Should we seek additional help?

March 28, 2014 8:24 AM

My 8 year old is showing some odd behavior - is this a phase, personality, or something that needs professional attention?

Very healthy no issues we know about 8 year old girl. About 4 months ago behavior started to change - to characterize its something like without sufficient details she gets confused. This timeline does coincide with a nasty allergy period in our city. I would not have though anything except that her teacher has twice pulled us aside to remark at the spaced-out nature of the kid, which is very new.

Some specifics, maybe you can connect the dots, if there is anything to connect.

- When reading stories at night we usually have to stop at least once or twice each paragraph to talk about the details, details that usually do not exist. For example the book might say "there was a door with a curved arch", at which point we will need to stop and discuss the material of the door, what is an arch, is the door open or closed, can the character see the door, who is describing the door, can the character open the door, etc. Seems like its very important for her, the author, and me to all have consensus in our mind's eye about what exactly the situation is.

- At school whenever this is the slightest ambiguity about what to do, she asks the teachers. This is what causes the spaced out comments from the teachers. They interpret it as 'we just discussed this' but she sees it as there was some slight variation from what the teacher first said. It should be noted that apparently there is no ambiguity for the other kids (at least they seem to know what to do and don't ask additional questions)

- Some ocd-like behaviors such as needing to watch digital clocks turn the hour, keeping things even, preferring to ride on divisible-by-10 chairlift chair numbers.

Schoolwork, play, social is all fine.

Does this sound like normal developmental stuff? I appreciate the teachers keeping us abreast of their concern, I just have no idea if I'm supposed to do anything.

posted by H. Roark to Health & Fitness (23 answers total)

You say this started during a bad allergy time in your city. Does she have allergies and if so, is/was she taking any medication for them? Because allergy medication can certainly fog up one's brain.
posted by agatha_magatha at 8:30 AM on March 28, 2014

Hmmmmn. You know... kids are weird. They just are. But by eight, they're slightly LESS-weird than they are as tiny little guys/gals. The thing that concerns me isn't the behavior itself (which is slightly weird, but not TOO weird), but the sudden onset. Weirdness that shows up out of NOWHERE has to have some kinda of etiology, whether it's psychological, neurological, or Other.

If you have insurance, it cannot hurt (and might help) to take her in for a visit with a pediatrician and/or a pediatric psychologist. They'll be able to either set your mind at ease OR guide you towards further help.
posted by julthumbscrew at 8:31 AM on March 28, 2014 [2 favorites]

Response by poster: Yes she has allergies, and she is on Alegra(I think), but it seems a little surprising that allergy-induced fog would manifest just this way, right? I don't think there has been any reduction in her comprehension, math, etc.
posted by H. Roark at 8:32 AM on March 28, 2014

Medications are funny. If the allergy medication makes her feel spacy it could promote the sort of minutiae focusing behavior you mention without necessarily affecting actual comprehension. If I was in your shoes that would be the first thing I'd explore before going further down the specialist path.
posted by edgeways at 8:39 AM on March 28, 2014

If my 7 year old suddenly changed that way I would be worried too. Yes, kid are just plain weird sometimes, but I would still want to check. When it comes to kids (especially MY kid) I am very much in the "better safe than sorry" camp. I frankly think the Allegra is a very likely culprit, but personally I would take her to see her doctor just to be sure. Maybe she will try a different allergy medication, or maybe they will think it is something else worth investigating.
posted by PuppetMcSockerson at 8:40 AM on March 28, 2014

Best answer: without sufficient details she gets confused

It doesn't sound like she's confused, it sounds like she's anxious about something being wrong or that she is thinking about objectivity (based on your bedtime stories experience).

In terms of the "spaced out" aspect, it sounds like the situation is something like the teacher saying s/he will tap students on the head when it's their turn to get materials, then instead s/he makes eye contact and nods, and your daughter says "I thought we were going to get tapped on the head?" or something like that. Is this accurate? There's a big difference between "this child is having trouble understanding and following directions" and "this child is unable to handle discrepancies between stated directions and what actually happens, even if it's a relatively minor difference". It seems like literalness and objectivity are important to your daughter right now?

