What are some telltale signs of ADHD and learning disorders in young children?
July 7, 2011 12:31 PM   Subscribe

Sometimes my 3 year-old daughter strikes me as "not all there." I've been so careful to not be a paranoid helicopter mom that I now wonder if I've missed something. What signs should I look out for when considering ADHD and/or learning disabilities and delays?

Right now, my daughter is incredibly verbal, funny and sweet. But in classes, her teachers make comments about her being "in a fog," and I agree. When the other kids (some as young as 1.5 years old) are raptly watching the teacher, my girl can barely focus. I've dismissed this as completely normal kid behavior in the past, but after three different teachers have made comments about her difficult behavior in the span of a month, I'm now worried. My husband was diagnosed as ADHD at a young age, so I realize now I should have been on the lookout for symptoms.

More specifics:

-In soccer class she's a bit of a space cadet. The other kids follow the coaches' simple directions while my nieces plays in the dirt at a distance. She pretty much never gets the basic concepts of "find the ball" or "jump on one leg" or "throw t-shirts at the coach" and stares off into space. I always thought this was kind of a hoot, as I don't care a whit if she's not athletic. But her coach sent off alarms when she referred to my girl as a two year-old and I corrected her by saying she was 3, and the coach looked shocked!

In music class, my daughter loves her music teacher so much that she constantly interrupts him with random questions. The teacher is very good-natured about her enthusiasm but last week he had to ask her to take a 3 minute break from the class because she wouldn't stop interrupting. Every time I attempt to distract or shush her, she gets agitated and louder.

In ballet class, she was held after class because she apparently kept trying to instigate goofing off and ignored the teacher's instructions. The teacher put her in time out for 5 minutes before bringing her back into the class. I thought my kid would be humiliated by this punishment, but she didn't really seem to understand what had happened and why she'd been separated from the class.

The final class we attend is more a free time play group where kids hang out, do puzzles and make art. It's not as structured as a real class, but I've noticed that kids my daughter's age can put simple puzzles together while she struggles with the same piece and gives up really easily. She's very social and funny, and she makes friends easily, but mental games like matchmaking seem to go over her head. Anything that requires following directions is out the window. Honestly, she's pretty behind on most developmental exercises that do not involve talking a mile a minute.

So now I'm a bit worried that she has her father's ADHD, and while I've been very critical of the overdiagnosis of ADHD, I do know that early intervention can help a lot with kids who have attention and/or learning disorders.

We've had her hearing and sight checked already, and there are no health issues to speak of. She is a very poor sleeper, if that matters.

We're going to talk to her pediatrician shortly, but what books should I look into in the meantime? Are there any exercises to try with her, or signs to watch out for?
posted by anonymous to Education (32 answers total) 3 users marked this as a favorite
 
Not a parent, but maybe all those activities are a bit overwhelming to a three year old? What happens when she has 1:1 time with you, reading a story, or playing? Is it different from when she is in these group activities? What time of the day are these examples happening, is it right beofre a nap, or food? Maybe she is tired, or is affected similar to how grownups get in pre-lunch (distracted) or post-lunch (food coma/glazed over) meetings?
posted by kellyblah at 12:38 PM on July 7, 2011 [8 favorites]


I'm far from an expert, but it's insanely important that young kids get enough sleep. If she's a poor sleeper and not getting enough sleep, that could make a huge difference.

I'm not sure what you can do to get her to sleep better, but the lack of sleep thing that you mentioned is sending up some big red flags for me. You mention it almost as an afterthought, but I'd make sure to bring it up when you speak to the pediatrician.
posted by asnider at 12:39 PM on July 7, 2011 [6 favorites]


I'd also echo kellyblah's thoughts. That was actually my initial thought, until I saw the bit about her being a poor sleeper.
posted by asnider at 12:40 PM on July 7, 2011


I think you'll find that most folks are reluctant to diagnose ADHD in children so young, and what you are describing is absolutely not out of the realm of typical behavior for a preschooler. The kinds of activities you are describing are pretty structured, and require focus over a long time; something kids this age just don't do well.

