For my daughter, where I'm seeing the trouble most is in her inability to organize her mind to write. She has IDEAS but the physical act of getting them on paper is completely overwhelming to her. It's not dysgraphia (she writes fine). But writing multiple sentences is so hard for her, particularly in comparison to her verbal skills.
"Hello babies. Welcome to Earth. It's hot in the summer and cold in the winter. It's round and wet and crowded. On the outside, babies, you've got a hundred years here. There's only one rule that I know of, babies-"God damn it, you've got to be kind.”
LOL Dude, none of that answers my questions. ADHD/ADD is about how one's brain works and how those workings affect your daily life. So the fact that she fidgets or whatever can definitely be a sign but isn't necessarily what ADD/ADHD is.
Also, I'm not talking about what her teacher sees, though of course that has value. I'm wondering what you see as her mother. Do you think she talks a lot because she feels like talking or do you think she really just does not have the impulse control to wait until it's her time to contribute to the conversation?
Is it really attention seeking or is that when she likes something, she's entirely too excited and focused on it and cannot move onto the next thing without fully working out and talking about everything wrt to that topic?
lol sorry
she has been talking just to talk her whole life. i think she cant control it. when she hears other people talk, she thinks it is TALKING TIME!!! and just will not stop.
but her concentration is good when she has a task at hand. she can play rounds of cards or candyland with laser focus. or coloring. she can easily color every fucking inch of a coloring sheet for several sheets. but she needs specific directions.
we cant just say "go clean your room." we have to say "clean your books, then clean your dollhouse then your closet" and she has to come to us between each one.
i can see impulse control and immaturity for sure.
This is so me. I was a very smart child and never struggled in school because it was easy and I didn't have to try hard. I never learned how to focus on things I'm not interested in (hello, that's why I'm gbcn-ing at work) or when things get hard. I have no clue how to make a plan and follow through with it. If I look at a project I get so overwhelmed that I just totally shut down and can't do any of it. Cleaning a room is so hard for me because my brain can't break the task up, all I see is everything that needs to be done and I can't piece it out. If you tell me exactly what to do and how to do it, I'm golden. But if I have to come up with it myself I'll just drown.
When they can actually test this- in a double-blind study- I'll get more excited.
It's human nature for parents to want to be the ones "helping". Feeding is a such a fundamental piece of parenting, and generally much more rewarding than behavior mods/discipline to put into practice.
For my daughter, where I'm seeing the trouble most is in her inability to organize her mind to write. She has IDEAS but the physical act of getting them on paper is completely overwhelming to her. It's not dysgraphia (she writes fine). But writing multiple sentences is so hard for her, particularly in comparison to her verbal skills.
That's executive function- organization and getting ideas from one's head to paper.
That's the thing, parents of younger kids tend to focus more on hyperactivity and impulsive behavior because so little EF is expected earlier. But as kids get older, many do outgrow some of the little kid symptoms while growing into the deficits that dog older kids, teens and adults. I think this is a big reason so many adult women are finally being identified when they try to multitask careers, families and social lives.
Those of you have had your preschoolers diagnosed and treated, how did you do that? DS is 4 and I'm practically counting the days until his 5th birthday because no one will even discuss ADHD in a boy his age. We're currently attending our district's pre-k program for kids with special needs and he's classified under Autism because they can't/won't call it ADHD at his age, despite scoring much higher on ADHD assessments that he did on the Autism ones. It's endlessly frustrating because his current and former preschools seem to have Autism tunnel vision and tend to not believe me when I tell them that I don't think that's what we're dealing with because we can't get a single doctor, including a pediatric neurologist, to agree with them. I've looked over the checklists and while I see a few of the Autism flags in him I cried the first time I read a full list of ADHD symptoms because it was near perfect description of DS. He's sweet, funny, smart, and very outgoing but incredibly exhausting and I'm so tired of feeling like the worst mother in the world because he's just so hyper and distracted. We've been kicked out of children's chapel at church, had to leave two different preschools, gymnastics, art classes, and I never know if any trip to a park, library, or class with be successful or end with both of us crying because he's just not able to hold it together. I feel like I'm about to lose it because everything is a constant struggle and I feel like I'm constantly on him to stop fooling around and do the age appropriate task I've asked or to stop running, bouncing, dancing, or loudly fidgeting. We can't afford any kind of therapy because it's not covered by our insurance and even if we get a diagnosis, which I need to get cleared up before he starts kindergarten in a year (the ONLY time his September birthday has worked in our favor) so I get the appropriate services for elementary school, it's not like it would do any good because DH is opposed to any medication and our pediatrician won't do them until he's 8.