That said, obviously I don't know your daughter and am not a medical professional and it seems like, yeah, talking to one might be helpful; does she seem anxious? Maybe she's just one of those kids to whom correctness and specifics are really important but there are professionals who can help you figure this out.
posted by Mrs. Pterodactyl at 8:45 AM on March 28, 2014 [21 favorites]

Best answer: As others have said, the sudden onset is the primary concern. Step one, pull her off the meds. Step two, make a doctor's appointment. Step three, keep a daily diary of the behavior that you or the teachers noted was unusual that day, until a few days before the doctor's appointment (hopefully a week or two out.) If you don't see the behavior petering out, keep the appointment; if the behaviors are on their way out, cancel the appointment and note that Allegra is not for her.
posted by davejay at 8:45 AM on March 28, 2014 [9 favorites]

I would say start with your pediatrician. Probably even before stopping the meds — he or she needs to see this in action. Side effects listed for children's Allegra don't include this kind of thing but who knows.
posted by beagle at 8:51 AM on March 28, 2014 [1 favorite]

Your pediatrician should be the first one you turn to with these sorts of questions. (And that doesn't mean you have to make an appointment; you should be able to ask whether, given the circumstances, you should see the ped, see someone else, or do nothing.) The doctor not only has the general expertise but also should know your daughter, have her medical records, and be able to direct you to local resources, such as a therapist, school-based support, or other.

If you don't have a pediatrician you feel comfortable asking, you might want to get a new pediatrician.
posted by Mr.Know-it-some at 8:51 AM on March 28, 2014 [1 favorite]

Best answer: I was very much like that at 8. For me, it was when anxiety issues started to show up that have been lifelong but manageable with help.

At the time, my mom had several talks with me about how life is not perfect, and I need to learn how to live with that. How she dealt with examples similar to the ones you gave:

-if I got hung up on the details in a book, she would remind me that the author made up the story using their imagination, and if I want more details, then it's my turn to use my imagination. If I insisted after another warning or two, then storytime was over, and mom walked away to do something else. The danger here is that you may be setting up your daughter for a life as a writer of fanfic.

-my mom wasn't that aware of what was going on in the classroom; it wasn't really the culture at my school for teachers to contact parents about anything short of physical violence or failing a class. My teachers saw my behavior as nit-picking their instructions and grade-grubbing, and had zero patience with it. They would say things like: read the instructions, I'm not going to repeat myself, etc. It might have helped if my parents had reduced some of the pressure for good grades on me.

-for the ocd-like behaviors, my mom has them, too, and she told me that she plays a game with herself called "see how long I can stand it." In other words, look away from the clock at 11:59 and see if I can not look back at it until 12:01, and pat myself on the back if I can do it.
posted by Bentobox Humperdinck at 8:53 AM on March 28, 2014 [17 favorites]

As a lifelong allergy sufferer: allergy medications are weird. Some drugs had no weird side effects until one day they did, and not always ones that were listed - brains are tricky. As others have said, I'd call your pediatrician.
posted by loolie at 8:54 AM on March 28, 2014 [1 favorite]

Mrs. Pterodactyl: "It doesn't sound like she's confused, it sounds like she's anxious about something being wrong or that she is thinking about objectivity (based on your bedtime stories experience). "

I agree; my intuition would be that she's in a developmental phase where order and clarity are very important, to the point that it's making her anxious. But I would very definitely call my pediatrician's nurse line and say, "So here's this weird stuff, what should I do?" And they would probably either tell me, "Pretty normal at this age, watch it for a month and call us back if it doesn't settle down by then or if any of these things happen," or "Probably normal, but why don't you have her come in so we can make sure?"

