I have a 6yo in 1st grade. And ever since he was in PreK at 4 years old he’s had a hard time in school setting with keeping his hands to himself when getting frustrated, angry or when he’s not able to do what he wants in that moment aka following the school routine.
He is medicated. He’s been on guanfacine extended release for almost a year now. He takes 3mg in morning now. And we recently started sertraline at night.
he goes to weekly therapy also
(We had him try adderall and Ritalin in Nov/Dec and it had a horrible effect - he was over hyper like a motor so we stopped it )
At school he has a 1-1 para for behavior support, gets OT, counseling and 4 periods a week of SETSS to get support w writing. School also has a BIP in place. He does swimming and ninja gym weekly.
And recently started working w a BCBA at home.
We are doing all we could do. But in school he has minimum 1 day a week where he hits either his para or the teacher- some weeks is 2-3 times. But never more than 1x in a day. Usually it is when he’s being asked to stop something he shouldn’t be doing (like taking stuff from teacher area or trying to use iPad) or when it’s time to start new task and it may involve something he’s not interested in like writing. We tell him it’s ok to have feelings and get frustrated but it’s not ok to express it by hitting.
we are beginning to be concerned and wonder could there be another diagnosis here? Mood related?
His diagnosis is ADHD Severe and Level 1 ASD. As well as SLD in written expression
At home he is defiant but he isn’t walking around hitting us every time he gets frustrated w us
And at school he isn’t hitting all day long either but just concerned that this will be forever. I think the school can probably do a better job at figuring out the triggers to avoid getting him to the point of hitting so he can start to learn to use the strategies. And they also don’t do a great job and painting the picture for us on What exactly is happening right before he hits. Like for example - how are they demanding things from him. Because something as simple as the tone can set a kid off.
Anyways not really sure what answers I’m looking for. Maybe if anyone here had a child this age w physical aggression at school and now they are older and are passed it then it will give me hope.
Any advice will be appreciated
I’m always worried about him 😞
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Guanfacine may cause irritability and mood changes...perhaps that's not the right medicine. He may have sensory defensiveness. Perhaps do a genetic test, and see what medicines might work best based on that
would guanfacine show up in that test. I recently did it for my son. But waiting to have appt w psychiatrist to review
To clarify we DID see improvement once he got on guanfacine bc his elopement went away in school and he is much less impulsive. It’s the resorting to aggression in moments of frustration that we need to figure out.
When we experimented w the stimulant in November there was a 2 week period he was NOT on guanfacine and we could TELL that it was actually working bc he was off the rails wout the guanfacine.
I mean you could be right that the guanfacine could be helping w impulsiveness but also causing aggression on back end.
I’ll see if the GenoMind test shows guanfacine. Thxxxx
My 7 year old son did well on Guanfacine ER for a few months on 1 mg and then it started to have extremely negative effects with irritability and mood when we tried 2 mg or went back down to 1 mg, so we stopped it and he is now on 20 mg Vyvanse with a short acting booster in the afternooon (2.5 mg Adderrall) to smooth out the crash from the Vyvanse. He gets nearly full-day coverage still, and the results are much less moodiness, irritability. We spend a lot of time at the trampoline or other parks because he has vestibular/movement hyposensitivity and movement helps calm him down in the way the Guanfacine had initially done in the first few months (sensory processing OT and dietary supplements for protein, magnesium, etc. have helped as well). My son has needed dosages to be pretty low to avoid negative side effects. He could only tolerate 10 mg Vyvanse for the first year when he was 6.
this is great to hear ! the psychiatrist said that at first glance of the dna test he said my son should do ok w Vyvanse. We’ll review it in full in early March. We’re scared for him to try another stimulant but if the dna result recommends it we are open to it. I know sometimes when a child has both ADHD and on autism spectrum we need to thread lightly w the medications. Thx for sharing about the success w Vyvanse. Did you switch to Vyvanse after guanfacine was fully out the system ? Or was it together? Any impact to appetite?
We first tried Guanfacine, which helped in the beginning, then added Vyvanse then took out Guanfacine and added an afternoon booster since my son really needed smoothing out when the Vyvanse stops working. My son has ADHD and Autism, and the sensory processing suppprt through occupational therapy has been very important.
I first want to give you big hugs for all you are doing, exhausting! You will not always need to do so much for help him, but now this may mean what he needs.
Working with the psycharitist should really help.
When the dose is right it may mean he stays on Initiv 24 hours a day. So a second dose in the pm might help a lot so it is not control ( help) then no control.
Where he is now is not where he will be once maturity starts working.
Also it will be really important that his school classroom also fits his needs, but is not over his head.
What sort of BIP is he on?Does it include a lot of positive requirements?
What sort of accommodations are in his IEP? Does it include speaking to him in a calm tone and acquiring proximity and eye contact before giving instructions?
all very important for sure. I do not think the iep mentions exactly how to talk to him so this is a valid point- adding to my notes for when I do next Iep meeting.
My son gets pulled out for OT, counseling and SETSS to help him w writing. He also has a 1-1 and a behavior plan.
There is supposed to be positive reinforcement. This is what they created last month and it’s been in effect for a month w not much improvement.
Lastly here are the strategies he can choose from.
They expect level 3 or 4 in order to reward him each period
Effort scale
I am so sorry for what you are going through.