The second issue is that you mention she's a poor sleeper. Several studies have been published in the last few years documenting how poor sleep can absolutely increase distractibility, impulsivity and other issues in children whether they have some kind of other underlying condition or not.

I would discuss your concerns with her pediatrician, or possibly seek out consultation with a developmental pediatrician who might be better versed in developmental disabilities (ADHD being one). They will be able to give you a better idea of whether further evaluation makes sense or if it would be better to observe her behavior and development for a while and see what happens. If she does end up with a diagnosis down the road, the main interventions are behavioral supports to help focus attention, organize, etc. and possibly medication.

If you have particular questions about ADHD, the website for CHADD is a good resource for balanced information.
posted by goggie at 12:41 PM on July 7, 2011 [1 favorite]


Oh, also it's very normal for kids to develop skills in different areas at different rates. It sounds like her brain has very much focused on developing her verbal and social skills. It may be that some of ther other skills like motor skills to put a puzzle together will start to come along on their own when her brain and body decide it's time.
posted by goggie at 12:44 PM on July 7, 2011


Do talk to your daughters pediatrician about this, and be specific about your concerns. Make a list of comments that have been made by others, as well as observations you make yourself. Don't let the pediatrician pass this off, insist on whatever testing, observations, intervention is available. The earlier problems (like ADD, ADHD, Autism Spectrum, Learning Disabilities) are diagnosed, the better the prognosis. Early intervention is the key to successful educational and personal outcomes. Good for you for being willing to address this NOW.

(I have two children with AS (Aspergers Syndrome) and a grandchild on the spectrum. Also, a daughter who exhibited absence seizures early on as well as AS; and a son with ADD).

Please ... pediatrician. Whatever it is ... including sleep disorders ... s/he can help you.
posted by batikrose at 12:45 PM on July 7, 2011 [2 favorites]


About half of children diagnosed with ADHD have disordered sleep. In addition, symptoms of a non-ADHD related sleep disorder can mimic ADHD symptoms, so it's really sort of hard to say if it's one or the other -- or both. Definitely go to a developmental pediatrician.
posted by elsietheeel at 12:55 PM on July 7, 2011


Probably worth talking to a professional, but on the other hand, your daughter seems to be a lot of different classes. Maybe she's tired?

Kids progress at different speeds. Both of our sons have grown up in a dual-language household, and both took a long time to actually speak. It was worrying initially, but they're both fine.

Maybe talk to a professional, but also realize that 3 years old is very very young to make kids focus on things.
posted by KokuRyu at 12:58 PM on July 7, 2011


I truly don't want to sound snarky, but what is a three year old child doing in **4** classes? You say she's behind in most development exercises except verbal ones. Please, please ... forget your husband's ADHD and do some research on normal 3-4 year development standards. Here are some: Holds a small cup in hand; feeds self with a fork; catches a large ball; puts on own socks and shoes; washes and dries hands with little help. This is normal expectation. It's a long way from "catches a large ball" to "soccer class."

She sounds like a cheerful little girl with good verbal skills, who is probably over-stimulated and needs more quiet time to develop her own rhythms and strengths. Different people -- any age people -- are more comfortable with different levels of environmental stimulation. Some kids might thrive going to 4 classes, but if she's not thriving, first try changing the environment. Good luck to you, and to her.

The part of the question that really baggles my mind is that there are people who are charging money to teach soccer and ballet to 3 year olds.
posted by kestralwing at 1:08 PM on July 7, 2011 [34 favorites]


That does seem like a lot of classes, maybe she's just overwhelmed, along with the poor sleep habits. I don't know if I could keep my attention up in that many classes on broken sleep. Maybe drop a class or 2 and let her be 3 for a while, she's got a full time jobs as it is learning to be a kid, learning ballet or soccer can wait a year or 2.
posted by wwax at 1:10 PM on July 7, 2011


I'm coming at this as a parent who has one child with severe ADHD and one child who does not. What you're describing here is exactly what we went through with the child with ADHD at the same age as your daughter. Does that mean your daughter also has ADHD? Not necessarily. You say she's a poor sleeper. Children who don't get the sleep they need often can't focus during the day and present with learning difficulties. If I were you, I'd investigate the sleep thing first. Is her room dark in the morning? Does she have a fan for white noise? Do you have a consistent bedtime routine? How many hours of sleep per night is she getting? Depending on her level of three-ness, she should be getting 12-14 or 10-12 hours per day (including naps if she's still taking one). If she's getting significantly fewer than 10, I wouldn't be surprised if its manifesting as behavior/focus problems.

