Anxiety & OCD

[lmh2402]

anyone have a young child (under age 4) "diagnosed" with Anxiety and/or OCD? if so, how have you been managing his/her manifestations? if therapy - what kinds? behavioral strategies? medication?

we've seen a gazillion different kinds of people over the last 3 years and always i've thought DS seems to obviously have an anxiety issue

he has no formal diagnosis, but many, many times we've heard that he seems to tick all the boxes for being on the spectrum EXCEPT for his relatedness.

our current psychologist specializes in autistic spectrum behavior management and again, when we had our first parents only meeting and described our concerns, DS' behavior, etc...the psychologist said, "sounds very spectrum-like to me, but let's have him come in so i can meet him."

at the end of his meeting with DS, he said, "no. definitely not on the spectrum."

ok. then after filling out these forms and having his teacher fill one out, the psychologist now says that DS suffers from anxiety fueled by OCD.

he says our options are behavioral strategies and/or medication.

i am very leery to start psych meds for my less than four year old kid

and we've seen some success with some of the behavioral strategies. but honestly, things are still really, really tough

the mornings are just the worst. we had a few day reprieve when we introduced a new set of rules that DS seemed to think was fun to play as a game. so that worked and he was happy to "play"

but then as of tues, out of the blue, right back to square one.

i'm really at my wits end and not sure what else to try.

we've been trying incentives. we've been trying negative consequences. we've been trying to extinguish by ignoring. but it feels like we're throwing cups of water at a house fire.

i'm extremely discouraged and so sad

he went to school this morning without any breakfast b/c he absolutely refused to yield and stop throwing the food. i have taken away all his favorite toys.

my heart is broken and my head hurts.

i am scared to medicate and scared that i will never see any improvement unless we do

and my husband is really totally useless in this whole process. he isn't here enough to participate. and when he does, he has no focus, no consistency and no time to stay the course and hold his ground. so DS just runs him in circles and then he leaves for work and i'm left to clean up the mess

ugh. any BDTD or advice or words of wisdom would be most appreciated

thanks

[mom2khj]

I don't have any advice for a little one that young, however, we have been through anxiety/ocd with DD1 (didn't start until age 9, likely set off by puberty).

These are a few resources we've found extremely helpful. I'm not sure how much will apply to such a young one, but I'll offer them up anyways.

My heart goes out to you, I know what a struggle it is to deal with DC going through things like this.

http://www.anxietybc.com/ <- this website had a TON of information for me, including specific things *I* could do to help DD

These are a few books we've used and found really helpful.

Kids Guide to OCD (http://www.amazon.com/gp/product/1591478057/ref=oh_details_o08_s00_i00)

Kids Guide to Anxiety (http://www.amazon.com/gp/product/1591473144/ref=oh_details_o08_s00_i01)

Freeing Your Child From Anxiety (http://www.amazon.com/gp/product/0767914929/ref=oh_details_o08_s00_i02)

Our ped also recommended Yoga, here are a few kids resources we used:

Kids Teaching Yoga DVD (http://www.amazon.com/gp/product/097992894X/ref=oh_details_o02_s00_i00)

Yoga Calm for Children (http://www.amazon.com/gp/product/0979928907/ref=oh_details_o02_s01_i00)

[wellyes]

DD has some of those issues. We are looking for a psychologist or family therapist that specializes in CBT ---- which is a very common therapy technique for anxiety. It's not easy to find someone who takes kids and is accepting new patients, but, we just keep trying.

I would absolutely not consider medicating a young child unless other therapy attempts failed. I know there are posters here who've had success with CBT for their kids, hopefully a couple will be able to chime in.

[Sweetum]

Have you contacted your school district? The IEP or related process can bring some help. In the process You could get an evaluation from a psychologist not for diagnosis but for goals to work on, for areas of challenge. You cold even find a private one. It seems like you have been focused on diagnosis when you have met these professionals. It may be time to move beyond that and get specific recommendations for things to work on. The same person(s) would be able to recommend the therapy strategies and who could provide them. It is important, I believe that a professional therapist work with you not just someone who you consult with. These people have training and chart the progress (I am talking about ABA here) and know when something is working or not working. Depending on each situation, the parents sometimes do the therapy themselves but IMHO it is best if the parent does not work but rather has strategies to manage in the interim.
Another important thing is to find local parent groups. They are going to be your best resource in finding the right help. Your school district might have a mailing list of all parents of kids with special needs. There may be an NGO that helps with this. Or contact any ABA company and ask what parent groups they socialize with professionally. You will find that you are not the only parent in this type of a situation.
I apologize if I have mentioned things you already know, I didn't look at your background.
When DS was diagnosed with Autism, I came here and posted a bunch of questions, and Gena and others guided me. That was my starting point and the best help I got to get started. You can take a look at my first post.
Hope some of this helps.

