When Nicholas was referred to a paediatrician at the Royal Children's Hospital at the age of six, he fell to his knees and began crawling in a circle on the floor. He seemed to tick all the boxes for being on the autism spectrum, says his mother Nicole Anderson.
But then the boy, now 10, surprised the doctor by stroking his mother's face, kissing her neck and chatting. "It's not Asperger's syndrome," Ms Anderson was told.
Nicholas did not fit the criteria for attention deficit hyperactivity disorder either, even though he was often hyperactive. He has high perceptual reasoning but lower scores for working memory. He also shows signs of obsessive compulsive disorder.
Nicholas's teacher realised something was not right in preschool, and by the time he got to primary school he was always in trouble for refusing to do what he was told, answering the teacher back and disrupting the class.
His behaviour surprised Ms Anderson as neither of her two older children had such problems, and as a former mothercraft nurse she felt she should have been able to manage his behaviour.
Secondary school is a real challenge as they often have large gaps in their learning and poor organisational skills. If they are not helped, some can become aggressive and increasingly non-compliant.
But she couldn't — and neither could the school.
Ms Anderson hated giving her son a label but felt relieved when he was eventually diagnosed with oppositional defiant disorder, a condition that affects one in 10 children under the age of 12, with boys outnumbering girls by two to one. Teachers are not always aware of the condition and can see such children as trouble-makers.
If the school does recognise that the child has underlying problems, staff may be perplexed about how to help. As they fail to meet the criteria for autism or ADHD, such children can miss out on funding for extra help such as an integration aide in class.
Without help, their behaviour can become a serious and escalating problem for teachers, and in the end a school psychologist may need to help a parent to apply for funding under the Education Department's "severe behaviour" criteria. This is an umbrella term that takes in students with challenging behaviour that doesn't fit other categories. ODD falls into this category, as does misbehaviour related to an abusive or deprived background where boundaries and social skills have not been learned.
Principals and teachers who deal with such students in Melbourne's northern suburbs describe Heather Hendry, co-ordinator of the department's social integration unit, based in the former Preston East Primary School, as an outstanding advocate for such troubled children.
Ms Hendry has been working at the school for 18 years. She, with one other full-time and one part-time teacher, work closely with about eight children three days a week over 15 to 18 months, with the number of days easing as the child makes progress. A psychologist works one day a week counselling students and their parents and offering parenting courses.
About four of every 10 students are diagnosed with oppositional defiant disorder, while the rest have diverse problems, including ADHD, OCD or a troubled family background. "Many never get a specific diagnosis but they all find it hard to follow school rules and so school is a very negative place," Ms Hendry says.
Students on the autism spectrum do not attend, she says, as the unit takes a cognitive approach to behaviour modification, which would make such children anxious.
The approach often has remarkable results, with parent Belinda Woods describing staff as "miracle workers".
Ms Woods's son Amos began at the school only in term 3 but is already happier and his behaviour has improved. She says Amos hadn't realised how much he was upsetting people or disrupting the class.
Julie Jones, principal of Morang South Primary School, says the unit is highly effective. She says Ms Hendry's retirement at the end of the year is a "huge loss, leaving hard shoes to fill". The position is being advertised.
Others who have seen Ms Hendry and her tiny team in action say they dramatically alter the lives of children who, without help, are likely to drop out of school. Intervention is particularly needed for the few who will develop conduct disorder, characterised by aggression and violent behaviour that can lead to prison. Some children referred to the unit have already come to the attention of police.
Ms Jones says many more social integration units are needed because they are so effective. It is also a lifeline for parents. "We try to use the same approaches as the SIU but when you have 22 to 28 students in a class, it is not easy," she says.
Child Safety Commissioner Bernie Geary also calls for more intervention programs for primary school students. "These students have diverse issues — psychological, mental health, physical — and they all have different journeys. It is a lazy way of working with kids to simply put them in a school setting and expect teachers to cope," he said.
An Education Department spokesman says primary schools can draw on the help of educational psychologists, student welfare co-ordinators, primary welfare officers and education support workers.
Chief executive of the Doxa Youth Foundation, Kirsten Bickendorf, backs urgent help for such primary students. Doxa runs two schools for 11 to 16-year-olds, with about 20 based at Bendigo and 20 in Melbourne.
"These children have different underlying issues but all have serious behavioural problems and by the time they get to us they are entrenched, which means parents are at their wits' end," she says.
"It saddens me that they couldn't get help earlier. We can only have about six students in a class because if one starts being disruptive they have to be taken out and you can't leave these students unsupervised."
Ms Bickendorf has about 40 students on the schools' waiting lists but says staff also refer to other alternative secondary education programs. Doxa plans to offer primary teachers professional development next year.
Ms Anderson says Nicholas was referred to the unit for defiant behaviour.
"He will refuse to do the colouring in, for example, saying he wants to do his own drawing. He then eats the piece of paper. To a teacher he is being cheeky, rude and difficult. But he doesn't generally start out trying to be defiant. He just thinks he is having a conversation with another adult and that he has adult rights. He is quite logical and has a wide vocabulary."
Ms Anderson says her son struggles to read body language or emotion so finds it difficult to make friends. The turning point was when unit staff ran a workshop at his school providing strategies to manage his behaviour. Staff also regularly meet each child's classroom teacher to develop a behaviour plan.
"If Nicholas chooses to eat his paper, the teacher no longer sends him to the principal. She says, 'You can do that, but you still owe me that work'. He quickly decided that he didn't like staying back to do it."
But she warns that change can take time as such children can be single-minded and stubborn. "These are not kids you can leave at home while you nick out to get a loaf of bread. They are likely to conduct a science experiment while you are out."
Ms Woods agrees that it can be exhausting. She was on the waiting list for a year before Amos got help, and would hate other parents to have to struggle on as she did.
Ms Hendry says progress is slow because it takes time to help such students. "These kids are always being suspended because of entrenched behaviours. We separate the behaviour from the child and tell them, 'You are a fantastic kid'. They all have more front than Myer but also have low self-esteem. They will tell you, 'I am a waste of space'."
She says they have to be taught how to behave in different settings.
"Secondary school is a real challenge as they often have large gaps in their learning and poor organisational skills. If they are not helped, some can become aggressive and increasingly non-compliant."
It can be lonely parenting such a child. Ms Woods appreciated the unit's support. "They encourage us as mothers. After years in primary school where your child has been ostracised, you become a bit closed off to protect yourself. It's also wonderful because finally someone, who is not their mum, believes they are a good person, even if they also tell them that their behaviours are not good."
Ms Anderson says Nicholas has successfully returned to Hurstbridge Primary School, and she cannot thank staff there enough for their support in reintegrating him.
Ms Hendry says such behaviour can affect children of all socio-economic backgrounds and can have a psychiatric element or an environmental aspect or both.
"By the time parents get to us, they are worn out and desperate. They love their children but they are challenged by them for every waking hour. They just want their child to be happy, and they come here as unhappy kids, with parents who fear what will happen to them.
"The parents are grieving that their child is not reaching the same milestones as other children. They are thrilled if their child can go to his or her first birthday party or camp at grade 5."