If her sleep issues are addressed and her behavior/focus problems abate, great. If not, then you can continue on to investigating other issues. Do not, for heaven's sake, go to a pediatrician or psychologist and tell them you want your daughter evaluated for ADHD. Present her issues and ask them what your next step should be. The next step ought to be an evaluation for developmental delays/learning disabilities. A specialist should never, ever start out looking to prove the child "has something."

And yes, four classes sounds a bit much for one kid. Unless each class has its own day? Still, seems a bit...scattered.
posted by cooker girl at 1:13 PM on July 7, 2011 [1 favorite]


Maybe she doesn't like soccer.
posted by rhizome at 1:14 PM on July 7, 2011 [1 favorite]


Oh, one more thing: specialists are (and should be) reluctant to diagnose a child as young as yours. You really shouldn't be directed to see someone until she's 5 or 6.
posted by cooker girl at 1:15 PM on July 7, 2011


Mod note: comment removed - if you can not be respectful in parenting threads you very seriously need to stay out of them, thank you.
posted by jessamyn (staff) at 1:17 PM on July 7, 2011 [1 favorite]


She's 3. I think those classes are too directed for a 3 year old. My kids are both as ADD as I am, but I wouldn't subjected them to this much instruction and direction at 3. The dance class can wait til she's older, as can soccer. Let her run around and use big muscles.
Learning to not interrupt is important (I swear I'm working on it), but still--she's 3.
ADHD and ADD are genetically linked. But I think that there's no point in pursing any treatment or even a diagnosis until she's older. You're not going to medicate a 3 year old, and she's not going to be educationally disadvantaged by not learning how to play soccer at 3. Early intervention can be helpful, but what form of intervention are you thinking about?

If she doesn't like puzzles, does she like to draw or color or pretend? I think having good social skills and making friends is very important, and if that's her strength--run with it.
posted by Ideefixe at 1:22 PM on July 7, 2011 [1 favorite]


Oh and, if she's a poor sleeper, she might need to get more physically tired out--big muscles need to get used, not the "sitting down and paying attention" ones.
posted by Ideefixe at 1:24 PM on July 7, 2011 [1 favorite]


Criticism of the OP's structured time for the kid isn't warranted here. Soccer and ballet aren't "classes" to a three year old as you and I think of them. They're activities, just like the free time. My child is in preschool all day for three days a week and she's younger than the child in question, and I don't think four weekly activities can be called "too much structure" by any reach.

The suggestion to look into early intervention is a good one, but the kid will be too old for EI in most jurisdictions. It's a good rule that if you suspect something, call in an expert to look into it.

Your pediatrician's your best resource, but there's a tendency to judge your child's development by his/her peers and that's mental poison for parents. I know because I do it, and I know that's it wrong. I don't think that you can know if there's an issue yet. Some kids develop things like attention span or mental refinement later than others, and that's still going on at three. I suspect your pediatrician will tell you that you have to wait to see if this is something that needs addressing, but it's best to ask. If it's ADHD, you're probably going to end up working with an OT to help your daughter maximize her ability to focus and to develop some coping strategies early.

