Behavioral Concerns

The first step is finding out what is behind your sons hitting and throwing behaviors: when they occur, what happens directly before they occur, who they occur with and where they occur and what are the consequences afterwards. For every behavior there is a reason behind it. Young children lash out by hitting, biting & throwing for a variety of reasons (and this list doesn't cover them all): A) they can't express verbally that they are angry, upset or frustrated B) they are imitating behaviors they see other children or adults do in real life or on TV C) they don't like someone being too close to them or in their "personal space" D) they are overly tired or hungry E) they want attention and have learned this is a way to get it (even if it is negative attention) F) Hitting, throwing, kicking and biting are fulfilling a sensory need for the child (a child may have a sensory processing disorder).

The keys to changing a behavior are consistency and for young children positive reinforcement is a big key as well. When a behavior occurs, everyone needs to be responding to it in the same way, at home, day care, grandmas, etc. For example, when Jack throws his car across the room, he is told to go pick it up. If he does not pick it up he is told matter of factly and in a calm tone by the adult "Jack, you need to go pick up your truck or I will help you to go pick it up". If he picks it up he is then told that "cars are not for throwing, they are for driving on the floor" and "if you throw the car again Jack, it will be put away". If he did not pick it up, the adult can walk him over to the toy and assist him in picking it up and then repeat "cars are not for throwing, they are for driving on the floor" and "if you throw the car again Jack, it will be put away". If he does throw it again, it is taken away for the rest of the day. But, keep in mind if he throws something at home and is allowed to get away with it, and then throws something at day care and simply gets yelled at and told "no throwing" and he throws something at grandma's and gets a smack on the bottom, this behavior may never change since it is being dealt with in an inconsistent manner by all the people involved.

Many young children get into a pattern of acting out for attention because over time they have learned that the only time adults are paying attention to them and responding to them is when they are hitting or throwing. They soon don't care if someone is yelling at them, scolding them, smacking them, etc. they only know that it is adult attention and that is what they are seeking. To change that pattern we need to "catch children being good" and lavish the praise on them whenever they are doing something positive or doing what we want them to do. They need to learn that attention comes from doing things well and listening and following rules, not for breaking rules or misbehaving. Many preschoolers are still in the "no" stage and can be defiant and this is not abnormal or unusual. But, if behaviors begin to disrupt learning or classroom routines, then this can be a problem.

Consequences for behaviors should match the behavior, so taking TV away in the evening because he hit another boy at day care would serve no purpose since the behavior occured hours earlier and there is no association with the actual behavior that occured. When he hits (or any behavior that hurts someone) it does need to be dealt with firmly, calmly and immediately and not with lengthy words or explanations or hitting him back. So he is told "no hitting, hitting hurts, you made Bobby cry" and he is removed from the situation immediately, while all the attention should be lavished on the child who got hit, not on the hitter himself. Time out is effective if used properly and consistently for hurting behaviors. No more than 3 minutes since he is 3 years old. When 3 minutes are up he is told again why he was in time out "You hit Bobby and made him cry. Hitting hurts. We use nice touches with our friends. Show me a nice touch". You can even use dolls or stuffed animals and act out scenarios with toys to encourage him to express feelings and learn it is ok to be mad, we all get mad, but it is not ok to hit people when he is mad. When he is angry teach him to use words "I am mad" and if he has a need to lash out, let him take out his anger or frustration by punching some pillows, etc. Some kids have a need to do this, so it's a matter of letting them get it out in a more socially appropriate way. Some child care centers have even created "quiet corners" full of pillows and maybe a tent like structure where kids can go when they need to be alone or need to kick and hit and burn off steam...this can be more positive than going to "time-out" and being told to sit in a corner in a chair. For some kids it's a matter of recognizing their early anger or frustration brewing and asking "do you need to go to the quiet corner?" and some kids will go willingly because they need that break and that time to release their frustration.

