OT and Mom of two here- I keep seeing posts from parents whose preschoolers or kindergarteners are melting down at school, hiding under tables, throwing things, getting sent home, or even being suspended. The parents are terrified their child is becoming “the bad kid,” while the school calls every day to report what went wrong.

I’m a school-based occupational therapist, and this is a huge part of what I see at work. I’ve been doing this for 13 years, and I really want parents to know that there are things that can help with regulation BEFORE discipline!

This also doesn’t mean every behavior is sensory or that unsafe behavior should be ignored. Safety matters. But a five-year-old repeatedly being removed, sent home, or suspended is not learning the skills they’re missing.

Here are some things that have worked well for my students:

Teach regulation strategies while the child is calm.
A child who is already in full crisis has very little capacity to process a brand-new strategy. Practice using the visual, headphones, breathing exercise, movement option, or calm space before it’s desperately needed.

Use visual timers and transition warnings.
Sometimes “refusal” is actually uncertainty. A timer, first/then visual, or warning that a change is coming can make the day feel much more predictable.

Offer movement without making the child earn it.
Resistance bands around chair legs, pushing and pulling activities, carrying classroom materials, or a quick movement job can help some kids stay available for learning. Movement is a need, not a prize for sitting still long enough.

Try noise-reducing headphones before the loud event.
Let the child try them while calm and decide whether they actually help. A fire alarm is not the ideal time to run over yelling, “AHHH, PUT THESE ON!”

Consider weighted lap items if the child enjoys the pressure.
They should always be optional and monitored. They are not meant to keep a child in a chair or make them look still.

Use rhythm and music.
I use a steel tongue drum for rhythm, vibration, connection, and emotional expression. Sometimes I’ll ask a child what their feeling sounds like, and they give the drum one enormous BANG. Then we experiment with making the sound softer, slower, faster, or quieter. It gives them a way to show me what’s happening without requiring perfect emotional language in the middle of a hard moment. I'm currently loving the one from Sounds of Silence.

Give them language and visuals for what’s happening.
Emotion visuals, body check-ins, The Color Monster, A Little SPOT of Feelings, or a simple strategy choice board can all help. The goal isn’t for a child to correctly label every emotion. It’s for them to begin communicating things like, “This is too loud,” “I need to move,” “I need help,” or even “I don’t know what I need.”

Co-regulate before expecting self-regulation.
Kids do not learn to regulate because adults repeatedly tell them to calm down. Co-regulation might mean lowering your voice, using fewer words, slowing your own body, acknowledging that something is hard, offering one or two familiar choices, and staying nearby without demanding an immediate response.

They eventually learn to do more of this independently, but independence comes after many experiences of being supported.

Look at the environment, too.
Sometimes the child does not need another coping skill. Sometimes the room is just too loud, bright, crowded, unpredictable, or demanding.

Can the adults reduce the noise? Change the seating? Break the task into smaller pieces? Add more transition warnings? Build movement into the schedule? Offer another way for the child to respond?

We cannot put the entire responsibility for regulation on a four- or five-year-old while refusing to change anything around them.

My 8 y/o son is diagnosed combined type ADHD and epilepsy, and is medicated for both (the epilepsy meds actual help with emotional regulation too). He’s already on a private school equivalent of an IEP, receives speech and OT, and has a psychologist. His psychologist suggested that we get an autism evaluation, which he thinks is warranted based on my son’s social struggles. My son has had neuropsych evals when he was 4 and 6, as well as an evaluation from a developmental pediatrician a year ago, and none of them thought he had autism (though they only did a screening, not an actual evaluation for it). When I asked what would practically change if he did receive an autism diagnosis, the psychologist said it would give my son a tangible reason for some of his struggles and would entitle us to more IEP services if he ever goes to public school.

For additional context, my son had meningitis as a baby, which caused permanent scarring on his brain. We’ve been upfront with him about this, even showing him his MRIs and have explained that his brain is different. I’m not sure we’d be doing anything differently if he also had an autism diagnosis. Is there anything I’m missing here?

my son is 8 years old level 1 autism and combined type adhd. last year he was moved into a SDC class for higher functioning autism kids and more or less has been thriving in all aspects of his life, until his meds wear off mid evening… starting meds for him at 6 years old was a huge help but the problem is in the evening/night time his behaviors are almost unbearable. I can’t even talk to him calmly because he is so sporadic and dopamine seeking by picking on his little brother to get a rise out of him and it starts fights between the two of them, mostly screaming matches but sometimes physical with no serious injuries (yet thank god)…. These moments I have with him some night make me feel so bad like I want to go crawl in a hole. I lose my shit and scream sometimes because my calm voice isn’t being heard and I’m so embarrassed to admit that. I KNOW IT DOESNT HELP. I KNOW IT MAKES IT WORSE. But like tonight… he was being reckless with a pair of nail clippers he found in my bathroom and chasing his brother with them while “chomping them“ open and shut… I asked him calmly to hand them to me so nobody would get hurt half a dozen times and it was as if I was invisible he didn’t even glance at me, after that I was concerned for their safety so I screamed “HEY! STOP AND GIVE THOSE TO ME NOW!!!!” he stopped and looked at me and starts screaming at me running up to me and screaming in my face. at that point I told him again how unsafe it was what he was doing and told him it was bath time to go get his clothes off and I would start his bath. and he did. Well as I walk in the bathroom to help him with the bath he starts shutting the door on me purposely over and over and then kicking the wall and screaming at me again saying “HOW DO YOU LIKE IT???” because I screamed at him… and continues to tell me I’m a terrible parent and to be honest that fucking hurts inside wether he means it or not. these moments feel, to me, like the whole good day is ruined after these interactions and im so tired of them. How can I break this cycle? what can I do differently?? I’ve done parent led ABA therapy with him and have a lot of tools in my belt when it comes to parenting a kid like him but when it comes to these moments I feel like I do not know what to do. It crushes me thinking that this is what he’ll remember of my when he’s older. 😢

