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Nephew Is Out of Control
Q: My nephew is four and a half years old. His daily routine is jumping all over the house, doing things he shouldn't be doing, and saying, "I want to cut my head off." He does not sit still for more than 15 minutes, and that's only when he's watching TV. Then he'll get up and throw something across the room and start climbing the side of the wall. He throws all objects at family members. When he's told "Daddy is going to hit you," he says, "I'll rip his eyes out and his arms off and kick him in the street." He talks about sex and killing. He puts the jets on the stove then tells everyone, "The house is going to blow up." He screams and runs all over the house nonstop, throwing toys at everyone, and cursing. I'm so upset. I feel for his grandmother. She watches him every day.
I would like to know: How is this child going to sit in a kindergarten classroom for five hours? I believe he needs medicine but his parents say, "No medication for him." But he's really not normal for his age.
I'm trying to get an appointment for him at the local hospital to see a child psychiatrist. Am I over-reacting? What can be the problem? Do you think he can go to school without sitting down for more than 15 minutes? Is this ADHD?
A: The behaviors you describe need immediate attention! You are doing the right thing by making an appointment with a psychiatrist. There could be lots of causes for such behavior, and ADHD is certainly a possibility. His apparent inability to sit still for longer than a few minutes may be a symptom of a severe case of ADHD. He may need medication. But most of all, he needs to a thorough assessment by someone who is very experienced in working with young children with behavioral and emotional problems.
When kids are "out of control" like this, it's often a signal that some very important need is not being met. At the very least, this little boy is looking for someone to pay attention to him or to set reasonable and consistent limits. If he's been in an environment for a long time that has been too "loose," your nephew may have never really learned how to behave.
You also mentioned that someone said to him: "Daddy is going to hit you." This suggests to me that physical punishment (later in the day?) has been one method of dealing with him. Kids who are hit a lot when they are young learn to hit or talk about violent behavior early in life, for they know no other way to deal with conflict. Parenting (or grandparenting) styles need to be examined, and the family may have to enlist the services of a behavioral psychologist to help them get this situation, and this little boy, under control. Some little children who make a lot of references to sexual and violent themes have been the victims of abuse. Such abuse could have been perpetrated by any number of people in this child's life, and the possibility must be examined.
Your nephew will probably need to be in a very structured and caring preschool for a year or more before even attempting to enter a regular classroom. Without proper intervention, kids like this are often inappropriately labeled early in their school career and this "reputation" can follow a boy for a long time. Keep working on getting that appointment, and get this boy's parents there, too. This is not just the boy's problem. You can also call his school district and ask them for help. Under federal special education laws, the public school has certain responsibilities for kids when they turn three. Educators have experience in matters like this, and may help you get an appointment with the doctor sooner rather than later.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.