We have a lot of information on our web page about dealing with behaviors in young children, and some of these links may be helpful to you: behavior management, changing behavior, negative feelings, positive reinforcement, and self-regulation. I would also suggest calling 718-522-7300 (All About Kids NY) for more information and then setting up a meeting with your son's day care staff and asking them to write up a formal "behavior plan" detailing how their staff and your family will be dealing with specific behaviors, and let them know that you want to actively work on helping him learn to dimish these behaviors and that you need them to meet you at least half way and help you work on the behaviors through their teaching at day care and your teaching at home.

What you need to establish for your daughter is whether this is typical for her age or if you think it's something more. Also, your child's teacher needs to have skills in behavior management in the classroom. If you are seeing these behaviors at home and school you and your child's teacher need to establish a behavior plan so that you can all be consistent in managing these behaviors and eventually diminishing them. For most acting out behaviors, the smartest thing parents & teachers can do is to be consistent, and to anticipate times when problems may occur. You have to be proactive, and head off situations in which there are likely to be meltdowns, aggression or tantrums. Parents and teachers can divert attention, for example, offering one child a different toy when two children are fighting over something. Offer choices when appropriate, explain things on the child's level, and enlist the child's cooperation as a helper in the classroom. Ignore what can be ignored, pick your battles and always lavish on praise when your child is behaving appropriately. Let them learn that they receive attention for behaving, rather than for misbehaving. Behavior sometimes escalates with changes, so a new teacher can be one reason she may be acting out, especially if she was attached to her other teacher. Basically at age 3 most children are still learning to self-regulate and most behaviors, although bothersome and worrisome at the time they occur (biting, hitting, etc) do not usually continue long term and by the time children are 4 they are much better at self regulation. So if your daughter was 4 going on 5 and still demonstrating these behaviors, I would say it would be a bigger concern. If you have concerns that your daughter's behavior is escalating or not improving over time, you could seek an early intervention evaluation with your local 3-5 service provider. But, I would definitely start with meeting with your child's teacher. For more information on behavior and self regulation you can check out these links on our web page: self-regulation, changing behavior, behavior management.

I would suggest reading the above articles and then planning a time to sit down with your child's day care teachers and discuss yours and their concerns so that you can both get on the same page regarding this behavior. You and your day care staff need to figure out when and why the biting is occurring: Is she tired, is she frustrated, is she angry another child took a toy away, is she upset someone is too close to her? Is this behavior only occurring at day care? Is it happening only in the presence of a certain caregiver? Are there certain children being bitten or is it random? There IS a reason behind a bite that most children cannot verbally communicate. Many day care centers do not have adequate staff to always "shadow" a biting child, however, if for a few weeks they are able to have a worker "shadow" your child and intervene BEFORE a bite occurs, this can be helpful. You need to all be dealing with biting in the same way and the second article tells you ways to do this. One thing you never ever do is bite the child back to teach them a lesson.

If your child is age appropriate in receptive and expressive language, you may want to give her something to carry with her when she feels that need/urge to bite, like a soft rubber toy or chew tube ( the chew tube is a therapy tool used by speech/OT) and tell her things like "It is ok to be mad, but you may NOT bite people" or "You may bite on this, you may not bite your friends/Susie/Mommy). Some children actually have an oral need or fixation to bite or chew things, but this is a special circumstance and my not at all apply to your child.

You might also start with some teaching outside the bathroom, such as reading toddler books to him on toileting and playing games involving the concept of "wet & dry" since the key to going elsewhere is to feel the discomfort in his soiled diaper. You can start by teaching hand washing and face washing skills and reinforcing when his hands/face are wet and dry. I would start with a schedule much like you would with a toddler of checking his diaper every 30-40 min and for a few days establishing what his elimination pattern is...this will help you know when to learn to encourage him to sit on the potty. Take him to bathroom after snacks and meals and upon waking. If he sits and does not go, praise him anyway for sitting and let him know you'll try again in an hour, etc. When he does go in the potty have a HUGE celebration with hugs, kisses and lots of verbal praise. I would suggest making him a sticker chart for the bathroom as well to help reinforce going to the potty and then reward him with something special if he collects a certain number of stickers (you can start out slow & then build up). I don�t suggest rewarding with food, since children with Down Syndrome can be prone to weight problems. You can read our article on special needs toilet training for more ideas.

