Any advice on how to help a struggling child?
February 27, 2017 12:06 PM   Subscribe

I have a small child in my life (between 4 and 5 years old) who is struggling to keep up with his peers.

He's smart but struggles with self control issues, such as being unable to sit still for any length of time. He is generally unable to remain focused on a given task (preschool classwork, staying seated while eating dinner, getting dressed on his own, and putting away toys without stopping to play with them again are all good examples). He is also more volatile than his peers, tending to break down into tears for very slight cause. At preschool, he tends to gravitate toward and play with younger rather older or same-age children. When he does play with children who are his age, they call all the shots (he doesn't interact with them as a peer).

He may also have a small amount of sensory issues -- an intense disliking of certain textures on his hands, for example, and covering his ears if he encounters a sound he doesn't like. These sensory issues are very mild, at least in the sense that were they to exist in isolation, they would not be causing any difficulty in his life.

To be absolutely clear, the instances above are being judged as difficult for him in the context of the performance of his peers (preschool classmates and same-age children in my network of friends and family). His teacher has noticed this and is encouraging an extra year of preschool to help him develop further. So please don't think I'm coming at it from a place of unreasonable expectations. All of the above examples are things every child struggles with, but his struggles are greater than his peers' and have a larger relative impact on his life at school and in the home.

I am coming at it from a place of relative ignorance, but I'm in a position where I can devote time and resources to help the child (and the parents welcome this help). Are there personal experiences that you could share that are relevant, or research-based interventions that have been shown to help increase emotional intelligence, self control, and related behaviors?
posted by Nonce to Human Relations (29 answers total) 3 users marked this as a favorite
 
I would send them a link to Hoagie's Gifted page.

He may be twice exceptional. The description sounds like my oldest when he was little. He was initially identified as just "special needs." He was 11 before someone informed me very casually that he was smarter than his younger brother who was a straight A student and qualified for the gifted program in three states.

Kids who are bright but also have some kind of disability struggle greatly and adults around them tend to fail to recognize that they need accommodation in both directions at the same time. Recognizing that is game changing for such kids.

I would also look into trying to improve his nutrition. These kids often benefit from extra b vitamins and certain other nutrients, like magnesium. I did a research-based supplement protocol I found on the internet with B vitamins and magnesium and after about a year my oldest son showed marked improvement in some of his problem areas.

He still was not normal by any stretch of the imagination, but he was much less difficult to deal with and much less miserable.
posted by Michele in California at 12:14 PM on February 27, 2017 [1 favorite]


This is what early intervention screening is for, he can be enrolled in all sorts of therapies to give him the skills to cope and develop. I don't know where you are, but this should have already been suggested by his teachers or pediatrician. Google resources in your area! This is all text book for being on the Autism spectrum.
posted by jbenben at 12:15 PM on February 27, 2017 [13 favorites]


Seconding jbenben. The parents should have the school get early intervention testing done. One could throw all sorts of solutions at this kid but it would make sense to get some baseline testing to get an accurate sense of where exactly he is and possible issues he may be having. Holding him back a year could be a good idea but he could also thrive in Kindergarten if he has appropriate supports.

The thing about testing is that is should be free and the parents are 100% free to disregard the results. Testing doesn't commit anyone to anything (except the testing).
posted by yes I said yes I will Yes at 12:22 PM on February 27, 2017 [3 favorites]


Nthing screening. An absolute must - it will help tremendously as the child continues in school.
posted by Ashwagandha at 12:23 PM on February 27, 2017


Definitely seek to get an assessment, buuuuuuuut... remember that all kids develop differently. There is a lot growth between 5 and 7. Amazing, really.
posted by My Dad at 12:46 PM on February 27, 2017 [10 favorites]


His teacher has noticed this and is encouraging an extra year of preschool to help him develop further.

I would be wary of this advice if the parents are paying for preschool. It would be far better to have the child assessed and receive appropriate services in Kindergarten (where he could get support and possibly repeat that year for free) than pay for another year of preschool where he's not getting special ed services.

This is all text book for being on the Autism spectrum. and He may be twice exceptional. and sounds like maybe adhd or autism or williams syndrome

Yes, and he may also be perfectly neurotypical and developing at his own pace. Based on this little information, it's not a good idea to diagnose a child with a disability.
posted by yes I said yes I will Yes at 12:59 PM on February 27, 2017 [6 favorites]


Could you please clarify what screenings / tests to request and whom to request them from? His pediatrician? The school system he's not yet enrolled in?

maiamaia, I googled William's syndrome, and he doesn't have the facial features associated with it.
posted by Nonce at 1:02 PM on February 27, 2017


There is a huge spectrum of normal at this age. My son is similar. Less on the emotional volatility front, but otherwise emotionally behind the curve of his peers and unable to sit still even to do things he enjoys. I do worry about him starting kindergarten next year, but at the same time he's clearly intellectually bored at preschool already.

