Could this be ADHD?

[nature girl]

My DD5 is intelligent and quite creative, has been reading since she was 3 and writing words soon after, and learns other subjects easily. She's able to sit for long stretches listening to books, and if anyone had suggested a couple of years ago that she might have an attention problem I would have laughed them out of the room. The problems we're seeing really only started when she was around 3.5, and they've gotten progreassively worse, especially in the past 6-8 months.

 

She's showing impulse control issues (she'll bite me and DH at times, or slam doors on our backs, sometimes seems unable to stop herself from repeatedly doing things we've told her not to.) Her emotions are all over the place--90% of the time she's on a spectrum between happy and jubilant, but she's also overly sensitive to everything, cries quite easily and gets very easily frustrated. If something she’s building falls down or if she has problems with reading a word, writing letters, finishing a puzzle or putting on clothes, she’ll scream and throw them, she just has no patience. And it makes her very reluctant to try and learn new things that she might not be immediately good at. She also talks nonstop, making up stories if she can't find anything to say, approaches every stranger she sees and talks to them a mile a minute, and in the past few months she's gotten much louder and more jiggly/squirmy...We were able to school pretty well a year ago, but other than reading it's become virtually impossible over the past few months, she's bouncing all over the place. I basically gave up because she's young enough and ahead enough that it's not yet much of an issue, but next year I'd really like to buckle down a bit more.

 

We have an appointment with a neurodevelopmental pediatrician, but all the doctors within driving distance have at least an eight month wait, and we won't be able to see the doctor until late fall.

 

Do those of you with experience think this could be ADHD, or something else? Do attention issues ever show up later in childhood? She seriously was the calmest baby/toddler, rarely had temper tantrums until a couple of years ago, and even then nothing like we're seeing now. Do you have any ideas of anything we might try before seeing the doctor? (And after as well, since we'd rather not start on meds if she's able to function without them.) I'm now trying to keep her away from gluten and dairy for awhile, to see if that makes any difference, as well as supplementation with B-vitamins, zinc and magnesium, and probiotics...(I haven't seen much difference yet, but it's only been 2 weeks, I'm not sure how much time to give it before assuming it won't help.) We're also considering behavioral therapy, but our local doctors don't take insurance, so I'm not sure how often we'd be able to see them. Thanks so much, I'd appreciate any insight you might have...

[PeterPan]

Has anything changed in her life?  Any change following vaccinations or a prolonged illness? Any environmental exposures?

 

You're definitely showing perfectionism that can go with giftedness.  The biting concerns me, because I'm wondering if there are communication issues there.  How is her speech?  

 

If there are speech issues, I would go ahead and get a speech eval.  I would consider an OT eval for self-regulation.  You can get into an OT sooner and they might turn up something.  Most kids with the mix of labels will have OT issues, and an OT who deals with sensory integration can give you some techniques or help you find patterns you're not yet seeing.  Might be your fastest way to make an actual CHANGE, and most kids enjoy OT.

 

Ok, now I'll ask the tacky thing.  How old is she on that 5?  Have you thought about grade-adjusting her and calling her K5 again?  Is the beginning of the symptoms correlated to beginning formal school work?  Maybe something coming to a head, like weak oral communication skills and some frustration, so she bites instead of using her words...

[geodob]

Everything that you have described, comes under the definition of the 'Perfectionism'. Which is classed as a disorder, due to the dys-function that it causes.  

It often develops in gifted children, for whom learning was very easy as infant and created this self-image of being perfect.

Which seems to have started to shatter, when she was 3.5.

That she has continued to try and deny.

Where typically, it then causes the development of an 'anxiety disorder'.

 

Though to address it, really requires understanding the 'mind-set' behind Perfectionism?

So that you can then help her to understand it, and develop a new 'mind-set'?

With the mind-set of a 'High Achiever' being a major alternative.

That recognizes mistakes, as an important part of learning and realizing one's potential.

 

Perhaps you could do some activities with her, that rather involve exploring different ways to do something?

To identify the best way.

So that making mistakes, is seen as important to finding the best way.

[nature girl]

Thanks so much for your thoughts! Responses below...
 

Has anything changed in her life?  Any change following vaccinations or a prolonged illness? Any environmental exposures? No illnesses, and I don't think I can really correlate the change with a vax, although it might have started within a couple months of her MMR? But nothing so concrete that I'd be able to pinpoint it.