It's probably nothing, but you're on top of it and she's very young so no matter the outcome, she'll be fine. It's hard to give meaningful reassurance when you're worried about your kid (speaking as the father of a girl who didn't walk until she was two and heard plenty of reassurances), but she will be fine either through natural or assisted development. She's lucky to have a parent who thinks that she sees something and reacts instead of denying.
posted by Mayor Curley at 1:31 PM on July 7, 2011 [3 favorites]


I'm just a bit frustrated reading all these answers suggesting that the questioner has unreasonable standards, is expecting too much for the age, or is unfamiliar with typical child development trends. The question mentioned the teachers' comments, and the mother is comparing her behavior to that of other children who are the same age or younger. "Honestly, she's pretty behind on most developmental exercises that do not involve talking a mile a minute."

Yes, as Mayor Curley notes, being behind peers does not definitively mean there's a problem, but it's still a meaningful flag.

My first suggestion would be to take this question, add any other specific details that you think might even possibly be relevant, and bring a printout it to the pediatrician so that you don't forget to mention anything. I'd also suggest that you try to remember and document any information about her developmental path. For some skills, being behind peers isn't a problem, but being behind and not improving could be. (My 3 year old was, and to some extent still is, behind in language development. When we first noticed that, we started trying to note any progress he made and realized that he was on a decent path, just lagging a bit.) It's sometimes easier to compare two children as they stand next to each other than to compare your child today to your child 3 or 6 months ago.

And what Mayor Curley said: "She's lucky to have a parent who thinks that she sees something and reacts instead of denying." Absolutely.
posted by Mr.Know-it-some at 1:42 PM on July 7, 2011 [2 favorites]


The guidelines from, for example, the American Academy of Pediatrics don't have doctors diagnosing ADHD of any type until age 6 or so as it's quite difficult to get a reliable diagnosis before that age.

That said, I think you should still talk to her pediatrician so that your family and her doctor can keep an eye on her over the next 3-ish years.
posted by asciident at 2:02 PM on July 7, 2011


Thankfully I didn't grow up in today's world and was able to stay out of school until I was 5. School was not even too much fun at 5 - I think I would have had to have extra-human patience to tolerate it at 3. My life's focus before kindergarten was playing in the neighborhood, having fun and not being graded or pigeon-holed.

I would think if you start making her think something is wrong with her, she will start to believe it. Just relax, she is 3 years old.
posted by JJ86 at 2:06 PM on July 7, 2011 [3 favorites]


The classes you listed seem like they might be park-district-style classes, yes? I would find a couple of preschools in your area where the staff have early childhood education degrees. Ask if your daughter can attend for some mutually-agreed upon period (a week?). Then get feedback from people who are trained and educated to recognize the signs of ADHD/ADD in the very young. (You may or may not want to explain the whole situation to them first.) Observing your child over some length of time, through various types of activities (solo play, group work, quiet time, etc.) will give them a much better picture than the teachers of one-off classes focused on a particular kind of activity.

This probably isn't helpful at all, but my sister-in-law could have written this question 13 years ago. My niece was EXACTLY like that at 3. FWIW, now (at 16) she is a beautiful, athletic, social butterfly who excels academically, has a large circle of nice friends and currently is extremely focused on her summer pharmacy internship. She never did get a diagnosis of anything except for being a chatterbox.
posted by SuperSquirrel at 2:25 PM on July 7, 2011


Darn it, I meant to say that, obviously, staff at a preschool can't diagnose your kid one way or the other, but someone who has seen lots of kids in lots of situations might be able to give you a more rounded picture of how your daughter behaves compared to other children, that you can then take to your doctor in an effort to provide as complete a picture as possible.
posted by SuperSquirrel at 2:28 PM on July 7, 2011


I think a ballet teacher that puts a kid in a time out for not following directions is too structured for a 3 year old. YMMV. My kids are in college, and have taken meds on and off for most of their academic careers. But structure too soon is an effective way to kill enthusiasm in my opinion. Teachers and child care workers are very alert to signs of attention problems, but seem to lack the old-fashioned strategies for coping with kids who aren't on the time-table.
posted by Ideefixe at 2:57 PM on July 7, 2011 [2 favorites]


IANAP. But as far as the "hopping on one leg" thing goes, I almost flunked kindergarten because I could NOT skip. Reading on a 4th grade level? Yes. Skipping? FAIL.

