(?).

DuddyH :

Is he generally pretty verbally expressive?

DuddyH :

...creative?

Customer:

yes, sorry, I lost my connection for a second

DuddyH :

No problem.

Customer:

yes, he's very expressive verbally

Customer:

He's creative in story telling

DuddyH :

lots of eye contact when he interacts with you before and after surgery?

Customer:

no, actually, when we're having a talk when I ask him to look at my eyes he has trouble

Customer:

during normal interactions I don't notice it as a problem

DuddyH :

why do you think that is?

Customer:

I'm not sure...he doesn't want to be "having a talk". He wants to get back to what he was doing, perhaps

Customer:

His teachers at daycare have mentioned that too

Customer:

what does that indicate?

DuddyH :

Well to tell you the truth, Experts on JustAnswer, are not permitted to provide any kind of formal assessment or anything like a diagnosis. I just wanted to take a few minutes to get as clear a picture as possible, of the situation you are describing as part of your question....

Customer:

ok

DuddyH :

In general terms a reduced eye contact in positive social interactions when a child has had the kind of tube procedure and complications you've described can signify any number of things...

DuddyH :

I don't think psychotherapy is indicated because at this age most effective interventions are behavioral or social learning based anyway. But what may be incredibly helpful is working with board certified behavior analyst, so that you can get:

DuddyH :

1) a very clear explanation of what's causing the problem behaviors; and,

DuddyH :

2) a tailored intervention to maximize helping your son cope and adapt to the pain and discomfort he is experiencing in terms of his social interaction on a day to day basis....

DuddyH :

Working with a BCBA over a few in-person and/or online and/or phone sessions would be very cost effective way for you to really understand and support your son right now.

DuddyH :

What are your thoughts?

Customer:

I live in a small town so I don't think there are any here. Can you direct me to an online behavior analyst?

DuddyH :

Sure but first, do you have any other questions? I have worked as school board behavioral consultant a program psychotherapist for kids and even for a few months as an behavioral instructor therapist.

DuddyH :

And by the way, a BCBA can work with you online and by phone and is can be incredibly cost effective as you can do a lot of the observation and intervention work.

DuddyH :

You sound like a very intelligent, pro-active parent.

Customer:

I guess my big question is- can this all be blamed on the ears? I know from going through it before that the behavior will improve with the surgery. I just worry that there is something going on underneath that is being exhibited now while the ears are making him irritable. I worry that the issues will still be there but we won't see the signs after his ears are fixed.

Customer:

or the signs won't be as obvious

DuddyH :

I gave that question a great deal of thought, and in fact, it's one that I've studied and considered for years. Luckily, there is no emotional abuse or neglect here. Sounds like quite the opposite....

DuddyH :

The other thing is that the research indicates that from problems as serious as autism spectrum to early temperament, mood and attentional problems, the younger kids are the more central are behavioral or environmental interventions. This is even true of adolescents who have experience serious emotional and behavioral disorders....

DuddyH :

I think that if you do an environmental intervention (and it sounds like that's what you're doing with teaching the positive "replacement behavior" of asking instead of tantruming etc)...

DuddyH :

...and with time outs etc)...

DuddyH :

You will best learn about the the extent to which there may be other problems that may require specialized non-environmental intervention....

DuddyH :

When you work with a BCBA, the basic, simple observation and charting that results creates a really clear clinical picture for any specialist that might be needed, where tailored environmental strategies fail (if they do). But it sounds like their working to some extent for your son right now. A BCBA would just precision target the effectiveness, add and/or subtract optimal interventions based on your sons immediate support needs.

DuddyH :

sorry sound's like they're working...

Customer:

OK. Thanks so much for the advice. You have put my mind at ease somewhat, and I will look into finding a BCBA.

DuddyH :

Let me get you a couple of links:

Customer:

thanks

DuddyH :

What is a BCBA?: http://www.bacb.com/index.php?page=4

DuddyH :

Finding a BCBA to work with: http://www.bacb.com/index.php?page=100155

DuddyH :

Finally, even if you are in a remote area you can work as I said online and by phone etc..

Customer:

Thanks a million! I will check out the links! You've been very helpful!

DuddyH :

You are very welcome. I wish you and your family the very best!

Customer:

Thanks!

David Akiva and other Mental Health Specialists are ready to help you