Hi,
My dear nephew who is 7 and in first grade is having trouble with emotional outbursts in school. Typically he sees somebody 'cheating' in a game in gym (which apparently they sometimes are in a not-so-big way and nobody else cares) or thinks someone is making fun of him at lunch (which sometimes they are, but sometimes are just being rowdy) and he gets upset and can't handle his emotions and sometimes ends up hitting. Recently he was suspended for hitting his teacher when she tried to intervene. My dear sister and her husband have tried a lot of things and are very frustrated. Nephew has been evaluated and found to be HG+ but did not meet criteria for any disorder (particularly ADD/ADHD). The teacher has been helpful with making some changes to help nephew stay out of trouble but it's not working even though she does seem to 'get' him and is trying to help (I think things like 'priority seating,' standing next to him when the kids line up, etc.). They're going to try social skills group work as well as continuing individual therapy but the school is pressuring them to get a diagnosis and an IEP which they are resisting because they're afraid it will mean they will have to put him on drugs, which they are completely against. It's unclear what the school would even want to put in an IEP and my sister is afraid they will want to put him in some kind of class for 'bad' kids. She thinks he'll outgrow these outbursts in a year or two as he matures socially but in the meantime of course this can't continue and they don't know what else to do. She might end up pulling him out to homeschool, which they have done before, but think it's better for him to learn social skills at school...if they can get him to stop acting out. Any BTDT advice on what else might help? Maybe neurofeedback? It seems like they're trying the things that would help, just that it's not helping (fast) enough. And they're worried that he might get expelled and that might go on his 'permanent' record and keep him out of other schools, public or private, and maybe even have to be reported when he applies college. I can't imagine it would affect college applications (unless he continued this behavior through high school), but don't know for sure. He's in a public school in Georgia but they would rather homeschool than get involved in any kind of legal stuff, plus of course they agree this kind of behavior is unacceptable. So very frustrating for everyone.

Has he had an OT evaluation?

If some issues were found in that domain then they might be okay with the treatment since it is usually exercises not medication.

I believe the best way to protect him is if he qualifies for and gets an IEP. He cannot be expelled for actions resulting from his area of disability - it becomes a whole new ballgame. Our school social worker would get involved in this type of situation working with him both independently and perhaps in groups. The parents cannot be required to medicate him - that is a medical decision and my understanding is the school would get in *big* trouble if they tried to force it - think practicing medicine without a license. We had a situation last year where our truly awful principal insisted on publicly punishing DD for an anxiety response. The district acknowledged in writing that this was a violation of her IEP and this action was included in our recent complaint to the Dept of Education. The playing field totally changes once he has an IEP - definitely worth going for if he qualifies.

Thanks for the responses. He did have an overall evaluation that I think included NEPSY and similar tests and does have some minor handwriting issues, but I don't think there were any other indications of problems although I will be sure to mention it.

Pemberley--thanks for the info. I have only a vague idea of how IEPs work since we have not been in public school and that was my impression, but I wasn't sure. I've been encouraging them to look into it more but they're worried about any label 'sticking' forever and they really seem convinced he will grow out of it (because of their own experiences as kids). But I think I've seen on this board some comments about IEPs changing or maybe even going away, which makes sense. I hope your complaint to the Dept. of Education goes well; I've been following your posts a little and am sorry you've had trouble. Who wants to become an expert on this stuff!?! Good luck and thanks again.

The way I look at it ... IEP = help + protection ... but nobody can force us into anything (absolutely in no way would I let anyone force me into medicating my kids unless I found it medically necessary). A lot of times it takes some big time jumping through hoops and loops to actually get an IEP so if they can get it, they should!

Awww-- poor kid, and poor parents!! It sounds like he's really having trouble with emotional regulation.

I agree with the others-- IEP = GOOD THING here.


Therapeutic interventions might well be a way to NOT have to just "suffer through" the problem until it naturally self-resolves. After all, by that time, he may well have gained a behavioral reputation even if he doesn't have an official "LABEL."

Besides, if the behavior slowly escalates in some fashion, it will be difficult for parents to detect just when things cross some line into disordered conduct. Earlier help with this problem seems like a good idea to me. {{hugs}} to them, though-- it's so hard to watch a good kid have problems like this.


I understand their fear about meds-meds-meds, but if they choose to approach things from a behavioral modification standpoint with a THERAPIST/counselor rather than a psychiatrist, then that should be more of a last-resort kind of thing. And unless he's truly a danger to others, I can't envision how anyone could force medication that parents didn't agree to.

