Please help we have a 9 year old son who has had anxiety and anger problems since around the age of 2, we have been to see someone twice now to have him tested for autistic disorders, the first time he was very young too young for a diagnosis and although they did say he was extremely anxious they didn’t think it was autism.

At school, he is very different he is very quiet, shy and well-behaved, so getting school to understand what he is like at home is very difficult because at home he is comfortable enough to show how he feels, so if anything upsets him at school he brings it home.

The latest doctor we have seen with him agreed his levels of anxiety were not normal for a 9-year-old boy and felt at first that his anger was a result of his anxiety.

She had been really helpful and understanding .The last time we went a fortnight ago she was explaining punishing him too much would not help, as he maybe did not understand his own feelings. She was also going to write to his school as I was concerned they didn’t understand that we needed to quite often go into school because he gets too upset to go in and say things himself i.e. over his schoolwork which is already a little behind.

She has done quite a few tests and although he has shown he is below his average age group in something’s he isn’t in others, which pushes them towards thinking he is anxious rather than having any kind of autistic disorder, but we have gone back to see her today as we are really concerned he is getting angry at everything and everyone to the point he is punching walls, and her attitude seems to have changed and she seems to have contradicted herself.

Her answers today were yes he is a bit anxious but there is nothing she can do for him, we are feeding his anxiety by trying to talk to him about how he feels, he has to learn life does not always go how he expects, and he is controlling our house and us. We really don’t know where this change of opinion came from unless she has spoken to his school, who obviously don’t see him as a problem because he sits quietly away from everyone but we feel really disappointed and let down by her reaction.

We just wanted to know if anyone could advise where we go from here as she was our last hope for help before he reaches senior school and now we are back to the same question we were when he was 2 years old what is wrong with our son because although no parent is provided with a text book, yes we make mistakes we wouldn’t consider ourselves bad parents neither would we say we spoil our kids we are just average parents that are worried about our son and his future.

Laurie and Dez

Answer:

Dear Laurie and Dez,

It sounds like your son may be having significant difficulties and needs a careful assessment. As a pediatrician, I know that parents know their children better than others and need to be listened to and supported in their concerns. It does not sound like this is happening. Your son may be better served by your looking for an alternative person or center to assess him.

There are some options available. These vary depending on your medical coverage and your child’s major areas of difficulty. It sounds like your son, like many children, has variable strengths and weaknesses. It also sounds like he has had difficulties with anxiety and anger for many years. He is showing those difficulties at home in an environment that he trusts, rather than his school environment. His punching in walls at age 9 is also reason for concern. You also say that he is falling behind in his school work.

I am not clear from your letter whether the recent doctor that you mention is your son’s primary care physician. If not and he has a good pediatrician or family practice physician, then I would suggest that you ask for some consultation time and bring your son to talk. Otherwise, it would be wise to seek another primary care physician. You might want to ask the health department or other parents which physicians near your community seem most interested in developmental and behavioral difficulties in children. The school nurse might also be helpful.

It is always helpful to obtain and make copies of your son’s previous testing including any that might have been done by the school. Assessments can always be accomplished faster if copies of previous testing are available. Your child is old enough to test to determine his areas of difficulty.

Possible assessment options include the following:

• Regional Centers will take referrals if a child is suspected of being delayed in development or autistic. You would need to call your local center
• Most major medical centers with pediatric departments have specialty departments providing multi-disciplinary assessment for children with developmental and behavioral difficulties. Often they are staffed by Behavioral and Developmental Pediatricians like myself, trained in doing a good assessment with other pertinent staff. Often a pediatrician referral is necessary.
• You have legal right to request and obtain a comprehensive assessment from your son’s school. Write a letter to your destrict’s Director of Special Education requesting a comprehensive assessment in the areas of academics, cognition, socio-emotional and communication. Tell the Director that you understand that you will receive an assessment plan within 15 days. The district will develop the plan, assess your son and then share their findings with you. If you disagree with their report, you can request an independent assessment

You deserve a caring professional to guide you through finding a correct diagnosis for your child. You and your child also will benefit from a professional that listens and has your best interests at heart.

A diagnosis is particularly important because it will guide the interventions necessary to help with your child’s anxiety, anger and school difficulties. It might also explain the differences in the way he is viewed across environments.

I hope that this will be helpful. I would like to hear how your son does and please feel free to email me if you have additional questions. It will not take as long for a reply when you write a second time.

Sincerely,

Kay S. Browne MD
Behavioral Pediatrician