Well today was very strange. Both boys were going to be at home today, and Bill had taken the day off to be home with them. We had our parent-teacher conference scheduled for this morning and then I was going to go in to work.
But Bill developed this horrible pain in his left elbow yesterday. He doesn't remember doing anything specific to it, but it suddenly became swollen, red and so painful. He was able to get an appointment with the doctor this afternoon, so I just took the day off also. You'd think it would be a nice day at home for all of us, but it really was a day of running around. That's the way it goes sometimes.
Bill ended up having an infection in his elbow! They had to drain fluid from it, which was very painful. (I'm trying to be as sympathetic as I can, but ladies, you know that I want to say "as painful as delivering a baby? I think not.") So I just finished my antibiotic yesterday, and he started one today!
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My question for all of you stems from our parent/teacher conference. Henry is doing quite well academically and in many social situations. He is making progress on all of his IEP goals and doesn't argue with his teachers about everything anymore.
He is, however, aggressive. I hesitate to say that this is a new problem, because it has always been a component of Henry's behavior. The discussion today, though, seemed different. His teacher basically said that Henry's unpredictable aggression is the only thing holding him back from spending most of his day with the regular ed class.
Many of the specialists who work with Henry have never seen this side of him. I can tell that this frustrates his teacher because she needs help in identifying why it happens. Sometimes the adults in the classroom can see the antecedent. But other times, to cite one of her examples, Henry will be reading in one quiet corner. Another child will walk into that corner to get a book, minding his own business. Henry will look up, stick out his leg, and trip the child. Or he will push an unsuspecting child from behind. Or he will unexpectedly scratch or pinch another child in the face.
These actions not always directed at the same person, nor do they always occur in the same situation.
The adults can handle this aggression to a certain degree, when it is directed at them. But Mrs. C. says that Henry often attacks children who cannot defend themselves. (I assume this means nonverbal children- she is always very careful about not naming names.) And her biggest fear is that he will injure one of the regular ed 2nd graders, which could potentially generate a huge political stink, and harm Henry's chances of being accepted in the general ed classroom.
The teachers try different types of reactions to these situations (talking quietly, giving him a big squeeze, threatening the loss of a privilege). Sometimes these attempts work to calm Henry down, sometimes they don't. And at those times, despite his small size, it is a real challenge for the adults to get Henry "off" of the child he has chosen to attack.
(The word attack may sound a little harsh, but the more I hear, the more it sounds like that's what's happening. I don't want to turn a blind eye to my son's bullying.)
The teachers, paras, and therapists seem to generally feel that these actions are almost uncontrollable on Henry's part. We have seen a bit of this behavior at home, but definitely not to the same degree.
I'd love to hear from any of you (either in comments or e-mail me) who have been through this with your child. Henry has never taken any medication, and I am wondering if that is the path that would help him? Bill talked to the pediatrician briefly today, and I will have to get back to you with the name of the medication that they discussed.
I certainly don't want to jump into anything, but I also want to help Henry as soon as I can. I thought about trying to get back in to see the psychs who diagnosed him, but I fear the wait to get in now would be even longer than it was 4 years ago.
Thanks in advance for your help, friends. Have a good weekend!
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9 comments:
Wow, Gretchen, I'm sorry to hear that Henry's having sp,e aggression issues. (Ok, that just sounded patronising and it wasn't meant to be at all! Sorry! :-o)
Have you (or has someone at school) thought about asking the district psychologist to do a couple of days observation? Might be helpful in identifying IF there is a common antecedent. That kind of information can be useful in identifying if there's any kind of pattern (time of day, weather, colors of clothing the kids are wearing, etc.) I know it sounds really extreme, but if Henry has any really subtle anxiety triggers, this might be a good way to suss them out. (Of course, I'm in MAJOR "detective" mode right now due to Nik's ongoing mystery ailment...)
GOOD LUCK!
We also had a lot of trouble with aggression when our son was younger--3 and 4 were the worst of it. It's started to taper off now and only comes up periodically and not often enough to freak me out. I know Henry is older, so our experience won't really lend you any insight, but I did want to say that I've been there and I know how hard it can be to hear those kinds of things said about your kid.