[StantonHyde]

DS was diagnosed with anxiety at 7. Shortlly after he started pulling out his hair (trichtotillomania) which is on the OCD spectrum. He was also dx with dyslexia and ADD. So we had a "triangle" of dyslexia, ADD, anxiety. At first we tried to treat the ADD with very low meds--if he could pay more attention, then he could learn more and would be less anxious. Didn't work--made him slightly more anxious. Went to sertraline and there was vast improvement.

In the meantime, he/we were doing CBT for the hair pulling. Freeing YOur Child From Anxiety was key--practical tips for us to do to manage his behavior. We had DS see: neuropsych for full eval, developmental Pedi for an eval, OT, psychologist, psychiatrist. They all basically came up with: he has a learning disability and he's anxious, but he'll be fine.

We continued to work with the psychologist, psychiatrist, and reading tutor. The psychologist was our "over riding provider". It was her job to make sure that he was mentally/emotionally healthy in the midst of all this. And she was awesome!! We followed her directions and it worked. Not overnight. But it did work.

I work in psych and I have seen kids as young as 4 medicated--but it is not common. And we wanted to work with people who were conservative about medicating kids. So I'm not entirely sure you will get much traction there till he is 6ish. But the CBT is a must--for you and for him. Keep going and keep as steady as you can. Listen to the psychologist and make sure you are working from a CBT base. He has had a lot of change with your DD this year.

Good luck!!

[JTsMom]

Jason is 7.5, so I can't speak to the young child part, but there are several things I want to comment on.

-First, the ASD stuff. I feel your pain here, truly. We heard the exact same thing during those years-"Wow, he sounds spectrumy- Nope, he's not! He's far too social!". We heard it over and over again. Then, at 7, we added the Asperger's diagnosis. I was so shocked after so many years of being told it wasn't that, it took a while to process it. I even posted here about it. The neuropsychologist who gave him the diagnosis actually said that, in her mind, it was quite obvious that it was the correct diagnosis, and that led to me feeling really frustrated about the fact that we'd been told it was definitely not the right fit so many times, over so many years. I wondered why we had bothered seeing all of these specialists if they couldn't even name the condition, let alone treat it!

But here's the thing- it doesn't matter that much. The challenges he faces are the same, no matter what we call it. It does help to have a nice, neat name for it, instead of trying to explain to people that he has "numerous issues", but our reality is the same. So as maddening as it is (and believe me, I know it is), just try to focus on the biggest challenges you're facing on a day to day basis, and try to address those. Know that the labels, may or may not change, but getting the right one is not going to be what's going to help anyway.

-Anxiety- we just recently began medicating, after trying everything else on the planet. It hasn't been easy. The current medication (Zoloft) is making him aggressive. So far, I'm not convinced this is going to work, but when we took him off of the supplement we had been using (5-HTP), and I could see the anxiety in full force, it was horrible. So I know we need to do something.

I also second the rec for Freeing Your Child From Anxiety. And a good therapist. If you can swing it, think about going yourself too, because knowing what you're going through, I can guarantee you can use all of the support you can get for yourself! This isn't an easy path to walk.

-OCD- Jason started experiencing OCD symptoms a few years ago. Feingold seemed to make them disappear. Right before we started medicating, we discontinued Feingold. During the process of experimenting with different meds, the OCD symptoms have occasionally come back. I think it's due to the meds though. Can't hurt to give that a try.

-Behavior stuff- I highly recommend The Explosive Child. We have tried every type of behavior modification technique known to man (aside from physical punishment). None of it has worked because the problem with Jason is not a lack of motivation, but a lack of skills on Jason's part. I can put him in time out a hundred times a day, take away everything he owns, and every privilege he has. I can do that consistently. It won't matter. The more I try to "crack down", the worse it gets.

He does his best at home with me, so I know that I'm on the right track. A lot of people have tried doing things the "right" way, and it fails 100% of the time. He is not wired like that. The things that "should" work, don't. Period. On the flip side, especially in recent years, many of the specialists we see have told me that what I am doing is right. Traditional parenting is never going to work, and it helps to have that outside confirmation that what my gut tells me to do is the best way to handle him.


The things that do help are empathy, avoiding problems when possible, structure, a calm environment, different expectations, and working together to solve his problems while teaching him the skills he needs to eventually do it on his own. I do not have all of the answers here. We struggle A LOT. But shifting my perspective makes it much more doable. I had to let go of the idea that it's ever going to be "fixed", and aim for "better".


