Therapy for young child (< 6)

[Clarita]

I feel like some of you have experience in this so I'm asking. I'm struggling with tantrums with one of my children. I've read a lot of parenting books and implemented the suggestions which have made things better but still not good enough (hard to sustain). I've made the decision to seek professional help for this. What type of person do I pick (MFT, psychologist), what's the difference? What does professional help even look like for a little kid?

Details: DC has no trouble doing school stuff and makes friends easily. The issue is sometimes stuff sets him off and he can't leave the angry/fight feeling (we've improved this from 4 hours 1.5 years ago to 2 hours). If I were to self-diagnos I would say depression is the problem (COVID coincided with one of his super close friends moving far away).   

[cjzimmer1]

I know very little knowledge about such things but your description of the "can't leave the angry/fight feeling" just really caught my attention because my nephew used nearly those exact words for years describing his feelings/thoughts and my sister struggled trying to help him process his emotions.  When he was a 15 year old, someone finally suggested ADHD to her and when she had nephew tested and placed on the appropriate medications (took a few tries to find the right one) all that stuff went away.  

So I have no idea if that was helpful or not but just wanted to throw it out there as something to consider because both my sister and my nephew wished someone had pointed them in that direction years sooner because they had no idea that was the source of his issues and how much better he felt once he started taking medicines (one advantage of being so much older, it was much easier for him to explain how he was feeling and could easily tell how much the medicines helped).

[Tanaqui]

Depression, especially in young children, certainly can manifest as irritability/anger. You're going to want to find somebody who specializes in this age group. The exact name of the job (counselor, therapist, psychologist) is probably less important than the fact that they work with young children. If you pick the wrong specialist, they can direct you to the right one.

[Carrie12345]

Resources vary SO much by area, so my first route might not be doable, but I’ll throw it out there.
Any organization with “Child Development”, be it Center, Institute, whatever, will have or should be able to solidly recommend someone with the right skills and experience.

[Katy]

I’d start by asking everyone you know the best place in the area to get a full evaluation for autism, adhd, sensory issues, etc. 2-4 hours is an unusual time to tantrum.

If he comes back with a diagnosis you’ll want to go to people who specialize in the diagnosis. If it is a behavioral thing I’d find a cognitive behavioral therapist. 

[kristin0713]

The best thing would be to get a full eval. You can only help the root of the issue if you know what it is. ADHD, anxiety, OCD, ASD—all of these can cause meltdowns like that. The right diagnosis is necessary to determine the best course of action for him. 

[ktgrok]

I'd look for someone that does play therapy for that age. I know people who had amazing results with anxiety and such at that age. 

I'd also consider a full evaluation for issues like ASD. My son at that age presented with getting 'stuck" in his feelings, rigidity, and anger that was secondary to depression. Bad melt downs. It turned out to be Aspergers (what they called it at the time, I guess ASD 1 now?)

I would NOT have guessed that, but after the diagnosis is made a lot of sense. 

[kbutton]

Adding to the call for evaluations. Educational psych, neuropsych, etc. are good places to start.

In my kiddo, it was anxiety that came from ADHD, sensory issues, and gifted IQ. That frequent adds up to ASD. We started with sensory first (technically with therapy for convergence insufficiency, but that was not separable from the meltdowns) and then addressed the ADHD. Both helped, and then we had some social/behavioral stuff with a BCBA that did broad work on those issues, not just ABA. Eventually language issues beyond the pragmatic stuff became obvious (narrow but deep and hitching up some very necessary skills)—he’d been able to limp along and draw on side skills until that point. We had work with an SLP and tutor for that using Mindwing Concepts materials.

[Lecka]

I am agreeing about an evaluation. 
 

In this age group a lot of things look alike.  
 

[Terabith]

I had a very, very hard time finding therapy when my kid was that young.  I really couldn't until she was 8, when she did some awesome sand tray therapy.  Occupational therapy can be helpful if sensory issues and emotional regulation is an issue, and they tend to be better at working with young children.

I will say that the inability to find therapy was a factor in us deciding to start an SSRI when our kid was barely five.  I had a lot of anxiety about doing so, but it was 100% the best parenting decision we've ever made.  Massively life changing.  

We saw a developmental pediatrician at 4-5, but neuropsych here won't look at them till 7.  

