Therapy or counseling for a six year old?

[alef]

We've been really struggling to know how to help dd6 with some emotional types of issues lately, and I'm wondering if some kind of profession counseling or therapy might help but I'm not sure what. These have been ongoing issues since she was quite small, I had hoped she would grow out of some of them but they actually seem to be getting worse. She is very emotionally volatile, when something happens that she doesn't like she doesn't seem able to cope at all--she turns into a screaming, kicking, biting, scratching banshee (I have scars on my arms from her scratching). There's not much we can do--she has terrible anxiety about being in a room alone (won't even go to the bathroom unless I or her big sister go and stay with her) so we can't put her in time out. I will try to hold/restrain her, but she attacks everyone around. She has night time troubles too that my other kids have not faced--she seems to have nightmares a lot and will wake up screaming and completely inconsolable--she is awake, and she does remember it the next does so this doesn't seem to fit what I have read of night terrors. She also wets the bed almost every night, I don't know if that is related to everything else or not but my other kids have mostly been dry at night from the time they were potty trained. 

 

She is very affectionate when she is in a good mood, and really craves adult attention. She would sit and listen to me read to her for hours every day if I had that much time. My concern is that she seems to be completely at the mercy of her emotions--fear, anxiety, anger--I don't know how to help her cope. Anxiety and depression issues run in the family.

 

Does anyone know what I should be looking for if I seek out therapy or counseling for her?

[Tokyomarie]

There are a number of underlying issues that could be driving this behavior. Since it is something that has been ongoing since she was small, my recommendation would be for you to see a developmental pediatrician. A developmental pediatrician can help you investigate physical, neurological, and mental health problems that may lead to the behaviors you see. This kind of doctor is often found in major medical centers and in private practice in the cities around such centers.

[geodob]

I would suggest that the focus needs to be on understanding and addressing the anxiety?

With the behaviour as symptoms of the anxiety.

Where 'screaming, kicking, biting, scratching', are innate life threatening responses. 

 

One approach is to develop different behavioral responses.

Though I think that the focus needs to on addressing the anxiety. 

So that the behaviors disappear as a consequence.

 

But perhaps instead of 'anxiety'? It could be looked at in terms of a 'state of fear'?

Where you might consider the difference between feelings of anxiety and fear?

So that when you say that she has terrible anxiety about being alone in a room?

This could rather be feelings of fear, as she feels safer when someone else is there.

 

Also in regard to nightmares and bed wetting? 

Loss of bladder control, is a typical response to extreme fear.

Where perhaps the real solution, is replacing these feelings of fear, with feelings of safety?

 

Though I'm reminded of a simple exercise to help with this?

It simply involves having her stand in front of you, with her back towards you.

Then she falls backwards, and you catch her.

Where you begin with catching her after just falling a few inches back.

So that she feels 'safe' at that distance, and then gradually increase it, further and further.

 

While this develops a feeling that we can trust someone else to catch us when we fall.

The other important element is that with you standing behind her and out of sight.

It develops a confidence that someone else will catch us, even when we can't see them.

 

Which can extend to feeling safe, when the other person is out of sight, and in the next room.

 

Though something else that you could introduce daily, is 'hugging her'?

Where a hug can provide a feeling of safety and security and reassurance.

So that perhaps when situations occur, that cause you to have to 'hold and restrain her'?

That perhaps when these situations occur?

That she might instead turn to you for a hug?

 

[Tiramisu]

There are a number of underlying issues that could be driving this behavior. Since it is something that has been ongoing since she was small, my recommendation would be for you to see a developmental pediatrician. A developmental pediatrician can help you investigate physical, neurological, and mental health problems that may lead to the behaviors you see. This kind of doctor is often found in major medical centers and in private practice in the cities around such centers.

 

I agree with the developmental pediatrician recommendation. I wouldn't wait because you may get more cooperation at this age. I've heard that some are better than others and there can be a waiting list, so I'd start looking around now and trying to get recommendations. 

