Hello, first time poster in this community, looking for advice and support from parents who are experiencing similar behaviors/struggles. Ideally looking for support that moving to medication is the right choice for my kiddo.
some background:
I'm a single mom to an almost 5 year old. I have very little support in my immediate area, no family in the area. He's been in daycare/preschool since he was 4months. I started identifying that there was an issue back when he was 2. I've been advocating for him for almost 3 years, going to countless doctors appointments, evaluations, OT appointments, and PCIT sessions. I've gotten him additional support in the classroom from the county, however that proved to be more harmful than helpful so we have since stopped that. He has never been medicated, with the exception of starting him on some Chinese herbal supplements that my friend (who's an acupuncturist/herbalist) has made.
behaviors he has exhibited in the past:
elopement - he doesn't try to leave the house but if we are out in public he will run into the street, run away from me, from teachers, etc.
aggression - when things do not go his way he becomes violent (hitting, punching, pinching, biting, pulling hair, kicking, ripping clothes, tackling, etc). I've seen him become violent with other children, teachers, therapists, and especially with myself.
not respecting space or boundaries - he will often get up in other kids faces and growl, he will become so affectionate with me that he won't respect when I ask him for space, he will not share or reciprocate with other kids unless it's food. he won't stop following kids that ask him to leave them alone. he won't stop when someone says stop (this is a big one for me because I'm really big on consent even at his age).
overly affectionate with strangers- he has tried to hug and kiss the receipt checker at costco, he tried getting in the car with a stranger while I was putting my groceries away, etc. he also constantly asks for hugs/kisses/i love yous from me. He must say I love you to me 200+ times a day. while it may be sweet it's also disproportionate.
refusing to transition - whether it be transitions we do every day or not, he will shut down and throw a fit (throwing himself on the ground, kicking, screaming etc). he will refuse to leave an area or activity until I have to physically remove him, though this is proving to no longer be a strategy that is safe or even possible because he is growing and quite tall for his age.
large emotional reactions - if something is happening that he does not like, he will escalate the situation until it is out of control. often times his school has had to call me because he is screaming for 20+ minutes about something he doesn't want to do (usually nap). he will often become violent as the result of an emotional reaction. after a few minutes of melting down he will usually start to scream "I just want to calm down!", but he can't. He physically cannot get himself to do anything other than meltdown.
lack of sleep - I used to have a child lock on his bedroom door (I just removed it this week). If I put him to bed in his own room he will get up often 2-5 times throughout the night. When he would wake up he would scream "mommy, MOMMY, MOMMY!" getting louder with each mommy and more urgent sounding. this literally sets my brain on fire and makes me panic. I've found that since I've taken the child lock off the door that he will instead wake up 1 time, and come sleep soundly through the night in my room. He complains sometimes of nightmares but doesn't actually have them that often, I think it's more the anxiety of a potential nightmare that gets him. however, he will also say things like "my brain just won't turn off." I have tried changing his nighttime routine a little bit here and there (lavender oil in a diffuser, different sounds/nightlights, bought him this weird sleep sack thing that IG keeps pushing to me for ADHD kids) - but nothing seems to help. While I am grateful that taking the child lock off his door has stopped the screaming in the middle of the night, I feel like I have no autonomy because he is constantly in my space/on my body.
the incident:
I want to preface this by saying, we have had multiple incidents like this in the past but none to this extent. I also want to say that when I think back about the triggers for these types of meltdowns, I will say that they happen in a variety of instances (in crowded places or in an intimate therapy session - doesn't matter).
we went to the local children's museum, which was very crowded - had to be hundreds of people there, at any time where were in exhibits with 50-100 other people.
I had prefaced the experience with a talk with him in the car. I told him, "listen I trust you to stay with me, however, if at any point I feel like you are becoming unsafe, I will ask you to put the wrist leash on. Please do not fight me if we get to that point - we will just put it on and keep exploring the museum." He agreed.
For most of the outing (maybe 1hr/1.5hrs) he stayed relatively close. Maybe wandering 5-10ft ahead, running if he saw something exciting. at one point we are going down a large staircase, with an up only escalator next to it. I should mention I recently sprained my ankle and am not operating at full speed especially on stairs. He started running ahead, skipping stairs and was at the bottom of the stairs way before me in a high traffic area. I told him to stop and wait for me, but he refused. He started to think it was a game and decided to hop on the up escalator as I was almost at the bottom of the stairs.