If your intuition is that something is a bit odd about your child, it's always worth paying attention to that intuition. (Your kid might just have a cold or be growing and cranky, but parents notice subtle early signs even if they can't always put their finger on it.) And if you talk with the pediatrician about it, even if it's within the range of normal, that gives the pediatrician some baseline, you know? So that if this is normal-range-but-slightly-higher-in-the-range 8-year-old concern about order, but next year you're having the same conversation again, the pediatrician will know this has been an ongoing problem over some time, and not just a brief phase. That's what the pediatrician is there for!
posted by Eyebrows McGee at 8:57 AM on March 28, 2014 [4 favorites]

The need for clarity in ambiguous situations thing could be linked to the OCD-like behaviours - as people have mentioned above, the need to make sure everything is exactly right (e.g. clarify points of ambiguity with teachers, possibly out of fear of doing The Wrong Thing) could be an OCD/anxiety symptom.
posted by terretu at 8:58 AM on March 28, 2014

When I notice changes in myself, or in my family, my first question is "what has changed in our diet?" It is possible to have very low level food allergies that don't manifest in ways that we think are allergic - like rashes or anaphylaxis. They manifest as changes in our mood, and in mental acuity, such as fogginess.

It's worth picking off the low-hanging fruit first. Start with a food diary, and try to think back if anything changed in her diet a few months back (has she started taking something different for lunch? Did she switch from brown-bag to school lunches? Did the school change their vendor - lots of kids have allergies to additives, which some vendors may use and others may not).

Then follow-up with her ped.
posted by vignettist at 9:00 AM on March 28, 2014

Yeah, it sounds like a good thing to check out with her doctor.

From personal experience, I had really weird experiences on both Seldane (the precursor to Allegra, which got pulled from the market) and Allegra. Psychotropic effects aren't listed on the label but they do apparently occur in a small fraction of the population. I'd ask the doctor if there's any reason not to switch over to Claritin, Zyrtec, or maybe even one of the nasal steroid options. (I've never had any psychotropic issues with those options, although some of them don't work as well.)
posted by pie ninja at 9:05 AM on March 28, 2014

With that particular cluster of behaviors manifesting out of the blue, I would definitely think a trip to her pediatrician and possibly a behavioral health specialist would be warranted to rule out anxiety or OCD-type behavior. It could very easily be normal developmental stuff, but anxiety and OCD are not only kind of shitty to deal with unmanaged, but also much easier to manage if you catch them fast before the behaviors have a chance to self-reinforce and build up other, less functional coping mechanisms.
posted by KathrynT at 9:59 AM on March 28, 2014 [1 favorite]

Best answer: Like Bentobox, I was a lot like this as a kid. I remember specific instances around age 6, being obsessed with the idea of honesty, precision, and order. Loads of anxiety, too, about cleanliness and health. I would memorize numerical sequences for fun. I would also watch the clock and assign weighty importance to some numbers.

Yadda yadda yadda, some gifted child programs and not a small amount of social awkwardness later, I'm an adult with a pretty good life and some manageable, low-level anxiety/OCD symptoms that generally have not gotten in the way of my employment or relationships.

This is a vote for "keep an eye on it but don't worry," and most of all, do what you can to be as loving and encouraging as possible. Don't do anything to make her feel like she's weird. I can't imagine how I might've gotten on my parents' and teachers' nerves, but I do remember the times that they humored me with a lot of love and gratitude.
posted by magdalemon at 9:59 AM on March 28, 2014 [2 favorites]

- Some ocd-like behaviors such as needing to watch digital clocks turn the hour, keeping things even, preferring to ride on divisible-by-10 chairlift chair numbers.

