Extreme anxiety?

[FloFTW]

I'm not sure this is the right place to post but I'm hoping someone that sees this will have insight. I apologize for length.

I feel like something is "not right" with my 4.5 year old son but I'm not sure I can pin down what it is to be able to get him/us help. He just seems like a tantrummy ball of wrath and anxiety at times. At other times, he is the sweetest, happiest, most compassionate kid ever. At first, we thought this maybe could explained away as typical toddler/young child behavior, but, we have a 2.5 year old girl as well...and now we are seeing that the tantrums/wrath/anxiety do not come with every child. We just want to figure out how to help him not be so...upset and anxious.

I feel like I should give examples. It seems hard to explain.

This morning, I was taking him into daycare, and I walked up the steps before him. I got to the top and he screamed "I WANTED TO GET TO THE TOP FIRST." and he started sobbing and kicking. Literally nothing else happened besides me walking up the stairs. He was then ruined. I couldn't go back downstairs and let him go up because he knew in reality I was first. If I carried him he thrashed and screamed. I had to drag him through the daycare, which was humiliating for both of us.

The other night, we were all having a perfectly good time reading library books before dinner. He was in a great mood. We sat down to eat, and I had not told him in advance that I was putting carrots on his plate. "I don't LIKE carrots." Instant tears. He threw his plate off the table and was crying and screaming at us the rest of the night.

He does not do ANYTHING like this at preschool/daycare, which is reassuring and frustrating. Reassuring because we know that he does know how to control himself, but frustrating because the little time we have with him can typically be spent with him sobbing and kicking and screaming over something that none of us have any control over. At the end of his tantrums, he always says through tears "I can't make it stop. I want to stop crying but my body won't let me" and it breaks our hearts.

So, how do we get help? I know that I can ask our ped for a referral but I don't even know what to ask for. Because...he might have an anxiety disorder? Something else? I guess I just feel like I don't know where to turn.

[craftyone]

I would make an appointment with a developmental pediatrician. They are more specialized in diagnosing issues such as you describe. it might simple anxiety but they will do an in depth evaluation more so than a regular pediatrician. They can discuss treatments or
Things you can do at home or school that might ease the anxiety.

[FloFTW]

Apr 25, 2014 15:14:27 GMT -5 craftyone said:

I would make an appointment with a developmental pediatrician. They are more specialized in diagnosing issues such as you describe. it might simple anxiety but they will do an in depth evaluation more so than a regular pediatrician. They can discuss treatments or
Things you can do at home or school that might ease the anxiety.

Thank you! I will have to search for one on our insurance.

[meij]

Wow my DD has said all of those things!! She often can't make her tears stop. (She is also 4.5)

My DD actually does have anxiety issues and is selectively mute. She was always in speech therapy for articulation issues so I don't know if the is really aware of her delays so that's why she doesn't speak? We've also seen behavior therapists and I'm looking into what more I can do. Wish there was a guidebook

Anyway, I wish I had magical answers but I just wanted to say I had a very similar child.

Also, I taught PreK for a few years and I always thought kids acted out at home because they work SO hard following rules and being good at daycare/school for so many hours. It really can be a long day for kids, especially ones who are anxious. My DD just goes to half day now, but she needs time after school to decompress and do nothing. I think it's just mentally and emotionally exhausting at times.

[spedrunner]

def make an appt with a dev pediatrician

Im sorry, i know how frustrating it is for you and for him  It def sounds like anxiety/control is playing a major factor.  Ive found that constantly talkign about it, showing social stories (its ok to NOT always be first, etc)  and over all adjustment is the best .  It will take time but it will get better 

[auntie]

I'm going to be the odd one out.

FWIW, DS has a GAD along with ASD (Aspergers) and ADHD.

Unless you see some behaviors that could be associated with ASD, the first line clinician I would suggest is a clinical child psychologist. A Dev Pedi would be overkill, and frankly a waste of very limited resource. Plus a good Dev Pedi can take 6-12 months to see in network during which time this situation would likely get worse. Unless he has ASD; he'd likely get turfed to a psychologist in the end anyway. If the psych thought he needed to see a dev pedi- they will know which one is best available and may get you seen faster.

The behavior you are describing often comes when a child has an idea about how something should be and then loses their shit when real life doesn't play out as they expected. This kind of rigid thinking is sometimes associated with OCD and/or ASD. In thos sort of situation, the anxiety is a piece but more of a symptom of the primary presenting condition than a stand alone dx. Do you have any family hx of either?