Happy to report that I can skip now, though I might break a hip.
posted by cyndigo at 3:06 PM on July 7, 2011


She's 3! When in her structured little world does she have time to just be a 3 year old? She has more going on now than I did in High School and I was exhausted then!

None of the things you are pointing out seem bothersome to me. I have kids with ADHD and grew up with a younger brother with it. Really, I think the problem your daughter has is over stimulation. It might be normal where you are, but around here kids don't start ballet until at least 4 and even then not unless their parents are super serious about them taking dance. Kids in our area don't start sports until they start school (there aren't even teams available for younger kids). And three year old kids have maybe 2-4 playdates a week with other activities scattered around.

My three year old spends most of his time tormenting the dog, coloring pictures, playing with toys, going to the playground, and playing in the back yard. He hardly ever stays in one spot for more than 5 minutes and if things get quiet then I know there's trouble. He does show some of the symptoms my older kids did of ADHD, but it isn't bothering anybody (except me and the poor dog) so we won't worry until he starts school. Then we'll keep a close eye on things and make sure his teacher is aware that there is a family history.
posted by TooFewShoes at 3:28 PM on July 7, 2011


As others have suggested, a developmental pediatrician if you can find one would be great. I manage an Early Intervention program and you cannot believe the huge red flags regular pediatricians regularly miss. Most of them are not well trained in developmental milestones. Your regular pediatrician should be able to work on the sleeping with you, and as others have also suggested, I would check that out first.

You can always go to your local school district and put in writing a request for evaluation based on your concerns, although they are largely shut down over the summer months. They are required to get you an assessment plan in 15 days. The assessments are completely free, as would be any district based services. These assessments are done by professionals who are trained in child development and know what to look for. Also they will not give you a diagnosis, but rather let you know her levels of functioning and if she would qualify for district based services. If for nothing else it may give you some peace of mind about your child’s development.

Here in California the Department of Developmental Services puts together a great little booklet about Reasons for Concern. For what it’s worth, they don’t list standing on one foot as a concern until 4. It is a nice little reference as are the materials the CDC puts together, here are the 3 year old milestones. These can help you put into words what your exact concerns are when you go to your doctor and to the school district.

Best of luck with your little one!
posted by Palmcorder Yajna at 3:53 PM on July 7, 2011


Trust your gut. You know when something isn't right. Take your concerns to a developmental pediatrician. She's not in too many classes. I know the kind of classes you're talking about and there's nothing wrong with a kid having a fun activity for an hour at a time, a few days a week .. soccer, art, ballet. It gets both of you out of the house and the socializing is good for everyone. I seriously doubt that she's overscheduled or overstimulated. Classes for 3 year olds are just organized playtime.

I also know what it's like to have that awful feeling that your kid is out of step with his/her peers. You're the parent and she needs you to look out for her. Get her checked out. Mefi-mail me if you want. I understand.
posted by Kangaroo at 6:37 PM on July 7, 2011 [1 favorite]


We have a pretty active kid. My wife fears for him having ADHD because she did. I probably fit somewhere on the spectrum but didn't ever get tested because I was also ahead of most of my classmates in math, reading, spatial relations, and some coordination. But yeah, he's a handful and we expected him to be one.

We do soccer Saturday mornings. Some days he listens well, others he doesn't. He's 3. What we found that helped us was giving him reason to listen to us. We found that simplifying our discipline techniques helped him. We found sticker charts. We found increasing his involvement in things while minimizing distracting information helped him a ton. We found a lot of these things in 123 Magic. The whole thing isn't just discipline. A lot of it is learning about your child and figuring out how to motivate them in a positive way.
posted by Nanukthedog at 6:52 PM on July 7, 2011


She's 3. She doesn't need all those classes. Let her run about in the sunshine with a stick.
posted by joannemullen at 8:14 PM on July 7, 2011 [3 favorites]


There is a rare (1 in 7500 to 1 in 20,000, meaning she probably doesn't have it) genetically-determined problem, Williams syndrome, which makes people warm and charming, very social, very verbal, and typically quite interested in music.