 

You're definitely showing perfectionism that can go with giftedness.  The biting concerns me, because I'm wondering if there are communication issues there.  How is her speech?  She's bright, but definitely not gifted. Her speech is quite good, vocab is pretty advanced for her age and she doesn't have an issue expressing her feelings. The biting has only started over the past month, and doesn't even seem correlated with emotions, which is part of what's so strange. She last bit me while I was preparing her lunch, I think because she was just so excited about eating (she loves food.) She slammed a refrigerator door on me also while I was preparing a meal, and one of the grocery store freezer doors on me while I was just looking at vegetables. Yesterday we were in a sandbox and she was playing happily, then for no reason threw sand on another child. It just seems to be an impulse control issue, she's feeling happy or excited, gets an idea in her head and just does it without thinking.

 

If there are speech issues, I would go ahead and get a speech eval.  I would consider an OT eval for self-regulation.  You can get into an OT sooner and they might turn up something.  Most kids with the mix of labels will have OT issues, and an OT who deals with sensory integration can give you some techniques or help you find patterns you're not yet seeing.  Might be your fastest way to make an actual CHANGE, and most kids enjoy OT. I'd never considered OT, I'll have to look into that! I'd always thought of it as useful for improving motor skills, not behavioral issues, but looking closer it seems like you're right, it might be a good first step.

 

Ok, now I'll ask the tacky thing.  How old is she on that 5?  Have you thought about grade-adjusting her and calling her K5 again?  Is the beginning of the symptoms correlated to beginning formal school work?  Maybe something coming to a head, like weak oral communication skills and some frustration, so she bites instead of using her words...We've never really done formal school per se, I've basically followed her interests, not requiring anything, just bringing materials out when she asked, or agreed with my suggestions. Reading was done without a phonics program, just through regular books, science was interest led, when the mood struck us. Math was a bit more formal, but she breezed through RS A and really enjoyed it, got through half of RS B and then just balked whenever I suggested bringing out the books, so I decided to take a break from it. (It wasn't even that it was getting harder for her, she was able to do the work, I think it just was no longer fun, and she has a hard time holding attention with anything she's not intererested in.) I'd like to start it up again next year, but I'm worried about how she'll react...I'd love to get that joy of learning back again, because we had so much fun with it last year, learning was play for both of us, but she seems to have completely lost that mindset.

 

As for perfectionism, yes that's definitely an issue, and we've been working on it for awhile. I purposely make mistakes and show her the right way to react, and have read a number of books that talk about how failure is a necessary step before improving and succeeding. I'll keep working on this, I know it's going to continue to hold her back until we can get a handle on it.

 

It sounds like your guess is that this isn't ADHD, then? Is that because it only seemed to develop later in life? I've looked through descriptions of ADHD kids, and she matches so many of them, except that she's not a risk-taker and is able to focus well on books, art and pretend play...

[PeterPan]

My most ADHD dc is the one whom the school denied ADHD on, lol.  I'm actually saying it's way more complex than just implying it's a ritalin deficiency.  My ds can sit and work for 45 minutes.  He's gifted, can hyperfocus, and gets an ASD label from one of the psychs to top off his other labels.  He gets called ADHD-combined, and he wakes up very ON, stays on, and pretty much has to have 4 hours of hard activity to come down to the level of other kids.  Behavior with him is an extreme challenge and something we're always working on.  

 

Contrast that with dd, who gets an ADHD-inattentive label.  She needed a timer even to work for 6 minutes when she was the same age. She fatigues easily, avoids exertion, and the ps had no trouble labeling her as ADHD this year, lol.  Same ps psych btw.  She has no ability to hyperfocus like ds.  She wakes very slowly, as in she typically needs 1 1/2-2 hours to become functional.

 

Those are HUGE contrasts, radically different situations, but they both get called ADHD.  It's just absurd biologically even to call them the same thing, as they clearly have such different brain patterns, and yet the first psych (idiot) called ds ADHD-inattentive like dd, something he clearly IS NOT!!

 

There is no such thing as a ritalin deficiency.  You can choose to use ritalin or meds as a tool, fine.  I'm just saying this construct of one label, one problem, fix it with meds is utterly, utterly absurd.  You're talking a spectrum of presentations under one label, and there are usually quite a few things going on co-morbid.