Your little friend may already have been evaluated for early intervention (in my school district, evaluators go around to all the local preschools, public or private, and do pull-out evals at regular intervals) but check and see. Generally, though, to qualify for free EI through the school district, the needs have to be fairly pronounced. My kid did not qualify (though they did come back twice to test him because he was on the cusp and they wanted to be sure).

One thing we do to try to foster greater emotional intelligence is that every night before bed, we talk about all the feelings we had that day. For him, he usually still just says "I was happy all day." (And it is true that he is happy like 95% of the time, which is both a blessing for us as parents and a bit of a curse because it makes it hard for him to empathize with negative emotions in others.) But I try to get him to talk about some other emotions he had, like say when he didn't want to put his shoes on, or when his friends were playing without him, or when he got a good behavioral report at school. And I talk to him honestly about some of the emotions I had during my day. (Leading to conversations such as, "Did you read the news today, mommy?" "Yes, I read the news every day." "And how did it make you feel?" "How do you think it made me feel?" "Angry.")
posted by soren_lorensen at 1:03 PM on February 27, 2017 [10 favorites]


It depends on where the child lives. Here's info about how to get it done. A pediatrician can ask for the testing, the preschool can refer the child or the parents can ask the school district's early intervention office.
posted by yes I said yes I will Yes at 1:06 PM on February 27, 2017 [1 favorite]


He may also have a small amount of sensory issues -- an intense disliking of certain textures on his hands, for example, and covering his ears if he encounters a sound he doesn't like. These sensory issues are very mild, at least in the sense that were they to exist in isolation, they would not be causing any difficulty in his life.

Honestly, there's no way for internet strangers to tell if kid has some problematic sensory processing disorders, hence that is why you'd want to get this assessed, but your description could be applied to children with a sensory processing disorder (or a totally neruotypical kid, as a few have suggested). Just because they don't appear to be negatively impacted by their sensory disorder, doesn't mean that's the case. 'Small' sensory processing disorders can really cascade into large problems if left unchecked. Kids only have so much energy to expend, and if they have to add in sensory processing problems on top of their normal energy expenditure, you can sometimes get behavior like you're describing. Basically, what I'm trying to say is that you don't know if the sensory problems are something or nothing, and recognizing and treating sensory problems can have a much larger impact than most people think. Get them screened. It's worth getting a positive or a negative on this, because then you know where to spend your energy in getting them help.

As for getting services, it really depends on what country you're in, and if you're in the US, it depends where you are regionally. But our path to diagnosing our kid's sensory processing disorder was long an twisted. Start with pediatrician, ask for a referral to a psychologist, ask the pschologist if they have experience with sensory processing disorders and how they screen for them (because some don't have experience with sensory processing disorders, and don't screen for them...which is problematic and will sometimes result in a false-positive autism diagnosis).

Parallel to this, kid's parents should be contacting Early Intervention services in their local school district (again, depends on where you are located). School districts work with kids well before they hit school age, and will often have a staff to go help the kid out at their daycare/preschool/home/wherever.
posted by furnace.heart at 1:09 PM on February 27, 2017 [2 favorites]


He's a boy and he's a little immature for his age. This is 100% normal, especially for boys.
posted by Rock 'em Sock 'em at 1:18 PM on February 27, 2017 [2 favorites]


Also, this description is not even close to autism spectrum or williams syndrome. Maybe maaaaybe adhd but frankly it's all well within normal range for a 4 year old.
posted by Rock 'em Sock 'em at 1:20 PM on February 27, 2017 [5 favorites]


If you are concerned for him based on comparisons with his peers I would definitely get him evaluated. You may help the parents out by trying to write out in detail any questions or notes about developmental milestones - CDC checklist version for 4-year old and also 5-year old and bring that to an evaluation or when you have an appointment with the pediatrician.

Has the preschool given you a sheet showing him progress on milestones? Can you get a list from the local school of what is considered kindergarten ready? (e.g., we got a list, e.g., cuts with scissors, listens to an entire story, etc etc).
posted by typecloud at 1:24 PM on February 27, 2017


In terms of research-based interventions, parent behavior training is recommended for ADHD before medication for younger children, so it might be worth reading about, but really the evaluation needs to happen first.
posted by typecloud at 1:28 PM on February 27, 2017


Nthing talk to your pediatrician to get an idea of how to go about getting screening. Both of our young boys were late talkers, and the older one was a late walker, and it was our pediatrician who suggested we pursue this for our boys. Both were screened by professionals and given supportive services at no cost to us (we're in New Mexico, FWIW). This helped older brother on both fronts, and now he's a non-stop chatterbox, while little brother is getting better at verbalizing.