DD is dual diagnosed (ASD/ADHD) her psych diagnosed her at 5 she didn't want to go there until then since DD wasn't in danger. The tests aren't normed for the littles so nosy are hesitant to go there. She did want to medicate once she was able to administer the test and DD came back with high scores. Don't write off the ASD diagnosis if he scored as on the spectrum he almost certainly is, he just may be like my daughter and have ADHD riding along. DD is definitely more obviously ADHD then ASD, she is a fairly typical female presentation of ASD and to a stranger they would probably pick up on the ADHD first and it would take a bit for the quirks to show.
I'm not entirely dismissing the suspicion of Autism but I am a bit skeptical because once I move outside the school system and start making appointments with doctors none of them are suggesting we do further testing and I was crying for it in the neurologists office because at that point nothing was making sense to me. On the school district's evaluation he scored an 8 on the ADOS and Very Elevated in almost every section of the Connors so I'm aware that we might be dealing with a dual diagnosis. Many of the play behaviors that were flagged as worrisome on the evaluation are things that he seems to have outgrown and he did not like the psychologist one bit and magically became more compliant when the diagnostician and SLP switched out with her for testing. DS has quite a few friends on the spectrum and with ADHD and while I understand that all children with special needs present differently I don't see much in common when it comes to my challenges with DS with his ASD friends (and their mothers' don't see it) but all my ADHD mama friends give me a look of solidarity when they see DS ping ponging all over the park. He's up for another full evaluation from the school district before our ARD meeting next spring and I plan on doing an independent evaluation with a doctor after his 5th birthday and I'm hoping that this time the results might line up better between the two than they have in the past so we can get some kind of answer and make a real plan for him.
I've felt so over my head with this since I've been dragging him all over trying to get answers since he was 2 1/2 after his godmother presented me with a list of all the ways he had acted appropriately since his first birthday and told me (and anyone who would listen to her) what a neglectful idiot I was. Ever since then I've been hyper aware of any time DS even farts funny and I'm constantly crying over my lack of answers and help since I can't afford to pay for any kind of therapy out of pocket over the long term.
Oh and I've also come to the conclusion that I most likely have undiagnosed ADD and I've been self medicating with caffeine for years. Suddenly my struggles in my career make perfect sense! But it may be another 30 years before I actually speak with a dr about it bc I can't get my shit together to make the call.
Mine got done because I made my husband make the call to schedule my appointment.
Those of you have had your preschoolers diagnosed and treated, how did you do that? DS is 4 and I'm practically counting the days until his 5th birthday because no one will even discuss ADHD in a boy his age.
Not a parent of a child dxd that young, but it is not particularly unusual for clinicians to hold off on an ADHD dx until the child is about 5-6. There's a huge leap in self regulation in typically developing kids around 6-ish that makes delays and deficits easier to pick up reliably. Most of the best scales for evaluation for ADHD are normed for 6+. Additionally a few scales have a student questionnaire normed 6+ which can be really useful.
Typically, unless a child is a danger to themselves, it's unlikely to get a dx before kindie.
We're currently attending our district's pre-k program for kids with special needs and he's classified under Autism because they can't/won't call it ADHD at his age, despite scoring much higher on ADHD assessments that he did on the Autism ones.
It doesn't matter the "degree" of ASD in terms of atypicality and/or impairment. If s person has ASD and ADHD (DS- ASD, ADHD, GAD and SLD), ASD would be the primary dx. It would be primary and first considered when putting a tx plan together for any comorbid behavioral health conditions but bipolar disorder and schizophrenia. Histroically, until DSM-5 a person with ADHD-like behaviors and ASD was supposed to have the ADHD subsumed by the ASD dx- you had one dx or the other. SPD is like this now; if a person has SPD and ASD, the sensory piece is subsumed by ASD. DS's dev pedi and psychologist both independently dxd him with ASD (Aspergers) and ADHD at the same time around the age of 7.
It's endlessly frustrating because his current and former preschools seem to have Autism tunnel vision and tend to not believe me when I tell them that I don't think that's what we're dealing with because we can't get a single doctor, including a pediatric neurologist, to agree with them.
Why a neuro? Does he have seizures? Developmental pedis are the preferred subspecialists for ASD in most communities. Back in the day when there was an explosion in kids needing services, there weren't enough dev pedis to handle the load, and some neuros and neuropsychiatrists doing the dxing but mostly it's dev pedis now.
It's not tunnel vision, it's more the primary dx thing. When a person has ASD behaviors and strategies to modify them have to be considered in the context of ASD first (Excepting bipolar/schizophrenia). ASD changes everything in terms of supports, interventions and tx. Medication, too.
YMMV, but when we were dealing with the sort of issues related to inappropriate behavior, we had to manage the ASD portion before we could tackle interventions for ADHD. Take a situation where you he can't behave in the manner expected of someone his age- say story hour at the library. You might be seeing ADHD, but the inappropriate physical bouncing around could be more of a function of a part of the ASD- not understanding the "rules" for the outing, being on sensory overload, anxiety, upset that the event isn't playing out as he expected it to or not wanting to do a child-specific activity.