Escitalopram Oral (Cilentra): Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. Therefore, it is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition. Tell the doctor immediately if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.         From what you have described it does sound like your son is very anxious, having perhaps panic attacks and         being impulsive by fighting with other children if someone is standing behind him, as well as being very         restless-not being able to sit in the car. These could all be side effects of the drug itself, unless         these exact same behaviors were occurring before he started the medication. I also read that seizures can         be a side effect of this drug, so perhaps you also want to be careful using this drug given your son's         past history of seizures.

I would definitely suggest discussing your son's behaviors again with your doctor and asking him         if his symptoms could have actually increased DUE to taking the new medication. You may also want         to take your son to a child psychologist or psychiatrist, who may be more familiar with disorders of         mood and behavior in young children. There are many other diagnoses that affect a young child's         behavior, such as attention deficit disorder (ADD), but these all need to be diagnosed by a doctor and         medication alone is not the answer. Children with diagnoses affecting mood and/or behavior need therapy,         family training, schedules and routines for home and school life, as well as sometimes medication to help         their conditions. Make a list of what behaviors you saw BEFORE your son started the Cilentra and then         make a list of what behaviors you saw AFTER he started the medication and let your doctor know if there         are new behaviors or if any certain behaviors have become worse since starting his medication. If you         son's behavior originally was not due to depression or a diagnosed mood disorder, than perhaps this         medication is not right for him? But these are all things you will need to learn directly from a physician,         psychologist/psychiatrist. I would also suggest talking to your son's teacher and school counselor if         there is one, and address your concerns with them as well. Ask them to document his behaviors in the         classroom, so that you can let the doctor know about the behaviors both in school and at home and how they differ, if at all.

Examples of Hypersensitivity include: Feeling pain from clothing rubbing against skin, an inability to tolerate normal lighting in a room, a dislike of being touched (especially light touch), discomfort when one looks directly into the eyes of another person. You can find more info regarding the services of an occupational therapist and how sensory integration dysfunction is treated at these links from the Fragile X Foundation. Since we do not know your son we cannot give you specifics for therapy for him, but would recommend that you consult with an occupational therapist through your son's school or a local hospital or clinic.

Young children do have relatively short attention spans and generally do best when alternating activities which require sitting still and focusing with those that allow for physical movement. This is one reason there are so many proponents of keeping activities like recess and gym class a part of children's daily schedules. Creative teachers will find ways to make lessons stimulating and can even incorporate movement into lesson plans to hold attention. Therapy catalogs even sell toys called fidgets to help children maintain focus in the classroom, and this is something you can talk to an occupational therapist about if you have children in your classroom who might need such an outlet to help them maintain focus for longer periods during classroom lessons. Here is a link to some "silent classroom fidgets".

You are also correct that teachers today have to compete with the technology that kids use at home, but often technology is also a part of classrooms today, so again, creative lessons involving computers or music can also help to hold young children's interest. We recently answered a question similar to yours posed by an elementary teacher who wanted to know the attention span of children in kindergarten and first grade which I copied below. You can expect that your second graders will be able to pay attention for a bit longer, but the reply below should give you a general starting point:

Children ages 5-6 years old typically can attend to one activity that is of interest to them for         around 10-15 minutes at a time and should generally be able to filter out small distractions occurring         simultaneously in the environment. They may only be able to attend to an assigned classroom activity         for only 5-10 minutes particularly if they find it uninteresting or difficult for them and do not         have adult guidance to stay on task. As a guideline some research suggests using a child's age as a         general starting point for the number of minutes a child can attend to a single assigned task...so 5         minutes for a 5 year old, 7 minutes for a 7 year old, etc. Small groups of children may be able to play         together for 15 minutes or up to a 1/2 hour if they are engaged in novel, interesting play activities.         Children ages 6-7 years may be able to sustain attention to one interesting or novel task for as long a         30 minutes. Typically in kindergarten and 1st grade getting kids motivated, interested and engaged in the         lesson is the key way of holding their attention. It also helps to keep lessons shorter and intersperse         movement activities in between your lessons that require sitting and focusing behaviors. Another key to         success in sustaining attention with young children is to have a teacher or aide in the classroom who is         always able to help with new, difficult or frustrating tasks and who can intervene and provide cues to         stay on task before a child loses interest.