As always, I'm pulling for you! Just keep going. One foot in front of the other. :hug:

[pinkmomagain]

My middle dd was dx'd with anxiety at that young age. Primarily at that time we worked with a child psychologist. She met dd just once or twice, but worked consistently with me on how to handle dd to manage her anxiety. At that time, she had OCD-like tendencies, bad separation issues, and even hoarding issues. I would describe incidents from the previous week to the psychologist and she would tell me specifically how to handle them (what to say, what type of affect to have, etc.). This definitely helped a great deal! I will say that for the transition from prek to kindy, the neurologist prescribed a very low dose of prozac to help dd because she was really such a mess with separation and novel experiences. It was extremely helpful and we only used it for about a year at that time (although at 13, she is back on it).

Books are super helpful, and I've ready many, but I found that having a child psychologist working with me as the parent was the best. Especially at that young age.

Hugs to you. Anxiety is tough. I am literally surrounded by it at my house. Some days are better than others..some months/years are better than others. It truly is something that waxes and wanes...and morphs. But I will say if you told me how improved dd would be now as a teen back when she was 3-4 yo, I never would have believed it. So there is definitely lots and lots of hope that it can be successfully managed!!!!!

ps. It sounds like you may be frustrated with the difficulty diagnosing. I was too at the time. My dd had many terms thrown about at 3-4 yo (Non verbal learning disorder, PDD-NOS, attention issues, anxiety). It's just so hard to tease out a dx at that young age. That's why treating symptoms seems to be the focus at that age. DD now is dx'd with ADD-inattentive type, anxiety (which really presents as social anxiety at this point), and trichotillomania (hairpulling).

[egoldber]

I agree about finding a good therapist who can help you work with him. Older DD was not diagnosed with anxiety until she was 8, but she had symptoms long before that. I was convinced she had ADHD-inattentive, but with the proper therapy and meds, she does not have ADHD symptoms.

We did start meds with her at age 9.5 when I felt that therapy had done all it could do and she still needed more help to cope. We did a brief trial with Zoloft (disastrous!) and then went to Prozac. She has now been on Prozac for almost 2 years and her life is so much improved. She also still sees her therapist anywhere from weekly to monthly (in summer) depending on the need at the time.

I would not have done meds with a child that young, but my DD's needs/issues were nowhere as severe as your DS's are. I would try to find a good therapist that gets him and that you trust and then see what happens after you have worked together. It could take weeks to months for therapy to really help.

[lmh2402]

thanks, everyone

my gut says no meds, but sometimes things are just so bad...and it's often so, so, SO IRRATIONAL. i mean seriously, the things that set him off are constantly evolving. i feel like i'm constantly walking on eggshells

and he's so unhappy. it's very painful to hear him ask me over and over how to be happy, why can't he be happy, why can't i be happy, etc, etc...it's just sad

the psychologist we've been using...i like him but he is definitely not in the "treat" DS directly camp - he says he's too young for it to be effective.

you all have successfully done CBT with someone as young as my DS?

thank you so much for the stories you've shared

i remain hopeful that we can continue progress. i really, really hate for him to be so low. he's only 3. life should be pretty sweet at this age. worrying about what to play next...nothing more.

i also hate that i feel like i make him sound like he's a monster and a horror all the time. honestly, he's not. he's truly such a sweet kid and he just loves to love. tells me constantly that he loves me, he loves his sister, he loves his dad and the dog, etc, etc. but these rages seem to come without any ability for him to stop or control himself.

and these weird, crazy...fetishes...they seem beyond his control as well

i feel like we did this to him. we *made* him...created him...flawed. and now he has to suffer

it's awful

anyway, thanks

[pinkmomagain]

you all have successfully done CBT with someone as young as my DS?


I may get flamed, and I am no expert, so please take this as just my opinion, but I am very skeptical about effective CBT applied directly from therapist to 4 yo on 1x week 45 minute session basis. It's been my limited experience that brain work is challenging and hard work even among the most mature, motivated people. I *personally* would not be spending my money on someone who wants to see my 4yo child for weekly CBT sessions. That's why I found it more effective to see a child psychologist myself as I described in the above post who walked me through parenting my anxious child. She coached me through not indulging my child's obssessive thoughts or behaviors. To distract my child with brief humor or simply refuse to engage in any of her anxiety talk. I spent the most time with my child, therefore I was the one who was effectively helping her with her anxiety on a daily basis. Now when I did this with my child she was more like 5-6yo (if I remember correctly) and it was also around this time (summer of prek to fall of first grade...or so) that we also implemented the prozac...so I don't know how much of therapy/meds to attribute to dd's success, but it really was the child psych who helped me in my dealings with dd's anxious behavior, that is for sure.

If you feel like you are not getting what you need right now from your current professional, you may want to explore others.