For DS and a lot of people with a dual dx of ASD/ADHD, you have to teach the stuff a typically developing child will intuit through some kind of NT-osmosis and then, once that is mastered, you can work on the self regulation to behave in the manner expected for the situation. The other piece, is that for many on spectrum, globalizing behavior isn't easy; they don't learn to apply skills from one place (say church) to another (library) easily so you have to constantly instruct and prompt which is exhausting as a parent.
I've looked over the checklists and while I see a few of the Autism flags in him I cried the first time I read a full list of ADHD symptoms because it was near perfect description of DS. He's sweet, funny, smart, and very outgoing but incredibly exhausting and I'm so tired of feeling like the worst mother in the world because he's just so hyper and distracted.
You do realize that sweet funny and smart don't R/O ASD?
DS is very bright, one of the funniest people I know and a very warm and engaging person, but he's still on spectrum.
I'm sorry you aren't feeling successful as a parent. But you are in a rough age right now. Four and ASD is tough. Part of the problem is that ASD is a delay. Even when the child is bright and very verbal (my kid spoke in real sentences at 15-16 months, college honors student) they still have the social and emotional maturity of someone 1/2 to 2/3 their chronological age. So even though he looks 2 on the outside, he's got the social and emotional tool box more like the terrible twos.
It can be hard to determine if a child with a dual dx is distracted from within or externally. For DS, a lot of what looks like ADHD inattention is, in fact, anxiety or thinking about special interests. If we treated this solely with an ADHD medication, we would likely make the situation worse. It's another reason why you need a firm dx.
We've been kicked out of children's chapel at church, had to leave two different preschools, gymnastics, art classes, and I never know if any trip to a park, library, or class with be successful or end with both of us crying because he's just not able to hold it together. I feel like I'm about to lose it because everything is a constant struggle and I feel like I'm constantly on him to stop fooling around and do the age appropriate task I've asked or to stop running, bouncing, dancing, or loudly fidgeting.
I'm sorry. This should improve somewhat with age, but alas the bar is set to typically developing kids, so you may find it's years before he's settled to a point where he can more easily behave in an expected manner like his same aged peers. BTDT, I always had the kid who wasn't able to do what the other kids could behaviorally and it sucked. I grew thicker skin so the judgement didn't bother me so much. But damn it was exhausting at times.
We can't afford any kind of therapy because it's not covered by our insurance and even if we get a diagnosis, which I need to get cleared up before he starts kindergarten in a year (the ONLY time his September birthday has worked in our favor) so I get the appropriate services for elementary school, it's not like it would do any good because DH is opposed to any medication and our pediatrician won't do them until he's 8.
If you had a medical dx of ASD, as opposed to an educational one, you might qualify for non-means tested Medicaid which could open up more services for you. In your situation, I would try to have him evaluated by this time next year at a developmental pediatric clinic. They'll likely reevaluate at school as well. But it's great to have a report signed by an MD and suggestions for building a kindie IEP.
Kudos to your pedi. I am impressed. Psychoactive meds should not be prescribed by PCPs under ideal circumstances. A dev pedi, or psychiatrist, is the safer choice should you decide to add medication to your tx plan. Stimulants for a child with a dual dx need to be managed very carefully. They tend to be more susceptible to the side effects of ramped up anxiety (which often makes behavior worse) and tics.
Is your DH open minded or does is medication a hill to die on for some reason? Meds can be life-changing; but they won't fill in the gaps around ASD, you need interventions and behavior mods as well.
I'm not entirely dismissing the suspicion of Autism but I am a bit skeptical because once I move outside the school system and start making appointments with doctors none of them are suggesting we do further testing and I was crying for it in the neurologists office because at that point nothing was making sense to me. On the school district's evaluation he scored an 8 on the ADOS and Very Elevated in almost every section of the Connors so I'm aware that we might be dealing with a dual diagnosis.
Even when the ASD is "mild", it would trump ADHD. DS's ASD is subtle enough that he wasn't dxd until a few weeks before he turned 7. He did really well in a traditional preschool and only struggled behaviorally when he started full day kindie.
It is very, very unusual for a school district to dx ASD where it doesn't exist. Seriously. The costs of educating a child on spectrum can be astronomical. They do not go there, as a rule, unless it's the proper dx. I have been kicking around Autismworld for about 16 years and have moderated a few ASD forums. I know of two kiddos who were given an ASD as preschoolers by their districts who were later reclassified. Kiddo #1 has an older brother on spectrum and presented with many of the same behaviors. I think they jumped the gun to get him services. He's in middle school now and is dxd with ADHD, SPL (dyslexia/dysgraphia) and CAPD. Ironically, he's struggling more than his older brother with ASD who is off to a lighly selective college in the fall while little brother is in a special LD school. My niece's little half brother lost his ASD dx. Not sure he really presented as "on spectrum" but it got him preschool services (His mom is an EI ECE, so she knows how this all works). He's in 3rd now and there's still something different about him. He has a lot of sensory driven behavior; he's a way tougher kid than mine ever was behaviorally. I suspect he'll have a mental health dx down the road given his family hx.
