Anxious Kid WWYD

[nicolewi]

*poof*

Thanks for the thoughts and advice. 

[namasteak]

Could it be ADHD? I know a lot of girls are misdiagnosed with anxiety as that and perfectionism are their main symptoms.

[nicolewi]

Apr 29, 2024 15:00:55 GMT -5 namasteak said:

Could it be ADHD? I know a lot of girls are misdiagnosed with anxiety as that and perfectionism are their main symptoms.

I mean...maybe??? I don't know!! I did a short questionnaire at her last appointment and it did not flag attention as an issue, but I think it could be a possibility. Again she functions 100% okay at school, but at dinner she frequently gets up and jumps around, and is hard to wrangle for homework. 

[penguingrrl]

A lot of what you’re saying sounds like she may be neurodivergent in some way (ADHD, autism, sensory processing, etc). I would see if you can get her in with a developmental pediatrician if you can. A lot of what we think of as typical symptoms of these conditions are how boys present and girls often present differently.

This is not entirely unlike how my 14 year old presented in elementary school and a lot of it was masking what turned out to be both autism and ADHD. With the right supports she’s a lot happier both at school and at home because masking these disabilities can be incredibly draining.

[penguingrrl]

Also, so many symptoms were downplayed and ignored because she seemed to be thriving. Kids who seem to be doing well socially and have good grades often don’t get diagnosed until later and it’s harder then to intervene.

[waverly]

I'm not 100% sold on the OT either, and I love OT for my son. But my daughter sounds a lot like yours, and she probably needs therapy more than OT. She doesn't seem to have much of a sensory component. I think I would keep looking or get on the waitlist for some of the other counselors. The lying on the floor flailing type behaviors can be addressed by OT, I just don't think they do much for rage.

Noise canceling headphones for the dishes issue.

It is common to not have a lot of control when you are in fight or flight because that part of the brain turns off. You could explore ways to get her back down from the fight or flight. I've gone to a couple of seminars in person on this (sorry, can't link anything digital), but in the moment it is still hard to get her back down even when we have both discussed it and came up with a plan. In the moment she refuses to do her plan to regulate.

Right now we are talking through these concepts/ i.e. I am the therapist in a way.  We discuss perfectionism, comparing ourselves, anger management etc. directly.  There isn't anything play related- just us chatting.  DD is 11.  

[devonpow]

My (now 12 year old) DS has general anxiety disorder - I definitely see some similarities in what you are saying, particularly with the raging and perfectionism. Those are both really common characteristics of childhood anxiety.

We started DS in therapy at age 8, but like you I don’t feel like traditional talk therapy was the best for him and his particular issues.

If I were you the first thing I would do, if possible, is to get a neuropsych exam. This is SO helpful and will let you know exactly what you are dealing with, plus will really help any future therapists with how they do treatment, if you ever do need accommodations in school etc.

If the diagnosis does turn out to be anxiety one of the best therapies is Cognitive Behavioral Therapy (CBT), so I would look for a therapist who does that. DS also had great results with a social skills group (mainly for things like frustrations when other kids didn’t follow rules, adapting to sudden changes etc) but that was particular to difficulties he was having.

In all honesty, for us it was meds that made the biggest difference (started after 3 years of therapy and we saw more improvement in a few weeks on meds than of years of therapy), but obviously again that’s very kid specific.

[expectantsteelerfan]

So, this is a minor suggestion, but maybe something little to help while you're trying to figure out, you know, everything. My dd has anxiety, as I've posted about many times, and had many similar behaviors. We are luckily in therapy with someone wonderful now, she is also medicated, and we've found a better balance with life in general, so a lot of her stuff has resolved. But when she does have free time, she has found 2 things that really help calm her, and I'm going to really suggest one of them for you...a yoga swing. It involves having room in your house to hang it (and someone to find a stud to hang it from, we had to hire someone to do it for us), but once it's hung, it's a really simple thing, and my active (dancer/gymnast) DD unwinds physically on that thing literally every day. I would have thought it was the type of thing more appropriate for someone younger, or my sensory seeking than her, but she seriously loves it.

