Help me diagnose my niece :)

[Slipper]

My sister and I have an on again/off again relationship, but I'm always there for her and she called tonight with a problem. Many of you have offered suggestions in the past which I have passed on to her.

 

My niece is about 3 1/2 years old and was adopted at birth. My sis doesn't have a lot of medical history for her and the birth father is unknown. A little over a year ago, they adopted their second child at birth. My question is about the 3 1/2 yr old niece, S.

 

S has had increasingly difficult behaviors that my sister finds difficulty in dealing with. Recently, this included:

-5 parent conferences with the pre-school this month, including a two day suspension after S kicked another student repeatedly and then told the teacher to shut up because she (teacher) was stupid

-lots of difficulty and disrupting her dance class. She was kicked out today and though my Sister has paid through the end of the month, she was told there would be no refund because they feel they have earned more than what they were paid.

-Sunday School teachers have changed three times for her class. They all mentioned that S was disruptive.

-Lots of temper tantrums and screaming, even over the most minor of things, for example, crayons falling off the table and onto the floor.

 

S is sweet and patient with her little sister, but is aggressive towards other kids her age. She picks up furniture at pre-school and church and throws it.

 

My sister feels like the most horrible parent on earth. She is on medication for anxiety and told me tonight she has put in a call to her psychiatrist for depression medication.

 

She says that while other parents notice S's behavior, they appear impatient with my Sister and will make comments like, "It's fine, just go - we'll take care of S" in an impatient tone which Sister interprets to mean that she is incompetent. S is sweet to adults for a few hours or days, but then apparently becomes unkind to everyone - yelling, screaming, calling names, hitting, kicking, throwing things (including furniture).

 

She asked the doctor whether S had ADHD but the doctor said she was too young to make that diagnosis. She asked her husband what he thought, but he said he felt the behavior was typical for a 3 yr old.

 

My advice (simply) was that she was a good parent, she needs to keep her psych appointment, ask the pediatrician for a referral to a psych (iatrist/ologist) and if the pediatrician won't do it, find another one.

 

Developmentally, S has always appeared fine regarding speech, etc. Any thoughts? I've offered to take in S for a week or so just to give her a break and she's seriously considering leaving her here after Thanksgiving (when they come to visit - they live about 3 hours away). She needs a break.

 

Any thoughts for me? Because she adopted the girls, she doesn't feel like a "real" parent at the moment. I admit she does some nutty things, but I don't feel like this situation is due to parenting at all. (She did say that she was going to ask her psych to suggest someone that can help her with parenting and how to discipline a child like S because she doesn't know how to make her mind her at this point).

[Tap]

DD5 is my great-niece and has been with us since she was 5mo.

 

DD5 sounds just like your niece. She has a 'light switch' personality. When things are good, they are great! When things are not good, they are horrid!

 

DD5 is aggressive, violent, quick tempered, irrational, and gets fixated. At 3yo, she spent 90% of her day in tantrums or negative behaviors. It was easy to count 20+ tantrums in a day, some lasting over 2 hours.

 

We have an 18yo son who is going to college to become a pastor and a darling 14yo daughter. Dh and I have a stable marriage. Our house is happy and joyful. We have been successful rasing two kids so far, but dd5 challenges me each and every day.

 

Right before she turned 2, we had her evaluated by Early Intervention (part of the school district). They suggested behavior therapy and occupational therapy for her. Her scores weren't low enough to get her services through the school district, but they were significant enough to get private referrals to the agencies we needed. DD started OT and BT shortly after. Therapy has been a God Send!!! It has been hard and at times daunting. Other days, it was the only thing that got me through. Seeing the baby steps of progress, adding up day after day, was my light on some very dark days.

 

I reluctantly started medicating her at 4yo. At that point she had over 100 therapy sessions. I was starting to lose it. I was seriously considering returning her to the state. I work in pharmacy, I understand the medications. I appreciate them, but also respect the 'dark side' of medicating (a child especially).

