My 4 year old has had some hitting issues since he was around 2. He is verbal, full sentences, still not very conversational, though if you ask him a question, he'll answer it. Pretty smart, but has a lot of language issues he needs to work out. The hitting issue has always been very easily controlled, it was usually just a brief tap, and it appeared to be mainly attention seeking, though he went through a period in daycare of pushing kids down. Follks at school felt the hitting would get better as his language got better. We were getting it under control with maybe one minor occurrence at school daily, if that, and the teacher was able to predict when he would do it and stop it from happening. In addition, he has pretty much replaced the hitting with screaming and whining at home, which is not great for us but better than hitting. Now, out of nowhere, the pushing has started again at school. This means two or three major pushes, causing a kid to stumble or fall. The problem is that it is impossible to predict when he'll push, it's almost completely random, especially to a teacher and aide who have 11 other kids to work with. I will say that I watch him closely on the playground and it seems to me that what will set him off there is some minor occurrence, like a kid accidentally bumping into him, or inadvertently getting in front of him in the slide line- typical playground stuff. But it doesn't usually set him off. He actually likes roughhousing. It's just impossible to tell what one event out of 50 will set him off. There also seems to be one girl he focuses on at school. She seems fairly bossy and I think he annoys her (which is understandable.) My best guess is attention-seeking combined with some sort of sensory issue. We are going to try tokens at school for going 15-20 mins without hitting, with the reward of getting to play with a toy he likes, and then spread out the time between the tokens if it works. Tokens work really well in the short term (in the space of an hour), but not so well in the long-term (over the course of a day or longer). I'm reinforcing it at home with a token app on my phone that he likes to play with. The teacher is also going to try to keep him away from the girl. She says she doesn't like separating kids, but this is probably a situation that warrants it. Other thing we have tried in the past: replacement behavior (rubbing hands) and that did not work. The social stories do not seem to be sinking in. He memorizes them, but it doen't really have an effect. Does anyone have any thoughts or suggestions they can share?