Need help with child (6 y.o.) with extreme acting-out. Where to get help?
September 24, 2012 7:14 AM   Subscribe

Need help with child (6 y.o.) with extreme acting-out. Where to get help?

Our son is a pleasure to be around 90% of the time. I will spare you the parental doting, but please take my word for it: he is happy, social, bright, etc. as a general matter. He started a new kindergarten this fall. He is having extreme acting-out behavior: hitting, kicking, spitting, breaking things, and saying violent things like "I will kill you" to his teachers. He has been in school only about 8 days so far - he has acted out in about half of those days. The other half he has been a "model student" according to his teachers. It is a true Jekyll and Hyde. He has done the acting out only a couple of times with me (dad) and it is horrible - it is like he is a completely different person. You say "you have to stop this now" and he says "no, you have to stop this now or I will kill you." He spits at my face and throws my stuff (like my iphone) - it is clearly a button-pushing attempt to make me extremely mad (which works).

Obviously, nobody is going to solve this here. But where to find help? There are so many different types of professionals out there - counselors, psychotherapists, psychiatrists, etc. We are seeing a counselor now and we are trying "positive reinforcement" stuff, but, so, far, the acting-out has continued. I am concerned that we need something more "heavy duty."

The most frightening thing about this is the "on/off" nature of the behavior. It makes you worry that (a) he is doing it on purpose; (b) there isn't any "treatment" because he doesn't really have a condition that shows itself full-time, but more like "spell" he goes into; and (c) this is some kind of learned/conditioned behavior that he is using to get something he wants (not in a conscious manipulative way). He seems totally terrified of school - we think because of social issues. There does not seem to be a single "bully" or anything like that.

So - what should we do? Psychiatrist? Psychologist? Pull him out of school? We are meeting with his teachers and principal today and I am worried they are going to try to throw him out of school.

Totally lost here. We are in Chicago if you happen to know any professionals that you would recommend.
posted by anonymous to Health & Fitness (27 answers total) 4 users marked this as a favorite
What does the kid have to say about it? Has he identified anything about the new school that makes him scared or angry or upset?
posted by colin_l at 7:17 AM on September 24, 2012 [2 favorites]

I don't know anything about this landscape in Chicago. But:

In toronto, i used to work at a social services center that worked with kids with behavioural problems (and their parents - to teach the specific parenting skills necessary). The families needed to be referred by "the system" - a school, a social worker, a medical professional. It had pretty good success rates, and was meant for kids like yours who were displaying behaviour that parents/teachers didn't know how to handle, but the kid didn't seem so far gone as to require a special school or something full time. I'd hope there'd be something similar in chicago.

As such, i'd start with a child psychiatrist and your school, and see what they recommend. Try a few of their avenues and see what seems right for your family.

(It's important to recognize the participation of the family in this process: you and your partner (and your other kids, if you have any) need to all get on the same program of rules/rewards/expectations in order to provide your son with consistency necessary to help him.)
posted by Kololo at 7:33 AM on September 24, 2012

I would not pull him out of school (he's been there 8 days!) If you do, he might learn that acting out gets him out of things, and that's not a good lesson to learn.

That being said, he's in kindergarten, he's starting a new school with new teachers (and new kids in his class, I presume?), and he's been there a total of 8 days. That's not a lot of time to adjust. Did the behavior present before he started kindergarten? What happens when he tells his teachers "I will kill you?" Does he get sent to the principal's office? Does he get a "time out"? Does he get a lot of attention from the adults in the room (no matter if it's good or bad attention?) Could it be that he has learned that saying that phrase and acting out gets him out of a situation he doesn't like? I would take a hands-on approach with the school: get details about their policies regarding this kind of behavior and problem-solve with them about what is going to reduce the behavior. Ask them if they have a behaviorist on staff to help. Talk with the school psychologist about what you can do at home to reinforce what's being done at school (and vice versa!)