Edited December 12, 2021 by Terabith

[Clarita]

Thank you everyone. I have some reccomendations from a friend (her son, same age as mine, is in therapy for ADHD stuff). I'll give them a call and see who thinks they would be a good fit. 

What is SSRI @Terabith? 

[Lecka]

That sounds good 🙂

[Terabith]

1 hour ago, Clarita said:

Thank you everyone. I have some reccomendations from a friend (her son, same age as mine, is in therapy for ADHD stuff). I'll give them a call and see who thinks they would be a good fit. 

What is SSRI @Terabith? 

An SSRI is an antidepressant.  

[DawnM]

We are dealing with this with my newly minted 4 year old, but I believe his stems from trauma of various kinds.   We have a play therapist and he is going to be evaluated in Feb.   We have tried everything and many days it is exhausting.

[Harriet Vane]

While I definitely encourage a good therapist, I also strongly recommend good old-fashioned Mr Rogers for regular infusions of how-to-handle-emotions. His show is a fabulous support.

[Clarita]

Update: I finally got a hold of a psychologist. We spoke for 30 min+. She feels a lot of the issues stem from pandemic. She outlined what normal should look like for a 3-5 year old. He should have more than one friend to see on a regular basis. He should have lots of friends, older friends, younger friends, and friends his age. She thinks this plays a major part in his issues. He should have been able to find a friend or friends to "replace" the friend that left for Germany, but that didn't happen. We'll keep monitoring but she feels that his problems will go away if he has more socialization with peers and more peers. She also gave me some pointers on how to deal with the tantrums (a lot we were already doing but one thing we have not was praising him in the middle of a tantrum when he demonstrated little actions of calming down). If he takes a breath between screams we encourage and say good job for taking a breath to guide him to find his own way of calming down. 

So we are doing everything possible to get him more kids to hang out with. Staying later after his PE class, going to all the field trips/school days our homeschool charter offers, essentially going to any social activities we can safely do. 

The psychologist said that he is too good at interacting with other people and to turn it off outside of "safe" spaces for her to say he has autism or ADHD.  At any rate, she is hesitant to give him one of those diagnosis without giving him an experience that is normal to his age group.

[KSera]

I’m not a psychologist, but having parented a variety of different kinds of kids, a couple of whom were emotionally intense, I really don’t know that you’re going to find that more time with other kids is going to change this particular thing. It doesn’t sound like he’s secluded without seeing any other kids, and I never found that increased exposure to other kids improved behavior. It’s fun, and mine tended to do well outside of the house, but then sometimes we would pay for that with more intensity after arriving home from a big day out when they could let loose and let it all out. I personally think a lot of people are pegging things on “the pandemic.” My youngest kid (preschool age) is the least affected by the pandemic for sure.

Some psychologists have a very schooly perspective where they think daily peer group socialization is a necessity from a young age and any problem in a homeschooled kid is because they aren’t in that environment (never mind that most of their clientele is from that environment, so it’s clearly not a panacea). It’s been a while since I read the first part of this thread, so I can’t remember what was recommended at that time, but have you already looked at any of Ross Greene’s Explosive Child stuff? (I think I have the right name. It’s been quite a few years since I had a kid like this in that age range.) Fwiw, my two explosive kids got diagnoses in their late teens that were missed when they were young because they were very social and functional and didn’t fit the stereotype (one adhd inattentive and one ASD). Based on your last paragraph, my kids wouldn’t have been diagnosed either, but very clearly meet the criteria now, and especially with the ADHD, the results of testing was super clear there (But I think a little guy the age that yours is is younger than I would test for ADHD either.)

If it helps to hear, one of my kids improved emotional regulation gradually with age and handled things pretty well by the time they reached their teens, with an occasional issue. The one with ASD was intense all the way through their teens, but have improved a lot with a combination of age, anti anxiety med and DBT therapy. 

[AnneGG]

I would get a second opinion. 
 

 

[Chris in VA]

17 minutes ago, AnneGG said:

I would get a second opinion. 
 

 

ITA. It sounds suspiciously like a health professional who doesn't like homeschooling. 

As a preschool teacher with lots of experience with that age as well as 3 grown kids, I think it odd that the professional thinks your child should have lots of friends, and that will help with executive function/emotional disregulation. 

