Q&A: My Son’s Doctor Wants My Child to be Evaluated

blockquote_bgMy son is 3 years old and his regular doctor sent him for an evaluation and early intervention, due to the way he behaves. When he gets tired and wants to go to sleep, he starts hitting his mother or sister; he becomes aggressive and he doesn’t speak as much. He understands very well but does not talk much. He was also sent to a neurologist because his doctor found that his head is kind of large. I personally don’t think so. Can you please give me some kind of answer to what should I do?

It sounds like your son’s delay in expressive language skills may be leading to frustration and because he can’t communicate his wants and needs well. He may be demonstrating aggressive behavior out of the frustration of not being able to tell you or his Mom or sister his wants or feelings. Children can also be more aggressive or show more behaviors when tired. I am glad your doctor has made a referral for you to early intervention for your son. Early intervention services are for ages 0-3 and then 3-5. Your son should have a full developmental evaluation by early intervention to determine if he is eligible for services. If he is delayed in his speech, then he can begin receiving therapy. You can also request a testing instrument called the TABS (Temperament and Atypical Behavior Scale) which is an assessment for young children which determines if they have any behaviors that are atypical for their age.

Aggression in a 3 year old boy who has an expressive language delay is not necessarily atypical, however, you do want to teach him that hitting his mother and sister is not an acceptable way of dealing with his anger or frustration. Hurting behaviors like hitting, biting or kicking need to be dealt with immediately by removing him from the situation with a firm, but calm “I know you are mad (tired, etc), but you may not hit, hitting hurts”. Redirect him to a pile of pillows or a stuffed toy if he needs to work out his aggression and tell him “you may hit these pillows, but not your mom or sister”. If he hits a person again after he was given a warning, then calmly take him to a time-out for 3 minutes with the same calm short explanation “You were told you could hit the pillow, but not your sister, you hit your sister again, so now you must sit in time out. I will tell you when you may get up”. His time out area should be away from people, toys, etc. like on a step or a chair in a quiet area. He will most likely scream and tantrum when placed there, but consistently and calmness on your part is the key. If he gets up, put him back. When he is calm and 3 minutes have passed he may get up and then tell him “you can go play now, but remember, no hitting your sister or you will need to sit in time out”.

You can find many resources on our web page related to dealing with behavior issues in young children, so please review these links for some tips on dealing with your son’s aggressive behaviors:

My advice is to definitely have your son evaluated and then follow through with any services they recommended and hopefully your son can begin to attend a local early intervention preschool and receive services to help him and to help you at home with his behavior. The size of his head would be a purely medical concern to discuss with his doctor.