I'm not a behavioral expert by any stretch, but one thing to keep in mind is that when a professional recommends a course of action to eliminate the behavior, chances are excellent that things will get worse before they get better. It's called an "extinction burst" and you might see that with your son as he realizes that what used to work no longer works. You say that he's been having these outbursts as you've tried positive reinforcement? Keep at it, stick with the recommendations from your therapist, and see how things go. It would be good to keep track of the number of outbursts he has so you can get some data about frequency.

Good luck!

On preview: Kololo has an excellent point: the entire family needs to agree to the course of action. That is very important!
posted by absquatulate at 7:37 AM on September 24, 2012 [3 favorites]

It's very difficult to suggest a cure without knowing the cause: social, traumatic, organic. I would consider a psychiatrist/psychologist that you feel comfortable in talking to and who will take a calm approach at getting to the source.
When you have an idea about the cause, then a treatment can be constructed.
posted by dances_with_sneetches at 7:42 AM on September 24, 2012

Have you checked with his pediatrician? One thing a good primary care practioner does is coordinate care, which includes referring you to the correct specialist. The pediatrician can also advise on whether a physical exam is warranted.
posted by Mr.Know-it-some at 7:42 AM on September 24, 2012 [7 favorites]

Just recently listened to a Moth podcast by Molly Ringwald who had similar issues when she took her 7 year old from a Montessori school to a public school. Her conclusion was that her daughter was in an unfamiliar environment and what animals do in unfamiliar environments is strike out in a fight for survival. You need to find some way of convincing your son that the school environment is as safe as your home. From my experience kids tend to strike out when they fear the unfamiliar.
posted by any major dude at 7:42 AM on September 24, 2012

I have a son with Asperger's syndrome and epilepsy. He is loving and caring almost to a fault, but then will have violent outbursts, often because he misread a situation. Your suspicion that your son is doing these things on purpose may be off; there could be any number of triggers that could be setting him off.

We've been able to keep the epilepsy in check with medication, but trying to understand the Asperger's is like trying to tie an angry eel into a knot. He's now 11 and just started junior high, which is a daunting experience for "normal" kids. My wife and I have constant meetings with his teachers, which is nice of them to make time for us, but also mandated by his IEP.

None of this is to suggest your son has either of these maladies, or any others. You need to raise your concerns with your pediatrician. He or she will likely refer you to a psychiatrist; your child could just be acting out to a new and scary environment, or he could have a debilitation.

I'm in Chicago also and we've seen every kind of -ist in the region. I can make more specific recommendations or answer any other questions you have if you want to memail me.

Also, it's very unlikely the school will kick him out based on what you've written here.

Good luck.
posted by Terminal Verbosity at 7:50 AM on September 24, 2012 [1 favorite]

Why Kindergartners Get Aggressive.

One of my nephews had trouble in school at first. His was more just not paying attention. But it's pretty common. Frustrating, anxiety, lashing out instead of using words.

I'd come up with a plan and also get him checked out by the pediatrician but it's not uncommon behavior in little kids. Has he ever been in a school before? Pre-school? Or is this a totally new transition for him?
posted by Marie Mon Dieu at 8:01 AM on September 24, 2012 [1 favorite]

There does not seem to be a single "bully" or anything like that

Except maybe him.

Former bully here... I was scared of school, of what other kids thought of me, of not meeting expectations of my parents. My parents were protective of me, i was good 90% percent of the time etc.

Bullies or other acting out violent kids are not typically terrors 24/7. I had a lot of excuses made for me as to why I acted the way I did, re: social pressures or being poor at adapting to change, or this is one time things because of a transition etc. I always felt like I was being attacked because I was so paranoid and fearful.

It took me until 8th grade to realize that I was the problem. I wasn't defending myself. I was intimidating and hurting other people so that I wouldn't feel so afraid.