Hi Dbat,
There is this site, wrightslaw, I googled wrightslaw georgia

http://www.wrightslaw.com/blog/?p=67

they might want to read up to learn more.

If I could go back in time with my DD, she had been in a school with good communication (meaning when something happens they have details about when and what) and nice attitude from her school, such as what you report the teacher is like, AND lived in a state where gifted ed were mandated I think I would have prefered the IEP route. But I would have wanted the gifted ed needs being met as part of the package, because those needs to need to be met for these kids - the higher the "G" the more crucial. DD never hit anyone though, she mostly broke down crying, or argued her teachers into a circle (her reasoning and verbal skills are off the chart, which isn't an excuse, but adults get caught up in it, forgetting her real age).

I can understand his parent's concerns very much. It might have been legal in the past for schools to say "medicate or you're out" but it's not now, but parents need to really know the laws and their rights and how the process works in order to stay on top of it. Have they spoken to their pediatrican yet? Drs or practices often have a base philosophy and your nephew's parents could see if they believe the doctor would support a no-meds approach. Also don't choose a psycholgist etc. from one of those large practices that is known for churning out the diagnosis and meds. There are usually ones with that reputation in every city/town.

If they choose to homeschool until he outgrows this as they did (keeping in mind school environments are so different now, so regulated and stressful due to the performance mandates etc.) I don't think he'd get that behavioral reputation. He might have similar issues though if he goes to group homeschooling activities, but it would be more manageable.

Also of course look into diet and allergies and exercise for ways to help him be calmer more over all. All that junk like the dyes and HF corn syrup in kid's meals (maybe even in school lunches still) really can aggravate/agitate more sensitive kids.

Yes, definitely the IEP = good thing for this!

Our DS would have been expelled or at least suspended over and over again if it weren't for his IEP for Asperger's. He had behavioral outbursts exactly as you describe (at least one for each of those same reasons, plus some) and would lash out at the other kids, sometimes hitting, sometimes yelling inappropriate things or threatening them. The school was fabulous for all the social skills training they gave him, and by this year we let the IEP go (with the understanding that we can put it back if needed) because he is behaving so well these days. But in the years when he racked up six pink slips, he'd have been gone if not for the IEP that protected him from suspension or expulsion.

As said above, they can't be forced to medicate him, and the IEP should contain what everyone agrees upon -- social skills training being paramount.

Did they do an ADOS, or look at the possibility of autism spectrum disorders? These kids are often missed when they're gifted, because their language is so good; yet the social thinking mistakes you're describing are very characteristic.


The school cannot legally recommend medication, let alone force it. The child is entitled to a free, appropriate, public education regardless of any decision about medication. There is no school record that follows a person through life.

As for the label: right now I'd bet that other kids are scared of your nephew for his unpredictable behavior. If there's something going on that can be labeled, that label is probably preferable to the informal labels that the kids are already giving him in their thoughts.

I would recommend cognitive behavior therapy and maybe Michelle Garcia Winner's Social Thinking curriculum. Those work explicitly on understanding how one's thoughts influence one's actions, and how other people think about what you do.


An IEP won't completely stop them from expelling him, but in our experience it gives much more leeway for appropriate correction of behavior issues and teaching the correct behavior. Highly recommended course of action is the IEP.

DeeDee

Thanks for the comments, everyone. It really does sound like an IEP is the way to go, and it's reassuring to know that IEPs can change or even 'go away.' They have been doing cognitive behavior therapy with the current psychologist and are now also reading more about 'Transforming the Difficult Child' and similar things--it's just not something that's going to help immediately. I don't know if the previous evaluation included ADOS, but I will ask--it sounded like a pretty thorough going-over. I hope things improve soon, though, because it does sound like some of the other kids are intimidated by his behavior, and then he has even more trouble trying to fit in. Thanks again; I'll pass it all along and hope it helps.

I have been there! My son started having meltdowns and outbursts Kindergarten. The teacher was really fantastic and helped him through the year by giving special jobs (taking stuff to the office/other teachers and whatnot), reading to other kids, and giving him 1st grade worksheets... same deal in 1st grade, though with less success. 2nd grade things devolved completely... he had an older teacher who was wanting to retire and had zero extra energy for my son. We were in full-on crisis mode before I finally accepted my son needed SERIOUS help.