[acr]

Apr 29, 2024 15:58:20 GMT -5 expectantsteelerfan said:

So, this is a minor suggestion, but maybe something little to help while you're trying to figure out, you know, everything. My dd has anxiety, as I've posted about many times, and had many similar behaviors. We are luckily in therapy with someone wonderful now, she is also medicated, and we've found a better balance with life in general, so a lot of her stuff has resolved. 

Same experience with us. DD (7) has been in play therapy for about 2 years, and while it's not really skill building like CBT, it does help her practice being uncomfortable. 

Medication has been incredibly helpful too. Like...massively helpful. DD just could not quiet the noise that ramped up her anxiety until she started on zoloft. While she still shows some avoidant behaviors and has intense emotions, it's way better. 


We just did a neuropsych evaluation, and for us, it was reassuring that there isn't anything going on with DD that we didn't already identify. However, it does give us more direction on how to support her at home, in school, and with therapy. 

[dcn]

I’d do a neuropsych eval to figure out what path you need to take.

My 8 year is like this too, just when I think he’s outgrowing it it pops back up again.

[thebreakfastclub]

Dear lord, the children need evaluated and medicated. So many threads, everyone answers, it goes nowhere.

[secretagent]

This sounds a lot like my DD1 at that age. Long story and several years later, she is in the care of a psychiatrist and has a private therapist as well as in school therapy related to her severe anxiety, and adhd which often triggers anxiety spirals. We are also on the waiting list for an autism evaluation which I wish we pushed for sooner. It’s a lot. Please get your daughter evaluated.

[pittpurple]

My daughter is like this - she's highly sensitive to noise and textures and clothing and has some sensory issues and anxiety as well. She's diagnosed with sensory processing disorder, selective mutism and social anxiety. Girls tend to mask really well and then fall apart when they are safe so she is 100% compliant and perfect at school - to the point where it's stressful for her to keep it up for that long of a day - and then has massive raging fits when she's in her safe space.

Some of what you are describing falls under sensory processing here in Scotland - having difficulty with noise and temperature are flags for the questionnaires here. I'm not sure how that's different in the states if you aren't having the same experience with evaluations.

What helps us is to be super mindful about how she's spending her time. Minimal screen time, lots of time outside, avoiding places with big crowds / lots of noise (or making sure that if we are someplace like that there's lots of downtime afterwards) and making sure she has access to fidgets, colouring, etc. so she can work on calming herself down.

[momof2]

This kid needs a full evaluation. And once you have a diagnosis (assuming there is something diagnosable), you need to stop being in the “I’m not ready for meds” camp. You need to talk to the experts and really, really consider meds if they could make a difference. Your kid doesn’t have to be on them forever. But at least see what they might do if ann expert says they might help. And don’t give up after one med doesn’t work.

I have lived in the SN world for almost 15 years. I would anecdotally say that 80% of parents I know in real life, communicate with in SN forums, etc. regret not trying meds sooner. There are about 10% that say meds never work (which I totally believe for their particular kid, but I don’t think it means others should not try them). And there are about 10% that will say some woo diet or therapy that has zero literature to support it changed their lives (which I don’t generally think is a good idea).

[imimahoney]

My 9 yr old daughter has an adhd diagnosis but her psychiatrist actually thinks its general anxiety. After 2 months of talk therapy were are adding in meds.

We are on a 14 month wait list for a full neuro psych eval by someone who actually takes insurance. 😭

[erbear]

I'd get a full eval. Your description has a lot of ASD indicators.

[AdaraMarie]

-

[bbdoll]

No specific advice, but hugs from one mom to another.  I know how hard it can be navigating all of this.  Hoping you are doing the right thing, but never quite sure.  It's exhausting.  You are a good mom because you are asking the questions and trying to help your child anyway you can.

[osulori]

To answer your question re: what I would try next-a neuropsych eval, 100%. See if your daughter's counselor can help facilitate the referral, that may speed things up a bit.

[niq]

What's the social situation at school? How many people would she say are her friends, and (if you can find out) how many would say she's their friend? What's the "other trusted adult" situation?

Teachers constantly tell me that it's within the range of normal for kids to behave differently at school than at home. I don't really understand why.