In retrospect a lot more firm confrontation of the issue and a lot less adult excuse making and hand wringing would have helped. The person who woke me up was not a counselor but a cop.
posted by French Fry at 8:03 AM on September 24, 2012 [14 favorites]

Assuming your school is public, they should not try to kick him out. Helping kids like him is part of the mission.

I can't quite tell if these behaviors have just escalated since school started, or have suddenly appeared. Either way, you need to find out what is triggering them. When exactly does he act out? Is it during transitions between activities, during social/group time, when he is supposed to be quietly listening, etc.

Once a kid has told you they want to kill you, you are past the point where getting mad back helps. One strategy that I've seen often with aggressive behavior like this is simply taking a break. Tell your son "I can see you are overwhelmed and angry. Let's take a break." Then he goes to sit somewhere else, quietly, for five minutes, maybe with a book or a stress ball. After he's calmed down, you say "You were angry, but it's not okay to [x]. Let's get back to our activity." You also want to encourage him to put himself on a break, when he starts getting stressed. It's not about a time-out, or getting in trouble, it's about getting him to recognize his inappropriate behavior while not engaging with it yourself. This approach also works in the classroom, particularly if there's a second adult available. If there's no second adult, often teachers will work with someone else in the school- he can take his break with the secretary, with the security monitor, sitting in a bigger kid's room, etc.

Your pediatrician will be helpful in identifying whether there's a disorder or something else going on, your kid's school will be helpful in teaching you and him ways to manage his behavior. You are not alone!
posted by that's how you get ants at 8:19 AM on September 24, 2012

Did he ever do anything like this before entering kindergarten? If not, then it seems he's just having a lot of trouble adjusting and needs time to adjust (I didn't want to go to kindergarten and my parents had to come get me - for me it was just all about separation anxiety and adjustment, even though I had already attended pre-school). Could you help him adjust by starting with very short days there and then gradually increasing the time?

It seems that a young child usually has to work his own way out of that kind of a temper tantrum or meltdown - you can't get them out of it for them.

However, the language he's using and anger and hostility he's exhibiting do seem to be more than just a typical tantrum, and if any of that is directed at other kids, the school may feel that eventually it's risky to the other kids to keep him there. So short term you could see if he improves by gradually increasing his time there and not reacting to his outbursts,, but mid-term you might want to get some help but without stigmatizing or labelling him in a way that could be counter-productive.
posted by Dansaman at 8:22 AM on September 24, 2012

Also, is he eating normal meals? Is his sugar intake limited? Are they giving him any snacks at school that he doesn't normally eat at home?
posted by Dansaman at 8:23 AM on September 24, 2012

I just wanted to jump in and let you know that there should be options for the school to evaluate your son for free through the school system. You can request a meeting to talk about your concerns--that have been brought up and documented by his teacher--and request an evaluation, or request some "interventions" and a return meeting to see how the meetings have progressed.

In my district, this initial meeting is called a "child study" meeting. You can call the administrator of your school (usually the vice principal at the elementary level) and request a meeting to consider an evaluation or behavior interventions. In my district, we have to meet within 10 business days of a parent request for the meeting.

The team would probably request a special education teacher (preferrably someone with an "emotional disability" certification, a school psychologist, and your son's teacher at the meeting as well as the administrator. They would talk about concerns at home and at school.

Depending on your son's behavior and how strict your district is, they may request an evaluation right at that meeting, or they may develop an "intervention" plan to have consistency among staff and a plan in place for what to do when your son shows this type of behavior.

The most frustrating thing about these meetings is the long deadline given to schools. If the school agrees that an evaluation is necessary, they have 65 business days to complete the evaluation before meeting back to talk about the results. If your son qualified for any special behavioral support, they would have 30 days from THAT meeting to meet back and talk about the plan. So, that's 95 days--more than half the year--before your son would get services.