It's pretty typical of kids to save their worst for home where they know they are loved unconditionally. I like this book for kids who are "chronically inflexible".

www.amazon.com/The-Explosive-Child-Understanding-Chronically/dp/0061906190

[FloFTW]

Apr 26, 2014 11:09:29 GMT -5 auntie said:

I'm going to be the odd one out.

FWIW, DS has a GAD along with ASD (Aspergers) and ADHD.

Unless you see some behaviors that could be associated with ASD, the first line clinician I would suggest is a clinical child psychologist. A Dev Pedi would be overkill, and frankly a waste of very limited resource. Plus a good Dev Pedi can take 6-12 months to see in network during which time this situation would likely get worse. Unless he has ASD; he'd likely get turfed to a psychologist in the end anyway. If the psych thought he needed to see a dev pedi- they will know which one is best available and may get you seen faster.

The behavior you are describing often comes when a child has an idea about how something should be and then loses their shit when real life doesn't play out as they expected. This kind of rigid thinking is sometimes associated with OCD and/or ASD. In thos sort of situation, the anxiety is a piece but more of a symptom of the primary presenting condition than a stand alone dx. Do you have any family hx of either?

It's pretty typical of kids to save their worst for home where they know they are loved unconditionally. I like this book for kids who are "chronically inflexible".

www.amazon.com/The-Explosive-Child-Understanding-Chronically/dp/0061906190

I will check that book out. Thanks.

There are no diagnoses of ASD in the family, but there is OCD and some personality disorders. My husband tends toward the anxiety and OCD although he's only been diagnosed with the anxiety. It's definitely a control thing, where he lashes out when things don't go how he plans, but since I know he can control himself at school I really want to figure out a good balance of letting out frustration and control so that there are less explosions.

Thank you. This was helpful.

[auntie]

Apr 26, 2014 11:47:11 GMT -5 FloFTW said:

Apr 26, 2014 11:09:29 GMT -5 auntie said:

I will check that book out. Thanks.

There are no diagnoses of ASD in the family, but there is OCD and some personality disorders. My husband tends toward the anxiety and OCD although he's only been diagnosed with the anxiety. It's definitely a control thing, where he lashes out when things don't go how he plans, but since I know he can control himself at school I really want to figure out a good balance of letting out frustration and control so that there are less explosions.

Thank you. This was helpful.

A couple of thoughts around this.

1. It's great that you're being proactive. IME, the raised expectations of kindie and first were quite a step up for DS. While he rocked preschool, his behavior tanked to a significant degree with the longer academic day and the stricter structure of doing as he was told rather than what her preferred to do. 

2. The best way to reduce this behavior is to give him the skills he needs to reframe his thinking/expectations so that he doesn't get frustrated. It would be so much better if he could get to a place where he's resilient enough to be OK when he isn't micromanaging situations and reacting when it goes badly rather than teaching him less annoying and stigmatizing ways to vent frustration around unrealistic expectations. You might look into a professional who works in CBT, especially if he's a bright kid- it can be life altering.

[gnorah]

I think I might second Auntie here... it sounds a lot like my son (who is 8 with Aspergers). Before he was diagnosed he had outbursts all the time and we could never figure out why. We got a pyscho-education assessment done by a child psychologist and it was like the lights came on. Turns out (among other things) his cognitive flexibility is low so if you don't tell him the plan, he'll make one up and then be unable to easily shift to something different.

Can you try figuring out what your daily routine is? Then tell him in the morning what the plan is. You could tell him the night before too. "Tomorrow is going to be a great day, we're going to do X, then Y, then we'll go to school where I'll drop you off. Then you'll have recess and lunch and then I'll pick you up at 3pm"

It may be that he is anxious about his day because he doesn't know what is going to happen so he freaks at every little thing. It may be that if he knows the plan for the rest of the day that he worries less about the small things because he generally knows what's happening.

And don't assume that he should know... we assumed that since we did the same thing everyday that DS would just know that this was the routine. Nope. We had to specifically explain what the deal was and exactly what he needed to do. We couldn't just say "get ready for school" we have to have a checklist that says "Getting Ready for School" means - eat breakfast, clean up breakfast, brush teeth, wash face, get dressed, put dirty clothes away, comb hair.