Does your/your spouse's employer have a "parent coaching" benefit? Until this year, I had 12 hours/year of telephone support with someone who had ABA certification and some other counseling experience. It was very helpful to just vent to another person about what's going sideways, and then have them come up with some small, concrete suggestions of things we can change around the house to both reduce pain points and also help the kids manage their feelings better. At a minimum hopefully there's an EAP that can help you find a list of providers. If you go to church/synagogue/etc, the church/synagogue/etc. leaders may have a list of people they refer to as well, or someone who has office space there and uses it regularly (though sometimes these counselors don't follow evidence-based practices)

PDQ: My sister's son is 7 and has some behavioral issues at school & home to the point where he's now on a behavioral IEP. She had him start taking prozac and she says it's improved the home situation.

Can you ask for a referral to a developmental pediatrician?

I think neuropsych is an overpriced racket and big time commitment for a lot of medium-grade kid stuff. I do not need to fund someone's Psych PhD to the tune of $4000 for a two-day evaluation that's only valid if my kid gets a good night's sleep and eats a big breakfast, all so someone can charge me $300/hour for ongoing lessons in how to best support them getting dressed and doing their chores in the morning.

[meanie]

My DD is veeeeeerrrry similar with the anxiety/anger. 

We have had countless talks when she is calm about how she can express her feelings in a healthy way, tools she can use when she feels like she is getting upset, etc. It's 50/50 if she will remember in the moment.

I let a LOT of little things go with her, and really make an effort to model behaviors like expressing myself in a calm voice, getting on her level, etc. For example when she says something flippant or mean to me I *want* to yell (Italian here) but I say "hey, that wasn't a nice way of saying that - can we start over?". I have to diffuse for her because she hasn't mastered it herself yet. She doesn't WANT to fight, but her inability to self-regulate and her stubbornness are big hurdles to overcome.

You have gotten a lot of good advice here about next steps, so I will just add that I have found it helpful to remember that when she is acting out it is a cry for help. It is so easy to get pulled in to a fight when your kid is saying hurtful things or being rigid and unwilling to compromise. If I reframe her behavior as needing help or that she is hurting it is so much easier to approach situations with compassion - and the results are so much better.

[ellipses84]

I knew DS2 had sensory issues but didn’t realize how bad it really was until we had an evaluation (because everyone in our family has sensory issues to some extent). Also I wasn’t paying as much attention to the sensory seeking behaviors because they weren’t causing daily life problems but they are still a huge part of the sensory issues. He has OT at 5-6 which was pretty late compared to most the kids at his OT and the referral /appt took a long time but it was all worth it. He loved the play based appt, was challenged on his major issues and they gave us tons of parenting tools to use at home.

After he graduated from that he was still having some behavior issues (mostly at home) and the OT and our pedi gave us list of providers we could see for play based therapy. We haven’t done that yet. Both my kids have anxiety like I do and none of us are medicated for it, but I don’t see it as a negative. You could try it for a short time and see if it makes a difference. I recommend getting on the waiting lists for some providers you want to see. Time will go by fast and you will have options in the future and can decide if it’s still needed.

[Poppy]

I don't know why you're opposed to meds, but that is what *I* would try. I mean, I relate to a lot of what you posted (but for me) and a simple anxiety med has made a world of difference to me in so many ways. I am MUCH less ragey, I feel so much more relaxed and happy. It is such a gift.

A lot of what you mention sounds kind of borderline in terms of whether it's "normal" or could be a symptom of something going on, but I think I'd start simple with meds (and always keep the door open for therapy) and just see how that goes. She seems high functioning so maybe if the anxiety was alleviated, that would be enough.

[waverly]

I'm half on the side of evals for everyone! And half on the side of, if I know my kid doesn't have the main things they are evaluating for then it wouldn't be useful. We've spent probably more than 60K on medical expenses OOP (with insurance) for DS, so I don't take on more medical expenses easily.

I decided to do a pyramid framework to approach it- with therapies (psych, OT/ PT, tutors, school counselor) at the bottom. If that doesn't work then I move up to eval and if that doesn't work then I move up to medication. We've done OK with the bottom of the pyramid. If you are not doing OK at the bottom of the pyramid, then you need to move up.

OT was helpful for the sensory part.