We did end up doing medication for his mood and his impulsiveness, and we got him evaluated by a neuropsychologist. This summer we got him in to a great cognitive behavior therapist, and then when school started he began doing group therapy with the cog. behavior therapist. He's been doing a MILLION times better in school this year.

I would strongly recommend they get him evaluated by a neuropsychologist or a developmental pediatrician. They are really the only doctors who are going to be able to do the full amount of testing/assessment, plus they will provide a full report and recommendations for what the school can do to help the kiddo.

Good luck to them. I wish I could give them a giant hug through the internet. Where they are SUCKS. They have to give in and accept the help of medical professionals... the sooner they realize that the sooner things will get better!

You don't mention how the academic fit is for your DN. Have attempts been made so that he gets to spend a significant amount of his time in school actually learning academic material?

It's hard to know what is causing a sensitive kid to act so stressed out until the stressor is removed, but I would have to guess that unless the child is at a school with a full time gifted program, the job of handling oneself while all day long while not learning hardly anything, and not being 'allowed' to ask the questions that matter most to the child is a pretty big one.

I like the book, Transforming the Difficult Child' and I think the workbook stands on it's own very well, as a way to 'hothouse' that kind of maturity, but I'd hate it if growing a kid's maturity means that then the child can be left in a poor fit classroom.

See what I mean?
Grinity

Grinity--apparently there is a gifted program, but the students must be recommended by their teacher and there is a 'behavior component,' which apparently would rule him out at this point even though the teacher is generally supportive. I don't think that DN has himself raised the issue of not learning enough, and I'm not sure anyone else thinks that is a problem at this point. But I suppose it could be part of it, or at least contributing. I'm not sure how one would sort that out--our own DD complained quite a bit about not learning new stuff before we started afterschooling, but it makes sense that not every kid would do that.

epoh--that sounds a lot like what happened with our DD as far as teachers and good and bad fits, and I'm glad to hear your son is doing better. Maybe my sister should have DN checked out some more; there's a new school psychologist they're supposed to meet with soon who might have some suggestions about that, I guess, so I hope things stay relatively stable at least until then. I think part of the difficulty too is that they aren't confident everyone at the school is really on their side. Hopefully if they decide to get an IEP team together and learn more about it they will feel differently.

Dbat - well, they aren't entirely wrong, the school ppl aren't 100% on the child's side. Their jobs are their first priority, not the child. A school psychologist isn't typically qualified to diagnose things like Autism or ODD or much of anything, to be honest. They need to go to their own doctor and start the process through their insurance.

Yes but having the school psych do a battery of tests also sets the parents up a) to possibly get an IEP and b) to reject the findings and request that the district provide a neuropsych eval or other testing. It's not guaranteed to help but I think it is the best first step, especially if there are certain school personnel who are already viewed as allies. This is where it's a good idea to spend some time with Wrightslaw and brush up on Child Find, IDEA, FAPE, etc

I second epoh on this - it sounds like your dn's parents are acting (at the moment) based on fears of what can happen at school. Some of those fears are unfounded - the school *can't* make them medicate a child and can't diagnose a medical disability. My advice is that they need to refocus their worries and efforts by concentrating on what their ds needs for *life* - not for school. It sounds like he is struggling with *something* and no one really understands what at this point. It truly could be *anything* - and a neuropsych and/or developmental ped are the professionals who can most easily help to *start* untangling the "what's up" puzzle.

It can be scary thinking your child needs help and it can take a long time (and may cost $) to get the private evals - but the knowledge gained through those evals is crucial both for parents to understand what is going on and how to remediate/accommodate/etc... *and* having the evals gives the parents important and credible information to use when advocating at school. Just as a brief example, before my 2e ds was diagnosed in 2nd grade, his teacher was beyond convinced he has ADHD - and I'm sure if a school *could* require a child be medicated she would have been greeting him at the door each morning with a huge pill He doesn't have ADHD, and medicating for it would not have done him one bit of good... as well as it would have deferred us from discovering the disability that was really behind his extreme anxiety.

You mentioned homeschooling - homeschooling can be very helpful in getting out of a situation like your dn is currently in, and might be very helpful for him in many ways - but I would still recommend seeking the neuropsych or dev ped eval. Homeschooling to avoid a situation that is troublesome rather than homeschooling (or continuing in public school) with the knowledge of what's up and trying to learn how to work with/through/remediate/accommodate it are two very different things - and if you don't figure it out now and work toward whatever is needed to help with it now, he's only going to be faced with another situation later on in life where he's potentially unable to cope.