[FloFTW]

Apr 28, 2014 16:40:20 GMT -5 gnorah said:

I think I might second Auntie here... it sounds a lot like my son (who is 8 with Aspergers). Before he was diagnosed he had outbursts all the time and we could never figure out why. We got a pyscho-education assessment done by a child psychologist and it was like the lights came on. Turns out (among other things) his cognitive flexibility is low so if you don't tell him the plan, he'll make one up and then be unable to easily shift to something different.

Can you try figuring out what your daily routine is? Then tell him in the morning what the plan is. You could tell him the night before too. "Tomorrow is going to be a great day, we're going to do X, then Y, then we'll go to school where I'll drop you off. Then you'll have recess and lunch and then I'll pick you up at 3pm"

It may be that he is anxious about his day because he doesn't know what is going to happen so he freaks at every little thing. It may be that if he knows the plan for the rest of the day that he worries less about the small things because he generally knows what's happening.

And don't assume that he should know... we assumed that since we did the same thing everyday that DS would just know that this was the routine. Nope. We had to specifically explain what the deal was and exactly what he needed to do. We couldn't just say "get ready for school" we have to have a checklist that says "Getting Ready for School" means - eat breakfast, clean up breakfast, brush teeth, wash face, get dressed, put dirty clothes away, comb hair.

We already do the daily routine thing, and we have since I can remember, since we noticed that that did give him anxiety. It's really the smaller things that we can't anticipate that seem to set him off now. (I moved a sock off the couch and he was pissed that I moved it and I had to put it back in the exact location. I pushed the button for the garage door opener when he was the one who wanted to do it that time. He wanted me to park in the other lane as opposed to this lane. That sort of stuff.)

I tend not to think it's ASD because what I know of that, I don't think he really shows other symptoms. It's the level to which he freaks out to these seemingly innocuous things that has us worried. It's a full-out emotional breakdown.

[niknik]

It sounds a lot like my 4.5 year old son. He has SPD and has an IEP and had in home therapy before that. I have been lucky with my great IEP team who is constantly suggesting exercises and ways to approach problems with him and he's changed quite a bit although maybe I am just accustomed to many of his behaviors now. He does have very high anxiety though and he needs to know in advance what is going to happen especially if his set schedule is going to deviate.

[auntie]

Apr 29, 2014 12:42:44 GMT -5 FloFTW said:

Apr 28, 2014 16:40:20 GMT -5 gnorah said:

I think I might second Auntie here... it sounds a lot like my son (who is 8 with Aspergers). Before he was diagnosed he had outbursts all the time and we could never figure out why. We got a pyscho-education assessment done by a child psychologist and it was like the lights came on. Turns out (among other things) his cognitive flexibility is low so if you don't tell him the plan, he'll make one up and then be unable to easily shift to something different.

Can you try figuring out what your daily routine is? Then tell him in the morning what the plan is. You could tell him the night before too. "Tomorrow is going to be a great day, we're going to do X, then Y, then we'll go to school where I'll drop you off. Then you'll have recess and lunch and then I'll pick you up at 3pm"

It may be that he is anxious about his day because he doesn't know what is going to happen so he freaks at every little thing. It may be that if he knows the plan for the rest of the day that he worries less about the small things because he generally knows what's happening.

And don't assume that he should know... we assumed that since we did the same thing everyday that DS would just know that this was the routine. Nope. We had to specifically explain what the deal was and exactly what he needed to do. We couldn't just say "get ready for school" we have to have a checklist that says "Getting Ready for School" means - eat breakfast, clean up breakfast, brush teeth, wash face, get dressed, put dirty clothes away, comb hair.

We already do the daily routine thing, and we have since I can remember, since we noticed that that did give him anxiety. It's really the smaller things that we can't anticipate that seem to set him off now. (I moved a sock off the couch and he was pissed that I moved it and I had to put it back in the exact location. I pushed the button for the garage door opener when he was the one who wanted to do it that time. He wanted me to park in the other lane as opposed to this lane. That sort of stuff.)

You might want to contact a child psychologist to help you put a plan together. What you're doing now might buy you some peace in the moment, but it's probably making his anxiety worse. Putting the sock back? The therapists who work with kids who are anxious would have you working deliberate sabotage into his day. There are a couple reasons why you can't let the tail wag the dog. Anxious kids seem to do best with parents who are secure in their authority- not harsh disciplinarians- but who have transparently clear behavior expectations. This may be why he's able to hold it together better in school- teachers tend to have clear expectations and structure. When you assume a more authoritative role, he may cede his adult-sized worries to you and relax more.