With us, it was as you describe. Difficult to say what the trigger was. Seemingly out of the blue. It was like his perception was out of whack (well, we know it was). Another kid would walk by and he would feel threatened and lash out.
I don't know what made it start to fade for us. I spent so many sleepless nights wondering how he would ever get through school.
I wish I had some easy answers for you. Can you talk to Henry about it? I will keep good thoughts for you guys. Good luck. And hang in there.
Hi Gretchen - I love reading your blog, first of all - I have a few sites that I make my rounds on daily and yours is always one of the first that I check. If there isn't anything new - I usually peruse your archives looking at the many pictures of your precious cherubs or reading the great stories about both of them (well, I should say all 3 of them - can't leave your daughter out!!) Well, this comment may be long - I was going to email this to you, but maybe it might help a lot of different parents, so I thought I would comment it instead. My son Koby is now almost 11 years old. He was labeled as Emtionally Impaired because of AD/HD, ODD, Sensory Integration, etc... this was back in preschool and Kindergarten. So, through that time he kept exhibitting strange behavior (hand flapping, echolalia, lining up toys, sensory problems - lots of sensory problems and... a TON, TON, TON of aggression with other kids). Most of all - it has been the social skills with him that have been severely impaired. He looks and acts much like an NT kid - so people are quick to judge him as weird, etc. He just didn't - and hasn't known how to interact with other kids. So - I am going jump to one prognosis that I think may be a clue to why Henry is doing what he is doing - since their social skills are so impaired - they basically do not know how to appropriately go up to another child and make an appropriate connection. So, maybe it could be that this is in effect one way that Henry is trying to reach out to another child to interact with them. I know that sounds crazy - but that could be one reason why. Koby has finally been re-evaluated and they finally found him as having Autism - officially. What I was telling everyone was finally proven true - so since I am an advid researcher - I started researching, researching, researching. This brings me to a recommended reading that I have for everyone with a Higher Spectrum child - it is called The Complete Guide to Asperger's Syndrome by Tony Attwood. It will give you many of those answers that you have dreamed of having... the answers that helps you put the puzzle pieces together. It certainly did for me. This brings me to another explanation about the whole anger and aggression thing - it is pure impulsivity. A lot of these kids do not have that thing (chemical, electric connector) in their brain that tells them "Okay, don't do that - because if you do that, this will happen". They just do it anyway. Is Henry remorseful after the fact that he has hurt someone? I think back when Koby was as young as Henry much of that was too early - he was sorry because he was in trouble - but it finally got to the point as he got older that he would be truly remorseful after something bad would happen - but it didn't prevent it from happening. We just did the whole talking thing - working, working, working with him to try to make him understand that those kinds of things were inappropriate and that if he did that when he got older that people wouldn't be understanding like mommy and daddy... he could get in trouble from the law for something like that and whatnot. Well, it really tore me up to keep telling him stuff like that because I would see his anxiety go up tremendously because when he would have an impulsive spurt and hurt someone he would freak out about it thinking that he would go to jail... so we didn't mention as much of that unless he really hurt someone seriously. I didn't want to scare him to death, but I figured if it scared him enough - he would be too scared to do something that might lead to that point. It has tapered off somewhat - but I think some of that has come with age and maturity - he still has the maturity level of a 3rd grader - even though he is in 5th grade. But it has gotten better in ways too because he has had a social skills group he has been in to help teach more appropriate ways to interact with other children. But, all in all - it still comes down to impulsivity. He still has those impulsive moments. (I am sorry - I just jump all over the place - I have a ton in my head to tell you I guess.) I am going to share something that I read in the Complete Guide to Asperger's Syndrome to help explain what I mean about the whole impulsivity thing. Please bear with me - there are a few different paragraphs that I would like to share.
1. Normal children acquire the necessary social habits without being consciously aware of them, they learn instinctively. It is these instinctive relations that are disturbed in autistic children. (Hans Asperger)
2. I am not going to type out the paragraph, but a good point was made on page 144 saying that "for very young children and even some adults with Asperger's syndrome, aggression can have the function of achieving solitude". You said that Henry likes to spend a lot of time reading or sorting piles of papers by himself, correct? Maybe this could be a reason?