Older brother also had trouble with fine motor skills, and was easily frustrated by that, which made pre-K trying at times, especially as he saw his peers doing fine. Now in Kindergarten, he's getting a lot more confident, but he's still prone to freak out about small things, including homework, when he's tired.

Older brother also does a lot of solo-play, because he didn't have an older sibling or go to daycare, like his little brother. He has friends in Kindergarten now, but he's not as much into sports with other boys, probably because we're not a sports-focused family. And he's obsessed with dinosaurs, which not everyone wants to play at school, so that may be another playtime friendship limiting factor.

In short: talk to your pediatrician for their input, and then their direction on screening, and find some comfort in the notion that this may well be a phase, but one that could be eased with special support.
posted by filthy light thief at 1:31 PM on February 27, 2017


If you are concerned for him based on comparisons with his peers I would definitely get him evaluated. You may help the parents out by trying to write out in detail any questions or notes about developmental milestones - CDC checklist version for 4-year old and also 5-year old and bring that to an evaluation or when you have an appointment with the pediatrician.


I get where this is coming from, but don't use a 5 year old milestone checklist to evaluate a 4 year old. He's 4 and it's best to think of him as 4 until he is actually 5. The physical change from 4yo to 5yo is not as impressive as it is from baby-to-toddler, but the change in preschooler behavior between 4 and 5 can be substantial.

As you can see from the checklists, not having a 5 minute long attention span is on the 5 year old checklist. It is not on the 4 year old checklist! That is because the typical behavior is different.
posted by Rock 'em Sock 'em at 1:33 PM on February 27, 2017 [3 favorites]


My oldest is a little bit older and in a mixed K/TK class. There are three TK kids in the class who sound just like the child you are describing. They constantly interrupt the class and constantly get scolded for it. In my opinion, as this is their first taste of actual school, they are being woefully underserved, and they would have benefited more from spending an extra year in preschool to develop their maturity a little bit. Tbh I'm a little concerned that they will become kids who hate school because they view it as boring and too rigid. So my two cents is listen to the preschool teacher and plan to hold this child back one more year, and then perhaps follow up on the other advice for early intervention screening.
posted by vignettist at 1:35 PM on February 27, 2017


Our son had some similar problems, and after speaking to our pediatrician, she recommended we take him for an occupational therapy evaluation. We took him to a private clinic in our area that was recommended both by the ped and by a friend. He was diagnosed with sensory processing disorder and some related gross motor delays. He's been going to OT for coming up on 2 years now, and it has been a strong positive for us and him. One of us goes to the sessions with him, and in addition to its improving his physical coordination, emotional regulation, and self-control, we've worked with the OT to develop strategies to manage him at home and school. There are definitely things that the adults in his life can do or not do that have a HUGE impact on his ability to cope.

One of the frustrating things about children this age is that there is such a wide range of normal that you get everything from "pfft, totally normal" to "omg autism" for the same behavior from casual bystanders. We probably waited longer than we should have to get help, because of all the "pfft, totally normal." Maybe a helpful way to think about it is, each individual thing our son did was within the range of normal, but most kids do a few but not all of those things. We knew he had some motor issues (but kids learn at their own pace), but we didn't realize how bad. Having an actual evaluation, with metrics, was very informative.
posted by telepanda at 2:27 PM on February 27, 2017 [10 favorites]


The things you do for a kid with ADHD - structure, repetition, patience - all help kids in general. I would recommend working on mastery of something not school-related, like walking in the woods learning plants, or swimming. Confidence helps, learning builds confidence, and physical skill helps build mental skill, certainly with kids.
posted by theora55 at 2:40 PM on February 27, 2017 [1 favorite]


I really want to nth the recommendation to get him evaluated. We here on the internet can't decide what is going on with him -- might be nothing, might be something subtle, might be something that is really straightforward, who knows. Someone whose job it is to actually diagnose a kid will be able to tease these possibilities apart.

I say this as someone who about a year ago asked a similar question about my then-three-year old. The advice then was overwhelmingly "go to have him evaluated" and after dithering for a while, we did. It was super super helpful, he was diagnosed with mild autism and is receiving services and doing well. Plus, my peace of mind is much higher, because I'm no longer stuck in "what if" land. Whatever happens, being out of that land is well worth it.