 

Is this your oldest dc?  I hate to say it, but some kids are a real pain in the butt to discipline.  I'm not saying nothing ELSE is going on, because something may very well be.  I'm just saying that, at the end of the day, no matter what, you have to discipline.  Throwing sand at kids, slamming doors, hitting, these are discipline problems.  My ds can be an ASTONISHING discipline problem. It's because his heart inside is bent toward being bad and only wants to do what HE wants.   ;)  His ASD/ADHD/social delay makes it a 1000 times harder.  Nope, makes it 10,000 times harder.  I've been punched all through walmart.  He has screamed so loudly in meltdowns that people were commenting on the other side of masonry walls.  He can be pretty astonishing.  We deal with the labels and we deal with the discipline, and it's not one or the other.

 

I'm not saying beat your kid.  I'm saying discipline, TEACHING, that gets to the heart and connects with their soul and explains what the expected behavior was and how they diverge and begins to help them, to the degree they're able, to comply.  My ds may not notice everything or understand everything, but he can comply.  He may not feel flexible, but if I prediscuss the situation with him so he has a heads-up that it's coming, he can TRY.  He's gifted plus a bunch of labels, and his need for very clear teaching and patience and firmness is astonishing.  And I've fallen down stairs and been hurt and had my glasses damaged and all sorts of things from him, so I'm not saying we're there.  It's a work in progress.  He's FINALLY to the place where I can require him to look me in the eyes and say I'm sorry and hug.  We're working on getting that I'm sorry to be more modulated, in a normal tone, rather than a yell or growling, lol.  Work in progress.  And we're working on getting the hug modulated so it's gentle, not too firm and not hurting me it's so hard.  He can't understand nuances I used with dd like asking forgiveness for infractions vs. saying sorry for accidents.  All that is lost on him.  I'm not even expecting him to notice and initiate any of this.  It's just that now, at 6 3/4, I can finally ask him to use some eye contact, say "I'm sorry" and give an appropriate hug and expect him to comply (with reminders of the steps).  

 

That stuff all happens at different times and ways for different kids.  I'm saying that's what teaching is, when we're willing to break it down and help them get there as they're ready.  I don't know what your dd is ready for, but it might be some teaching would be in order, some coming alongside and explain what was expected, how she acted, etc.

 

 

 

[Storygirl]

Anna's Mom, it sounds like you have some reasons to be concerned. I think having the evaluation by the developmental pediatrician in the fall will be valuable for you. While you wait, you can ask your pediatrician to screen your daughter for ADHD or refer her to a psychologist or pediatric psychiatrist for ADHD screening. Only an expert who evaluates her in person will be able to tell you for sure whether ADHD is present. And sometimes even the experts come to different conclusions, because different issues can present with the same symptoms. And the same disorder in two children can present differently. Sometimes a child can be diagnosed one way as a child and receive a different diagnosis years later when they are older. And even when you do have a diagnosis in hand, you won't have all the answers.

 

We want answers, so that we can best help our children. I think my advice to you is to talk over your concerns with your pediatrician and ask for his or her help. I also agree that having an OT evaluation might be helpful. OT definitely can help with sensory issues. Sometimes what seems to be ADHD is really sensory. The OT can teach calming and regulating techniques that may help, whether the issue is ADHD or sensory or something else. My son has ADHD combined type, sensory processing disorder, and other challenges as well. His occupational therapist had a lot of idea of what to do to help him. An OT may be helpful for your daughter as well, and you would not have to wait until late fall to start.

 

These things are hard. I hope you will stick around on the learning challenges board, because here you will find a community of people who want to share their knowledge but also just want to offer an understanding and compassionate shoulder to lean on.

[camino]

I think it is very hard to figure out exactly what is going on with young children, and some can be especially complex. I can tell you that much of what you say resonates with our experience with our oldest, who is now 9. He was the easiest, calmest, happiest baby imaginable, and also very precocious in the early years. We started to see some impulsive behavior in the twos and threes, but... well, there is a huge range of "normal" at that age. A lot of what he exhibited in the early years seemed to be related to emotional regulation challenges, mostly not being able to calm down easily or come down from a joyful high. It was like he had too much excitement and he didn't know where to put it. We also started to see a lot of attachment to routines and general inflexibility, which we hadn't seen before. I used to be very concerned with how my son had changed but I have to come to realize that, in his case, it was probably more life changing around him. And, for whatever reason, he didn't have the resources to easily handle the demands life presented him as he grew older. Sometimes it is impossible to see exactly what is going on with a child until the child is in a particular context and reacts a certain way. I also think that some very sensitive, bright kids can compound their particular challenges by being very hard on themselves and getting into negative cycles as their awareness of their deficits (compared to their peers or even compared to their expectations for themselves) increases.