3. "There may be neurological reasons why there is a problem with emotion management in general and anger management in particular. We know that a part of the brain called the amygdala can be structurally and functionally abnormal in children and adults with Asperger's syndrome. The amygdala has many functions, including the perception and regulation of emotions, especially fear and anger. A metaphor to help understand the function of the amygdala is that of a vehicle being driven on a highway. The frontal lobes of the brain are the driver, who makes executive decisions on what to do, where to go, etc. The amygdala functions as the dashboard of the car, providing the driver with warning signs regarding the temperature of the engine, the amount of oil and fuel, and the speed of the vehicle. In the case of people with Asperger's syndrome, the 'dashboard' is not functioning consistently. Information on the increasing emtional 'heat' and functioning of the engine (emotion and stress levels) are not available to the driver as a warning of impending breakdown." In my opinion - in the case of my son - it could explain why he goes from 2 to 10 without anything in between when it comes to getting angry about something. It can be something quite minor - on in a lot of our case it is something that pertains to a certain "rule" that Koby believes is established about something and he finds injustice in what that other child is doing or has done. He will not for instance let me bring candy into a movie theater - he says it is against the rules and he will not go if I do that. (I know it is against the rules... please don't bust me - LOL - well, it wouldn't matter anyway - I can't with Koby.) LOL
4. "Feelings of anger can also be the response in situations where we would expect other emotions."
5. "When feeling angry, the person with Asperger's syndrome does not appear to be able to pause to think of alternative strategies to resolve the situation, considering his or her intellectual capacity and age. There is often an instantaneous physical response without careful though."
6. "In conflict situations, typical young children will become angry and use acts of aggression to achieve possessions, dominance and control. Gradually acts of aggression and threats are replaced by negotiation, compromise and cooperation and the knowledge that one can sometimes get what one wants by being nice. These strategies may not be obvious to children with Asperger's syndrome, who tend to rely on immature, but sometimes effective confrontation strategies and emotional blackmail."
7. "Feelings of anger in response to what someone is doing can lead to acts of aggression as an effective means of making people stop." In our case this can be due to sensory disturbances - someone hurting Koby's ears by yelling may have ben hit by Koby as a means to get the child to stop the behaviour.
There are more examples and reasons that Dr. Attwood gives in his book, but these are a few good ones to maybe help with shed some light on what you are going through. Our son has always been very hyper and has a number of stims that are present as well - so early on we debated and debated and debated and finally chose to try medication. It has helped more than I can tell you - but it has mostly been for hyperactivity. He can sit and focus and is purely lovely one on one the majority of the time. He is a big cuddler with me still - even at 11 and he tells me and daddy how much he loves us all of the time. He just has a hard time with other kids - especially those of the same age. It is a constant work in progress and I feel for you a TON because we have gone through it. Koby was much bigger (always thin, but tall and muscular) than Henry and he has really hurt kids at times. I does scare the bejeezers out of me all of the time when it happens because I know one day he will be big enough to have it be called Assault and Battery - and that just terrifies me!! So - that is one of the reasons I try to read whatever I can put my hands on about these kinds of things. I hope this has been helpful and I apologize for the lllooonnnggg post. Good luck and keep us posted!!!
I forgot to mention – going back to Koby – he would hit so often, we had to do something about it. So, we did a point system thing in the classroom – like if you go this long without hitting, you get a point. Made it visual for him at home too – he would get poker chips for good behavior and “Spidey Bucks” – I made some dollar bills on the computer and put Spiderman’s face in the middle instead of the President. They were about the size of Monopoly money and on the back it would say “This Spidey buck is good for ½ hour extra time at bedtime to watch a movie” or “This Spidey buck is good for 1 hour of playdough time with mommy” or “good for an ice cream cone at the party store”, etc. The poker chips were very similar – I still do something similar – he can turn in poker chips he has saved for movies, games, time, etc – it is all laid out on a whiteboard so that he knows exactly what he can get. It encourages the good behavior. We started out with just one thing – like “No Hitting” to see how he would do with it and it worked very well. It didn’t eliminate it, but it reduced it. Also – I would do visual reminders – when he was about Henry’s age, I would draw in marker a smiley face on the back of each hand and tell him these were his “Happy Hands” – and happy hands didn’t hit. I think it helped as a visual reminder. Later I used bracelets – kind of like the WWJD bracelets. That seemed to help too. Hope this is helpful.