Your tone from your question is one of concern for your son, not finger-pointing or blaming the school system. Your tone shows that you are truly looking for help and reasons, and your son's school will see that if you end up meeting with them to talk about your son.

I am a speech therapist in a school and I'm pretty familiar with the system and what your rights are as a parent, although behavior issues are a professional weakness of mine. If you have general questions along the way, please memail me if you think I could help.
posted by shortyJBot at 8:29 AM on September 24, 2012 [1 favorite]

I also did not mean to jump the gun and suggest that your son has special needs. Just, if you feel like you need to go there or want an evaluation, the school is a possible free option.

It does sound like he is just having difficulty adjusting to his new environment in kindergarten and testing his boundaries there.
posted by shortyJBot at 8:31 AM on September 24, 2012

Is this behavior completely new with starting school, or did you experience some of these issues before school started and it seems to be amping up? If you saw even a fraction of these issues before school, I would suggest first meeting with your doctor.

If this is all completely new behavior, with no inkling of it at all prior to beginning school, I would seek the support of your school counselor, social worker, nurse...any support person you feel comfortable with and who you feel will be an advocate for your child. From that point, you can propose a meeting with the teacher and support staff to develop a plan for your child. The mental health expert can help to come up with proactive strategies (communication techniques, ways to relax, pin-pointing when these behaviors are occurring, etc).

Or, you could pursue both paths at the same time. It is possible that there is a medical reason for these behaviors, but while that is being explored, it cannot hurt to plan for his days at school as best you can.
posted by retrofitted at 8:54 AM on September 24, 2012

Also, if you really are thinking they want to "throw" your child out of school, you might want to research the rights you and your child have in terms of public education. Start with the State Department of Education or the school district websites and go from there. Another option is to look at information from educational advocacy organizations (these are typically framed as rights for kids with disabilities, but the information applies to all kids). If this is a public school, there are policies in place to protect your child. This will be good information for you to have and keep. You may not need it, and I wouldn't recommend using it at today's meeting unless you have to. Try to approach it as "I want to help my kid, and I want everyone involved to feel happy and safe" etc...Good luck! (ok, I'm done!)
posted by retrofitted at 9:02 AM on September 24, 2012

I am not an adolescent behavioral specialist, but I HAVE worked with them and I HAVE written multiple IEP/IBP plans and I have done and participated in a LOT of counseling.

The key issue, always, is to identify the root problem. Is he scared? Is someone hurting him that the teachers aren't seeing? Is there something telling him to do it? Did he stay up too late the night before? Is he sleeping? Is he sleepy? Is he hungry? Does his tummy hurt? Is he having nightmares? Do his shoes fit?

I tend to always revert to food and sleep, because with the kids that I worked with, those were almost always the root problem. I'm not saying it's not something else, but almost no qualified professionals are going to give you a *diagnosis* for a 6 year old, and most behavioral specialists are going to ask what I did and then come up with a game/chart/system.
posted by TomMelee at 9:06 AM on September 24, 2012

Sorry, this sounds like a really trying time for your family.

As some of the PPs, I admire that you aren't pointing fingers at the school and I'd encourage you to continue to work with them. They should have counselors that you can ask to speak to.

FYI in many states they actually can "kick" a kid out of regular school as long as they pay for them to be sent to an alternative school. These schools are chock full of kids with extremely severe psychological and behavior problems. This is really as a last resort and normally there are a ton of hoops for the school to jump through first. That being said, I agree you should be aware of your child's rights in this situation.

If you feel like your school doesn't have enough resources, call your health insurance company (assuming you are insured) and ask for recommendations for child therapists. Call around and explain the problem, get a feel for 2-3 whose approach you like and then visit with your son.

I agree that you should also see your child's pediatrician and possibly a psychiatrist to explore the possibility of a medical issue.

As you note in your question, there are a lot of avenues for treatment. I'm not sure anyone can know exactly where you will find the answer; it's just important to get the ball rolling.

