Typical, or worth investigating?

[Anonymous]

Apologies if this isn't the right forum for this.

I am getting increasingly concerned about my dd, who will be five in a couple months. But, since she's my oldest, I don't know what is actually concerning and what is age-appropriate. These are the things I'm concerned about:

1. She doesn't talk to anyone outside her "circle," child or adult. Her friend's mother has commented that during drop-off playdates, dd doesn't say a word to her. If I prompt her to say hello to a family friend, even one that she's met many times before, she'll ignore me or say "no." But she's getting better at talking to people like doctors. She also doesn't talk to kids she doesn't know.

2. She seems to struggle a lot socially. In school last year, she had two close friends, but totally ignored everyone else in the class. If someone else said good-bye to her at the end of the day, she would ignore them. If we ran into a classmate on the weekends or something, she would also ignore them. At camp, she chose to sit down by herself rather than talk to any of her classmates.

3. She still has massive melt-downs over the littlest frustrations.

4. She never, ever makes eye contact, with anyone. Even when I prompt her to look at me, she looks away after a moment.

5. At home, she's playful and full of energy. But when we're out -- even if it's just us -- she constantly complains that she doesn't have any energy, that she's tired, that she doesn't want to do anything.

Thoughts?

[Anonymous]

My DD was like that at that age. The social stuff wasn't exactly the same as you describe but there are some common elements.

She was suffering from anxiety -- some of it went away and we also took her to a great therapist who taught her some cognitive behavior techniques.

Then at 9 she was diagnosed with ADHD, primarily inattentive, and treatment for that has really helped. It has also helped the social things and the meltdowns.

I have learned that ADHD has a lot of effects that don't seem specifically attention-related, but mirror a lot of what you are saying. So no arm-chair diagnosis on my part, but it might be worth it to read more on ADHD and consider having her evaluated. I don't know that you can get a good eval at her age but it would be worth talking to a professional. I also recommend a good therapist, one who can help her now and is also familiar enough with developmental issues to help you identify if there is anything else going on.

We used Alvord Baker in Silver Spring.

[Anonymous]

PP here -- I also meant to add that my older child also did some of these things at this age and has no developmental issues. He is, however, extremely bright, and there's a lot of info out there about sensitivities in highly intelligent kids.

So it could be just a phase that she will pass through.

[Anonymous]

OP here. ADD/ADHD is interesting; I hadn't considered it. She can focus amazingly well on something that interests her; we've often commented on her extremely long attention span. But if it's an activity started by others, she will completely tune out. Her teacher last year said that she was the first kid she'd ever had that literally would turn her back to circle time when she had had enough. And getting dressed in the morning is a nightmare; she'll forget what she's doing between putting on shoe #1 and shoe #2, although I was thinking that was age-appropriate (though annoying!)

[Anonymous]

My son, 6, used to be like this (and much worse). Also really happy, playful, interactive at home and a different kid in the rest of the world. He has Generalized Anxiety Disorder, of which a major component is social anxiety. He has been in play therapy for over a year and that has helped a lot. So, in our case, I'd say our son's problems are due largely to his anxiety (and some sensory issues), which are sometimes magnified by a very intense, sensitive, perceptive personality.

What has forked for us: It helps a lot if he is prepared for what will happen. Structure/routines are a necessity and, absent these, he needs to be prepped for anything new. If we are going to encounter someone outside the inner circle, I help him anticipate by walking through what you say when someone says hello. I don't ever say "You must say hello" or "you must shake hands" or scold him for not doing so because a) this sort of thing really exacerbates his anxiety and b) he is a super stubborn kid and it doesn't work to draw a line in the sand. I just calmly explain, "First A will happen and then you could say B, C, or maybe D" and then we often practice. This sort of explanation has helped a HUGE amount. It feels like a different life from the way he was at 4. BUT if I don't prep him, it is really hit or miss, depending on the day, his mood, the context, etc. He still comes off as rude more often than I'd like.

Re: frustration threshold, depending on his level of anxiety my child's frustration threshold can also be really low. I think what has helped in this area is for me to create a calmer, more predictable life for him and to avoid over-stimulation. Things that seem like the most fun in the world to most kids are just too overstimulating for him. I am not saying that I don't let him go to birthday parties or to an amusement park, but if he does go that is the one activity of the day. Of course meltdowns still happen and when they do, I try to be very calm and not trigger more emotion in him by scolding him or acting annoyed. But I also try not to create an over-dependence by fixing his problems. I try to give him ideas/suggestions of ways to make himself feel better.

[Anonymous]

She may benefit from one of the several social skills groups run by various therapists, which focus on appropriate social behavior and interaction. It doesn't necessarily sound like ADD/ADHD, but it does sound like a problem.