Many of the play behaviors that were flagged as worrisome on the evaluation are things that he seems to have outgrown and he did not like the psychologist one bit and magically became more compliant when the diagnostician and SLP switched out with her for testing.
This sounds a little like denial. I spent a lot of time second guessing DS's dx until we were able to see the dev pedi. I made both appointments at the same time, but the psych had the earlier opening. It make make sense to see a dev pedi for another eval. You could be correct that he's mis-dxd. Or, the second opinion may help you move forward with making plans for the best kindie placement and supports. Like I mentioned previously, if he does have ASD he may qualify for Medicaid and more services that way.
The way the evals work is that as the child gets older, new skills should be seen. I'm sure he's progressed and matured since his last eval/ADOS, but if he is on spectrum, he will still be flagged because of he'll still be behind where his typical peers are.
IME, and DS has been tested to death- clinical psych, two different dev pedis, a developmental neurologist, and so many school psychs I've lost count. He's been all over the place in terms of cooperation and even medicated or not, the results always come back the same. Were you in the room for ADOS? Because I'm thinking if he didn't like the clinician (and sometimes that's intentional to elicit certain behaviors); there were certain referencing behaviors a typical child would do in that situation that a child on spectrum might not that would actually make the eval's results more reliable rather than less.
DS has quite a few friends on the spectrum and with ADHD and while I understand that all children with special needs present differently I don't see much in common when it comes to my challenges with DS with his ASD friends (and their mothers' don't see it) but all my ADHD mama friends give me a look of solidarity when they see DS ping ponging all over the park.
That's interesting. I used to have this annoying neighbor who used to tell me DS had ADHD from the time he was about 18 months old. I didn't see it at the time, but man she was spot on. My niece's ex swore DS acted like the little dyslexic kids at the reading lab school he attended. Teachers and DS's pedi suggested by preschool that he might have an ADHD dx in his future. DS's kindie teacher referred him for an eval. I still wasn't really bought in until we'd gone through 2 private evals.
During this time, not a single person mentioned ASD as a possibility until kindie when DS was 6 1/2. When I approached his PCP pedi, the man told me no way my kid had ASD. He said DS was "just the highly valued and very bright child of older parents". He did give me the referral to a dev pedi and bet me that I was nuts. Sadly, I was not. DS often flies below the radar. He's had a number of teachers question the validity of his IEP classification before getting to know him well. Even his intermediate reading teacher, who had taught in an ASD/ABA classroom didn't believe it at first. She called me at the end of the first week of school to ask me about it.
It's funny, the first person to mention DS and ASD was his swimming instructor. This kid was a high school senior who taught swimming at an Easter Seals camp that had an ASD program. He said DS reminded him of some of the kids he taught at camp, only he was really smart and could talk. This 17 year old saw what I saw and connected the dots years before any teacher or physician did.
He's up for another full evaluation from the school district before our ARD meeting next spring and I plan on doing an independent evaluation with a doctor after his 5th birthday and I'm hoping that this time the results might line up better between the two than they have in the past so we can get some kind of answer and make a real plan for him.
This is a great idea. Six would be a good age via the school. At 6, he would qualify to do the student interview of the BASC and TOPL which looks at pragmatic language glitches. Vineland is another scale that can tease out delays related to ASD in otherwise bright and capable kids. If he's the kind of kid who had no speech delay and whose fine motor and adaptive skills are age appropriate or advanced; it might make sense to look at GADS when the testing is redone.
I've felt so over my head with this since I've been dragging him all over trying to get answers since he was 2 1/2 after his godmother presented me with a list of all the ways he had acted appropriately since his first birthday and told me (and anyone who would listen to her) what a neglectful idiot I was. Ever since then I've been hyper aware of any time DS even farts funny and I'm constantly crying over my lack of answers and help since I can't afford to pay for any kind of therapy out of pocket over the long term.
He needs a better godmother. And you need a better friend. Yikes.
I did the same with DS. There was always something more intense about him and I felt like a parenting failure. DS's didn't tantrum and was actually pretty well behaved, but he wasn't like other kids and nobody who should have known what was up had any ideas. That took time. Even DS told me he wasn't "like those other kids" when he was 4 and in preschool.
I hope you find answers that are accurate and make sense for you and that you can make a plan to get him the help he needs to be his best self, whatever the dx.