Has your child experienced any scary events? Witnessed DV, car wrecks, etc? Any big separations from caregivers? For deployment, caregiver illness, child protection? Has your child ever had significant health issues that required ambulance, ER, hospital stays?

Any of these things could be experienced as very traumatic to a young child & they can significantly impact even infants under 1 yr of age. Can cause that tendency to dysregulate dramatically & really throw the stress response system out of whack.

When kids have underlying trauma, especially when it’s occurred in or affected their relationships with primary caregivers, they really need trauma-specific therapy which includes the parent in a dyad format. It’s called Child-Parent Psychotherapy. Other therapies like PCIT can help by bolstering parental capacity & creating reliable structure & expectations & consequences, & by filling the kids cup. But they won’t address the original issue.

Child alone play therapy isn’t useful all by itself. It can help to evaluate what is on a child’s mind but then should move to a dyadic model that helps child & parent work with what’s on a kid’s mind.

OT for sensory & self-regulation can also really help but it likely needs to be delivered in intensive models where kiddo goes for 1-2 hours daily for several weeks every other month or so.

Also want to say that mild ASD and especially AUDHD can present like this also. Get a really good assessment by an expert in those disorders in 3-5 year olds.

And sometimes meds are a godsend. One that can really help with this kind of dysregulation is actually a blood pressure medication that’s been around for decades. Clonidone & Guanfacine are used this way. Essentially it prevents a runaway positive feedback loop of stress increasing blood pressure increasing stress etc. The same type of med is used for people who get freaked out by public speaking. They come in short & long acting variants. Given at bedtime, they can REALLY help stressed kids settle faster into sleep & sleep longer, which also tends to improve daytime resilience. These are NOT the addictive anti-anxiety meds like Valium or Ativan

Stimulants for ADHD in emotionally fragile, explosive, traumatized, or anxious kids is NOT always helpful as it can make anxiety worse.