Took Broccoli to dentist, and turns out his teeth work great

[luuknam]

Broccoli (almost 6yo, no diagnoses whatsoever), used to love the dentist. Enough so that he's cried before when someone else had a dentist appointment and he didn't. Not today though. He said he doesn't want to go to the dentist. Apparently because he doesn't like the toothpaste flavor (I explained to him they had lots of flavors, or that he even could do no flavor). Did not work. Had to wrestle him to the car, and then when I pulled him out of the car at the dentist's office, he bit me. Ugh.

 

For the good news, having him sit in my lap, and bribing him did work in the end to get his teeth cleaned. I'm just feeling completely drained though. He's been so intense lately. For example, on Sunday he had a private swim lesson and he spent the first 10 minutes freaking out about the water level. The water was all the way up to the top edge of the pool, whereas normally it's about 1.5-2 inches lower than that. In neither case he can touch the bottom of the pool in the shallow end though, and he's normally fine with being in the deep end, so it was completely irrational to be freaking out about the water depth. Not that this kind of thing responds to reason.

 

Part of me wants to drag him to the pediatrician for an evaluation - I suspect he could get diagnosed with SPD (he's also been putting his hands over his ears more often, and is picky about foods), but not convinced it would matter (it's not like a diagnosis would actually solve these issues). Maybe there's even more going on - an anxiety disorder (his ped suspected that when he was constipated at 3yo)? autism? (his older brother has an educational autism diagnosis, and his uncle is autistic as well), though I'm not convinced, and again, a diagnosis wouldn't actually *solve* anything. His brother gets stuff like OT and Speech, but I don't think Broccoli needs anything like that. I just wish he'd freak out less often (but not enough to put him on meds at this point), and not convinced of the merits of CBT for a kid who's not even 6 yet, kwim? (it took years for CBT to actually do any good *in the moment* for me, and I was in my 20s)

 

So, I don't know. Obviously, all this is pretty minor compared to some other kids, but things seem to be getting worse, rather than better, lately.

[PeterPan]

I'm so sorry he bit you.  I've been hurt by my child and know how hard that is.  It sounds like he's really struggling with change.  Also, I think that sometimes their level of awareness and anticipation changes as they age, so something that was ok before can be not ok later.  It makes it hard!

 

It sounds like things are becoming more obvious as he matures and shows more of himself.  If you scheduled evals now, they'd probably hit as he's turning 6, which can be a good time.  I find the wait for evals hard, because once you realize you need them you REALLY want them.  Maybe go ahead and schedule the evals, just based on family history and growing concerns, and just see what happens?  By the time 6 rolls around, you might be really ready for them.

 

Also, you mentioned CBT.  In the US we have ABA and in-home options.  Maybe you have more options where you are?  I agree, if CBT where you are is what CBT is here that it wouldn't be as useful as ABA.

Edited October 20, 2016 by OhElizabeth

[luuknam]

I'm so sorry he bit you.  I've been hurt by my child and know how hard that is.  It sounds like he's really struggling with change.  Also, I think that sometimes their level of awareness and anticipation changes as they age, so something that was ok before can be not ok later.  It makes it hard!

 

It sounds like things are becoming more obvious as he matures and shows more of himself.  If you scheduled evals now, they'd probably hit as he's turning 6, which can be a good time.  I find the wait for evals hard, because once you realize you need them you REALLY want them.  Maybe go ahead and schedule the evals, just based on family history and growing concerns, and just see what happens?  By the time 6 rolls around, you might be really ready for them.

 

Also, you mentioned CBT.  In the US we have ABA and in-home options.  Maybe you have more options where you are?  I agree, if CBT where you are is what CBT is here that it wouldn't be as useful as ABA.

 

I'm in western NY. For some reason ABA didn't cross my mind as I wrote that post. I guess I'm not real sure how ABA would work for unanticipated issues. It's not like he melts down over transitions in general - he's pretty good about "put your shoes on, it's time to go to...", even without warning. I wouldn't have known he'd freak out over the water level in the pool until he was freaking out over it.

 

And yes, I feel like it's practically guaranteed that if I were to schedule evals now, they wouldn't happen until 2017, what with us being out-of-country from mid-November until mid-December (he turns 6 in a month). I hate evals. I hate having to answer a million questions, and doctors being all judgmental and stuff (BTDT with a ped acting like we were too lax with our parenting of oldest while he was lining up all the toys in her office behind her back - she did apologize, and say that it did look like he might have HFA and that she just did her regular spiel because some parents just don't punish their kids when they misbehave, but ugh - there's a reason oldest only has an educational autism diagnosis and not a medical one - could not hack doing the evals twice).