My thought is- once he does hit etc what happens then? Does he get taken out of the class? I am asking this because kids with ASD often especially when young may not be able to express themselves well but if they suffer from sensory integration disorder then they might not cope well for longer periods in a full on loud and busy classroom. So it well may be that he worked out that if he initiate a situation where he demands something he can’t have or not follow instruction and then he hits staff etc then he will get taken out of the classroom? So he will achieve what he needed - to be in a calmer environment. I am guessing because you didn’t give detail to those situations.
You haven’t said if your son was assessed by OT for his sensory profile…
Equally all those medications, even non stimulants can have side effect of irritability I think? I mean, I definitely first would do what OT advises for him- help him with his environment and see for a few months how this is going for him and only if this doesn’t work, then maybe do a review of medication. You still have Kapvay (Clonidine) to try…Maybe that would agree with him better than Guanfacine?
To give you another example, I was once chatting with this lady and she said her son was awaiting ASD assessment. She said he is very sensitive to tone, sound, loudness, pitch etc of voice, and previous school year he had a teacher who had a very quiet and soft voice and he was fine. This year teacher is really projecting her voice, her voice in general is very loud- that’s how she is and to be honest for the 99% of kids that’s great as they can hear what she is saying and she is ‘motivating’ and keeping kids ‘alert’ with her voice and even kids at the back hear her very well- she can’t change it because this is how she is and this is her voice! But the kid can’t cope, it’s like a torture for him all day at school. He luckily is expressing himself well and he explained it to his mum and she passed it to the teacher, I think she mentioned they will be trying ear muffs and he will be allowed to just leave the class if it’s too much for him etc.
My friend has a son who is mildly on a spectrum and first 2 years of school he wasn’t coping in the classroom. He had his desk outside the class and was working there on 1:1 with a teaching assistant who was assigned to him. Had he been forced to sit on the class with everyone else he probably would become aggressive etc. Then as he was growing older he was managing to spend more and more time in the classroom and now by year 6 he is completely fine and noone would even remember how he was at the beginning of school as a young child.
I’d say at home probably you don’t demand things from him so much plus he is in a quiet environment and safety of his home… Hence he doesn’t hit…
Also with young kids it’s a learned behaviour and funnily enough it may be learned in one environment and it doesn’t transfer to another environment. He might not even remember or know when and why he developed hitting as a way of communicating at school…
I’d say his environment is the clue. But of course you need to do more detailed investigation of situations and also if he hasn’t been assessed by OT then it’s probably a good thing to do.
Just chiming in. I don't have much experience of that w/ the 2 of our kiddos who have ADHD diagnoses. & it sounds like you're going above & beyond already.
But one thing I've been thinking about a lot lately w/ our older 2 is just how hard behavioral intervention is at this level bc of their age. Ours (7yo boy & almost 9yo girl) will be doing so much "better" & then suddenly change & I can't figure it out, especially on the school end. I feel like I need a GoPro cam to review the day's footage for the environmental/social stuff. Or like a detective: "What exactly did he say/do?" They get so annoyed at "all of your questions"! It's so hard for me to get out of thinking like an adult mode & realize I have close to no idea how they actually think & feel when not w/ me.
Anyway, just something I've been thinking a lot lately that seemed a tiny bit related. Hang in there!
omg this is so applicable to me! Haha yes same here I’d love to get a ‘play by play’ like in sports so I can see full scenario! Because as you feel it too I’m sure there IS a reason why the child is reacting that way. And same some days my son won’t have any incidents involving hitting. Some days he would. But I’m only told that he hit - I am given the period it happens and I know what the subject was. But like ok did he all of a sudden just raise his hand and hit. Bc that’s not how it works ! Ugh. Glad you can relate.
I don’t have much advice, but I just wanted to say we’re right there with you. Our son is 6 and in Kindergarten and has always struggled with impulsivity and aggression at school, much moreso than at home or in extracurriculars. We do deal with defiance at home.
He’s had an IEP for a year and a half for dev delay due to sensory processing but also recently diagnosed with ADHD. Waiting to see child psychiatrist in a few weeks. We’ve done private OT and ST, worked with a BCBA and are currently working with an LMHC. At school, he receives OT support as well as support from a behavior analyst and resource teacher. We’ve tried Vyvanse but couldn’t handle irritability and things went off the rails with aggression increasing in the second week of taking it (first week saw progress somehow). Just started metadate cd today and have been on intuniv for one week. Feeling rather discouraged and just hoping we can find the one thing that can help our son succeed. Hang in there…
My son has ADHD and ODD and he would self harm himself when he would get over whelmed. We had to sign a agreement with the school (he went to a specialized school for ADHD and autism) that they could use utilize ways to safely restrain him. It usually consisted of 1 person giving him a bear hug from behind him so that they could immobilize his arms and just wait for him to get tired and calm down.
It sounds like you are doing an amazing job and advocating for him and getting the help he needs. When I was first trying to figure everything out, I feel that I was lost and didn't have as nearly as much help as you do. Good luck.
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Single Mom of 5 year old in Pre-K with ADHD. He is on an IEP and has services.
really struggling w aggression 
Please help-ADHD medication 
ADHD/ Behavior Issues
Ideas for upcoming IEP meeting (specifically refusing to do non preferred homework at school)
