Support for dysregulated 4yr old - Occupational Therapist?

We could use more focused support for our 4yr old but not sure what type would be the best fit.  She has a million awesome qualities but I'll just share what we're struggling with.  From very early on she has been very spirited, strong willed, energetic, impulsive and defiant.  At preschool and home we see negative attention seeking behaviors like knocking over toys, ripping books, hitting/pinching or pushing kids, yelling when she doesn't get her way or feels slighted or is dyregulated for some unidentifiable reason.  Full on meltdowns of screaming/kicking/throwing have become less frequent as she's gotten older but it's still a couple times a month. The negative attention seeking and dysregulation is multiple times a day.   It's worse when she's tired but often it feels unpredictable.  She is very social (but sometimes too in your face, especially adults), can play well with other kids, verbal, physically capable and smart. She's also very sensory - needs to be touched or be touching something, loves paint and lotion all over herself, not good with physical boundaries.  

All this background to ask - what type of support would be most helpful for her and us parents?  Preschool struggles with this behavior (and they are very adept and work closely with her) and I'm concerned it will carry over to TK next year.  It also impacts our family life and siblings.  Is this something for a child psychologist (play therapy?), OT (what do they do with kids like this?), parenting coach for spirited kids (many don't involve the kid in sessions)?  I'd like something more focused and ongoing (Kaiser behavioral health has been limited in their offerings for a kid this age but perhaps I'm not asking for the right referral or support?)

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Our experience with OT is that OT may be a good fit for your kiddo. OT will likely provide "heavy work" exercises and other ways for kiddo to move her body in specific ways that can help with these types of behavior issues. Unfortunately, Kaiser is not great for this; their OT department is knowledgeable but seems to be more medically focused as opposed to behavioral, and what you might really need is for someone to observe your kiddo at preschool and Kaiser can't do that. You might find it more helpful to pay a private OT out-of-pocket for a couple of hours if possible since you'll be able to get more effective support. 

One place to start might be to take the parenting spirited children class that Bananas offers for free fairly regularly. It helped us so much to understand and parent our spirited kid. It's taught by the parenting coach Rebecca from Witts End parenting. If you like her you could hire her for more help with coaching. We didn't do that but considered it. 

We also have sought out OT and counseling for our kid. That is really a long game though, I'm afraid, and may not make much of a difference in the time frame of hoping to get things more settled for TK. Very few counselors take under 5 because it's a special license. Those who do are very booked up so waitlists are long. Finding someone who takes your insurance is even harder. Same with OT. So, get on all the waitlists you can now. Counseling has definitely made a big difference for my spirited kid but it was a long journey to get there. And then once you're in it takes some time to see the fruit. OT will be starting through his public school next school year. 

One of the best things that the spirited kids class helped me reframe around was that this is my kid's temperament. It will always be that way. He will mature and grow and I can help him in that journey, give him tools and fine him supportive people and places to be. But he will never but be spirited. It is so hard to see when you're in the pit and day to day is so tough, but it can and does get better. 4-6 years old was the toughest for us (Thanks, pandemic) but now our 8 year old spirited kid is doing so much better as he grows and matures.

I'd encourage you that lots of these kids exist and teachers have seen them before. Our spirited kid has gotten lucky with a string of great teachers who get him, love him for his spiritedness and want to see him grow and develop. I know that's not everyone's experience with schools and spirited kids, but don't feel like you need to fix this before TK.

I've found OT to be very helpful for my daughter (almost 5) for a wide variety of behaviors stemming from disregulation and for her sensory needs (my daughter is sensory averse rather than sensory seeking). The OT has been very helpful for me to better understand what's happening for her as well as teaching me strategies to help her stay regulated. A lot of what we have worked on is integrating what they call "heavy work" (which can be things like deep pressure, pushing, muscle force, squeezing, etc.), sometimes motions she does, sometimes things I do to her body. These types of heavy work are apparently very regulating and counteract some of the nervous system some stuff happening in disregulation and also in my daughter's sensory aversion. 

You should try OT. My 5-year-old is hypersensitive and we were referred to OT. After a long waiting list, we got a spot at Full Circle. Their intake form was enlightening about categorizing all the things that bother my child. Basically, her body was too overwhelmed by sensory input so it made her act in ways that weren't great. My daughter isn't aggressive; she tends to withdraw, but they are flip sides of the same coin. She has improved dramatically after a year of OT, which is ongoing. I also recommend the book The Out of Synch Child. See if any of that resonates. There may be other things that could be driving your daughter's behavior but OT is a great place to start. 

Also, I realize that I didn't answer your question about "what do they do" in OT. It's like a gym and they have exercises/activities that give your child the sensory input their body craves in ways that are constructive. You carry this work over at home. The OT also works on strengthening areas that are weak or underdeveloped. 

Your child sounds like my twins were at that age. Parenting was an incredible challenge to say the least. We had them assessed for sensory processing disorder, which they had and saw an OT who works with kids w sensory issues. 
As they got a little older they were diagnosed w ADHD and some LD’s.  I resisted meds for the ADHD for about a decade.  I tried dietary changes, lots of sensory sports, outdoor time etc. In middle school, my child was still struggling w impulsivity/ emotional regulation and requested to try meds. Since she requested, we did and it has been a game changer for her and us in multiple ways for the better.  

I’d recommend getting your child evaluated. School districts do this for free and can design supports in the classroom if they think they are warranted.  You can also ask your pediatrician for recommendations for sensory and ADHD evaluators.  A private neuropsychologist assessment is also an option but expensive. 

Please feel free to reach out to me if you have other questions.

Hi - This is such a hard age and these behaviors can be so upsetting as a parent. My oldest is 5 and has had some similar behaviors that we have found very challenging, if not infuriating to manage. However, we have made a lot of progress over the past year with the help of a parent coach. We still have challenges, but we have a ton of tools, both our son and us as parents to work through these flare ups when they happen. They are now less frequent and when they do happen, he is able to calm down and re-regulate much more quickly. Depending on your budget, I highly recommend Julietta Skoog who started Sproutable: Julietta is an expert in early childhood. Good luck!

Your situation is very familiar! We have attended Rebecah Freeling's Spirited Child workshop through BANANAS twice then decided to work with her directly because we needed more support. We met with Rebecah once a week over zoom to discuss how the previous week had gone - what worked and didn't work. She has a TON on experience and was really flexible with the needs of our individual kid and situation. She totally gets these kids and absolutely loves them. We have tools now that actually work and that my kid actually hears instead of him breaking things, hitting us, or otherwise totally melting down. I can't recommend Rebecah enough: 

Wits' End Parenting
(510) 619-5920

Best of luck!