Armchair diagnosis take with a huge grain of salt: It is very strange to me that this behavior has stared all of a sudden. Did he attend preschool or is this his first time in a classroom? If you havent already, sit down to discuss this with your son when he is in a good mood. Don't accuse, just tell him you are concerned that something is bothering him. I would ask him if anyone has said or done anything to upset him. Not to scare you, but I might also ask if someone has touched him in an inappropriate way.
posted by murfed13 at 9:12 AM on September 24, 2012

You need to see a behavioral specialist sooner rather then later. If you trust your pediatrician they should be a good resource for you to find a specific specialist. If you don't have a regular pediatrician then the school should have resources they can recommend.

Is there anything "wrong" with your son? I don't know, it's certainly possible that he's "just" having trouble adjusting to a new routine. But he's clearly having a LOT of trouble adjusting, and seeing a professional could at the minimum offer him some better coping strategies for these times.

6 year-olds can be challenging to get specific, accurate information out of. My child started kindergarten this month as well, and I've heard a lot of complaints about it being boring, but I can't get specific details to save my life. So if she were having more dramatic issues, or acting out I would have no material to address the problem with.

My 8 year-old nephew has had a lot of anger issues, starting when he went into a more structured preschool program at 5. He would be fine and then just snap- with a anger that was frightening because of how real and intense it was. His parents tried a ton of coping strategies, they changed his school, they did positive reinforcement, they saw a psychologist. They did everything they could think of for 2 years. Last year they finally allowed him to try ADHD medicine, and the change was instantaneous. The relief that my nephew felt was obvious, his behavior improved, his anger subsided. IANAD, I have no idea if your son has the ADHD or any other clinical problem. But I do know that the universal response I've heard from people who finally seek professional guidance is "I wish I had gone sooner. We suffered with this for too long because we thought there was some shame or stigma in getting help"

Go sooner. Find out what your options are, you don't have to follow the advice but you should at least hear what they have to say.
posted by dadici at 9:25 AM on September 24, 2012

Ok, it's education acronym time!

In 1990, a federal law called IDEA (Individuals with Disabilities Education Act) was passed. IDEA says that schools must provide every student with two things:

(1) FAPE (Free and Appropriate Education). This means that every student will be provided with an education appropriate for them, free of cost. Your school district must provide the services your child needs. There's no just kicking him out.

(2) LRE (Least Restrictive Environment). This means that schools must give each student as much time in a regular classroom in a regular school as possible. They can't just ship kids off to "alternative schools" at the first whiff of a problem.

How do schools determine what is appropriate and least restrictive?

(3) IEP (Individualized Education Program). This is when you, your child's teacher, other relevant school staff, and other relevant professionals get together periodically to make a plan for how to best educate your child.

I don't think that you will necesarilly end up here, based on 8 days of bad behavior. But if you do, know that there will be a whole community of professionals working with you for your kid. That's not to say that it will be easy, or that you will always agree on what he needs. You may end up having to being a strong advocate for him. I just want you to know that no matter what problems a kid has, his school district MUST educate him. Schizoprenic kids? They go to school. Blind, deaf, wheelchair-bound kids? They go to school. Three-year-olds with Down Syndrome? They go to school.
posted by that's how you get ants at 10:44 AM on September 24, 2012 [4 favorites]

Do you know where he might have learned those things? Is there a child in his play group that says those kinds of things? Does he say anything when you ask him why he says those things or how he feels?
posted by discopolo at 11:14 AM on September 24, 2012

Instead of a child psychiatrist, perhaps start with a child psychologist?
posted by discopolo at 11:15 AM on September 24, 2012

MeMail me?
posted by Andrhia at 11:30 AM on September 24, 2012

If he were going to be expelled from a public school in Illinois, you would have been served written notice by certified mail and/or process server. It's a Constitutional Due Process requirement.