It's so hard to watch our kids be unhappy and not seem to enjoy life the same way their peers do. I've totally been there. I hate to hear others go through it. Sending you mojo that you will quickly find answers and things will improve for your ds and your family.

[egoldber]

Our therapist does not do CBT with kids that young. They do need to be have the maturity to be able to reflect on their actions and be able to consciously implement the taught strategies. A 4 year old doesn't really have that maturity.

But like pinkmom said, the therapist could work mainly with you on more effective strategies for anxiety management (older DD's therapist still does this with me) and see him occasionally on a check in basis.

[lmh2402]

thanks, guys

yes, our psychologist is working with us - parents - on a weekly basis. bc he says that's the only way to do it - he gives us general guidance and we talk through things that came up the week before and how to maybe better handle. basically parenting strategies given DS' unique needs

it's helping some. but not enough in the mornings.

[JTsMom]

I spoke with 2 different specialists about CBT for Jason, and they both felt he was too disregulated for it to help, so there's that too.

If you are struggling mostly in the mornings, maybe it would be worth brainstorming with either the therapist, or even other moms, to try to figure out a plan for just that one issue. I've found I have to put out those smaller fires since I can't fix the bigger one.

[sste]

lmh, my ds does not have special needs or OCD but he is one heck of a PITA, esp. in the AM.

Does your DS have a favorite TV show that he is really, really into? I mean, "currency"? Or something else that you can hold off and give him once all morning tasks are done?

What worked well for us at your son's age was to use a visual calendar and then ONLY allow him to watch 20 minutes of his beloved scooby doo once he had finished his morning routine and was dressed, shoes on, fed, teeth brushed, and sitting on the sofa. Then he got the reward of the scooby doo cartoon. That was the only time of day and only way he could watch scooby. We didn't frame it as punishment (per our behaviorist) - - it was I really hope you can finish your oatmeal so you can get your special morning scooby. I don't know that this would work with OCD but the throwing food stuff etc it may help with. If your DS doesn't have a currency it is much, much harder.

[lmh2402]

ok, so i would so welcome brainstorming

we've been talking with the therapist about this since we started working with him

sste, yes, he's got lots of currency

problem is, for whatever reason...beyond anything rational...he is unable to keep perspective AT ALL in the mornings.

so, here's what goes down pretty much every morning.

anywhere from 5:30am-6:30am, we'll start hearing him over the monitor. chatting, singing, talking to his stuffed guys in his crib, etc.

at 7:00am, his time-to-wake clock turns green. he immediately calls out, "dada, the green clock turned green."

99% of the time, all of what has transpired so far (as heard and seen via video monitor) as seemingly pleasant and good-natured.

so then DH goes and opens the door.

and 99.9% of the time, this is where it goes off the rails.

almost instantly, DS will start screaming. sometimes it's words - "no!!! i want to sleep more!! get out!! i want mama! i don't like you!, etc, etc, etc

sometimes it will just be guttural sounds - no words.

almost always it involves physical thrashing. throwing things from his crib. throwing himself around

it can unfortunately evolve quickly into him reaching out of his crib to grab and heave whatever he can get his hands on -the clock, the noise machine, trying to rip the wall-hung lamps off the walls, pulling and breaking the lamp shades, trying to remove the pictures hanging above crib to throw them, etc, etc.

when we see things heading in this direction, we will quickly role up the rug to make room to pull the crib way forward out into the middle of the room to reduce his reach

how long the hysteria will last is unpredictable

there are days when i end up dragging him out of the crib in time to get in the car and go right to school - no food. physically forced through the process of changing his clothes.

he'll be soaked with sweat and snot

other days he can pull it together but the reasons why are not consistent

things we've tried (both before starting to work with current therapist, and since)
- DH altering his entrance. meaning, he tried being upbeat "good morning, DS!", he tried being quiet and calming, he tried being firm, he tried being silent

- doing lots of talking the night before about the positive incentives for not flipping out. "remember, no yelling tomorrow and if you do no yelling, then daddy will have time to play with you before work (huge currency), or you can watch XYZ (also huge), etc"

- also tried adding night-before talk about negative repercussions - "if you yell, you won't have time to play with daddy." or "if you yell and yell, than i will take away xyz toy for the morning."

- tried leaving the room the second he starts screaming and telling him we wouldn't come back until he stopped.