 

I am not going to go into our whole story but just to wrap it up, my son's first diagnosis was Generalized Anxiety, later ADHD, and later Dysgraphia. He is also gifted. And he is also just a super intense, perfectionist-oriented, sensitive, talkative but highly introverted, fiercely loving and loyal boy. All of these qualities determine who he is and make him spectacular and also very challenging for his parents!

 

We did start with private OT, and went weekly for over two years. It didn't really help us but I think that it is a logical first step and that it helps a lot of people. What was hugely helpful for us was working with a wonderful child psychologist. She helped us understand our child and learn when to challenge him and when to support him and how to do these two together. We saw her weekly for four years and I will be eternally grateful to her for getting my son immediately and teaching us how to help him. 

[geodob]

Coming back to where you wrote: " If something she’s building falls down or if she has problems with reading a word, writing letters, finishing a puzzle or putting on clothes, she’ll scream and throw them, she just has no patience. And it makes her very reluctant to try and learn new things that she might not be immediately good at. "

I wonder how she would react, if you only allowed her to start something, and then you tell her to stop. As you will finish doing it for her.

Depriving her of the opportunity to finish it.

Perhaps she might just let you finish it?

Or maybe she might resist, and say that she wants to finish doing it herself?

 

 

[PeterPan]

We also started to see a lot of attachment to routines and general inflexibility, which we hadn't seen before. I used to be very concerned with how my son had changed but I have to come to realize that, in his case, it was probably more life changing around him. And, for whatever reason, he didn't have the resources to easily handle the demands life presented him as he grew older. Sometimes it is impossible to see exactly what is going on with a child until the child is in a particular context and reacts a certain way. I also think that some very sensitive, bright kids can compound their particular challenges by being very hard on themselves and getting into negative cycles as their awareness of their deficits (compared to their peers or even compared to their expectations for themselves) increases.

...

We did start with private OT, and went weekly for over two years. It didn't really help us but I think that it is a logical first step and that it helps a lot of people. What was hugely helpful for us was working with a wonderful child psychologist. She helped us understand our child and learn when to challenge him and when to support him and how to do these two together. We saw her weekly for four years and I will be eternally grateful to her for getting my son immediately and teaching us how to help him. 

I think this is an important point, because it's not just whether it's there, like some lightswitch, but that they've maxed out their ability to handle it or mask it.  And that maxing out point is different for different kids.  

 

On the OT, I got it with my first dd when she was 11-ish, wasn't very pleased with the progress (but was with the eval, which was very thorough and clued us into all kinds of things we didn't realize), and quite.  That was once a week, very vague, scattered therapy.  Fast forward.  Ds6 is getting 2 hours a week, with 1/2 hour daily homework, a lot more continuity and follow through, and he's NOTICEABLY calmer and easier to work worth and more regulated, with less meltdowns.  For a while in August we may be stepping that up even more to add in neurofeedback.  So it *can* be good for some kids in some scenarios, with certain needs.  His mix of issues is different from dd's.

[Heathermomster]

I'm curious to know if there is a family history of ADHD?  You could look at the Feingold diet.  Absolutely consider an OT SIPT evaluation for sensory as you wait to see the neuroped..

[Arcadia]

My intense firstborn acted out similar to what your child did. Banging refrigerator doors and such. He was just exhausted emotionally, having a bad day or didn't have a good night sleep. It is harder when we were outside but at home he had a safe corner to calm down.

 

For perfectionism, my firstborn would smell a rat if me or anyone else purposely makes a mistake. I think it was more helpful for my boy to see the mistakes I make half awake like pouring coffee into the wrong cup, than to purposely do something imperfect.

My kids get bored easily with work. It is hard to get a good match for every subject. I just let them get in done and play.

[Tiramisu]

I'm dealing with one of my kids now who had a behavior change. We are waiting for blood test results to rule anything out physical first. Even when my older dd who had always had behavior issues went to the psychiatrist, she wanted bloodwork. Among the two, we've had various thyroid tests, iron levels, Lyme, autoimmune and inflammatory markers. One of the tests my pediatrician added was something to screen for PANS/PANDAS. That can explain behavioral changes.