My question has a lot of feedback from people about how to get him evaluated, what it entails, etc. so you may be interested in reading it for that. I found those comments extremely helpful and it sounds like you're in a similar place to where I was.
posted by forza at 3:23 PM on February 27, 2017 [2 favorites]


This pretty much describes my son at that age. I was told by an old hand preschool teacher that he might be best served by starting school a year later. There was nothing diagnostic although later a doctor did diagnose ADD and we attempted medication for a few years in middle school.

I think he was just emotionally immature with some sensory integration issues as well. I didn't hold him back because he is very intelligent and also because he has a cousin who although almost a full year younger would then be in the same grade. In retrospect, I didn't hold him back because I didn't feel comfortable with it, as if he had failed preschool. My fears that he'd be bored were silly as the range of competencies of children in every grade allowed for all kinds of learning. Many of his friends in his school years were a year older as they had been held back and it seemed to serve them well. He did not struggle academically, but struggled in other ways more difficult to see. If I had it to do all over again I would have let him mature a year. I asked him a couple of years ago when he finished high school and he said that, yes he thinks he might have been better off in the same grade as his cousin and doesn't think it would have bothered him as it is so common with boys. He feels he wouldn't have been playing catch up to boys that were more self assured, but would be better integrated with real peers.

I know it's a hard decision, but know that it's a common one.
posted by readery at 3:38 PM on February 27, 2017 [1 favorite]


The only thing that really helped my kids was time. Various psychologist-approved strategies were attempted but none seemed to be helpful. Treating my kids with respect and empathy, and not forcing them into situations or behaviors they were uncomfortable with, was important to me and I believe helpful in the long run.
posted by metasarah at 4:58 PM on February 27, 2017


I would also recommend early intervention services. It could be nothing, but it's late enough in the school year where I feel that the teachers have a good handle on how well he's adjusting, and I'd take their input seriously. It's not unusual for boys this age to exhibit these behaviors, but it is unusual for there to be no progress in this area. This assumes that he's closer to 5 than 4.
posted by snickerdoodle at 5:18 PM on February 27, 2017


Also, this description is not even close to autism spectrum or williams syndrome. Maybe maaaaybe adhd but frankly it's all well within normal range for a 4 year old.

This description fits my 4 year old autistic son very closely. I'm not making any judgement on whether the child in question is on the spectrum; I agree with the recommendation to pursue professional assessment in that case. But there is a lot of misinformation about ASD, and it really is a vast spectrum, so I did want to counter the incorrect statement above.
posted by JenMarie at 6:53 PM on February 27, 2017


"Nthing talk to your pediatrician to get an idea of how to go about getting screening. "

Pediatricians can sometimes be helpful but sometimes not as much; if your tiny friend is in the US, the public school district that serves his geographical area (so, yes, the one he is not yet enrolled in) is responsible for providing screening and early intervention services to children 0-5, which are federally funded. Typically if you google "Pasadena District 220 Special Ed Early Intervention" or whatever, you'll turn up the right contact info -- parents ARE allowed to self-refer and do not require a pediatrician's referral. (If you can't turn up early intervention/screening info online, call the district's special ed department and ask.)

Where I am, the 0-2 screenings are done at Easter Seals, and the 3-5 screenings at a local school with a pre-K program. Similarly, some services come from Easter Seals, others directly from the district. That's all normal; schools may aggregate to provide services from a specialist provider like Easter Seals, they solve all the money parts on their end. It's also normal for districts to do it all in-house, or to refer all of it out, or to have a "circuit rider" team who visit several smaller rural districts; there are a lot of models. (And every state has slightly different funding and provision models, of course.)

But yeah, the place to start is to talk to the pediatrician and/or call the local public school district and ask about developmental screening. Kids develop SO unevenly before about 7; it's difficult to tell if they're having normal lags and leaps that all kids have, or if there's a developmental problem. Screening can help sort that out. And some kinds of developmental problems can be really successfully addressed with early intervention (speech/language delays are a great success story of EI, for example) and resolved; other developmental problems are longer-term or life-long issues (such as the autism spectrum or ADHD), but the sooner you know what you're dealing with, the sooner you can start getting supports in place that will help not just the child but the whole family. (Also, sometimes with kids this young, the diagnosis will be "We think there's something here but we can't tell what until he's a little older" and you'll get support for the issues you're facing on an ad hoc basis, and they'll keep evaluating as he grows, and that's okay too.)
posted by Eyebrows McGee at 7:16 PM on February 27, 2017


My two youngest who I parented at that age had special needs that were identified by teachers and parents and needed adaptations, but they were strikingly obvious differences. Another child I am closer to right now is getting feedback about falling behind similar to yours, but this is coming from a new teacher in the school when the other adults in this child's life who are much better evaluators due to experience with multiple special needs are rolling their eyes because the kid is smart, happy and doing very well, just at her own pace and not according to the teacher's rigid checklist.

