4 Year Old - SPD? ADHD? Something else?

poppins123

I hope you don't mind me posting here. My sister would love some advice on where to head next and some fresh perspective on her little one.

Her daughter is 4.5 years and she has had some concerns for a while about her attention, energy level and something being not quite right. She will be starting Kindergarten early next year (our school years run with the calendar year) and her preschool teachers have just mentioned that they don't think she is ready for school in a number of areas. The mentioned concerns with listening, following instructions and that she responds differently to rules (still waiting on clarification of what they meant by that).

She has always been an energetic child but this has settled a lot over the last 12 months. Her language has been assessed and she came out above average for receptive and expressive language. Conversationally this comes through but she struggles in group environments (e.g. swimming lessons, preschool) to remember instructions and stay on task. She has difficulty staying still and seems to have some sensory seeking around movement and touch. She will often chew things while watching tv or if given a fidget toy will play with this. She loves to talk and is very chatty. She really liked to please and when she doesn't follow instructions it really doesn't appear to be deliberate.

She makes friends well but can be a bit overexcitable / intense (e.g. having to stand right next to them, hold their hand, lots of saying goodbye dramatically like it's the last time she will ever see them). She shows good empathy towards others. Friends are typically girls around her age.

She has a great sense of humour and tells / makes up jokes that aren't too bad! She is very imaginative in play and can construct detailed stories. She maintains topics well in conversation and can properly introduce new topics. 

I guess we are not sure where to head next with this. My sister is looking into OT for a sensory assessment but isn't sure if psychologist/paediatrician/someone else is also needed. Her big concern is that when starting school she will be labelled as a naught child due to not following instructions/listening in the classroom and that she wont learn as well as she could if we could put supports in place. She just wants to understand what is happening and get her the support she needs.

Any suggestions would be much appreciated!

poppins123

Thanks Fredalina - I've lurked here a while and from memory of your previous posts I agree that they probably present very similarly.

We have come across a few articles looking at children who are gifted and a seemingly high incidence of sensory issues. It's something my sister is  keeping in the back of her mind but we  agree that she's probably not in that top level of giftedness but most likely would qualify. 

Are you doing any other therapies apart from OT? 

funchicken

I'm curious about why your sister isn't posting this herself, too. My oldest DD is diagnosed with SPD and ADHD, as well as a fine motor delay. She's in the last month of kindie right now, and she's had a great year with a little support from the teacher and guidance counselor.  

Honestly, I'm not sure if there's more going on that will reveal itself over time.  She's reading significantly above a kindie level (she tested at a 4th grade level for decoding and 2nd grade for comprehension), but I don't know if she's gifted or just really good at reading. My DH and I have worried about ASD or an LD, too.  Every professional we've talked to has told us she's "complicated" which I think just means they're not sure.

I would encourage your sister to join the board and start asking questions and to look into what resources are in her area.  She should talk to her pediatrician about her concerns as well.

funchicken

bubba2b said:

mrszee2b said:

I'm curious about why your sister isn't posting this herself, too. My oldest DD is diagnosed with SPD and ADHD, as well as a fine motor delay. She's in the last month of kindie right now, and she's had a great year with a little support from the teacher and guidance counselor. 

I would love to chat with your sister as well. We are a welcoming bunch! Moms are a wonderful resource

Honestly, I'm not sure if there's more going on that will reveal itself over time.  She's reading significantly above a kindie level (she tested at a 4th grade level for decoding and 2nd grade for comprehension), but I don't know if she's gifted or just really good at reading. My DH and I have worried about ASD or an LD, too.  Every professional we've talked to has told us she's "complicated" which I think just means they're not sure.

LOL...we also get the word "complex" and once I heard "unique". Absolutely means perplexed. I think it there can be some pain in the IEP room as pull down goals are prevalant. Gotta think outside the box.

I would encourage your sister to join the board and start asking questions and to look into what resources are in her area.  She should talk to her pediatrician about her concerns as well.

Developmental pedi can help sort out the nuances.

The developmental pedi used the word complicated, too  I think the nuances will reveal themselves more as she gets older and we can do different types of evaluations.

funchicken

bubba2b said:

sorry mrszee...I meant the dev pedi for the op. I agreed totally with your post and "complicated"...totally caught my eye. Sorry...I probably should have written to op when quoting your post. I was just shaking my head in agreement with you.

It occurred to me after I posted that you were talking to the OP  I got another "she's complicated" from the school guidance counselor yesterday...sigh.

poppins123

-auntie- said:

Poppins321 said:

I hope you don't mind me posting here. My sister would love some advice on where to head next and some fresh perspective on her little one.

Is there some reason your sister isn't here asking the questions? Often when a concerned relative or friend posts about a child who seems different, it's because the parents don't seeem, IHHO, to have the appropriate sense of urgency. I would invite your sister to participate. 

It's something that we have been discussing a lot together and she was happy for me to ask on here. She was the first one to identify concerns with her DD from an early age and has been proactive with trying to get assessments / support but it having trouble.  I definitely will encourage her to participate and join the bump. I think it's a way I can help her while she follows up with appts etc.

Her daughter is 4.5 years and she has had some concerns for a while about her attention, energy level and something being not quite right. She will be starting Kindergarten early next year (our school years run with the calendar year) and her preschool teachers have just mentioned that they don't think she is ready for school in a number of areas. The mentioned concerns with listening, following instructions and that she responds differently to rules (still waiting on clarification of what they meant by that).

Where does she live? Australia? Yes - we are in Australia.

I'm surprised preschool teachers would be entertaining the notion of kindie readiness- in May with a January start date- in a child who is has strong verbal skills. Especially if that child has solid language skills. Especially given the next sentence where you suggest she's matured behaviorally in the last year.