If it is the overstimulation that you feel is affecting him (too noisy in the room, too many kids), perhaps they can create a quiet corner for him in the room where he can go inside a little tent made with blankets and pillows when he needs to be alone and calm himself and listen to quiet music in headphones or read books away from the other caregivers and children, but he may not leave the room to see you or go home early just because he wants to or gets upset. Some child care centers are starting to make quiet corners, so that children can go there to be alone or to pull themselves together emotionally if need be and this has proven quite successful since there are always times when we all want to be left alone. Young children lack the self-regulation and coping skills to do this on their own, so we need to create ways to help them self-regulate and cope in situations they may find difficult. Try to gradually build up his tolerance time, for example, if he indeed makes it a full 45 minutes before becoming upset, set an alarm clock to go off in 5 minutes from that time and say "when the bell rings we can go home" and then reward him for sticking it out another 5 minutes. If he can do 50 minutes, then increase to 55 so that hopefully he can eventually tolerate the full 1.5 hour period.

It would help if you could practice this with the staff on non-meeting days and be prepared for him to act up more when first beginning, as with trying to change any behavior it usually gets a bit worse before it gets better and it does take time and patience. Do not become upset yourself, and have the staff remain calm, firm and positive. Also, when allowing him to leave the situation, be sure to do it when he has calmed himself and stopped crying or fussing, so that you are rewarding the desired behavior and make a big deal of how he made it through the hour. The staff may also want to do something very special for him once he makes it through the 1.5 hours on his own. If you are getting the feeling that his issues seem to be more sensory based, related to overstimulation from being around too many people, loud noises or different environments outside the home, you could also seek an early intervention evaluation from an occupational therapist to look at his ability to handle sensory input (sight, sound, touch, taste, smell) and a developmental evaluation to assess his current social skills. This is a link to the free early intervention services in your area: http://www.aacps.org/infants/itp.asp

This is typically surgically repaired and babies usually do very well. I would not think the rocking would be related directly to gastroschisis or to her being a preemie. In infancy, assuming your granddaughter is between 6-7 months old, I wouldn't see rocking back and forth necessarily as a red flag. At this age babies are learning important motor milestones such as how to sit with balance, crawl and eventually pull to stand. She may be simply experimenting with movement, she may get into sitting and start rocking in an effort to find her sitting balance or she may get on her on hands and knees and rock back and forth in an effort to figure out how to crawl, or she may rock back and forth when held in a standing position simply because it's fun. Some babies and young children rock as a self-soothing or self-calming measure when they are tired or upset. If you can easily re-direct your granddaughter from rocking and engage her in age appropriate play with you, I wouldn't be too concerned at this age, especially since you mention that your granddaughter is meeting all her other milestones at this time. Repetitive rocking in toddlers and older children can be a red flag for autism, but typically these older children are not meeting all their social and communication milestones and cannot be easily distracted from rocking by an adult. If you continue to be concerned I would mention it to her pediatrician at her next well child visit so he can observe the behavior and give you further advice.

By preschool age you can also use incentives for listening and    positive behaviors by making a chart & using stickers. For example if    you want your daughter to pick up her toys before bedtime, write that    as a chore on her chart, if she does it without complaint 7 days per    week you can reward her with something small at the end of the week.    You may also choose to take away special privileges for not complying    with rules or for not listening. For example, if you have planned to    go to the park and your daughter is not listening or following    through with your directives than she stays home from the park as a    consequence for not listening.