[wanderingback]

Apr 29, 2024 18:00:33 GMT -5 thebreakfastclub said:

Dear lord, the children need evaluated and medicated. So many threads, everyone answers, it goes nowhere.

I’m having déjà vu!

[carolinagirl831]

All you described is 💯 my 11 year old. We finally had a neuropsych eval last year and learned she is neurodivergent, ADD (executive functioning), autism, anxiety
All of this extremely difficult to diagnose in girls- all we really knew is she had anxiety and sensory issues. She also is great in school, very smart and comes home and absolutely falls apart. She has tantrums and fits she can’t control after keeping it in all day at school.
We finally found a therapist who works with girls like this. (After going through several)
We have decided medication is needed and have an apt with a psychiatrist-
There is honestly no other way to help her level of anxiety, and add which should help her extreme meltdowns
I am so happy to be on this path at 11 and no starting it at 15. It’s only going to get much harder.
I am not trying to scare you but encourage you to have a neuropsych eval (private- not through school) and go from there

[gretchenindisguise]

Get them evaluated.

Then do what they recommend.

It may be therapy or meds or both. Learn about what they do and how they work before you say no to either.

[beerlover]

OP, absolutely not judging you (I know I post lots of things about my son too!) - but it does seem that you have posted numerous times about your child (or children's) anxiety and not much has changed. It is clear the therapy isn't working or isn't giving her everything that she needs. I would revisit the idea of being open to medication. She could possibly feel so much better and happier on meds! You won't know until you try. It sounds like she has been struggling for a long time. I would also pursue a more in-depth evaluation, but some medication might help her in the interim.

[nicolewi]

FWIW...I poofed original. But I do think people are confusing my anxious kids. I have another who is also anxious and IS on anxiety meds. So it's not like I'm not already familiar with this. We aren't willing to start them yet until with this kid we feel like we have a better idea of what's going on and what's really warranted; whether the things we've done now have been the right approach. she's been anxious but only lately seems to be having more issues. We're in the midst of figuring things out and it's not like meds have zero side effects, so we're weighing side effects vs benefits, considering her ability to function right now which is very high generally except in her 'safe place' home.

I'd be shocked if it were ASD...I'm probably overstating the sensory issues...nobody has ever mentioned this (not teachers, counselor, relatives, pedi, etc). I truly think it's mainly anxiety based but I'm not sure if there is a sensory or attention component. If it were this, it would be very mild. She's shy but has a lot of friends and is very socially aware; loves fashion/makeup/Taylor Swift. No imaginative play issues. Maybe I'm using ASD stereotypes? but she's never been into ordering, sorting, stacking; doesn't need a strict routine, etc. Can go to movies, dances, etc. with noise, lights, etc fine.

To those saying "just do the eval," it's not so easy. I have obtained a list of private providers I can call. When I looked into something like this several years ago, it was going to cost us $5,000 out of pocket. Is that worth it if we are still 85% sure it's all anxiety? Pay $5,000 and they tell me she is anxious? It's not an easy call unless more stuff happens to tip us in that direction. In the meantime, I can call re: pricing and maybe it's not as bad through these providers. Also, I AM the only one pursuing this so don't come at me about it!!! Counselors, pedi, teachers...no one else has suggested this. Counselor talked about doing the OT eval only.

Believe me, if I could pay a $50 copay and set her up next week at our local clinic I'd do it in a heartbeat.

I know the age she's at now, was also a tough age for my other kids with anxiety stuff. I am anticipating it will be a lot better over the summer...but we'll see.

[nicolewi]

Apr 30, 2024 14:58:13 GMT -5 waverly said:

I'm half on the side of evals for everyone! And half on the side of, if I know my kid doesn't have the main things they are evaluating for then it wouldn't be useful. We've spent probably more than 60K on medical expenses OOP (with insurance) for DS, so I don't take on more medical expenses easily.

I decided to do a pyramid framework to approach it- with therapies (psych, OT/ PT, tutors, school counselor) at the bottom. If that doesn't work then I move up to eval and if that doesn't work then I move up to medication. We've done OK with the bottom of the pyramid. If you are not doing OK at the bottom of the pyramid, then you need to move up.

OT was helpful for the sensory part.

I agree with this. I'm just currently at the stage of wondering whether we need to move up past the bottom.