[73349]

And while waiting for an appointment, keep a journal of what's going on. That may help when the ped/therapist is trying to pinpoint the frequency, severity, and triggers for her.

[alef]

I searched our insurance provider list for a specialist in pediatric development--they list the specialty but no providers within 100 miles. A google search pulled up a name in the nearest large city, she is listed under my insurance as a pediatric behavioral health specialist so maybe that is who I should try?

[Ottakee]

I agree it sounds like she needs some help.

 

A developmental pediatrician and/or neuropsychologist might be a good place to start. I would ask the primary for some basic blood work to be done to rule out anything like thyroid, blood sugars, anemia, etc.

 

For my daughter with those behaviors, it ended up being pediatric onset bipolar. Proper medication has made a huge difference.

 

You might also ask for a sleep study as sleep problems can cause daytime behavior issues or be related to them.

 

You might have quite a wait to get into a specialist--sometimes 3-6 months but try to get on a cancellation list as that can help you get in earlier.

 

In the meantime, you might want to read The Explosive Child on some ideas of how to just manage and survive until you get more answers. Also try a simple chart where you record her behavior each day, sleep habits, eating, meltdowns, activity level, basically any concerning behaviors you see. I did this in a spreadsheet where each day I could give each of about 20 behaviors a 0 (none) to 3 (severe). Over time we could see a pattern of cycling. You might see one where good sleep = a good day, or certain foods/situations, etc. cause her trouble.

 

Write down ANYTHING and EVERYTHING you can think of before the appointment---no matter how small you think it is. The more pieces the doctor has, the better they can figure out the big picture.

 

Is there any family history of mental illnesses? If so, that might give you a direction as well.

 

On the positive, my dd is now my easiest child 95% of the time.

[alef]

Though something else that you could introduce daily, is 'hugging her'?

Where a hug can provide a feeling of safety and security and reassurance.

So that perhaps when situations occur, that cause you to have to 'hold and restrain her'?

That perhaps when these situations occur?

That she might instead turn to you for a hug?

 

She gets lots and lots of hugs.

 

It's like the anxiety/fear/anger whatever turn off the rational control switch in her brain. If I can head it off soon enough with a distraction I have a chance to keep the switch from flipping, but once it flips there's nothing I can do that will calm her down.

 

When she was still breastfeeding I could turn to that as a recourse, though even that didn't always work. At least nursing was a way to comfort her, she wasn't fully weaned until about the time she turned four; when I tried earlier she ended up screaming for hours on end every night for a week. She remembers nursing and tells me she wishes she still could.

[Ottakee]

I may be WAY off base here but with the "flipping a switch" thing, have you looked at a mood disorder? Kids can show signs of these from infancy on. It often looks like "flipping a switch" on behavior, sometimes very ADHD behavior, parents/other family members feel like they are "walking on eggshells" etc.

 

If this might fit, check out the book The Bipolar Child and the websites www.bpkids.org and www.bipolarchild.com I have one with bipolar and one with a mood disorder and I can say that medication has made 95% of the difference in their lives.

 

Obviously it could well be something totally different in which case a different course would be indicated.

[Tiramisu]

It's like the anxiety/fear/anger whatever turn off the rational control switch in her brain. If I can head it off soon enough with a distraction I have a chance to keep the switch from flipping, but once it flips there's nothing I can do that will calm her down.

 

I completely know what you mean. Two of mine have got that way due to SPD hypersensitivities. It's much better now that they are a little older and we understand better about the triggers. Otherwise, their behavior has always been pretty good. Another one is a sensory seeker and gets that way when she is frustrated from not getting what she wants. Her meltdowns have been more frequent and worse. They continue to happen occasionally but have improved with age. I wish I had consulted the right kind of specialist when she was younger. We did do counselling but it wasn't helpful and didn't give concrete answers. I sometimes think my biggest mistake was thinking she would grow out of it. That's why I think you should try to make an effort to go to a good specialist in order to get an appropriate diagnosis if there is one and that will be a start in finding the best ways to approach it.