 

She turns 6yo soon. One year ago at 5yo, she had had 3 years of therapy and had been sent home from day care 6 times in just over 1 month. She was suspended for 2 days after attacking the director and assistant director, scratching them both deep enough to draw blood. She had chased teachers around their rooms, destroyed items, trashed the lobby and classrooms, went after other kids and was just generally getting worse. The medications were helping, but not enough and not in the right ways. We changed her daycare and I started working only weekends to minimize her time away. She went to daycare for 5 hours a day (2hr nap, 3 hours awake) just so I could get a break from her and to help her keep on an active daily routine. She is one of those kids who do not stop, and she was Exhausting to keep up with. She did nothing independently and never played with toys.

 

The new daycare (right at 5yo), had experience with special needs children. My BT had her own Autistic child at this center and highly recommended it. I was very upfront and honest with them so the center was prepared for her. 4-6 weeks in, and they told me that they needed a one-on-one for her to stay at the center. She was walking chaos and leaving destruction in her wake. We got the state to provide a one-on-one for her and the daycare made Huge accommodations for her. She is still there and is doing good.

 

 

A year later, and she just starting kindergarten last month. She is 6 and is doing really great! She still has issues but is in class with out a one-on-one for K, and is happy to attend. She is pulled out for resources 2x a week and has only had one tantrum for a her teacher! We have modified medications (added meds/stopped meds/changed dosages) almost every single month for the past 2 years to get her to a good therapeutic level. She has a pretty good cocktail right now and is the happiest/ most flexible/alert/content that I have ever seen her. She has had over 100 OT sessions (graduated about age 4) and probably 120 BT sessions!!! Not including the thousands of hours that we have done work at home. She has a psychiatrist that she sees or I have a phone consult with bimonthly/monthly for 2 years. He is the one who adjusts her meds for me.

 

She is not 'normal' nor will she ever be. But we have less than 10% of bad behavior each day, not the 90% that we once saw. She still has tantrums daily, but manageable. She hasn't kicked a new hole in the wall for at least a month :D !!

 

Her current diagnosis is PDD-NOS (likely Aspergers), Generalized Anxiety Disorder, Sensory Processing Disorder and is treated for ADD. We suspect that she is Bi-polar due to her cyclic behaviors and 'light switch' behaviors.

 

I would be happy to talk with your family member if she would feel comfortable chatting with a stranger. I live in SW Washington and am up pretty late so we could talk after she puts the kids to bed in almost any time zone. :001_smile:

 

 

Early Intervention works.

[jelbe5]

I am wondering if there may be food sensitivities that are contributing to the rage behavior in your niece. The Fiengold diet may be worth exploring.

 

http://www.feingold.org/

 

 

Hugs to you and your sister.

[Momling]

I don't have an idea about diagnosis, but I have an aggressive 3 1/2 yr old foster son. The thing that has helped us more than anything is an evidence based therapy called PCIT (parent child interactive therapy). In our county, this therapy is free through county mental health, and our family resource center (respite nursery). Also, have her request an IFSP evaluation (like an IEP) through the special Ed or child development agency in her county. There may be services available to the family to help!

[SpecialClassical]

Honestly, I would take her for a neuropsych evaluation. Our adopted daughter went to a neuropsychologist and was evaluated for possible FAS. Your niece sounds like she could have a number of issues she is dealing with. Impulse control problems, sensory frustrations, and the personality switch could be caused by FAS.

 

However, they could be caused by other organic brain issues and the key is to identify what the source of the symptoms is and then treat her symptoms accordingly. For example, you can see some of the same behaviors with ADHD as you do with bipolar, but if you went the medication route the meds would be very different.

 

I feel for your sister. We are fortunate to have had a very strong willed bio daughter who put us through the wringer when she was young (up to abput 11, so a long haul). From parenting her we know that our younger daughter's behaviors and lack of improvement are not a reflection on our parenting. It is extremely distressing to have a child that will not behave no matter the consequence, incentive, or amount of love and attention given. Despair would overcome me if I wasn't 100% sure she was meant to be in our family.