- tried refusing to leave and trying (ha) to ignore the screaming

- tried talking during the day about how yelling makes everyone feel - sad, upset, mad, scared, etc, etc

- hired a behaviorst back in May '12 b/c things were so bad. she came up with a "game" - told DS it was the "(DS' name) game!!" she wrote out each little step for the morning - 25 steps. each step was on a separate index card with a number. DS LOVED the orderliness of this. loved turning the cards and memorizing which task was which number. this worked for almost two months - longest reprieve we've ever had. but then it lost its luster

- the psychologist right nwo has told us that we have to face the fight head on. he said DH should not ever walk out. DS wants him to leave, so he shouldn't. also, we need to totally keep our composure. ha. we have to move the morning along as though nothing at all is amiss. curtains opened, blinds opened and up. theoretically fight getting him undressed and then dressed. of course, this will immediately create opportunity for DS to physically attack/hit/kick. the psychologist said we are to deal with that by just trying to work through - not acknowledging the hitting

- current psychologist is also focusing on DS' currency - wanting me. he is wanting us to talk up, the fact that if DS gets through a very specific list of tasks without screaming, than i will come right into his room. we tried this and it worked so well! for two days. then this seemed to stop being enough.

ugh. this is long enough already. i'm sure there's more things we've tried. but my brain hurts to keep thinking about this

[wellyes]

Trying to brainstorm here, sorry if all this sounds obvious...... I would get rid of the clock. I would wait for him to be up for a couple minutes, then have your DH go in (annoucing he's coming in first) with a cheerful "let's go make muffins" or "do you want to come help me sort my socks?" or "let's go look outside, it's raining". Or something else that is not the he plays ~ he calls your husband ~ he lashes out at your husband dynamic that has become such a deeply embedded pattern. Because with OCD, anything you spend so much time and effort on can become an embedded ritual. Don't try to change the ritual, putting more attention on it makes it MORE important to him. Change the parameters. Again, probably extremely obvious, that's just what jumped out at me reading your post.



It's just, when I have an obsessive pattern or thought, no matter how much I hate it, I really want to spend ALL my energy focused on it. It's like I can't help myself. And it seems to me like this battle is something your son has become so invested in. Don't feed the beast, it only empowers it.

ETA. I know that contradicts what your psychologist said, and he/she probably is the one to listen to. Lord knows I am not an expert.

[egoldber]

Is he hungry? Potentially he could be up from 5:30 to 7 without haven eaten since the night before? Some people (me :o ) need to eat ASAP upon wakening.

I appreciate you not wanting to wake before 7, but younger DD went through a longgggg phase of waking at 5:15/5:30 because she was starving. I would consider leaving out a non-perishable breakfast for him to eat when he wakes. Something like dry Life or Cheerios in a cup, a Nutrigrain bar, etc. and a juice box.

It has been my experience that many of these non-neurotypical kids also have low blood sugar struggles.

[pinkmomagain]

Read your post and am brainstorming here. A couple of things come to mind:

1) I wonder what would happen if he were sleeping in a bed rather than a crib and had the freedom to leave the bed when he wants to? I wonder if that transition of getting out of bed would be better for him if someone didn't have to come in and take him out of a crib?

2) Have you conisdered putting him to bed in his clothes for the next day? That eliminates fully dressing in the morning (just shoes). I did this for probably 2 years (prek and kindy) with my little one who was (and still is) difficult with transitions and getting dressed for school.

eta: I like wellyes' idea of getting rid of the clock. A clock was terrible for my OCD middle one. I actually had to turn the face to the wall because she was obsessing about the #s/time.

[sste]

Ok, don't lose hope here! It sounds like there is alot of trial and error involved.

Is he better at night. I would personally perm. relocate his crib to the center of the room so that you don't start your morning with things being pulled off and flung -- you need to conserve your patience for later morning challenges. I would also try dressing him at night in his school clothes. Would he tolerate that? My DS has alot of those boden jogging pants and flannel "tartan baggies" that look and feel just like pajamas and there are also carters fleece pants. No need to even tell him he is wearing his school clothes imo. Just dress him for the next day and the next morning remove dipe if applicable and then tell him he can wear what he is wearing now to school.

Then that just leaves breakfast, shoes, and teeth. :)

Does he not do well with waiting for breakfast? With certain foods? With throwing? Again, to avoid stressing out you and your DH can you at least use foods that are easy to pick up if he chucks them -- I am thinking TJ's frozen waffles and pancakes, not cut up.

Or if breakfast is too much how does he do with a breakfast or protein bar in the car seat? Does he behave decently in his car seat? If that works, I might consider getting rid of the breakfast table debacle too and going with "trucker's breakfast" or whatever cute name you want to make up.

I am sure others here know much more than me . . . I am just thinking of things I might try. From an outsider's perspective I wonder if there is just more than he can do separating him from his "currency." If you haul him out of bed dressed you can plop him at the table and say as soon as you eat some waffle we are going to spend some special time. Or just teeth and shoes and then special time and some food in this car. This makes the reward more immediate and ups his chances of success. Over time if it works maybe you can start reintroducing one at a time getting dressed and breakfast at table.