[luuknam]

Just talked to my mom, and she suggested he might be having more issues recently because of our scheduled trip to NL in about 3 weeks. He's excited about going, but that doesn't mean it's not more stress.

[PeterPan]

You could make the appt for the evals, since the wait would likely be many months, and cancel when you get closer if you conclude they're not needed.  With a sibling on the spectrum and behaviors that far outside the norm, it would seem pretty reasonable to eval.  

[kbutton]

You might find (over time) that other issues crop up with unanticipated events, and I would guess that ABA has a way to address those. I know our ABA therapist exposes my son to novel situations as often as possible because that's when issues he has crop up with any sort of reliability (some are like what you are talking about, but they often sound "more" rational simply because he's 12, and he has more life experience), and it continues to be an issue as he ages vs. him becoming more age-typical. The ABA helps him sort out a plan, and it's good for his confidence to deal with things and learn new ways of tackling things.

[Daria]

I'm in western NY. For some reason ABA didn't cross my mind as I wrote that post. I guess I'm not real sure how ABA would work for unanticipated issues. It's not like he melts down over transitions in general - he's pretty good about "put your shoes on, it's time to go to...", even without warning. I wouldn't have known he'd freak out over the water level in the pool until he was freaking out over it.

 

And yes, I feel like it's practically guaranteed that if I were to schedule evals now, they wouldn't happen until 2017, what with us being out-of-country from mid-November until mid-December (he turns 6 in a month). I hate evals. I hate having to answer a million questions, and doctors being all judgmental and stuff (BTDT with a ped acting like we were too lax with our parenting of oldest while he was lining up all the toys in her office behind her back - she did apologize, and say that it did look like he might have HFA and that she just did her regular spiel because some parents just don't punish their kids when they misbehave, but ugh - there's a reason oldest only has an educational autism diagnosis and not a medical one - could not hack doing the evals twice).

 

In my experience, one way that ABA can be very successful for unanticipated behaviors is when it teaches and reinforces specific calming, regulating, or problem solving strategies.  I know as a classroom teacher who has worked with kids who struggle with disregulation, sudden shifts in mood, and aggression*, we work really hard on establishing a handful of behaviors such as moving away to a safe spot, using words to label feelings, self soothing behaviors such as deep breathing, and listening to an adult.  

 

So, for example, we might use a behavioral technique to establish the behavior of moving away, or moving to a selected location.  We might practice this skill in an artificial context (e.g. in the classroom we'd sit down and talk about what we were going to do, and then practice), with a reinforcer immediately after the child moved.  Then we'd practice when the child was in a good mood, but not expecting this (we called this "magic time out", I'd approach the kid, ask them to move to time out, and then when they got there instead of problem solving, I'd give them a high five/fist bump/sticker/opportunity to watch a quick youtube video/snack, and thank them for moving so quickly).  Once we knew the kid could do it in the moment, then we'd move from reinforcing each incident, to reinforcing at the end of the morning/afternoon if they'd done it every time I asked.  This gave us an opportunity to sit down and reflect on the behavior, and also meant that the kid who acted up a lot and got asked to move a lot, wasn't benefiting from that, because the reinforcer was the same if I didn't ask a kid to move all day, or if I asked a kid ten times, as long as they moved every time.  We'd also add other behaviors to the chain, so that a kid got reinforced if they moved, and then when I got there turned off their voice while I asked what had happened.  Or then they had to move, turn off their voice, and tell me in a sentence what had happened.  I'd also talk about and reinforce "noticing you need to move before the teacher does".  

 

Once those behaviors are well established, and reliable, then there's an opportunity for less behavioral techniques, such those from Glasser's reality therapy, or from Ross Greene's work to be used.  

 

I should say that I'm not a huge ABA fan.  I've had a lot of training in it (4 graduate level classes, years of classroom experience), and while I think it's a powerful tool in the arsenal, I think that it's way over used and people see it as the only tool.  This, however, is one place where I do think it works well, in part because it can help kids regulate to the point where other techniques can come into play.  

 

*These aren't descriptions of your kid, just descriptions of the kids I've used these techniques with. 

[luuknam]

Once those behaviors are well established, and reliable, then there's an opportunity for less behavioral techniques, such those from Glasser's reality therapy, or from Ross Greene's work to be used.  