[Slipper]

Thank you for all the answers so far. I wanted to add that my sister is a floor nurse (or is it a charge nurse?) and extremely knowledgeable in many ways. She's just lost at this point.

 

Tap,tap,tap - your great-niece sounds exactly like my niece. I know that Sis keeps hoping things will get better, but they seem to be getting worse. I'm taking note of the things you did and will pass along your kind offer to her and see if she's interested.

 

jelbe5 - I asked the same question. She said that she's greatly reduced the sugar that S receives and has cut out red food dye. I've encouraged her to get a full allergy work-up for as many things as she can.

 

Heigh Ho - I've always felt her language was appropriate for her age. (I have a functionally non-verbal 12 yr old so I tend to hone in on that in kids). I've never had trouble understanding her when she wanted things or was just playing with our girls.

 

Momling - I'll look into that, thanks. I know she's past the window for early intervention, but it may be that she can still fit into some school testing.

 

Jvander - we weren't sure where to take her. I told her to ask her pediatrician for a referral to either a psychiatrist or psychologist or development type person. If they don't check for the things you listed (FAS/bipolar and so on), I'll make sure they do.

[chiguirre]

My advice (simply) was that she was a good parent, she needs to keep her psych appointment, ask the pediatrician for a referral to a psych (iatrist/ologist) and if the pediatrician won't do it, find another one. /QUOTE]

 

You're on the right track here. Your sister's in a hard place right now, but once she knows what she's dealing with and how to find help, it will get better.

 

:grouphug:

[thescrappyhomeschooler]

Honestly, I would take her for a neuropsych evaluation. Our adopted daughter went to a neuropsychologist and was evaluated for possible FAS. Your niece sounds like she could have a number of issues she is dealing with. Impulse control problems, sensory frustrations, and the personality switch could be caused by FAS.

 

However, they could be caused by other organic brain issues and the key is to identify what the source of the symptoms is and then treat her symptoms accordingly. For example, you can see some of the same behaviors with ADHD as you do with bipolar, but if you went the medication route the meds would be very different.

 

I feel for your sister. We are fortunate to have had a very strong willed bio daughter who put us through the wringer when she was young (up to abput 11, so a long haul). From parenting her we know that our younger daughter's behaviors and lack of improvement are not a reflection on our parenting. It is extremely distressing to have a child that will not behave no matter the consequence, incentive, or amount of love and attention given. Despair would overcome me if I wasn't 100% sure she was meant to be in our family.

 

:iagree: OP, while I was reading your post, I immediately thought of a friend who adopted a baby at 8 mos. They already knew/suspected she would suffer from FAS. This little girl was in my son's preschool class and was the most disruptive and volatile kid I'd ever seen. She could also be very sweet and charming when everything was going her way. The girl is in 3rd grade now and with lots of family counseling, other therapies (OT) and good meds, the girl is much more calm and even. She has come over for playdates with the boys and I can't believe the difference in her.

 

Thank you for all the answers so far. I wanted to add that my sister is a floor nurse (or is it a charge nurse?) and extremely knowledgeable in many ways. She's just lost at this point.

 

 

Even people in medical professions can't always see the forest for the trees when they are in this kind of situation. It's different when it's your own kid, and yes, this daughter is HER OWN KID, even though she may feel like a failure. Even if you have biological children, you never know what to expect. They could have serious issues to deal with just like an adopted kid. Doesn't matter. Your sister needs to hear this. She is overwhelmed. Having a challenging kid is overwhelming. She needs to find the support systems that will help her get through this.

[LostSurprise]

I would never try to diagnose someone online, but I agree with the poster that suggested an early intervention evaluation. She sounds like someone with an altered (drugs/alcohol in utero, absence seizures, neuro diagnosis) brain chemistry.