[lmh2402]

thanks guys!

so clock - yes, we've thought to get rid of it and actually tried. he viewed it as punishment and after several days we caved and gave it back b/c no amount of reassurance that it wasn't punishing could relieve him. also, i think he legitimately missed it b/c he took likes to obsessively check the time

also tried putting him to be in his clothes. this freaked him like you would not believe. we have tried talking about it like it's fun to get to sleep in your clothes. but no. he is SO, SO, SO routine oriented. it was like we were torturing him to suggest he not sleep in his PJs

would love to get him out of crib. BUT - he gets very upset when we suggest switching to big boy bed. also, at this point...this sounds horrible, i know...but right now, given how things often go...i'm grateful for the opportunity to contain the violence and destruction

and lastly food - yes, i've thought that too. i could try leaving food out. what we had been doing was having DH bring something to eat / drink in with him. he usually rejects. but maybe leaving something he can get to on his own would be a good idea

he doesn't always wake at 5:30. the vast majority of the time it's closer to 6:30

we used to have the clock turn green much earlier than 7. but the hysterical screaming that he was still tired. coupled with the fact that he yawns all day long, made us think he really was tired. so we have gradually pushed the time back to the latest it could turn green, and still give enough time to get to school

[JTsMom]

I hate to start with this, but im phone typing so have to be somewhat brief- I think your psychologist is on the wrong track. if he's motivated to do well, and still failing, I think he's unable to meet the goals for some reason. I think the transition is likely the problem, and thats not uncommon. Is he verbal enough to tell you how he would like things to go (during a calm time)?

Here are a few other ideas:
Have you tried going in instead of DH?
What if you brought in a drink?
Played music?
3 minute warning that transition is coming?
Story before getting up
Picture schedule in his room
Reintroduce card system
Good morning song
Has your it taught you anything that might help? Deep pressure, brushing, joint compressions, etc?
I'd even do tv if that helps him stay calm.
I've seen some moms here mention having their kids sleep in their clothes so they can skip that step, then doing breakfast in the car. I'd pretty much do anything that worked. You could always change it back to something more ideal down the toad when things fall into place a bit more.

I agree that breaking that battle cycle is key, which is why I think the psych's advice is off base. I've said before that your Ds reminds me of mine , and I can tell you that the more we try to crack down on things, the worse things get. The more i can show im on ds's side, the better thongs go. I think I may have mentioned The Explosive Child up thread. There's also a website with videos that are helpful. I really think it would be a good match for you guys.

[JTsMom]

Sorry- was typing while everyone else was, and see you already addressed several of these things.

[egoldber]

I would definitely consider getting rid of the clock.

Also, the thing with low blood sugar, is even if you are getting him breakfast ASAP, it may be too late. He could already be crashing. Once younger DD reaches that point there is simply NO reasoning with her until we have managed to get some calories in her. And at that point, it's usually juice because nothing else will work because she's too hysterical to eat.

[lmh2402]

thanks so much all

ok, so i know i'm not going to address all the ideas you guys threw out

here's what i do know:

if i went in every morning, things would be pretty much fine. but that's just not realistic. there are mornings when i need to leave for work by 7. and/or i'm nursing DD or getting her up.

psychologist seems to be telling us that DS needs to be desensitized. that life is not going to be how he needs/wants it to be all the time. that school and the world isn't going to revolve around these...obsessive, often irrational, often changing and unpredictable needs

no, he doesn't have a hard time waiting for breakfast. in fact it's often a battle to even get him to sit and eat. days he does best is when there is nowhere to go and we can let him lounge in crib. then lounge further in room. until he feels ready for us to all go downstairs - him calling all the shots - who walks down first, etc. the only day of the week that is this relaxed is sat. and as a reference point, this past sat he was not ready to eat breakfast until 9am. that is just not realistic on a week day. or even on sundays

ugh. ugh. ugh.

[egoldber]

he doesn't have a hard time waiting for breakfast. in fact it's often a battle to even get him to sit and eat.

I feel like I'm harping on the blood sugar thing, but it is absolutely true that you can miss the window on the food. If younger DD does not eat ASAP on waking, she could easily go hours without eating, but the fallout is horrendous.

It's easy to try leaving him some food and a small juice box in his room. In another thread someone mentioned smoothies that don't need to b refrigerated, and that could be a good option too. I would do that and encourage him to eat when he wakes and see if it helps.

And while the pysch is right, yes he needs to become de-sensitized, that does not have to happen all at once. Right now your family has a serious issue that does not allow you to function in the mornings. It's OK to come up with an interim solution that makes things better and then you can tweak that in awhile. It's a process.