FWIW, this last bit was what DS's psych had us do. My parenting style was pretty breezy when DS was younger; it wasn't a good fit for him. He needed someone who was more "in charge" that I was by nature. Early on, I resented the shit out of having to change how I was- but it came down to letting go of the dream child I had planned to raise and doing right by the kid who actually lived with me.

The other reason to have higher expectations is that when you set the bar too low- by putting the sock back- you communicate to him that don't believe he's a capable enough kid to get to being OK when something is different than what he was expecting. If he doesn't think you believe he can do something, it will be a self fulfilling prophecy.

I tend not to think it's ASD because what I know of that, I don't think he really shows other symptoms. It's the level to which he freaks out to these seemingly innocuous things that has us worried. It's a full-out emotional breakdown.

The need to be first up the steps and to push the garage door opener is a very Asperger thing. Kids on spectrum sometimes don't intuit the socially constructed hierarchy that puts adults in charge. His ordering you around seems kind of like he hasn't figured out that he's a kid and isn't quite your "equal". This was an issue for DS- pre-dx we used to call him the teeny tiny tyrant. It's funny, this is one of those things that's sort of cute and even typical at 2, a little off at 4 and downright odd at 6. If he starts to do this with peers, it will impact him socially.

What sort of things do you see that you feel rule out a potential ASD dx?

[FloFTW]

Apr 29, 2014 14:00:34 GMT -5 auntie said:

Apr 29, 2014 12:42:44 GMT -5 FloFTW said:

We already do the daily routine thing, and we have since I can remember, since we noticed that that did give him anxiety. It's really the smaller things that we can't anticipate that seem to set him off now. (I moved a sock off the couch and he was pissed that I moved it and I had to put it back in the exact location. I pushed the button for the garage door opener when he was the one who wanted to do it that time. He wanted me to park in the other lane as opposed to this lane. That sort of stuff.)

You might want to contact a child psychologist to help you put a plan together. What you're doing now might buy you some peace in the moment, but it's probably making his anxiety worse. Putting the sock back? The therapists who work with kids who are anxious would have you working deliberate sabotage into his day. There are a couple reasons why you can't let the tail wag the dog. Anxious kids seem to do best with parents who are secure in their authority- not harsh disciplinarians- but who have transparently clear behavior expectations. This may be why he's able to hold it together better in school- teachers tend to have clear expectations and structure. When you assume a more authoritative role, he may cede his adult-sized worries to you and relax more.

FWIW, this last bit was what DS's psych had us do. My parenting style was pretty breezy when DS was younger; it wasn't a good fit for him. He needed someone who was more "in charge" that I was by nature. Early on, I resented the shit out of having to change how I was- but it came down to letting go of the dream child I had planned to raise and doing right by the kid who actually lived with me.

The other reason to have higher expectations is that when you set the bar too low- by putting the sock back- you communicate to him that don't believe he's a capable enough kid to get to being OK when something is different than what he was expecting. If he doesn't think you believe he can do something, it will be a self fulfilling prophecy.

I tend not to think it's ASD because what I know of that, I don't think he really shows other symptoms. It's the level to which he freaks out to these seemingly innocuous things that has us worried. It's a full-out emotional breakdown.

The need to be first up the steps and to push the garage door opener is a very Asperger thing. Kids on spectrum sometimes don't intuit the socially constructed hierarchy that puts adults in charge. His ordering you around seems kind of like he hasn't figured out that he's a kid and isn't quite your "equal". This was an issue for DS- pre-dx we used to call him the teeny tiny tyrant. It's funny, this is one of those things that's sort of cute and even typical at 2, a little off at 4 and downright odd at 6. If he starts to do this with peers, it will impact him socially.

What sort of things do you see that you feel rule out a potential ASD dx?

We do try to do the deliberate sabotage stuff in already. Like in the sock example, I put it back for a few seconds just while I sat down and talked to him, but then said that I have to move it to wash it and explained why I moved it, etc etc. And for the garage door and parking examples:  I didn't let him open the door and I didn't move my parking spot. And being first up the stairs...well, I mean, I couldn't undo that.   But in all those cases, the damage was already done. I know what you mean though. It's frustrating because we know these landmines are just waiting for us and we're not trying to anticipate them to avoid them - they have to happen - but we just cannot get him to accept that they have to happen. I've already ordered the book you recommended. Hoping there are some good methods in there. 