Ky's biggest problem area in the beginning was aggression. With us it was tied to sensory - once we got a handle on his sensory stuff - and started guiding him more on the social end - oh and maybe some extra time for maturity :o) - he's gotten through it. So maybe it was more than sensory after all Hee hee... but it was a bunch of stuff. He would be overloaded internally, and the unlucky child that happened to cross his path would get walloped. Or kicked. Or even pushed down and choked (yes, my sweet little guy did that awful thing). He also had trouble joining a group of kids already engaged. Instead of asking to join, he'd just pick the nearest player and push them out. We've come a long, long way from there.
Maybe because Henry had other, bigger things going on, you're just surfacing this now?
We talk to Kyle a lot about feelings. About feeling overloaded and needing to go somewhere else. About it being OK to be angry. Doing things like "how did you feel when Suzy took the book from you? I would have been so angry I would have wanted to kick her! But do you think that would have been ok?" Those kinds of things - validating the feelings but not the actions...
Hugs to you! Sometimes I think the aggression is the worst - because it's what the other folks will remember the most, and I didn't want him to come away with a label of Bully. :-(
Gretchen, I just left you an e-mail about this. I've been dealing with some similar things, though I haven't been blogging about it. As I said in the e-mail, sometimes I find that too much advice can be more difficult for me to manage than no advice at all. Anyway, I tried to stay advice-free in the e-mail, but let me know if you want any more info! :-)
Sounds like you have gotten a LOT of advice already. And since I don't have much to add, I'll just say hang in there and I know you will figure out a way to help. My first thought when I read your post was that it is sensory, but who knows. Keep us posted.
First of all, what is it with men and infections in their arms?! Do they not wash out injuries or what? Rick had the exact thing happen last February!
http://thingsicantsayoutloud.vox.com/library/post/6a00cd9741c19b4cd500d4144d6f136a47.html
Onto Henry. I feel your pain because you know that we have gone through the same thing with Conor and he does the EXACT SAME THINGS. To the letter. No one has been able to figure out the antecedents, other than the fact that there seem to be many (which includes but is not limited to inappropriate socialization). I absolutely agree with Kristen that it just seems as if he suddenly feels threatened by the proximity of the child. Conor will also seem to "target" the ones who are weaker and won't usually pick on someone who will give it back to him (And, he puts a CHOKE HOLD on these kids' heads, making it a wrestling match to get him off of them.) This includes our dog and cat. He picks on the dog relentlessly (who is the most patient animal I've ever met) but knows not to mess with our cat, who'll take your eyeball out if you look at her wrong. Could it really be possible that nature (survival of the fittest) is playing out in its rawest instinctual form??)
Again, as you know, Conor has been on Risperdal since June as a result of his terrible anxiety issues in every aspect of his life. It seems as if the behavior incidents are not as frequent or aggressive, but he still has pushing issues. In fact, he pushed a boy in church over a month ago and the boy shoved him right back (which resulted in a huge gash on his forehead). That actually seems to have helped quell some of the behavior and he now says, "GO AWAY!" or "GET OUT OF HERE!" to people in his 'space' (which is great when someone is just innocently walking by, as you can imagine) All of this to say that medication probably isn't going to eliminate these behaviors but might lessen the frequency.
I'll be looking to this thread to see the comments that you get. I, personally, have been hoping that his increasing maturity level will lessen the incidents. I've tried everything else. All I've got left is time! Hugs.
Tc does the same thing at school..especially if he feels like someone is trying to take a toy or book away. Or if they invade his space, he kicked a little boy in the "privates" not too long ago. His teacher always takes him to the side and talks to him. He will now say,"Mom, we don't hit." They have created a space in the classroom for TC to go have his own quiet time, he is in a regular classroom all day long. He gets pulled out for speech and inclusion therapy. We do OT at a facility here in our town 2 days a week. TC is somewhat aggressive with me and even today, he scratched me on the face. I try to explain that it hurts Mom when he does that.
Good luck, maybe the school can help Henry work thru these issues. The teacher really needs to keep her eye on what is happening when he lashes out.
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