Best wishes,

polarbear

Now knowing how the parents feel about the school overall I'd probably weigh in with homeschooling for the time being if they are willing and able, with them seeking more information about their son's profile and putting him regularly in group social situations with his peers to practice things. From everyone I've ever known with an IEP it does take diligence and communication is so important from the school. As a previous poster said, the school personnel, with all due respect to those who really care about the kids and who try so hard, overall many of them have their job as the bottom line as well as 1-not getting sued 2-not ending up on the news for something negative.


I'd second the info about school psychologists not being able to diagnose intricate 2E issues. Once my DD came home from school and said "what does ADHD mean and why would I have it?" I tried not to over react. I said "it means...said what each word stood for...and could mean that your brain is set up different than some others but also that you can have REALLY COOL ideas!!!"

For a child that age who is acting like your nephew, and likely very intune and sensitive, the break of homeschooling would be nice and also lessening the anxiety of what will happen from day to day for the parents. Everyone will sleep better.

oh yes and have private testing done - you pay, you keep. And find out if the potential psychologist or practice has an association/contract with the school district they live in (the one used for referrals, school observations...lawsuits... We found out about this little potential fact when we lived in our last state.

Hi,
Thanks again for your comments. Just an update...and also (yet another) cautionary tale about school psychologists. So my dear sister and her husband went in for the first meeting to try to set up the IEP and the school psychologist was there (i.e., the on-staff school psychologist with whom they would have to work to develop any IEP). The upshot was that the school psychologist announced that they didn't believe the independent psychological evaluation that said dear nephew had difficulty controlling his emotions but with support would be expected to improve over time. Apparently they indicated that he must have some disorder and were discussing which one it might be--all without having even met the kid. So the parents didn't see this going anywhere positive, despite the teacher's support, and have decided to homeschool for the foreseeable future. While the school wasn't threatening to expel him (yet), apparently in Georgia if you are expelled you can't go back until high school, so they didn't want to risk it and might try to get him readmitted after a period of homeschooling and working on his emotional control with social skills classes and interaction with other homeschooled kids. I'm pretty sure it will all work out in the long run, and I expect that he will be a happy, emotionally healthy, productive person when he is older--he just needs to work through this with positive support, which I think he will be getting now, so I'll be keeping my fingers crossed for him.

I'm sorry the school psychologist was just as useless for them as they were for us, but I'm very glad they have the option/ability to homeschool! I don't know how things are where they live, but I know in some places homeschool kids can go to the public school a few days a week for certain classes (music, art, whatever).

Dbat, I am so sorry to hear about the school psych (alas... not as shocked as I should be). I hope your DN will get what he needs!

DeeDee

That's a very severe law, good thing they knew about it!

I'm glad they'll keep him at home and help him in these early years. When I took my DD out of kindergarten it was sweet relief, and we had such wonderful, wonderful days and she wrote me sweet notes about how much I must love her to teach her at home.

Before I took her out, when I had to drop her off with the social worker and psychologist before school for her social skills training, DD very uncharacteristically was clinging to me and crying "don't make me go with them". I was devastated. Don't worry anyone, it only lasted a couple of weeks...)

Not shocked either. The psychologist in the school my DD left,2nd public school, during a meeting in 2nd grade, said it was appropriate for DD to daily have at least three kids standing around her harrassing her and DD breaking down in tears or finally shouting at the kids to leave her alone (for which she was reprimanded, the other kids weren't) because "it will allow her to build her coping skills". Not to mention she miscalculated a friend's son scores, calculated something like IQ 79 (he's on the spectrum) ...when tested privately, with a better 2E testing and evaluated properly his IQ is more like 130!!!

I'm sure your dear nephew will turn out fine with such caring parents who are able to balance information and take action according to what they feel is right for him.

Glad that they have a solution that is going to work well for your nephew!!

(And really, really glad that they saw that psych. for what s/he was before turning their child over to such a person for "reprogramming" or something. Yowza.) I, too, would like to be shocked by that turn of events, but I'm not. Much, I mean. Usually they aren't so brazen as to diagnose without even meeting the child, in my experience, even if they HAVE already got a diagnosis in mind. What a fortuitous tip-off that turned out to be, eh?