I am dealing with a 6 year old boy who has some very serious behavior problems. He has been diagnosed with Autism and ADHD. He takes Ritalin every three hours durning the day and Valproic Acid 3 times a day. I have been babysitting him 5 days a week for 6 months.

When he first started coming to my home he would spend the majority of his day either sleeping or screaming. Although he made hourly trips to the restroom, he would wet himself frequently. Within the first couple weeks of watching him the wetting disappeared completely, and the screaming only happened a couple times a week. The parents however, are still having frequent problems at home, and at kindergarden he is out of control the majority of the time.

I am concerned with several different issues. First of all is the violent thoughts this child has on a regular basis. It is common for him to be sitting quietly and out of the blue make statments like "I am going to get a knife and stab someone in the back of the head" or "guns and knives can be used to kill people". He is not exposed to violent games or allowed to watch any type of violence on TV. These statements become worse when he is in a time out, and are usually directed at the caregiver. They vary in content from day to day, but always have a violent theme.

The second problem is outbursts that are clearly out of control. He will start screaming, as if being tortured, for no reason. He will throw himself backwards onto the floor. If you approach him he will lash out and try to hurt you. This can go on for several hours at a time. At other times he will sit and stare into space and not respond appropriatly when you speak to him. His outbursts are happening at least 3-4 times a week, and frequently more than once in the same day.

He also uses foul language frequently when he is upset. At home he tries his best to get ahold of knives. The parents both have back injuries and he definetly takes advantage of it.

He does not respond to a reward system at all. He will stay in a time out for me, although he continues to scream, curse, and hit or spit at anything he can reach. At home he will run from his parents and become destructive, and they have to physically restrain him in order to keep him in a time out. The behavior seems to end from exhaustion, but will frequently continue after he rests.

What i am looking for is resources for the parents (and myself) in dealing with his behavior. The doctors so far have made changes to his medications to try and control the behavior but offer no advice on how to deal with the outbursts. They have switched doctors twice. Their choices are financially limited, and they are running out of options.

Any suggestions would be appreciated.