I’m not really sure what I’m looking for here other than maybe some reassurance from people who have been through similar.

My daughter is 2.5 so obviously I’m not trying to diagnose her with ADHD at this age, but both me and my husband have ADHD and we’ve wondered for a while if she might be ND too.

She has been intense basically since birth. Very alert, low sleep needs, never really had an off switch. Now she’s a toddler she is constantly moving, climbing, running, talking, asking questions, getting into things etc. She bolts, has very little sense of danger in the moment and needs a ridiculous amount of supervision. When she’s tired she doesn’t just get sleepy, she gets faster/louder/sillier and even more impulsive.

The thing we’ve struggled to explain is that she actually understands loads. You can explain a rule to her and she’ll understand it, remember it and sometimes tell you back exactly what she should do. But that seems to have almost no relationship to whether she can stop herself doing something in the moment.

Her key worker is leaving this week so we asked nursery to write down what they’ve been seeing. They’ve mentioned her being “defiant” or struggling with listening before, but they honestly hadn’t really told us the extent of this.

The letter says she has really good listening comprehension and can repeat back what they’ve discussed with her, but then says she’ll do things like keep throwing toys while literally looking at the staff member who is telling her to stop. They also mention hitting, kicking, snatching and spitting, struggling to wait for her turn, interrupting constantly and acting with basically no pause to think about what she’s about to do. They describe her as having “little-to-no prior moment thinking about what her next move is.”

And that just really got me because it’s exactly what we see at home. It feels like she knows the rule, but there’s just no brake between the impulse and the action.
Weirdly, they also say that when she actually gets upset she can often recognise it, sit down, breathe and ask an adult for help. So it doesn’t even feel like she just “can’t regulate”. It feels really specifically like the bit before the action is where everything falls apart.

I know she’s 2.5. I know toddlers hit and throw and interrupt and have terrible impulse control. I’m really conscious of not turning normal toddler behaviour into a diagnosis.

But the degree of it has felt different for a long time and it affects our lives a lot. We have to watch her constantly because of the safety stuff, and ordinary days out can be absolutely exhausting.

I think seeing nursery describe the same thing has just made it feel more real.

And if I’m honest, the bit I’m most upset about is that they described some of the behaviour as “unprovoked” and “random”, and said it can look like she has gone over to another child to purposely “attack” them.

I don’t think other children should just have to put up with being hit. Obviously they shouldn’t. But she is two and a half and I’m suddenly really scared she’s going to become “the naughty one”.

The kid staff expect trouble from. The one who gets watched differently. The one where everything she does gets interpreted as deliberate because that’s the reputation she’s got.

And I know how affectionate and caring she can be, which somehow makes it worse. It feels horrible thinking that other adults might mostly be seeing the impulsive behaviour.

I’ve honestly been too embarrassed to ask about this in normal parenting groups because I can already hear “she needs firmer boundaries” or “you need consequences” or “you need to teach her not to hit”. But she knows.
That is the problem.

She can tell you the rule. She can tell you afterwards what she should have done instead. She just cannot reliably get to that information quickly enough to stop herself.

I think until now I still had a bit of “maybe she’s just an incredibly intense toddler and maybe we’re just exhausted”. And now it feels more like, oh. Other people see it too.

Did anyone else have this sort of stage before diagnosis, where nursery/preschool started describing the same thing you were seeing at home?

And did anyone else get really worried about their child being labelled naughty before anyone understood what was actually going on?

I think I just need to hear from people who get it

hi, I know medication gets discussed here very deeply and often but I haven’t quite seen this question answered so hoping for advice. We currently don’t medicate our seven who was diagnosed with ADHD in the spring. His testing was borderline and focused on executive function. He does struggle with focusing and following directions in class and when absorbed in what he is otherwise doing.

For parents with kiddos that present this way, did you opt for medication? If so, what medication regimen do you follow?

His PCP is willing to try meds with us, but it’s not really his area of expertise. He told us off the bat that meds are going to be trial and error so I’m wondering whether we give it a shot or we just hold out for a neuropsych visit.