[Anonymous]

14:29 here... just read your last post and wanted to add that my child also hyperfocuses, which can definitely be a sign of ADHD (or a dysregulated attention system), both as a way to tune in and tune out. And maybe your daughter really does have ADHD, but I would still consider the anxiety component. In our case, when we have gotten the anxiety more in control he lost a lot of the ADHD symptoms.

[Anonymous]

OP here again. For anxiety, do kids actually express worry? DD never says she's worried about anything, even when I specifically ask. For example, she says (and acts) really excited about the new school she'll be attending in the fall, even though she doesn't know anybody there. But she does say that "it's not much fun" to sit by herself not doing anything at recess; she doesn't respond when I ask her why she then doesn't get up and play.

At what age can ADD/ADHD be diagnosed? When I look at the checklists on-line, a lot of things don't seem to apply, like paying attention to school work (she's never had any!)

Thanks for everyone's thoughtful replies.

[Anonymous]

Re: expressing worry, my child had to be taught to articulate feelings of fear or worry. He didn't have a very developed emotional language. It was a huge advance when he started to express worry because then we could talk through it and talk about other instances when he had worried and what he had done to feel better, etc.

I think it is a great sign that your daughter is excited about school. I will say, though, that until my son started to develop more self-awareness, he too, was generally excited about new things until they actually happened. Once he started to realize that new things were scary, he started to avoid them. But if you don't see that kind of avoidance, or resistance at least, maybe anxiety really isn't the issue.

[Anonymous]

My experience is very similar to the PPs whose kids have anxiety and ADHD. We, too, didn't initially consider ADHD because DS didn't fit the model for what we thought ADHD was (among other things, he isn't hyperactive or impulsive). It took us a while to figure out because like the PP, he didn't have the emotional language to describe what he was feeling much less understand it. He was also excited to do new things until he became aware that they increased his anxiety. Initially, he just stuck near us or kids he knew. Later, he started refusing to go. If we did push him, he totally shut down and that's when we really knew we had a problem. He's now 8 and we're just starting cognitive behavioral therapy. We've been doing a lot of OT (DS also has some motor planning/coordination issues as well as hypotonia) and some social skills group. I can see how some might benefit from the social skills group but it didn't do much for DS.

[Anonymous]

Anonymous wrote:OP here. ADD/ADHD is interesting; I hadn't considered it. She can focus amazingly well on something that interests her; we've often commented on her extremely long attention span. But if it's an activity started by others, she will completely tune out. Her teacher last year said that she was the first kid she'd ever had that literally would turn her back to circle time when she had had enough. And getting dressed in the morning is a nightmare; she'll forget what she's doing between putting on shoe #1 and shoe #2, although I was thinking that was age-appropriate (though annoying!)

PP here with the daughter with ADHD. She can also focus (without meds) for a very long time on her own projects, like art projects, drawing, etc. But it's hard for her to concentrate on things she's not interested in. She's also the same with getting dressed in the a.m.

[Anonymous]

PP again. I'm not sockpuppeting on purpose! But I wanted to also make the point that ADHD and anxiety are often co-morbid, and that treating one helps the other and vice versa.

[Anonymous]

This sounds a lot like our DS, 8, who has both ADHD (combined type but primarily inattentive) and anxiety. He has a very difficult time talking to adults in particular, sometimes even friends and family. It has gotten better over time. The psychiatrist he sees for ADHD medication has said he likely has what's called "selective mutism" although the anxiety has in the past been reflected in things like new activities, separations (us going out for an evening) -- the latter (separation fears, new activities) has improved immensely in the past year. The social anxiety with adults is still an issue and obviously has had an impact in school (he has an IEP).

We have done play therapy, in-home therapy (individual/family) and both have helped. DS currently takes a low dose of Prozac (liquid) and medication for ADHD (Vyvanse and Intuniv) -- we really have seen a lot of improvement but at times, we do worry about how he'll make his way in the world if he isn't willing to talk

[Anonymous]

Have you researched selective mutism? A friend of mine has a daughter with this and her behavior was similar to what you describe. She is doing much better with therapy.

[Anonymous]

"PP here -- I also meant to add that my older child also did some of these things at this age and has no developmental issues. He is, however, extremely bright, and there's a lot of info out there about sensitivities in highly intelligent kids."

NP here. What levels of intelligence are you talking about when you say extremely bright? I have a kid who is smart - we haven't done specific IQ testing - and has some of these behaviors, especially not saying hello or goodbye to friends.

Does anyone think a language-based learning disability could cause some of these behaviors?