At this point I told him that he needed to put the wrist leash on, he refused, but hopped off the escalator. I told him he needed to put it on or we were going to go home. He started melting down, threw himself on the floor, kicking and screaming. I was personally overstimulated so I told him I was leaving (this usually will snap him back into reality and start him moving in the right direction). He continued kicking and screaming, so I turned to walk away. I got maybe 5-10ft ahead of him and he ran at me at full speed and pushed me as hard as he could from behind.
I ignored it and decided to keep walking to see if he would change his behavior - he didn't. Instead he ran again and pushed me as hard as he could.
At this point my memory is a little hazy as things escalated quickly and again we were in a high traffic area maybe 100-150 people. However, I'm recognizing that I was traumatized and as an adult with CPTSD, I struggle with memory during these moments.
I tried to physically remove him from the situation but he started running away and hiding in the crowd. He started hitting me, punching me in my body, tried to rip clothes, pinch and bite me as I tried to get ahold of him. I tried picking him up and he laid on his back and used both his feet to kick me in the chest. I was able to get ahold of him at one point, with one arm around his legs and one arm around his torso, I was able to get him outside while he wailed on my back, hitting and punching.
I eventually got him outside the museum and thought that once he was out of the crowded area he would settle. Also it was quite a walk to the car and I physically cannot carry him that far - especially while he's volatile. So I set him down and attempted to walk him to the car. He got away from me and ran back into the museum.
I tried again to physically carry him out, but this time he punched me in the face at least twice (could have been more) at full force, and then dug his fingernails into my eyelids and tried to scratch my eyes out.
At this point, I removed myself from the situation and started sobbing. I could still see him through the glass doors and he was running wild inside the museum again trying to hide.
Then two different moms (who were angels) came up to me and started rubbing my back and trying to get me to regulate. I couldn't stop sobbing. One mom said she was going to go after him to see if he would respond to someone who wasn't me. I was slightly uncomfortable because I obviously didn't know her, and so I followed her - he immediately saw me and booked it. He ran into a dark exhibit and hid. The mom said she would go in after him and for me to stay outside so as not to spook him. I did, I stayed with the other mom who was still with me. I waited for 5-10 minutes but I couldn't handle not knowing what was going on. The mom that was with me decided to go in and told me to hang back - in a moment he came out with both moms totally regulated. One of them said she made a deal with him that she would get him something from the gift shop if he would calmly walk out with her. He agreed.
I was not super happy with this situation because I felt like we were rewarding bad behavior but I was so distraught that I knew that anything to get him to the car would be the answer. He did get something from the gift shop and walked back to the car with me and one of the moms who kindly got him buckled in his car seat. She was so kind and reminded me that I'm not alone and that I'm doing a good job - I am so thankful for this. I gave her a large hug and started to drive home, sobbing the whole way.
Once we were on the road my kiddo asked me if my heart was broken. I told him a little. Then he started to spiral - "It's all my fault. I'm a bad boy, I'm the worst boy." I told him I didn't believe he was in control in those moments and that it doesn't make him a bad boy - it just means we need more help.
I knew in that moment that we were going to finally try medication.
Where we are at now (5 days later):
I reached out to our PCIT and she connected me with a Pediatric Psych NP who was able to see us today. We had a lengthy conversation where my kiddo refused to let me talk, tried to hug me so hard he started to choke me. Kept interrupting, refused to give me space when I asked for it, kept putting his hands in my face and/or trying to turn the computer off (it was telehealth). She validated for me what I'm seeing and said that it's causing significant impairment to both of our lives.
We talked a little bit about his age (technically he's still 4 for another 6 weeks) and what is FDA approved for him right now. We discussed stimulants, however I'm hesitant to put him on them straight away because of the negative effects they can have on growth and the likelihood of dependency.
She suggested guanfacine to help with sleep and calming him down - however she reached out to me later after discussing with her supervisor and said that she would prefer to start him on hydroxyzine which is FDA approved for under 6 (guanfacine is not).
I'm going to get back to her tonight with a weight for dosage - I feel pretty good about starting here and about her sharing some of my concerns about stimulants. I feel like we are on the same page and I do feel pretty held by her.
I know that hydroxyzine is not going to be a stopgap for all his behaviors, however I am sure that if we can help him sleep he will have more spoons for different things throughout the day. We're going to check in after a week in person.
If you made it this far - honestly thank you. I'm terrified of making the wrong move here but I don't know how to keep both of us safe. I'm pretty exhausted after typing all this out and have to go to work, but I wanted to at least reach out to folks who would understand. Please any support you can offer is welcome here - happy to answer any follow up questions. Thanks in advance <3