This is indeed OCD-like, and given the relatively sudden onset and the association with respiratory problems, I think it's reasonable to consider the possibility of PANDAS:

PANDAS is an acronym for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. This term describes a hypothesis that there exists a subset of children with rapid onset of obsessive-compulsive disorder (OCD) and/or tic disorders and these symptoms are caused by group A beta-hemolytic streptococcal (GABHS) infections.[1] The proposed link between infection and these disorders is that an initial autoimmune reaction to a GABHS infection produces antibodies that continues to interfere with basal ganglia function, causing symptom exacerbations.[2][3]

The PANDAS hypothesis was based on observations in clinical case studies at the US National Institute of Health and in subsequent clinical trials where children appeared to have dramatic and sudden OCD exacerbations and tic disorders following infections.[4] There is supportive evidence for the link between streptococcus infection and onset in some cases of OCD and tics, but proof of causality has remained elusive.[5][6][7] The PANDAS hypothesis is controversial; whether it is a distinct entity differing from other cases of Tourette syndrome (TS)/OCD is debated.[3][8]

PANDAS is controversial and is not a fully recognized diagnosis (the linked Wikipedia article does a fairly good job of exploring those issues), but I think something is clearly going on there in some kids.

I'd like to see you take your daughter to a pediatrician with experience treating OCD, and who is familiar with the issues surrounding PANDAS.
posted by jamjam at 10:35 AM on March 28, 2014 [12 favorites]

I'm a principal of a high school for kids with emotional and other disabilities and I've got three kids, one with bad-thought OCD.

The first thing we would ask is: What has changed recently in the child's environment/diet/medication/social life/etc?

So narrow that down and start analyzing what changes have occurred.

Seems like it's very likely the allergy meds. I'd switch to something else and see if that makes a change within a week or so.

Also, when my kid with bad-thought OCD has spring allergies, his anxiety hugely increases. He doesn't take meds, but I've found (also true of many of my students) that there is a HUGE mind-body connection with kids.

When they're coming down with something or their bodies are dealing with allergies or anything physical, I absolutely see changes in behavior.

It could be as simple as allergies/allergy meds.
posted by kinetic at 10:39 AM on March 28, 2014 [2 favorites]

The first thing we would ask is: What has changed recently in the child's environment/diet/medication/social life/etc?

Also, puberty? For what it's worth, she does sound somewhat anxious to me -- maybe some of it is stemming from feeling out of control or noticing changes in her body or getting worried about the changes to come? Even if she hasn't started puberty yet, other girls in her class might have and she might be pretty mixed up about it.

Personally, I would take her to the GP, and see if her doctor wants to give her a referral. Also, if the school is a good resource, it might be helpful for your daughter to talk to the school counselor.
posted by rue72 at 11:50 AM on March 28, 2014

This was me starting at age 6 or so - basically when I was conscious enough for my anxiety problems start manifesting. (Or at least, this is as far back as I can remember it being a Thing.) Starting at that time, I was very anxious about details, minor discrepancies in instructions, etc. I needed a lot of things clarified because I was anxious about accidentally doing something wrong - it wasn't that I wasn't listening, or that I didn't understand what I was hearing, but I needed to make very very sure just in case. I'd like to strongly second everything Bentobox said about what I wish my parents had done for me at this time.

Also - given that this has happened so quickly and markedly for your daughter, it does seem likely that being on medications has something to do with it, even if it is just exacerbating some other developing/underlying anxieties. Like others said, I'd keep an eye on it but not get too worried just yet.
posted by pemberkins at 12:24 PM on March 28, 2014 [3 favorites]

If you want a wild theory - there was a time in my life where being in the care of erratic and untrustworthy adults made me terrified of getting into trouble for things like "not listening" so I was hysterically trying to make sure that the adults and I were, as I now say to untrustworthy bosses, "on the same page."

But it's probably nothing. See the pediatrician.
posted by Lesser Shrew at 6:18 PM on March 28, 2014 [2 favorites]

behaviors such as needing to watch digital clocks turn the hour, keeping things even, preferring to ride on divisible-by-10 chairlift chair numbers.

So I am a grade school teacher and this doesn't sound typical to me. She might have some anxiety and OCD which certainly doesn't mean there is anything wrong with her or she's not a bright and beautiful child, but it might help her if she had some strategies/support to work through it.
posted by mermily at 7:03 PM on March 28, 2014 [1 favorite]