It may very well be Aspergers/ASD. I honestly don't know that much about it; that's was the reason for the post, to see if it could be something like that other than just anxiety around control issues. Let's see, just things I'd heard/read that just haven't raised red flags for me:

He has never had any trouble with eye contact or forming emotional bonds, with his family or with friends/teachers. He's shy, but once he meets you more than once, he's fine.

He's never really had an intense infatuation with any one topic. Everything we've seen has seemed to be normal interest in trains, dinosaurs, cars, etc. Typical toddler stuff.

Motor skills have always been right on track for age.

Has never seemed to be especially sensitive to anything physically...like no overreactions to sounds/lights/fabrics.

Speech development right on track for age.

He doesn't seem to have the need for order physically - he's never been one to line up his toys, or books, or whatever. His physical world can be "chaotic" and he doesn't seem to notice.

[auntie]

Apr 29, 2014 14:45:23 GMT -5 FloFTW said:

Apr 29, 2014 14:00:34 GMT -5 auntie said:

It may very well be Aspergers/ASD. I honestly don't know that much about it; that's was the reason for the post, to see if it could be something like that other than just anxiety around control issues. Let's see, just things I'd heard/read that just haven't raised red flags for me:

He has never had any trouble with eye contact or forming emotional bonds, with his family or with friends/teachers. He's shy, but once he meets you more than once, he's fine.

Most kids with Aspergers are quite attached and engaged with people they know. Often these kids do better with, and prefer, adults to same aged peers. My son is pretty much only "shy" with girls his own age. Otherwise, he's fairly outgoing and really likes people.

He's never really had an intense infatuation with any one topic. Everything we've seen has seemed to be normal interest in trains, dinosaurs, cars, etc. Typical toddler stuff.

Most with Aspergers do have a special interest by this age. But it isn't necessarily 1 thing only. DS has a range of special interests in play that have morphed a bit over time. Trains, dinos and cars were his preschool things, he moved onto space, geology and disasters in elementary school, he added history and politics in high school. These days he still likes trains, politics, history, music, and cars. His knowledge base in these areas is pretty extensive. It's one of the things that made him seem to stand out- his adult-like interest in topics that appealed to him- he has a soft spot for Thomas, but would be more excited to see something like one of the CSX heritage units by the time he was 5.

Motor skills have always been right on track for age.

Same here. Gross motor was pretty average. Most of his fine motor skills were advanced for his age.

Has never seemed to be especially sensitive to anything physically...like no overreactions to sounds/lights/fabrics.

The ASD criteria stipulate unusual reactions to sensory input. Some kids are hyposensitive to stimuli- not realizing when they're hungry, having a high threshold for pain. DS has issues with certain sounds and off key singing, but he's not a kid who need special sunglasses or can only wear elastic waist pants.

Speech development right on track for age.

Most kids with Aspergers are quite advanced in their speech- they usually talk early and have rich, precise vocabularies. A significant number of littles with Aspergers-like ASD are reading at your son's age.

He doesn't seem to have the need for order physically - he's never been one to line up his toys, or books, or whatever. His physical world can be "chaotic" and he doesn't seem to notice.

That's more OCD. DS is a rote slob. His room looks like an oversized rat's nest. I try not to look at it. DS pretty much always played appropriately with his toys; he did do a little scripted play from his Thomas DVDs but could also do more novel open ended play as well.

It's probably not ASD, but it could have some features in common in terms of anxiety. I hope you can find some answers and strategies to make things better at your house. It's tough to watch your child be so upset.

[cinnamoncox]

He sounds very similar to my DS. He's 15 but when he was younger these outbursts completely took over our lives/house.
It's been a long road but honestly , auntie really knows her stuff here. Her DS is older and she knew his dx at a much younger age. We got our (un officially dx'd by school psychs but totally makes sense) dx at 13/14.
It really made sense of a lot of things.

Good luck and I hope you are able to get a referral to a psych soon.

Eta: I never said what dx, sorry. He has Aspergers.

[gnorah]

I'll just ditto Auntie again... DS was diagnosed when he was 6, and we didn't really have a clue that something was going on when he was 4.5. Just that he would get upset really easily and we couldn't predict it.

Another book that I liked was called "Freeing Your Child from Anxiety" by Tamar E Chansky. It talks about different kinds of anxiety and has some ideas for strategies that might help.

[FloFTW]

Thanks so much everyone. I am going to start reading some books and see if we can get a first appointment scheduled.