This time of year is when enrolments for Kindergarten are done for the next year and orientation programs begin. It's a hot topic in preschools at the moment so I think that's part of why it has come up now. It worries us that they have brought it up now, with the opinion that even with 8 months before school they don't feel she will be ready.

She has always been an energetic child but this has settled a lot over the last 12 months. Her language has been assessed and she came out above average for receptive and expressive language.

Why was she assessed? Is this something typically done for all students her age or was this at the request of her parents/school?

I am an Paed SLP and I suggested it to help rule things out / get all pieces of the puzzle. It came after her swimming teacher had said she doesn't understand instructions. We knew her language skills were good but I guess we wanted something to back us up when we are claiming that she has good underlying language skills and can in fact understand, but perhaps she is not being taught in a way that allows her to show this.

 Conversationally this comes through but she struggles in group environments (e.g. swimming lessons, preschool) to remember instructions and stay on task. She has difficulty staying still and seems to have some sensory seeking around movement and touch. She will often chew things while watching tv or if given a fidget toy will play with this. She loves to talk and is very chatty. She really liked to please and when she doesn't follow instructions it really doesn't appear to be deliberate.

TBH, this sounds a whole lot more like ADHD (combined type) than pure SPD. But then, I see behavior as primary over sensory when a child has both in most cases. I find a lot of parents get stuck on SPD as the context through which they parse behavior- perhaps because it's typically recognized first in a child or perhaps because it seems more like something the child truly can't help. Things like ADHD seldom travel alone. 

IME, if she has ADHD, she's more likley to have a couple other issues as well- perhaps she has an auditory processing delay- this common comorbid to ADHD and SPD (and a lot of others things) is an immaturity around processing (understanding, responding to and remembering information that comes in via speech). Sometimes these kids don't seem as bright as they really are, because the process of processing takes them more time that well developing children; this can make them seem a bit dull.

Thanks Auntie - I agree that behaviour is primary over sensory and that there is likely to be a combination of the two with her. She doesn't necessarily fit what I typically see with auditory processing, however most of the time when I see her it is in a more ideal environment and more 1:1. I can see how this would be more obvious at preschool etc. 

She makes friends well but can be a bit overexcitable / intense (e.g. having to stand right next to them, hold their hand, lots of saying goodbye dramatically like it's the last time she will ever see them). She shows good empathy towards others. Friends are typically girls around her age.

Tell me why you think she's empathetic. Most people confuse empathy and sympathy. A true empath would not be crowding a friend or hanging onto them because they would intuit that such behavior is not pleasing to the other person. Empathy is when you respond to another person by way of knowing and absorbing what they are feeling rather than what you think you'd feel in that situation. A lot of really sweet and kind kids are really sympathetic. TBH, this behavior seems more impulsive than sensory seeking.

Impulsive is definitely how we would describe her! I see what you mean about empathy - she definitely is very kind and sympathetic. Maybe an example of empathy - when she can see her sister is a bit down, giving her space and not getting up in her face, but still being nearby and playing more quietly/letting her choose what to watch on tv etc. Is that empathy or sympathy?

She has a great sense of humour and tells / makes up jokes that aren't too bad! She is very imaginative in play and can construct detailed stories. She maintains topics well in conversation and can properly introduce new topics. 

This is great. I see you and @fredalina have been discussing giftedness. Your niece sounds a bit like my sister and younger niece at this age who were both later identified as gifted. They both had older sisters and were reading and doing simple arithmetic by this age. Both were very intense and impulsive kids. Both had sensory issues and ADHD. Both entered school on the early side; my sister was one of the youngest in her class and her DD went a full year early. Starting academics helped them stay out of trouble because of boredom. Educating a kid who is ahead of her peers academically and significantly delayed around self regulation can mean making compromises in placement.

I guess we are not sure where to head next with this. My sister is looking into OT for a sensory assessment but isn't sure if psychologist/paediatrician/someone else is also needed. Her big concern is that when starting school she will be labelled as a naught child due to not following instructions/listening in the classroom and that she wont learn as well as she could if we could put supports in place. She just wants to understand what is happening and get her the support she needs.

I'm not sure what is available where you live and how you would access these sorts of specialists. In the US, your sister could contact her local school district for a free evaluation in all areas of suspected disability. Access in countries with socialized medicine can be trickier. She might ask her primary care pedi to refer to a clinical psychologist for an evaluation. This person should understand how to obtain necessary services for children with special needs in schools where you live, This person could also refer you to a developmental pediatrician if they felt this was more of a developmental condition rather than a behavioral one.

Unfortunately services are particularly well coordinated here - it's more up to the parent to seek out the individual services they need and often figure out what it is they need. She is looking into a clin psych now who works a lot with children this age and who can assist with the transition to school. Depending on how that goes she may look into a developmental paed.

The other piece is that your sister needs to think through the approach that will produce the more capable and resilient child. "Supports" for ADHD, and SPD to a lesser degree, are about teaching appropriate and expected behavior rather than lowering the standards for a child who struggles to meet them. While I understand the benefit to things like movement breaks and preferential seating, the interventions needed to teach he to meet the standards of her peers will benefit her more in the bigger picture. 

That's a really good point and I think that fits well with how she has always tried to parent her and teach her new skills. I guess it will be how we can get that happening at school. 

Are there any good books or resources you can suggest?

Any suggestions would be much appreciated!

Mrszee2b - 'She's complicated' and "I just can't put my finger on it' has now been said a few times. Very frustrating to hear! So nice to see your DD has done well.

Sounds like a paediatrician may be good to get on board too.

Thanks for all the suggestions!