Remember, preschoolers will assert their independence and test    your rules and limits, however, it is up to you to stick to your guns    and calmly, but firmly teach them about listening or help them to    learn the consequences for not listening.

You can find more information on positive reinforcement and    behavior on our Early Intervention Support website at this link: http://www.earlyinterventionsupport.com/parentingtips/behavior/positvereinforcement.aspx

Some families have addressed concerns with aggression and    outbursts with the child's teachers and have asked for more    behavioral therapy to work on specific issues, or visited a    psychologist to assess whether any other disorders are contributing    to their child's aggression (ADD/ADHD, Conduct Disorder, Oppositional    Defiant Disorder). Some families have chosen to try medication to    control aggression and have found success. I would definitely address    these concerns first and foremost with your son's teaching team at    school and see if perhaps goals can be built into his IEP to address    these issues, then if that is not successful you may want to move    onto one of the other above mentioned steps. You asked about his    accountability, and I do not believe a child's diagnosis or    disability excuses him from his actions, so his aggression with his    younger sibling should be addressed in a manor that is suitable to    his intellectual level.

This is the only way he will begin to  learn that his actions were not appropriate in that situation. If he is  hurting his sister it cannot be ignored and must be dealt with in the  moment when it happens, but you would deal with it based on his  cognitive level, whether it be a time out, loss of privilege or a  demonstration of how he could have acted differently and more  appropriately. It sounds like your son may need to be in close  supervision with an adult when he is around your younger child, and  should not be left alone with her. Many parents do acknowledge that  their children with PDD can be extremely loving, caring and sweet, but  that often little things may set them off...and your son can probably  not yet understand that the behaviors of a one year old (dropping her  bottle is a game to her, but to him it was just plain annoying or  distracting) are not intentional and intended to annoy him and so he  may deal with her as if another 9 year old were to continuously throw  or drop a toy.

Children with PDD also often have language and social interaction difficulties, so instead of your son being able to say "Knock it off sis" or "Mom, she is bothering me", or being able to understand the social cues of a baby, he acted out toward his sister to stop her actions from bothering him. You may be able to do some role modeling and positive reinforcement with your son at home to work on specific situations which may occur with his little sister...for example, when she is dropping her bottle from the high chair, you keep picking it up and making it a fun game, demonstrating to your son a positive way to interact to this situation and rewarding him for his appropriate play with your daughter. Lastly, you might want to look into sensory issues with your son, if this isn't being addressed, for example an oversensitivity to sounds (the sound of the bottle hitting the floor), could be enough to cause an outburst. An occupational therapist at your son's school should be able to explain sensory therapy. I have also found a link that describes aggression associated with PDD: http://www.selfgrowth.com/articles/Baldwin3.html

To help you in getting help for your daughter I would suggest starting to keep a log of her tantrums that includes when they occur (date & time of day), what triggered the tantrum, what she does during the tantrum (scream, hit, bite, etc), how long they last, and what happens directly afterwards. Also, do these tantrums occur only at home or do they also occur in other environments and with other caregivers besides yourself? Keeping strict documentation of your child's behaviors will often make a doctor take a closer look. Also, has she been having these tantrums since she was a toddler or did they start or increase in intensity just recently? Pay attention to any changes in your or her life that can increase tantrums (i.e., did you recently move, did she recently start school, did you recently get a divorce or new partner, did you recently have a baby).

Typical tantrums in children ages 18 months to age 5 last around 3 minutes, and tantrums lasting longer than 5 minutes, while they may occur sometimes, would not typically occur on a regular basis. Younger children tend to lash out more physically because they don't have the words to express anger or frustration yet, however, by age 4, most children can express anger with words and can also self-calm when upset, something that it sounds like your daughter is having difficulty doing.

I don't want to alarm you, nor can I make a diagnosis, but violent tantrums in ages 3-5 can be associated with mood disorders such as depression or other disruptive disorders of early childhood. I would definitely seek a second opinion and/or schedule an evaluation with a child psychologist as soon as possible to get you and your daughter the help you need.