[AnneGG]

I thought about this in the shower. 😂 

I’m certainly not saying that your DS’s struggles couldn’t be from the stresses of the pandemic. I just find her comments very peculiar. School or daycare from 3-5 is a relatively new phenomenon. Many children grew up to be fully functioning and social adults despite interacting almost exclusively with their families from birth to 5/6. 
 

My 6 year old has an spd and adhd DX. At 18 months, early intervention told me if I put him in daycare all his delays would disappear. His ST once told me I should’ve had him daycare at 6 weeks old so he could socialize. Some people (perhaps subconsciously) just don’t like the idea of parents staying home with their kids. 

[Innisfree]

Did the psychologist see your ds, or was this a phone conversation?

I'm having several thoughts.

Certainly no one should diagnose ADHD or ASD without a thorough evaluation, which, at least for ASD, would involve hours of testing and interaction, plus a detailed case history. The pandemic might make me hesitant to ascribe social difficulties to ASD quickly (on the presumption that the child has been unusually isolated), though it sounds like your ds is getting a good bit of social activity. But the problem you're describing isn't a social deficit, it's an emotional regulation deficit (which can be a huge part of ADHD or ASD). So, how would the pandemic be the cause? Maybe just by increasing overall stress in the family? I could see that. But I don't see it as an issue caused by a friend moving, or cured by more friend time. 

Next, from personal experience I can say that psychologists and therapists don't always recognize what's in front of them. They're trained professionals, but they're also humans who miss things, have preconceptions about what kids with _____ look like, were trained before current thinking was current, etc. That doesn't mean your ds has anything diagnosable; just don't assume one person has all the answers.

Try her suggestions, by all means. But if the problem persists, don't think all the questions have been answered because of what this person said.

[Scarlett]

I am glad to hear several of you say the suggestions of more peers and more time with peers sounds suspiciously biased.  At that age I do not believe it could be negatively impacting him to that degree.   But what do I know. 
 

I know many here wish they had intervened earlier….but I will also say that many many kids go through periods like what you are describing and turn out fine.  It is hard as heck to deal with in the meantime but not everything is doom and gloom for every kid.

My son’s friend up until he was 12 was a very wild child. At 7 she was still being carried out of religious services screaming.  She got through that stage and is a very lovely young adult.  
 

I would definitely get a second opinion. 

[Clarita]

1 hour ago, KSera said:

’m not a psychologist, but having parented a variety of different kinds of kids, a couple of whom were emotionally intense, I really don’t know that you’re going to find that more time with other kids is going to change this particular thing. It doesn’t sound like he’s secluded without seeing any other kids, and I never found that increased exposure to other kids improved behavior.

Actually, he has been secluded. From March 2020 to June 2020 he didn't see any other kids aside from his sister in person. From June 2020 to March 2021 he saw 4 kids in total one of which was his sister. Libraries, museums, places to visit for children are just starting to open up now (in-person church didn't even start for us until Sept 2021). I mean public parks and playgrounds were closed for a few months in 2020.  We live in CA in a heavy lockdown area, from what I've read about other experiences on this board. 

She gave me some things to be aware of. And if I didn't see improvement or academics/focus/interactions get worse then to call her back for another evaluation. She did say she didn't think a test or anything like that would be helpful at this time because of his age (at 5 years old there is a brain transition) and he is just coming out of an abnormal situation. 

1 hour ago, KSera said:

Some psychologists have a very schooly perspective where they think daily peer group socialization is a necessity from a young age and any problem in a homeschooled kid is because they aren’t in that environment (never mind that most of their clientele is from that environment, so it’s clearly not a panacea).

I offered up the information that I was homeschooling and would consider sending him to private school. She felt like I could absolutely provide enough people interaction doing homeschool (it's actually a popular option in my area - I live near some pretty bad school districts). She felt that the previous heavy lockdown was the big problem for him and he's still reeling from it.

1 hour ago, Innisfree said:

So, how would the pandemic be the cause? Maybe just by increasing overall stress in the family? I could see that. But I don't see it as an issue caused by a friend moving, or cured by more friend time. 

The thing is that she feels like he may not have a regulation issue because he is social and functional outside of his "safe spaces"(place in which he feels people there will love him no matter what).  I mean he is 5 so he should still be learning some regulation skills. The lack of ability to calm down she thinks could be in general discontent/stress and being 5 learning regulation and expressing emotion.