There should be resources through the school to help him. Memail me if you have questions about the discipline and expulsion process in Illinois. Or special ed bureaucracy.
posted by Eyebrows McGee at 3:02 PM on September 24, 2012

School can be a huge transition for kids. I am not in the US, so I don't know what agencies you have in Chicago. But, here in Canada, I would tell you to go to your doctor and see if you can get a designation for a support worker at the school, so that there is an extra person in the class to help your son with his anxiety. I know some people who have a son who has been asked to leave kindergarten and I think it makes more sense to seek a designation, rather than put your son through another transition. I would not worry that this creates a stigma - they aren't necessarily even allowed to tell people who the support worker is for.
I would see if there is a family services agency in Chicago and ask them where to go. Or maybe your doctor would know.

Memail me if I can help more - I can give you more detailed info.
posted by Chaussette and the Pussy Cats at 9:25 PM on September 24, 2012

Mefimail from (purported) anon asker:

"He usually says "I don't want to talk about it." It is very hard to get any kind of explanation out of him. But sometimes he says "kids were making fun of me." He has social difficulty with large groups of kids but plays very very well one-on-one. He is socially outgoing but in groups he often becomes the target of teasing or exclusion - he's outgoing but a little awkward. We think he is having a hard time socially at school, and that he is overly sensitive to social issues, but it is still hard to explain the totally over-the-top extreme acting out."
posted by colin_l at 8:09 PM on September 25, 2012

OP, I want you to know -- as someone who reads discipline files for a large district -- the behavior, while obviously something that has to be dealt with, isn't that unusual. If we had your son's file and someone in the meeting asked, "Why is that kid behaving like that?" everyone with experience with school discipline would reply, "Because he's six." I responded so briefly in my first comment because I was actually between two school discipline meetings and using my phone to respond.

Honestly, one of the most common forms of acting out we see in boys, until they're like TWELVE? Growling threateningly at adults, as if they're dogs. Not, like, under their breath, but growling menacingly in response to a question or a gentle suggestion. It goes on for years as a weirdly common stress response by boys to adults in positions of authority. It's never a girl thing, it's usually when a child feel stressed by a combination of school and social stress, and it's sometimes combined with hiding under desks. Kids act out in WEIRD WAYS that do not reflect on you as a parent; it reflects on their inability to process their emotions, connect them to their stressors, and express any or all of that. So instead they hide under desks and growl at math teachers. (I know you FEEL like it reflects on you as a parent -- my kid keeps pushing other kids at pre-school and OH GOD I feel like the worst parent -- but it really doesn't reflect on you. Kids act out in odd ways.)

Down in my district, we would have him talk with some of our district therapists (who are licensed in various ways). Maybe a social worker, maybe a psychologist, maybe a developmental assessor, who identifies any areas of concern in intellectual development. Sounds like tough adjustment to school, which they can work with, and help with the social issues. Our district is big on behavior plans, where the professionals work with the student (and teacher, and parents) to come up with a student-directed plan to keep his behavior within appropriate boundaries, and what to do when he can't. Maybe when he feels the rage coming on, he can get a special hall pass that lets him go right to the principal's office. (Sometimes kids can't identify the problematic triggers, but they know when they need to leave or lose it.) It would include consequences, plans for how to get help, support services, scripts for him to follow when he needed a teacher to step in, all kinds of stuff like that.

I mean, this is bad acting out, no question, and you want it to stop. But it's not a crisis and it's not a novel situation and there are lots of caring people in the schools who have the tools to work with this. (And even if he's in private school, he's entitled to certain services.)

There should be a lot available to you through the school. But I do know a psychiatrist who works with children and adolescents who is FANTASTIC and who is the man you want to see if you go private. He's especially good with bright or gifted kids who are struggling. He's in Evanston (with whatever they're calling Evanston/Norwestern hospital these days). Memail me.
posted by Eyebrows McGee at 9:35 PM on September 25, 2012 [1 favorite]

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