It sounds like she has a strong need to move. This may be vestibular dysfunction, which is a type of Sensory Processing Disorder, meaning that she has trouble processing information from her movement ' gravity, balance and space. She is always "on the go" because she is seeking out information and she doesn't get enough movement. She is bumping and crashing into things because she has a strong need for intense movement sensation. Her brain, and particularly her central nervous system, is craving more information from her body.

Different types of movement may have a "calming effect." Use the playground swings, sit 'n'spin toys, an office or dining room chair that spins; sing and spin to "ring around the rosy"; or use a blanket or sheet to make a hammock, while you and another person swing your daughter as she lies inside. Help her to have safe movement opportunities. If you can, make a "crash corner" in your home using a beanbag chair and pillows where she can safely crash and flop herself. If you set this up, she will use it!

ou are very observant of your daughter's behaviors and should have your concerns addressed. Seek out an evaluation or screening from an Occupational Therapist who specializes in Sensory Integration. You can contact the Infant/Toddler Alliance in your area for a free evaluation - you do not need a referral from your pediatrician. Early Intervention services are provided in your home. Services are free and are provided by your state to all children from birth to age 3 who qualify. (Find early intervention contacts in your state.)Ask for an Occupational Therapy evaluation and report on all the behaviors you have shared.

It is typical for 2 year olds to snatch toys from one another and to even hit other children to obtain toys for retaliation if another child takes their toy. Many children at this age just don't have the social, cognitive or language skills at this age to be able to share. You may have seen the popular Toddler's Creed:

If I want it, it's mine.
If I give it to you and change my mind later, it's mine.
If I can take it away from you, it's mine.
If I had it a little while ago, it's mine.
If it's mine, it will never belong to anybody else, no matter what.
If we are building something together, all the pieces are mine.
If it looks just like mine, it is mine.

This is why in Toddler rooms in child care centers you will often see 10 of the same toy, because everytime one child picks up the toy phone, all the other children want it.

Having said that, it is great that you are having play dates since she is an only child and exposing her to same age peers to encourage sharing and turn taking. Toddlers learn to share by having the behavior modeled for them by adults and older peers. Implementing some turn-taking games at home, first with you and your husband and later with her playmates, might be a good start. You can start turn-taking with things that don't involve toys, such as "I am sharing a bite of my sandwich with you...will you share a bite with me?" or "I am stirring the soup, now it's your turn" or "I am sharing my phone with Daddy" and emphasize when you are sharing with her or your husband. Praise her for all attempts at sharing with you and try to ignore her if she says "no" or resists. You want to use positive reinforcement as much as possible. For your play dates you could tell your daughter to pick three of her favorite toys that she can put in her bedroom and doesn't have to share with her peers, but when the friends come over, the toys that she didn't hide in her bedroom will be used for sharing and turn-taking. You can even set a timer for 3-5 minutes (most 2 year olds don't play with one toy longer than this) and when the timer goes off, all the kids will be asked to pass their toy onto a friend, making it into a game.

Also let her see you praise the other children for sharing. You can use a reward system with stickers or anything your child (or for her friends too) finds reinforcing and every time she shares she can get a star, etc. When she collects 5 or 10 stars, whatever you decide, she can then get some special reward like a treat, etc. If sharing the toys is especially difficult to start with during play dates, you can instead do something such as a craft or Playdough and build in turn-taking/sharing with "Can you pass the blue paint to Susie?", or "Can Joey use some of your red Playdoh?". Again, praise all attempts verbally and call her attention to other playmates who shared "Did you see Susie shared her doll with Amy? That was such nice sharing!".

As for speech and language skills, if your daughter currently has a vocabulary of at least 50 words and will imitate new words and seems to be picking up new words weekly and if she is putting 2-3 words together, then she is within normal limits. It sounds like you are more concerned about the clarity of her speech. We do not become concerned about clarity of speech (articulation) until a child reaches age 3. If after age 3 your child is not intelligible at least 75% of the time by people other than her immediate family you may want to have her evaluated. Many children work on pronouncing specific sounds of speech until around age 8, so some sounds we would not expect a 2-3 year old to pronounce clearly. However, if you are still concerned about clarity/articulation after age 3, a Speech Language Pathologist will be able to let you know if your daughter is eligible for speech therapy services.