So, the pandemic meant he lost all his close friends in Mar 2020 (he was 3 so zoom meetings with friends didn't feel real to him). Also, more social time does have a positive impact in his behavior. January started up and activities began again, and things are much better than Dec. break time. I mean I don't have a lot of data to go from, but more social time has made things better.

Yes in general he is an intense kid and I did read The Explosive Child. A lot of the things she suggested (that I already knew about) came from that book.

 

[KSera]

3 minutes ago, Clarita said:

The thing is that she feels like he may not have a regulation issue because he is social and functional outside of his "safe spaces"(place in which he feels people there will love him no matter what).

This is the kind of statement that makes me think she isn't experienced enough with that. It may be totally true in his case that it means that, but it's a very common thing for kids with these kinds of issues to hold it together when they are in public and only display this kind of behavior at home. That was absolutely the case for my kids like this. They were model children in public; I got complimented all the time.

Fwiw, we have been more secluded than what you describe, but it sounds like for you it's not enough, so that's legitimate for you. Doesn't mean it will end up having anything to do with his particular emotional dysregulation, but I get the idea that you would feel more comfortable if he was spending a lot of time with other kids.

Do you know this psychologist's qualifications? I would be looking for referrals to good neuropsychs to see when the time is right. It's especially helpful to see ones who have experience with asynchronus or 2E kids, so they don't automatically interpret a high functioning kid as not having anything that might benefit from addressing.

[Clarita]

23 minutes ago, KSera said:

Do you know this psychologist's qualifications? I would be looking for referrals to good neuropsychs to see when the time is right. It's especially helpful to see ones who have experience with asynchronus or 2E kids, so they don't automatically interpret a high functioning kid as not having anything that might benefit from addressing.

I work with a wide range of people from infants, children, adolescents, and adults who are struggling in their life.  I can help identify why you or your child is struggling through psychological or neuropsychological assessment.  I also treat people with common symptoms such as anxiety, OCD, and depression.   (describtion from her website)

She was recommended to me by a friend whose kid does see her for ADD stuff (I want to say he's mild but he isn't perfectly functioning in public). 

Plus, it was really hard to find available therapists for someone under 6. So, I'm Ok with let's try some things and see where we are. She did keep the door open if we see more concerning things or things don't improve.

[Arcadia]

Summit Center generally has good reviews and they do evaluations for children from 2.5 years old. They have locations in NorCal and SoCal. https://summitcenter.us/locations/

[kbutton]

1 hour ago, Clarita said:

She gave me some things to be aware of. And if I didn't see improvement or academics/focus/interactions get worse then to call her back for another evaluation. She did say she didn't think a test or anything like that would be helpful at this time because of his age (at 5 years old there is a brain transition) and he is just coming out of an abnormal situation. 

Yes in general he is an intense kid and I did read The Explosive Child. A lot of the things she suggested (that I already knew about) came from that book.

I am glad she gave you things to look for. I am in Camp Suspicious in spite of that. Intense kids, especially if they are 2e, are easily missed. I would've loved some help at 5 (or heck, infancy, lol!) vs. a diagnosis at almost 9 and years of trying to find the "right" help for an intense, 2e kid. 

You might be surprised at how much he's holding things together entirely because you provide intuitive, helpful support. 

1 hour ago, KSera said:

This is the kind of statement that makes me think she isn't experienced enough with that. It may be totally true in his case that it means that, but it's a very common thing for kids with these kinds of issues to hold it together when they are in public and only display this kind of behavior at home. That was absolutely the case for my kids like this. They were model children in public; I got complimented all the time.

Yep, although mine could go from angel to the opposite in seconds, and I was credited and blamed accordingly. Fun times. The same kid that could listen to a Magic Treehouse book on CD in one sitting at 2.5 (and understand big hunks of it) couldn't stop himself from feeling up the silky shampoo bottles at the grocery store (and knocking them over like dominoes) at some embarrassingly late age, honestly. Any attempt to try to explain behavior was me being a helicopter parent, but if I wasn't helicopter-y it was my fault when something unexpected happened. 

I would try to bypass that, lol! It's not a fun experience.