[JTsMom]

Well, you can look at it that way, or you can look at it as what can we do at home to make life easier for him before he goes out into the world to face all of those things we can't change. As he gets older, he's naturally going to learn skills and ways to get along better in the world. But right now, he's just a very young boy with a heck of an uphill battle to face just to get through the day, you know? I can't imagine that he wants to melt down like that. If kids can do well, they will. Meeting him where he is right now is kind of like the other needs you meet for him that he'll have to learn to do on his own later.

If it were me, I'd ask myself if this approach is making your family's life better or worse, then go from there. You could see 10 different therapists, and they'll likely give you at least 5 different opinions. If you like this guy, and you feel like he's leading you down the right path, by all means, carry on. But don't feel like you have to stick with him or his approach if its not working for all of you.

[lmh2402]

Well, you can look at it that way, or you can look at it as what can we do at home to make life easier for him before he goes out into the world to face all of those things we can't change. As he gets older, he's naturally going to learn skills and ways to get along better in the world. But right now, he's just a very young boy with a heck of an uphill battle to face just to get through the day, you know? I can't imagine that he wants to melt down like that. If kids can do well, they will. Meeting him where he is right now is kind of like the other needs you meet for him that he'll have to learn to do on his own later.

If it were me, I'd ask myself if this approach is making your family's life better or worse, then go from there. You could see 10 different therapists, and they'll likely give you at least 5 different opinions. If you like this guy, and you feel like he's leading you down the right path, by all means, carry on. But don't feel like you have to stick with him or his approach if its not working for all of you.

yes, to all and especially the bolded. this is the sentiment that i feel mos tortures me on a regular basis. i'm so torn b/c i really don't know what to do. and also, i really can't live hostage to all his many needs. seriously. it's not feasible b/c if we did, we would be walking on every third crack and breathing through our left nostril while typing with our toes...i mean he really, really tries to control every single thing all the time.

and i'm trying very had to keep my DD in mind - making her needs second always to the fact that i have to be the person to shepherd DS through the morning is just...really hard to swallow

i know i sound like a broken record, but i'm so sad.

i do know for sure that he doesn't want to be this way. he doesn't want to be so upset all the time. especially first thing in the morning.

beth, i'm going to try leaving food and see if that gets us anywhere

i really am so unsure. the only thing i know that will make it all go away is if i go in and do all the stuff - i get him out of crib, get him undressed, accompany him to bathroom, get him dressed. and he's a slow poke. none of this would be fast.

so, what would i do about DD and he needs/wants to nurse or get her diaper changed. yes, DH could do her diaper, but nursing is obviously all on me. and she's at a very distractable age - can't really nurse well /efficiently in group settings these days

[JTsMom]

I 100% get everything you just said, and to don't sound like a broken record. This is what we're here for.

If it feels wrong, it probably is. You are the expert on your child. You're right that you can't cater to every demand. It's just not possible. But if you make As many things easy as you can, and try to find as many win-win solutions as possible, it will help all of you. This is obviously a big issue for all of you, and it has to suck starting the day off like that.

Can you nurse the baby a few minutes earlier, then move on to DS?

[JTsMom]

Videos:
http://www.livesinthebalance.org/solving-problems-collaboratively

[lmh2402]

Thank you, Lori. You have all been so helpful. Even just to hear me out. Have appt w psychologist tomorrow. He's a nice guy and had said he's always open to talking about other tactics we might want to consider. I have a lot to discuss tomorrow. Thanks again. Will update if/as i see progress. Or not.

[Sweetum]

You probably mentioned, but what specificially happens when you don't concede to his demands or things being in a certain way? again, sorry if you already mentioned it, but the thing I am getting at is, would you be able to reason and negotiate? and make it a small negotiation - what do you want for breakast? pancakes? ok, in that case we eat now (or before the long hand has reached 10 or whatever) or some similar. Does he feel like he needs to fight for control all the time?
Another thing, you could prepare a visual schedule (yes, that means you have to plan ahead) for the next morning, go over it with DS before bedtime, and leave it in there to look at as soon as he wakes up. Yes, he might form some rigidities around things having to go that way if one particular morning for some reason you cannot do it, but if you get him to understand and follow it, you could place some things that you feel might help you next morning vs what he wants. You could also eventually introduce the concept of a wildcard which means he should expect some uncertainty and have to go with the flow.
DS has a lot of intervetions and each day sees 3 different people and the next day they may not be the same 3. And of course, some he adores and others he abhors! So, I have a visual schedule for him to look at whenever he is not sure who is going to see. I also have some activities in my stash that I pull out when a session is canceled last minute for some reason. It helps him, and has actually helped him keep track of the days of the week!
Just some ideas, hope they give you more. good luck!