 

I should say that I'm not a huge ABA fan.  I've had a lot of training in it (4 graduate level classes, years of classroom experience), and while I think it's a powerful tool in the arsenal, I think that it's way over used and people see it as the only tool.  This, however, is one place where I do think it works well, in part because it can help kids regulate to the point where other techniques can come into play. 

 

Thanks for the long explanation. Still not sure how ABA is really relevant when walking away and taking a time out is not an acceptable response to the water level in the pool being 2 inches higher than normal, or to not wanting to go to the dentist because you don't like the flavor of the toothpaste. Walking away is exactly what he'd want to do in those situations. But things like those are scheduled - they're not "well, take a break, and when you feel up for it, you can do them" kind of activities.

 

It's been a few years since I've tried to read Ross Greene. I've tried a few times, and I just can't seem to get anywhere in that book. And I've read parenting books, and I've taken a college course in ABA, and all that stuff - I'm capable of reading books, but Ross Greene's book just... I don't know. I should probably try, again. At least this time it would be with a different kid in mind.

 

Not familiar with Glasser.

[Lecka]

You start at Point A and then go to Point B and then go to Point C.

 

If you have a child whose Point A is far from the appropriate Point C we all would like to have, sometimes it is worth it to look at really establishing some behaviors that are in Point B range.

 

Not our ideal in the long term, but acceptable compared to Point A.

 

Then once Point B is established, move to Point C.

 

I have seen a lot of progress with my son starting with giving some control of the situation to

him with breaks. If my choice is allowing a break on my terms (meaning he will come back to the activity in some way and on some timeline), or having something just not go well

at all, I am willing to allow a break.

 

But as the new norm became calmly taking breaks and then doing the thing, his self-regulation overall has really increased, and he needs far fewer breaks.

 

What ABA helped with is the process of: yes you get a break, but no you don't get to just not do the thing you don't want to do. A break really can be to get ready to do the thing, not just a way of avoiding it.

 

If you are seeing that you are a lot closer to Point C, then an intermediate step might not be practical.

 

But for is Point C was out of reach directly from Point A, and yet we are mostly at Point C now with some Point B, and Point A has really been replaced by Point B.

 

But yes, I would have to be willing to take a 2 minute break even when it might be embarrassing or make someone else wait for those 2 minutes. But often he will be ready in 30 seconds instead. Also sometimes this may not be a good strategy for various reasons for me, there are places I know it wouldn't work out.

 

For the swimming example I think it would. For the dentist we go to it would. There are other things where it wouldn't and I would try a different strategy instead.

 

When we started with a break strategy, I thought it was laughable that it would work that my son would actually take a short amount of time, self-regulate, and then return to the activity on his own terms (not literally his own terms, but with him saying he was ready when he was ready and having control of that on his terms, but within a time frame I would set as a reasonable time). I couldn't see him getting to that point from the point he was at. But other people could see it, because they had seen other kids reach that point over time.

 

Everything choice-based is good for my son. This allows him a choice within limits I set. He always does good with choices like this as things become his choice (even if he doesn't actually want to do them, he can still have many things be on his terms, and then it just goes

better for him.).

 

You might look into anxiety approaches more, too, though. At the support group I go to, there are parents who have pursued a more anxiety kind of approach (my understanding is they to to a counselor who does CBT and they do some things that are good for autism and anxiety together). If he has fearful self-talk and is acting out from feeling scared in the moment, but overall is doing well the vast majority of the time, you might like it more. There is stuff on the Social Thinking website you can look at.

 

If there is more of the desire to do many things totally on his terms and he does not regulate well once things are starting to require him to be a bit flexible, and it is just all the time, and he is rarely actually cooperative unless you are extremely catering to him.... this was more my son and I really like ABA for this, for building up his flexibility by the practice of being more flexible.

 

There are parents at my support group where that is not describing their kids, though, where it is more that they really do very well this way when they are not anxious.

 

In practice, locally, it could be that there is an ABA provider who would be good with your son. Or maybe a counselor. Or maybe you have either option. People can tend to specialize, and you would want someone who seemed to have a good sense of kids like your son and what would work out well.

 

Edit: I do think, depending on the length of the break, he may already have a good coping mechanism. If he needed to go the bathroom on his way into the dentist, nobody would mind waiting for 2-3 minutes, I think. If he took 2-3 minutes and then went back to swim class, I think that could be unnoticeable if he needed to get out and adjust his ear plugs. There are ways like that that people take little breaks, and it is not noticeable.

 

If it is more that he is just going to delay and never do it, that is different.

 

But if he could take a short break and return, I do think that is really functional. Especially when maybe he doesn't need to do it often!

