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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5421
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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My five year old son, who has always been strong willed but

Resolved Question:

My five year old son, who has always been strong willed but who previously responded well to our discipline strategies, has suddenly (within the last month) become VERY defiant and combative all day every day. He yells at us, hits and throws things at us when he isn't getting his way 100% and nothing we say or do seems to make an impact. We've previously taken away favorite toys, privileges and given time-outs and occasionally spanked him, but rarely. I'm at a complete loss as to what changed in him or what could have triggered this new extreme behavior and what to do about it. He has his anual check up in two weeks and I plan to ask his dr about it, but do you have any advice or suggestions in the mean time? What, specifically, do I need to tell his doctor, or ask him to check for?
Submitted: 1 year ago.
Category: Mental Health
Expert:  Dr. Z replied 1 year ago.

DoctorZ :

Hello I believe I may be able to help you with your concern for your son

DoctorZ :

May I ask does he only exhibit this behavior with you and your family, or does he does he do it with others as well (e.g. School or daycare)?

Customer:

ok, great....

Customer:

it started with just us, but has started doing it in front of others as well, he's done it at store, at his orthopedist's office and with both sets of grandparents.....his teacher at daycare says she's never seen it at school.

DoctorZ :

But even though he may do it in front of others, it is still mostly directed to you and the rest of his family is that correct?

Customer:

yes, thats correct.

DoctorZ :

And you said this is a recent behavior and has anything changed in his life that could correlate with this behavior? Maybe he is getting bullied at school/daycare for example

Customer:

nothing except school got out and our schedule changed. My husband and I are both teachers and so we are home together three days a week. He still goes to school two days, for a few hours to participate in summer activities, but he's with the same kids and teacher. I have asked him about bullies, etc and I talked to the coordinator at his school as well. both my son and the director didn't indicate any big changes or problems. I thought at first he might have just been reacting to the change in schedule or the fact that he will be going to a new school and kindergarten next year. but the change is just so extreme! im at a loss.....

DoctorZ :

It is possible that he may be reacting this way in anticipation of going to a new school. Some children have a temperament where they do not respond well to change. Because the behavior has not been more long term I would not want to label it a disorder just yet, but it is possible he could be diagnosed with something called Oppositional Defiant Disorder. I will post a couple links that will give more detail on them

DoctorZ :

When he is in a more calm state I would ask if he is looking forward going to a new school possibly

DoctorZ :

As him about what he is looking forward to and what he is concerned about, if anything

Customer:

I'm familiar with ODD. I've read some things about it as staff development for my school district and have done a book study on "Try and Make Me" by dr. Ray Levy. My sister is an elementary school counselor and she has mentioned that she sees signs of it in him before all this new stuff started. I'll continue to talk to him about the new school, etc. Can you recommend anything that we might do differently to deal with the behavior right now, besides what I mentioned before?

DoctorZ :

You are definitely well versed in ODD. I can recommend some books at the end of this chat if you like. But right now positive reinforcement is a good for him when he does something well and negative reinforcement with the use of timeouts are good too. Try not to yell or spank, because children with ODD do not respond the same with conflict as other children and it will just escalate the matter

DoctorZ :

After he has calmed down then you can discuss why his behavior was wrong

Customer:

As we speak he just ran away, screaming at the top of his lungs, from his dad, who was trying to bathe him, to tell me he "wasn't taking a bath until we go buy him a new balloon!" when I refused to pick him up and take his side, he called us idiots and hit me......he has NEVER done that before a few weeks ago and obviously we (my husband and I) don't behave that way......this is exactly the kind of thing that he does all the time.

DoctorZ :

He may be escalating to ODD, it may be possible to see what his warning signs are and try to prevent him from escalating, but this does not always work

Customer:

ok, would you say that isolating him (like his bedroom) when he's in this state until he calms down, no matter how long it takes is a good thing to do? how do we keep him from running out, chasing us down, etc?

Customer:

i sometimes thing he may be getting low blood sugar. He's very active and eats very little. sometimes, eating something will prevent a meltdown or help end one, but more often than not, he will refuse to eat anything and my suggeting a snack actually sets him off.

DoctorZ :

Yes I think a timeout in his room (with no toys, tv, or videogames) is a good step to take to allow him to calm down. Be firm with him, but do not raise your voice too high as this will escalate him (in fact he wants the situation to escalate). If he chases you down you can hold him firmly (not a wrestling hold mind you) and put him in his room for a timeout.

DoctorZ :

Low blood sugar may be a cause, but the irritability would be short term and he would pass out from low blood sugar eventually and that does not sound like that here

Customer:

ok we'll try that. im just really afraid that we will make it worse in the long run

DoctorZ :

The food may distract him, which is why he calms down.

DoctorZ :

Well my advise for the long term is to see a good child psychologist that will help him with this. In fact the child psychologist can involve the family for family therapy to help each one involved understand their concerns and feelings over your son's behavior

Customer:

thats true, too. i am going to read up on ODD from the sites you sent and go from there. i will ask his dr to recommend someone. thanks for your advice.

DoctorZ :

The good news here is that you most likely caught it early and that is a good prognostic factor for full recovery or successful management of this type of behavior

DoctorZ :

Anytime, I am always happy to help. I will get you some links for books that I think will be very helpful too

Customer:

thanks so much. I truly hope so!

DoctorZ :

It will take some time, but I am confident that therapy will help your son in the long run

DoctorZ :

If you have any other questions or concerns please feel free to contact me anytime

DoctorZ :

I hope I provided you with excellent service today

DoctorZ :

Before you sign off though, I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much

Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 5421
Experience: Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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