They also tend to be left-handed, have "elfin" features, tend to blurt irrepressibly, can have spatial reasoning deficits that might make soccer and jigsaw puzzles incomprehensible and cause difficulties in visual processing, lack fear of strangers, lack intrinsic racism, and have sleep difficulties at a rate of 97%.

I mention such a remote possibility only because WS people can also have heart problems and other issues that can benefit from early intervention.
posted by jamjam at 8:15 PM on July 7, 2011


I too would argue that she is involved in too many structured activities. This might be good for a kid who is advanced WRT focus and attention, but not so good for someone who isn't. This is the time that kids are just learning what paying attention is, and to over-challenge that seems like it might be stressful. Heck, even kindergarten is structured with lots of short tasks and intervals so as not to tax the short attention span of kids.

Maybe the number of classes and activities isn't wrong, but the structure of them might be. Most of the effort should be on stimulating/exciting the kids for what is about to happen, maintaining that for an age-appropriate amount of time, and then giving the kids a challenge to focus on and be able to complete.

In other words, soccer isn't that. Or at least anything closely approximating soccer, where you shove 22 kids onto two acres of land with only one ball, where only the most athletic 5 or 6 of them ever get anything to do.

Learning focus is about anticipation and reward. I have a thing to do, I want to do it, and when I complete it I feel good because I completed it. These are things like:

-coloring books (filled in all the lines = yay, stick it on the fridge, mom!)
-baking cookies (idea of yummy cookies + some work + some waiting = yummy cookies)
-sporting drills, like the classic standing in two lines and waiting ones turn, and then a kid from each line gets their turn to pass the ball back and forth between each other around the field
-even watching (proper) children's tv shows. The good ones follow this routine, and have a plot that gives a sense of completion at the end.

So anyway, the idea is to get the kids used to this routine. (Not for nothing, it is the classic plot structure) Once they get used to the routine of start-do-finish, you start to add in some complexities. Add in some waiting, some clean up time, some adversity, all the while allowing them to still have success. Eventually, you build in some of the more challenging lessons like "it's not whether you win or lose, but how you play the game" or "math is hard, but getting an A on the report card is good". Because they have practiced and succeeded at the skill of maintaining focus, they will have the tools to focus on things that they may not want to do.

One issue that a lot of people with ADHD have is "stickiness", or not wanting to be pulled away from what they are doing (procrastinating) onto what they should be doing. If your daughter exhibits this behavior, I would also suspect some ADHD tendencies. This would be an indication to double down on teaching coping mechanisms. Which there are two of: learning how to anticipate time, and learning to put aside something for later.

(As an aside: I hated growing up, and a good third of that was the fact that mom called us in for dinner in the middle of a TV show. My god, that almost physically hurt to do. It is the anticipate-do-reward mechanism getting short circuited.)

The trick for that is to manage expectations. In the beginning, don't let them start something they won't be able to finish. If dinner will be ready at 6:15, tell them at 5:30 that this show is the last one, and they will have to turn off the TV at 6 and go wash up. Then remind them of that during the commercial breaks. When the show is done, turn off the TV and have them go wash up. Add in some filler activities if necessary- help mommy set the table, etc. As they get older, you can start letting them make some of their own mistakes, so they start developing the executive function necessary to manage their own expectations. This leads them to learning how to not start what they can't finish on time, and to learning how to schedule.

The point is: everyone needs these skills. I don't know if it is possible to train a kid out of having ADHD, but my guess is that there are some edge cases where environment and training can mean the difference between a kid who will need to be medicated or not, or when the medication is needed. Regardless, the more successful you are with "focus training", the better the kid will be able to cope with future challenges. Good luck!
posted by gjc at 4:35 AM on July 8, 2011


Get the kid screened immediately. Print out your original post, take it and the kid to a professional who can do a few simple tests. The yardstick is other kids, not the hive mind. But the only significance of other kids is that they signal that looking into thevservices offered by EI or a competent pediatrician is worthwhile.
posted by Mr. Justice at 7:51 AM on July 8, 2011


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