 

But I could see it being a poor strategy if he got more nervous in that time.

 

My son is much more about having choices, and much less about anxiety, and so I don't think it is always the best.

 

But mainly I just think, you may want to consider things that people are saying "hey, this can work for some kids" even if it is getting you to Point B and what you want is Point C.

 

Sometimes the important thing is how much of an improvement Point B is.

Edited October 25, 2016 by Lecka

[PeterPan]

Thanks for the long explanation. Still not sure how ABA is really relevant when walking away and taking a time out is not an acceptable response to the water level in the pool being 2 inches higher than normal, or to not wanting to go to the dentist because you don't like the flavor of the toothpaste. Walking away is exactly what he'd want to do in those situations. But things like those are scheduled - they're not "well, take a break, and when you feel up for it, you can do them" kind of activities.

 

It's been a few years since I've tried to read Ross Greene. I've tried a few times, and I just can't seem to get anywhere in that book. And I've read parenting books, and I've taken a college course in ABA, and all that stuff - I'm capable of reading books, but Ross Greene's book just... I don't know. I should probably try, again. At least this time it would be with a different kid in mind.

 

Not familiar with Glasser.

 

Honestly, I didn't respond, because either you're willing to bring in help, or you're not.  Until you TRY to bring in help, you won't know all they can do for him.  ABA is a big umbrella term, so it's not reasonable to say oh this is what ABA (blanket term, the way I'm using it on the board) would do, because a behaviorist will have gotten training in LOTS of things, have LOTS of tools and ways to work on stuff, and will bring OPTIONS that they can work through to get an approach that works for him.  Saying ABA just means get your insurance to cover it.  Sure ABA as a term means something, but when we're saying it here we mean get your insurance to cover it, get a behaviorist walking in the door, let them help you.

 

As far as your actual discussion, it's anxiety.  Our behaviorist has been AMAZING for anxiety, and there's a TON they could do for him in other situations, teaching calming techniques, working through "size of problem" materials, working on calming strategies, etc. etc. that would help.  It's not ONE technique or option but MANY.  And they would work with him in situations that, over time, allow him to experience his emotions in small, controlled, guided situations, so he can learn the skills, practice his choices and tools, and get proficient at them.  

 

Generalization, the ability to apply the tools to new settings, takes time and lots of experiences.  So what you're realizing is that doing something one time in one situation isn't going to generalize to him having that as a tool in more situations.  You are correct.  But when you bring in a team and they work with him, he'll get the chance to use his tools, over and over, in small, controlled situations, with a variety of people, in a variety of things.  And over time he'll get stronger and start to use the tools for himself. 

 

It's a PROCESS.  

Edited October 25, 2016 by OhElizabeth

[mom of 2 boys]

Have you looked into ABA therapists/agencies? I live in Central NY (and have two kids on the spectrum) and ABA is basically non existent in this area. There are a lot of loopholes in the health insurance laws which make it very difficult/impossible to get funding through insurance in our state, and I have only ever heard of one program (preschool) that offered any ABA therapy that was funded through the school districts, and only 5 students actually receive ABA therapy there per year. I'm not sure how it is in your neck of the woods. Hopefully better, but if not, then ABA might not be much of an option for you anyway. 

 

Personally, I haven't been very happy with the therapy services here. I even pulled my 5 year old out completely because it just wasn't worth our time. My 2 year old is still enrolled, but they come to the house at this age, so it's a lot easier. You might be interested in getting a diagnosis so you can get services through OPWDD though. They will give you funding for respite care and other programs that might be more useful for you than the kinds of therapies that might be available. We use OPWDD for programs at our local YMCA and a 1:1 aide that they fund to accompany him. They have a social skills class that I'm going to enroll him in in place of speech therapy (this would match up with his skill level), and they have other programs that I'm considering such as a sensory class that takes place in a warm therapy pool, they just started a sensory arts class, they set up a sensory gym once per week for free play, and they have a special needs swimming class. I know that OPWDD also funds summer camps and things like hippotherapy. So, there are "alternative" options to therapy that you could try, if you wanted. You can also get them to fund therapy equipment for you to use on your own at home. 

 

You can try calling Liberty Post http://www.lrpost.com/buffalo/. They serve birth to 5, but when I had my son diagnosed in the Syracuse office, the waiting list was relatively short, so maybe they could squeeze your son in before he turns 6. I found their process to be very straight forward and reasonable. If not, maybe they can recommend a developmental pediatrician to you. Otherwise, there's Kirch developmental in Rochester, but I wouldn't be surprised if their waiting list is a million miles long.