Possible ADHD, ASD and anxiety -- how to evaluate?

[Anonymous]

Over the past several months I've become increasingly concerned about my 4yo son and his behavior. My husband is very ADHD so I initially thought perhaps this was the issue but the more I read/research, am thinking things may be a bit more complicated. Here are some of my concerns:

--He's a pretty rigid/inflexible kid who gets extremely upset when things aren't done exactly as he wants. For example, a few mornings ago he lost it as we were walking out the door because I was trying to hand him his umbrella on the front porch. He wanted me to give it to him in the house and insisted that everyone, including his sister, come back in the house until he had the umbrella in his hand. This is just one example of a behavior we see frequently.

--He seems to have significant issues with emotional regulation, and often flies off the handle with little or no warning. Sometimes this is just yelling but it can also involve hitting, pushing and kicking.

--When playing he is easily over-excited and has difficulty calming down. For example, when he runs around outside with friends, I often can't get him to come back in the house. Instead, he wants me to chase him. No amount of bribing or threatening seems to work. (His older sister is the same way on this issue and was recently diagnosed with ADHD-combined type.)

--After a full year of weekly swim lessons, he still refuses to let go of his teacher in the water (says he doesn't want to sink). He also talks frequently about death, which seems odd to me. For example, he announced in the car yesterday out of the blue that he doesn't want me to die. I have no idea where that came from.

--Seems to get "stuck" on certain things or ideas and can't let them go. For example, when he gets a new lego set, it's a battle getting him to tear himself away. All he wants to do is put legos together until he's done. If he sees a toy advertised on TV and decides he wants it he will ask about (or demand) that same toy over and over again.

--Bad at transitions, in general--particularly if they aren't a part of our normal routine.

On the positive side, he's a sweet and social kid, who loves hugs and seems to get along well with others. His preschool has reported almost no behavioral problems or issues. Like other kids, he gets an occasional time-out. A few days ago, he actually approached another little boy who was crying on the playground and tried to comfort him. He's also a great, non-picky eater who will try almost anything. His intelligence, motor skills, etc. all seem normal and his spatial skills, in particular, are fantastic.

Any thoughts on what this could be? Advice? And how do we go about evaluating? A developmental pediatrician, psychiatrist, private psychologist? Is 4 too young for a diagnosis? I'd hate to wait 6 months for an appointment, only to be told he's too young to be evaluated.

Thanks so much

[Anonymous]

If you don't mind paying out of pocket, I think David Black is the best at understanding the edges of autism and what is and isn't autism. We've done neuropsychs with him; I don't know what testing he would do for younger kids. caatonline.com.

[Anonymous]

Sounds similar to my kid at that age with ADHD/ASD/anxiety. I agree David Black is very good, but 4 is too young for a full neuropsych. He can do an ADOS though. You can also see a developmental pediatrician.

[Anonymous]

I would go to developmental pediatrician at children's or KKI b/c one or both will be covered under insurance.

Save the money for dr. Black for when you actually need it--like testing in a couple of years for the neuropsychological evaluation.

We went to KKI then Black, so my recommendation comes from experience.

[Anonymous]

Did you post elsewhere? My similar kid ended up with a diagnosis of generalized anxiety and severe adhd. There were a lot of red flags for autism--I would say at 4 my child was more rigid than a couple kids we know with autism--but when evaluated, he showed some "strengths" that ruled out autism. In sum, diagnosing at that age is very tricky. (It becomes a lot more obvious as kids get older.) Try to find someone really strong so that you can support your child's deficits appropriately.

[Anonymous]

Anonymous wrote:Did you post elsewhere? My similar kid ended up with a diagnosis of generalized anxiety and severe adhd. There were a lot of red flags for autism--I would say at 4 my child was more rigid than a couple kids we know with autism--but when evaluated, he showed some "strengths" that ruled out autism. In sum, diagnosing at that age is very tricky. (It becomes a lot more obvious as kids get older.) Try to find someone really strong so that you can support your child's deficits appropriately.

This. We have had the same experience. Some days I still wonder if we are really looking at ASD but mostly the pieces are all falling into place for us.

[Anonymous]

NP. For a 7-8 year old, do you have a recommendation for who to see?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Did you post elsewhere? My similar kid ended up with a diagnosis of generalized anxiety and severe adhd. There were a lot of red flags for autism--I would say at 4 my child was more rigid than a couple kids we know with autism--but when evaluated, he showed some "strengths" that ruled out autism. In sum, diagnosing at that age is very tricky. (It becomes a lot more obvious as kids get older.) Try to find someone really strong so that you can support your child's deficits appropriately.

This. We have had the same experience. Some days I still wonder if we are really looking at ASD but mostly the pieces are all falling into place for us.

This is the OP. Really appreciate the input. I’m curious if either of you feel like ADHD or anxiety meds helped with the rigidity and inflexibility?

Thanks so much

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Did you post elsewhere? My similar kid ended up with a diagnosis of generalized anxiety and severe adhd. There were a lot of red flags for autism--I would say at 4 my child was more rigid than a couple kids we know with autism--but when evaluated, he showed some "strengths" that ruled out autism. In sum, diagnosing at that age is very tricky. (It becomes a lot more obvious as kids get older.) Try to find someone really strong so that you can support your child's deficits appropriately.

This. We have had the same experience. Some days I still wonder if we are really looking at ASD but mostly the pieces are all falling into place for us.

This is the OP. Really appreciate the input. I’m curious if either of you feel like ADHD or anxiety meds helped with the rigidity and inflexibility?

Thanks so much

Np here. My kid has ASD/ADHD/anxiety and the meds definitely helped with that. I suspect that whatever disorder a kid has, they feel out of control and the rigidity is an attempt to maintain control.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Did you post elsewhere? My similar kid ended up with a diagnosis of generalized anxiety and severe adhd. There were a lot of red flags for autism--I would say at 4 my child was more rigid than a couple kids we know with autism--but when evaluated, he showed some "strengths" that ruled out autism. In sum, diagnosing at that age is very tricky. (It becomes a lot more obvious as kids get older.) Try to find someone really strong so that you can support your child's deficits appropriately.

This. We have had the same experience. Some days I still wonder if we are really looking at ASD but mostly the pieces are all falling into place for us.

This is the OP. Really appreciate the input. I’m curious if either of you feel like ADHD or anxiety meds helped with the rigidity and inflexibility?

Thanks so much

OP, I am the first PP. My son took an SSRI for anxiety for about two years. It was life-changing. Absolutely beyond my expectations. He started to talk himself into doing things that before he had flat-out refused to do without explanation. He was able to go with the flow and able to handle little things not going his way. We also worked with a wonderful child psych for years, 4 or 5. There were many other parts to our interventions but those were two key pieces. He was still the same intense kid, with the same strong likes and dislikes, but so much more able to rationalize and think things through.

We stopped the medication after a couple of years and he has been doing okay without it for many years. He is still anxious but can use strategies he learned in therapy. I would not be surprised if at some point in his life he took an SSRI again--I wouldn't wait so long next time. Medicating for the ADHD has been much trickier because of the side effects. But, to answer your questions, for us the rigidity was very clearly tied to the anxiety. I wouldn't say that now, at age 13, he is the model of flexibility ... he still likes consistency and structure. But he can handle change and absolutely is willing to take input from others and is generally a very respectful considerate kid.

[Anonymous]

I’m the second OP and I don’t know yet! We are starting ADHD meds next week, as soon as we can get the chewable.

Several doctors are telling us that the meds will help with the anxiety too, which is counterintuitive to me. But things are getting harder for her every day and I want to try.