 

We also have anxiety, depression, and ADHD in our relatives. I suspect we may also have relatives who are on the high functioning end of the spectrum. There is a genetic link in all those things, so you might want to think about things like this and make a list.

 

Also look for subtle signs of bipolar in your dd or any relatives, as Ottakee mentioned, because you would want to be careful about medicating for anxiety if that's a risk. For bipolar, doctors ask you to take notice of changing energy levels. More and less sleep, for example.

[Lecka]

Don't worry about driving to the nearest large city.  It doesn't mean there won't be someone to see closer to you, once you get a direction to go in. But while you are trying to figure out what direction to go in -- I think the people who specialize in just that one little thing (of figuring out what direction to go in) are in the nearest big city for us, too, a 2 hour drive. 

 

Also, this doesn't totally effect us, but if there are larger cities a similar distance away, but crossing state lines, they might be options.  There is another university clinic in another large city, but in a neighboring state, that can have a shorter wait time.  It is something that never occurred to me before I heard of people getting on the wait list there. 

[ondreeuh]

Like Ottakee, I have one with a Bipolar dx (that didn't appear until adolescence) and one with a mood disorder dx that has been apparent since ... Very young. I trust that you have done everything you can think of. I actually suggest seeing a child psychiatrist. I took my youngest in because I expected he would be dx with ADHD, but she saw the red flags for a mood disorder which honestly are what you are describing. He has an insanely short fuse (what they call irritability) and when he gets triggered it is an all-out meltdown. We did try stimulants and his behavior was 3x as bad, so she tried him on a mood stabilizer that is used for irritability and it made an 80% difference overnight. I am not even kidding. It really proved that this was not about him making a bad choice, or me not parenting appropriately. I believe that it may be the same for your daughter.

 

Another thought - between the nightmares and irritability, have you thought about a sleep disorder? I just wonder if she could have sleep apnea or something which makes her wake up scared, and lack of good sleep could be exacerbating her mood issues. Does she snore? All 3 of mine have trouble getting to sleep and/or staying asleep and it really does have a huge impact!

[texasmama]

I'm a play therapist, and I recommend (as others have said) that you see a developmental pediatrician, a neuropsychologist, or a pediatric psychiatrist intially.  In other words, you need someone to help you sort out the underlying question of "what is it we are dealing with here?"  Without the answer to that question, you are kind of shooting in the dark.  If you don't know where to go, start googing, asking around, searching the web, ask a pediatrician, inquire at the local school district if you have any contacts there - basically, beat the bushes to get some personal recommendations rather than trying to pick someone out of the phone book or an insurance list.  Call friends, neighbors, your dh's associates...anyone you know who might have a connection in this field.  A good neurologist might be helpful, as well. 

 

Play therapy can be a helpful and positive experience for young kids (and parents), but I think it would be good to get some concrete medical/neurological issues first.

[Ottakee]

You can try http://www.thebalancedmind.org/connect/find to help locate a doctor or other specialist. Many of these are well versed in bipolar but they work with young children. Just because a doctor is not on this list doesn't mean they are not good, but it can be a place to start.

[sbgrace]

Does she snore? She has enough issues with sleep (and I'll throw the wetting in that), that I think a sleep study would be a good idea.

I think a lot of my son's daytime issues with emotional control, and certainly his night terror like stuff, was related to newly diagnosed sleep apnea. I really had no idea. But seeing the symptom list, I feel badly we didn't do a study long ago.

[alef]

Thank you everyone for sharing experiences and advice. I will work on making appointments this week. I really appreciate the affirmation that yes there probably is an underlying issue and that professionals can help me figure it out and address it. I very much feel that this is something dd is experiencing and not something she is choosing, so if we can help change her experience that would be great!

[LMV]

Your pediatrician should be able to recommend a developmental peds specialist or child psychiatrist (or both) after their evaluation. Based on their evaluation they may recommend you go in one direction over the other or recommend that you start with one.  You may need a referral from your pediatrician (you will get much more out of the first visit if they send their records ahead of time so fill out a release if they don't do an official referral) and they may be able to expedite the scheduling process. Good luck!