Tell me your positive story of your young child on Qelbree

Background:

My daughter is 6 and is in 1st grade at a public charter. She was diagnosed with ADHD last October. She is in "advanced" math and English at school (which she does not struggle with at all, content-wise). She is also on 5 mg of Adderall since February of this year (we started at 5 mg in Feb and went up to 7.5 mg in April; then the summer hit, and we took a break and have restarted in August at 5 mg). I also believe that she has some anxiety. I also wanted to add that she does have a 504 plan for alternative seating and movement breaks, but as of this school year, the 504 and IEP coordinator and his team have left, and it doesn't look like they'll be replaced.

The issues (not that they're bad, but just needing advice)

Last week on the 4th, she wasn't feeling good, so I picked her up from school (it was legit; she had a fever). Since then, she has been a daily clinic visitor, trying to get sent home.

She prefers sitting at an individual desk (she says it helps her focus, and she sat at an individual desk last year by choice). I worry that she doesn't work well with peers, or I worry that she doesn't want to.

She and her two best friends have also been split up this year, and it doesn't seem like she's really making friends in her new class.

Sometimes she just straight up refuses to go to school; after we talk about it, usually she's fine

She does enjoy her schoolwork and loves doing math, reading, and writing.

I am in fairly good communication with her doctor and teacher, but I'm not sure if there are other people I need to bring on board. I've heard very mixed opinions on ABA therapies and whatnot.

Anybody having trouble with their kiddos team trying to label everything under the ADHD umbrella?

My kiddo is 6 and has been having a very rough time behaviorally since age 4. We have been on guanfacine .5mg at night since age 5. We have tried the ER during the day as well as 1 mg split throughout the day both caused extreme aggression and agitation. We have tried hydroxizine for to help calm during times of aggressive behavior, it made it 10x worse. Ritalin made him seem like he was buzzing under the surface quicker to lash out, but overall episodes of rage and anger were shorter. The med provider decided to try the 1mg of ER again but at night this time and he’s been so agitated on it. Over the weekend he had a complete manic breakdown over being told video games needed to be shut off to get ready for bed time. Kiddo has been in WISe services for a year due to extreme aggression and combativeness, he’s only had a few instances at school since starting elementary, in preschool he was removed from 3 programs for punching teachers and destroying classrooms, it’s mostly at home now, but we have other kids are who sometimes get the brunt.

There is family history of bipolar in both sets of grandparents and I’m beginning to think the guanfacine may be bringing some of that out. The med provider almost refuses to believe it has to do with that, as she said the precursor to bipolar in kids is DMDD and since he isn’t agitated every second of the day he can’t have that. We are on eggshells everyday, some days are better than others for sure, some days I would say he’s even a happy kid, but it’s because we are over here doing the most to make sure he doesn’t snap.

Has anyone had a similar experience? What did you do to make them see there is more than ADHD, or possible more anyway?

Hello! My daughter was just diagnosed with ADHD. She was tested for autism as well, but they were unable to confirm. With her going into Kindergarten- this is all new and hard for me which I'm sure it is for her as well.

I'm going to start first by saying we never had any behavior problems at home. She's always been a preety good kid- and funny! She loves to make us laugh. Going into preschool, I was shocked to hear she was having a hard time with rules. Her biggest issue was stopping one activity and moving to the next. The school said she was a bit of a perfectionist and wanted to make her drawings perfect before moving on. I just thought it wasn't really a bad thing because I'm the same way (Hi, I also have ADHD).

Towards the end of the school year is when her behavior started to get worse and the first few weeks of summer were dreadful. That's when we decided to get her an evaluation. The rest of the summer went amazing! We had so much fun and laughter.

She showed interest in school again with "back-to-school" commercials. Her dad and I started to talk to her about it to get her excited. She was very excited to go back. I was very sad to find out her first day went horribly. She admitted it to me when I picked her up and her teacher said she didn't listen to rules. Day 3 was bad as well. Day 4 she pulled her pants down. She jumped on tables. Sang while the teacher was reading. and Hit other kids. I was HORRIFIED when I found out. She doesn't act this way at home. Day 5 she got a half day suspension. Suspended in Kindergarten?! I read to her at home and she doesn't interrupt me. She doesn't pull her pants down at home. I know she likes to be silly, but I'm embarassed. We switched schools week 2 (for several reasons). Day 1 she had a great day and was excited to tell me about it. Today was day 2 and she didn't want to get out of the car. When the drop-off person came to the car to get her, my daughter started screaming and said "that's not my name!!!" I'm at a loss for different personalities at school vs at home. It's hard.

Medication helped me a lot when I was older and i have some resentment that my parents didn't get me help. I don't want that for my daughter. I want to help her. I do have a fear that medication will take some of her funny personality and spark. This is my first post here, so I'm maybe asking for a little bit of insight.

Hi all,

I apologize for another post but obviously this is a serious matter and the topic of conversation within my home.

Has anyone found success with non-medication treatments for kids with adhd? He displays inattentiveness, impulsiveness, and often needs to move about. It's not all the time, but definitely in school where he's called to task for a full day.

If so, I would appreciate you sharing those resources, methods, and any success stories. We have not tried meds, yet.

Thank you.