 

I've watched my youngest change profoundly since his seizures started. It doesn't take much to throw the brain off-kilter and with these children the smallest thing (low blood sugar, allergic reactions, lack of sleep, authoritarian rule set) can really enhance behavior problems.

 

I recommend the book The Explosive Child for some techniques dealing with her. It works more with verbal older children/teens so younger children may need to mature to manage the negotiation part, but its a good start in how to view the situation and work with the child. My son's behavioral psychologist recommends it.

 

Regarding language: my son is very verbal. I never considered it to be a problem, but when he was evaluated by a neuropsychologist he was targeted as lacking some skills. Its not vocabulary or expression, but there is some language logic where he is not at his level. If you see a picture of a boy with a scissors on one side of the picture and a curtain with a hole in it on the other side he does not automatically put the two together. Nor does he classify things well. So a good talker who's on level may still have SLP problems (not that I'm saying your niece does).

 

Please tell your sister to get an evaluation (early intervention, medical or neuropsychologist) for her daughter, and let her know that she is not alone. She is not a bad mom. Children don't all fit naturally into the norm or respond to normal parenting. Her job is to keep looking for something that will work and surround herself with supportive people. Getting a diagnosis and finding a group (online, IRL) for support can really help.

[Slipper]

Thanks for the continuing replies. :) My sister has always had a lack of common sense (although she is apparently a genius in the surgery room) so some of this hits her hard. I called our mother and asked her to call her and reinforce - medication (for sis), evaluation for niece and respite care in some way -asap.

 

I'm hopeful that she will let my niece come stay with us for a week. Because of my oldest daughter's diagnosis, we know a lot of therapists who would probably eyeball dniece and share some thoughts (unofficially). Regardless, my sister is in need of a break, desperately. I could tell from her voice that she's about to snap. Part of it was the dance studio kicking S out. She's not sure what happened and they didn't want to tell her. They met her outside the dance studio with S and put her in the car, telling Sister that this wasn't going to work out.

 

My niece is 3 1/2 so I don't think she qualifies for early intervention (birth - 3). But, would she qualify for testing from the state in the 3 - 5 yr old gap?

 

Editing to add - my mother told me that when S gets angry or frustrated she starts clearing surfaces and throwing everything on the floor.

[chiguirre]

My niece is 3 1/2 so I don't think she qualifies for early intervention (birth - 3). But, would she qualify for testing from the state in the 3 - 5 yr old gap?

 

Editing to add - my mother told me that when S gets angry or frustrated she starts clearing surfaces and throwing everything on the floor.

 

The public school provides testing and special ed preschool for kids 3-5. The quality varies, but it can be really good.

 

I have a swiper too. Melamine plates are a good choice and keeping anything breakable out of reach as much as possible.

 

ETA: Although Swiper from Dora is stealing stuff, the phrase "Swiper, no swiping!" did help Geezle to sometimes be able to think before he knocked everything off the tables without escalating the situation. There's something about a cartoon character's phrase that's less triggering than straight mom talk.

Edited October 26, 2012 by chiguirre

[walkermamaof4]

Sounds like eliminating food sensitivities that an IgG or elimination diet can help her. Removing sugar, dyes, gluten, dairy, eggs, and nuts from diet for more than 6 weeks then one by one reintroducing them can help determine which affect her most. And also, maybe some alcohol was drank during pregnancy and has affected her. Search youtube for brain gym and google brain gym 26 movements and brain gym PACE and you will find exercises that help the brain. Brain Balance centers do this as well and will test her. If she asks for free testing there, they probably will do it free.

[Ali in OR]

At least in our county, Early Intervention (EI) and Early Childhood Special Education (ECSE) are run by the same people, same therapists, etc. You're in EI until age 3 and then in ECSE. ECSE is typically centered in preschools rather than the home. She can check with her local county health department to find about how to get an evaluation. 3 is definitely not too old to get some help!