Most children by age 2 1/2 can follow simple one and two step commands such as "Go get your shoes" or "Get your cup and put it on the table". Two year olds are typically active and busy as well, so this is not unusual. It helps to give young children directions/commands or to ask questions by first gaining their attention. Many active two year olds are so involved in play that sometimes they just are not attending to what you are asking them. When you want your son to do something, get down on your son's level so he sees you, encourage him to make eye contact with you so he sees and hears what your saying, and keep directions or questions simple and to the point. For example, if he is running around in the yard or driving trucks on the floor, slow him down so he's facing you or get down on the floor with him and say "It is time to eat dinner, you can play for a few more minutes and then I will help you clean up your trucks". You can even set an egg timer to signal the "end" of playtime to ease the transition into dinner, bath, bedtime, etc. For example "When the timer bell rings, it will be time to take your bath".

I would not advise getting into a pattern of threatening and punishment to make your son listen to you. Time out should generally only be used for "hurting behaviors" such as hitting, kicking, biting, etc and should be no more than two minutes long (one minute per a child's age). Use natural and logical consequences for behavior when possible, more information on behavior can be found here: Behavioral Tips for Parents

Many two year olds are rebellious by nature, so it is best for you to remain calm, say your directive in a calm, firm voice using simple words "Tommy, you need to put your pajamas on"...wait a few minutes and then repeat your same request. If he does not respond, then you may need to physically get your son (kicking and screaming or not) and restate what you asked him to do, but then guide him into doing the task telling him you gave him a chance to do it on his own and now Mommy will need to help him do it. Most two year olds are in a struggle for independence and are only asserting themselves by refusing to do certain tasks. Ignore temper tantrums.

Choices are also very helpful with 2 year olds. Try to offer them when possible, although there will be times when choices are not appropriate. At lunch time, ask "Do you want a sandwich or macaroni and cheese?". But when it is time to leave the playground, it is indeed time to leave whether he likes it or not. Pick your battles at this age, ask yourself, "is this something worth the struggle?". For example, if he wants to wear one red sock and one blue sock and he will have a meltdown if you make him wear both socks the same color, the battle may not be worth it-yes, he'll have 2 different socks, but so what? But, if it is time to go pick up a friend and he does not want to get into the car, you will have to put up with the tantrum and tears in order to get him in the car, it's not a choice at that point.

It may help you and your son to make a picture chart of your daily routine that you can hang on your frig, as having a consistent daily schedule is very important for toddlers. You can cut pictures out of magazines or use a real camera to take photos of his daily routine. For example 7am-wake up & get dressed, 7:30am eat breakfast, 8am playtime, etc through his whole day. This will help him learn what is coming up next, as advance warning for transitions to new activities are particularly helpful for toddlers.

Aside from the above suggestions, if you son has had a lot of ear infections, I would recommend scheduling a hearing evaluation by your doctor or local hospital to rule out any hearing concerns contributing to your son not listening. We want to make sure first and foremost that he is hearing you clearly and children with chronic ear infections sometimes are not. Secondly, if your son is not consistently following one step commands (get the ball) and two step commands (get your shoes and give them to Dad), you want to make sure he is not having a problem processing or understanding language. This can be determined by having him evaluated by a speech and language pathologist through your local Early Intervention Program (birth-3 program). A full team early intervention evaluation would also look at your son's overall development such as his behavior, attention and play skills to make sure that he is on target for his age.

Also be sure to look over our page on Speech Skills for 24-36 months and note the red flags to the right side of the page which would mean a need for evaluation: Speech Skills for 24-36 Months

Here is a list for early intervention contact information by state so you can find referral information if you need it: Early Intervention Contacts for Your State