[wellyes]

psychologist seems to be telling us that DS needs to be desensitized. that life is not going to be how he needs/wants it to be all the time. that school and the world isn't going to revolve around these...obsessive, often irrational, often changing and unpredictable needs

.

That sounds like he's saying 'he needs to learn to deal with life, despite his OCD'‘. That does not seem to me, based on my life experience, a successful strategy for dealing with an anxiety disorder. You can't explain to him he's wrong. You can't break his problems with just firmness. Just as you can't order an adult with depression to snap out of it, you can't convince a 3 year old whose mind is wired to be compulsive to stop being compulsive.

I am so sorry you are caught between a rock and a hard place here, your frustration and compassion are both coming though so strong, I know from my own family how maddening and heartbreaking it is to deal with these kinds of disorders.

[pinkmomagain]

Another vote for visual schedule. Totally forgot that this is something I used extensively for dd2, in fact her school took my visual schedule for the school day and incorporated it into the classroom. I would draw a schedule with pictures (or you can take photos) and have that in your child's room so that he can look at it. I would not put specific times as you don't want him to harp on that, but I would put things in the order they are going to happen (wake up, get dressed, have breakfast...etc). Make sure he has access to it and can look at it when he wants.

Other things I am now remembering that are helpful when dd was in full-blown anxiety mode:
- During meltdown, I'd say something like "You are having such a hard time and seem so sad and mad. Maybe you need a hug? I'm here for you when you need a hug." And calmly wait and repeat if necessary. This really works with my youngest one now and she'll say "I need help calming down/to stop crying. Say something to make me laugh."
- Sometimes drawing a picture while kiddo is melting down is also helpful. My middle one would stop to watch me draw. I'd draw how she seemed to be feeling, or what we need to do next.
- Start to use language about dc's thoughts/brain. Things like "Is your brain stuck? Do you need help getting it unstuck?" Down the road, CBT & mindfulness is really about being able to step back and observe/change your thinking. I think braintalk at an early age helps kids start to separate themselves from their thoughts so that eventually they can get some control over them. So like if my youngest now is thinking about something bad, she'll say that her brain won't let her stop thinking about it and she needs help "changing the channel."

Finally, I think it is hard as a parent because we are very sympathetic to what our kids are going through but ultimately they need help gaining control and part of that is not indulging their OCD/anxiety's demands...because by doing so, it becomes reinforced. It really goes against our nurturing instincts...I had such a hard time being firm, and still do to some extent...it takes practice and I don't think every aspect can be tackled all at once, but I don't think the psych is totally off-base about not allowing your ds to control everything.

[JTsMom]

Just to be clear, I'm not advocating letting him control everything either. I'm saying that it's possible to find a solution that works for everyone. Just like we wouldn't say to a child with FA, "Hey, sorry, but the world isn't going to cater to you with food needs. You're going to have to toughen up and learn to eat this.", someone with neurological differences might need some accommodations to help them succeed. If this particular routine is setting him off every single morning, and no amount of motivation or consistency is changing that, it's time to tweak the plan in a way that will work for all involved.

Maybe that means that Dad still goes in, but changes his approach to more of a cooperative one. Maybe it means taking care of the baby, then the older child- whatever works for this family.

But meltdowns beget meltdowns, ime. The more of those you can eliminate, the better the whole family feels, and the more time and energy that you can devote to catching them up with whatever lagging skills they're dealing with. The faster they gain those skills, and the self-control that goes with them, the faster you can get to the point where you don't have to give so much.

[sste]

Can you go back to the behaviorist that had the card thing that worked for two months (sounds like the visual schedule idea so many of us like). If she had one idea that worked maybe she has others. The behavior place I went to was exceptional but they would watch the parent interacting with their kid behind one-way mirrors and set up different behavior challenges (e.g., fun gym but then have to change tasks or end gym time). And then they advise. Does your former behaviorist know of anything like this or the child psych? Do people do home visits in this field? It would seem VERY helpful!! It seems to me that your DH in particular needs some coaching in the moment and some support to help him build his relationship with your DS.

Also, I did my own at home-trial with two slices of turkey bacon this morning with my own DS - - first thing upon waking and he had a radically better morning. If bacon or some other food is a treat or favored food of your DS maybe your DH can bring it in and it can help with blood sugar and also help them develop some positive AM interactions!

I guess I am wondering if you need to break this down and work on one piece of the morning at a time. Good luck to you!

[BunnyBee]

Older thread, but I got some helpful ideas for my DC, so thank you.

Have you done a sleep study? Is it possible he has apnea and isn't sleeping well/deeply?

On the hypoglycemia angle, what about trying a spoonful of almond butter before bed?

[JTsMom]

lmh- any improvement?