[Tap]

Thanks for the continuing replies. :) My sister has always had a lack of common sense (although she is apparently a genius in the surgery room) so some of this hits her hard. I called our mother and asked her to call her and reinforce - medication (for sis), evaluation for niece and respite care in some way -asap.

 

I'm hopeful that she will let my niece come stay with us for a week. Because of my oldest daughter's diagnosis, we know a lot of therapists who would probably eyeball dniece and share some thoughts (unofficially). Regardless, my sister is in need of a break, desperately. I could tell from her voice that she's about to snap. Part of it was the dance studio kicking S out. She's not sure what happened and they didn't want to tell her. They met her outside the dance studio with S and put her in the car, telling Sister that this wasn't going to work out.

 

My niece is 3 1/2 so I don't think she qualifies for early intervention (birth - 3). But, would she qualify for testing from the state in the 3 - 5 yr old gap?

 

Editing to add - my mother told me that when S gets angry or frustrated she starts clearing surfaces and throwing everything on the floor.

 

She would still qualify, they may just call it something different. The purpose of the program is to offer services for kids before they hit school age.

 

The people in my area were very nice and were wonderful to work with.

[PrincessAriel]

nt

[Galatea]

Any thoughts for me? Because she adopted the girls, she doesn't feel like a "real" parent at the moment. I admit she does some nutty things, but I don't feel like this situation is due to parenting at all. (She did say that she was going to ask her psych to suggest someone that can help her with parenting and how to discipline a child like S because she doesn't know how to make her mind her at this point).

 

I just want to say as an adoptive child myself, that if your sister loves her daughter she is as "real" a parent as it is possible to be. :grouphug: I didn't always get along with my adoptive parents, but they loved me and they ARE my parents.

 

Many adopted kids have emotional, psychological and physical issues that can manifest as time goes by. It sounds like your sister and your niece could each benefit immensely from individual counseling. And the remark from your BIL that this is normal 3 year old behavior makes it sound like full family counseling would be helpful as well. A good counselor and/or psychologist will be able to help them find out what is wrong and how they can help her. If your niece is adopted, mental health care should be included as part of her Medicaid coverage. It was for me, I hope that is still the case.

 

A 3 year old child lashing out like that is experiencing pain of some kind. She needs help. And your sister needs support too. I went for counseling four years after my adoption because I needed that support. There's nothing wrong with reaching out for help. It doesn't mean your sister has failed in any way, just that she took on a child she didn't fully create herself. That is a wonderful but often difficult thing.

Edited October 29, 2012 by Galatea

[Laurie4b]

Agree with the others about an evaluation. I'd go for an occupational therapy evaluation concurrent with a global evaluation by either a developmental pediatrician or a neuropsychologist. The reason I'd go with OT right away is that sensory issues are part of a number of issues (autism spectrum, ADHD, etc.) and if they are present, the OT can start treating right away. Meanwhile, the dev. ped or neuropsych can be figuring out what the more global issue is. There are often long waits, so encourage your sister to call ASAP. If she wants to try diet type stuff, fine, but don't delay evals to see if something or other might work. Your niece's behavior sounds very serious, certainly not typical 3 year old behavior. However, the earlier interventions get started, the better the outcome is likely to be.

 

I'm so glad for your sister that she has you to give her a break.

[Slipper]

Thanks everyone :)

 

I've mentioned attachment problems to her before (sorry, I can't remember the term, is it RAD?). She didn't feel that was her problem with S. She may be more open to looking into it now. I am really pushing her to contact the school system and my mother plans to drive down to see her this Friday.

 

I plan to gently push for this to be resolved even if things temporarily improve. My niece has always been sweet around me (although she goes a bit nuts when my sister walks into the room and she is definitely more attached to men than women). Her bad behavior is what I consider typical (coloring in books, etc). I believe my sister though. Plus, the dance studio, pre-school and church are all commenting and complaining.