I've had an evaluator tell me one kid would never be able to manage to read or live independently, another tell me the kid had no real speech issues - first kid has a a job, reads novels, travels on their own internationally etc, second one struggled due to missed speech therapy. Get evaluation, but talk to other parents to get a good evaluator if you have the choice, someone who other parents recommended does a thorough job. If you live anywhere that's got non-profit driven, I'd go for that because my experience has been that the profit driven places have more dire diagnoses, overall, but I live somewhere with a flawed but good national healthcare system.

Early intervention and diagnosis is great, even if it is just to say yup, your child is fine. Teachers are not developmental pediatricians. They're early screening tests by way of seeing lots of kids, but they aren't experts in specific diagnoses and there will be false positives.
posted by dorothyisunderwood at 7:48 PM on February 27, 2017


Teachers are not developmental pediatricians. They're early screening tests by way of seeing lots of kids, but they aren't experts in specific diagnoses and there will be false positives.

This. I'm a special education teacher and even though I do testing that is considered when creating an overall profile and I'm part of the TEAM decision, teachers don't diagnose kids. Teachers know better than to make educational recommendations for kids who haven't been tested, and we definitely should not recommend red-shirting a kid unless they've been tested (red-shirting is holding a kid back a year).
posted by yes I said yes I will Yes at 2:12 AM on February 28, 2017


Also, this description is not even close to autism spectrum or williams syndrome. Maybe maaaaybe adhd but frankly it's all well within normal range for a 4 year old.

This description fits my 4 year old autistic son very closely. I'm not making any judgement on whether the child in question is on the spectrum; I agree with the recommendation to pursue professional assessment in that case. But there is a lot of misinformation about ASD, and it really is a vast spectrum, so I did want to counter the incorrect statement above.

Thank you for clarifying! I should have said that it could describe a neurotypical child or a child with ASD but that nothing in the description stood out to me as being necessarily atypical. We may disagree on that, which is fine, but I certainly did not mean to imply that it is incompatible with an autism spectrum diagnosis. So thank you for pointing that out.

The difficulty with these kinds of online descriptions (and why I should have been more careful!) is that this also perfectly describes the way my neurotypical 6.5 year old was as a 4yo. In my family there are several diagnosed ASDs, other developmental disorders, and learning disorders. Additionally, my son has restricted eating (one of the things that tends to come with ASDs). So we had really intensive developmental evaluations done at 1.5 and 3yo, and a screening done at every physical. Ultimately, our son grew out of almost all of the behaviors we were concerned about, which includes all the behaviors described here. Similarly, he was definitely a behavioral outlier for his preschool class. Much shorter attention span, not great at playing cooperative games, lower language skills than average---in short, he was "that kid" in his class. However, it seems like that likely had more to do with the demographics of the preschool (upper middle class and wealthy, lots of very high-acheiving parents who could be expected to pass their outlier self-control, intelligence, and verbal skills onto their children). My son was not actually developmentally behind, he was in a bubble of weirdly calm, verbal, and obedient kids.

I remember one weekend when we went to a playground and I ended up hanging out with strangers from the more demographically "normal" neighborhood I lived in, instead of our regular UMC preschool crowd. All of a sudden my son went from being "that kid" to being an average kid. In the end, even though he didn't have a diagnosis, we ended up holding him back a year. It helped his self-esteem an enormous amount because he got to be a sort of leader in the preschool classroom for a little while (Montessori does this on purpose) and he felt like he able to achieve mastery of a lot of the self-control and self-care skills he was a bit behind the other kids on. (I was also lucky to have access to a preschool that was phenomenal at switching things up and keeping him entertained and challenged.)

I do want to make it clear that there is nothing at all wrong with getting evaluated, and I definitely recommend helping the parents do so if it seems doable for them and they are worried. At the same time, I would really hesitate to start worrying about specific disorders without much more information than what we have here.
posted by Rock 'em Sock 'em at 3:23 AM on February 28, 2017 [1 favorite]


If for whatever reason you decide you want an independent screening/evaluation other than the one your local public school district provides, that is a service Minds In Focus provides.
posted by brainwane at 8:10 AM on February 28, 2017


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