What early childhood conditions should I read up on?
August 20, 2013 10:52 AM   Subscribe

Our four-year-old is hell-on-wheels. We have an appointment this week with his pediatrician to discuss his behavior. What do I want to read up on before this chat?

He's four and a half. He's previously seen an occupational therapist. That didn't seem to provide much benefit (though we did a very poor job of involving the interventions into our daily routine).

He's not potty trained. He has very poor emotional regulation. Reading the diagnostic criteria for ADD, those seem to describe him quite well.

What else should we read up on? Autism spectrum stuff? If so, are there particularly good web resources? What else?

We'd like to sit down to discuss this with the pediatrician as well-prepared as possible.

posted by colin_l to Human Relations (19 answers total) 1 user marked this as a favorite
Issues with sleep?
posted by HMSSM at 10:58 AM on August 20, 2013

It might be worth looking into sensory processing disorders, specifically sensory craving/seeking, which can often be confused with ADHD.
posted by logic vs love at 11:06 AM on August 20, 2013

Did the OT not provide a diagnosis of some kind? I had to get a diagnosis before my kid could get OT.

"Hell on wheels" is really vague. He doesn't listen? He has outbursts? He struggles to learn things? He zones out and does repetitive things (some autistic kids do this; opening/closing boxes, spinning wheels)? Does he have speech issues? Trouble manipulating small things? Etc.

But really, none of us are your kid's doctor, and a competent doctor will know what to ask you. You don't have to study before hand. It might be better if you didn't, so that you didn't go in with preconceived answers in mind. Don't assume ADD, autism or anything else. Just try to be as clear and detailed about your kid as you can.
posted by emjaybee at 11:08 AM on August 20, 2013 [6 favorites]

Best answer: I agree with emjaybee: probably better not to make guesses, or worry about something that may be ruled out by the doctor right away. If the pediatrician's office didn't give you some kind of checklist or paperwork to fill out before the appointment, though, you might want to make a list of your concerns. Might be good to ask your son's teacher if he has one, OT, grandparents, etc. what concerns they have and write those down so you remember to mention them.

Sounds like at least two parents/caregivers will be talking with the doctor? That's good. One of you may think of something to ask or say that the other doesn't.
posted by homelystar at 11:26 AM on August 20, 2013 [2 favorites]

Has he ever been lead tested?

Also, frankly, regardless of what his final diagnosis is, it sounds from your description like getting him in a therapeutic preschool (perhaps one that uses ABA and has OT therapists on-site) would be helpful in helping him (and your family). At this age (too young for medication for attention issues) early intervention and therapeutic services are going to be the key to getting him on track - so, the question is not "what does he have" but more of a "how can we evaluate what his needs are and help him get the help he needs".
posted by anastasiav at 11:31 AM on August 20, 2013 [3 favorites]

Best answer: Write a list of concerns - detail the behavior, when it happens, when it doesn't happen, when it started, and how you typically respond when it does happen. Describe the home environment, interaction with other parents, teachers and children, and/or siblings.

Ask for referrals and tests - psychological and physical testing (hearing, sight....)

I would read up on early childhood development up to age 4 or 5, so I know what kind of "milestones" the doctor may be looking for. But at present I wouldn't try to self-diagnose.

Listen to the doctor AND trust your parental intuition.
posted by St. Peepsburg at 11:32 AM on August 20, 2013 [6 favorites]

You might want to check out The Out of Sync Child and see if you recognize your kid in any of the behaviors they describe.
posted by 41swans at 11:41 AM on August 20, 2013

Best answer: Please stop reading because you'll find bits of your kid in everything. It's really unlikely your kid has everything.

High school sped teacher here and seconding St. Peepsburg's advice. Do not try to diagnose your kid at this point. Seriously, this could be food allergies or autism or oppositional defiant disorder, inconsistent parenting, attachment disorder or I have no idea.

Definitely trust your instinct that something's off, but this could be almost anything. I strongly advise against reading about ADD, Sensory Integration Disorder, Autism, ODD, etc. You'll find bits and pieces everywhere and the truth is this: the diagnosis doesn't matter; what matters are the behaviors and ways to help your kid.

You want to detail as much as possible what happens and when it happens. Note sleep patterns, napping, diet, exercise...everything.

What you want from the pediatrician (assuming this isn't anything physical like an allergy or a stomach/bowel problem, etc.) is a referral to a child psychologist who can do testing so you can get an accurate assessment of what's going on and ways to help.
posted by kinetic at 11:47 AM on August 20, 2013 [10 favorites]

Some kids who are "hell on wheels" are suffering (something I call) "Bored Gifted Kid Syndrome." This is often accompanied by comorbidities, like ADD, ASD, OCD, Etc. All of these are associated with sleep issues.

If giftedness is part of the problem, that needs to be factored in or "treatment" will tend to make for more problems. Also, 2xE kids (twice exceptional -- ie gifted and "special" in the not good way) are hard to pin down because their strengths mask their weaknesses and vice versa.

A couple of resources not yet mentioned:

The book "Different Minds."
The website http://giftedhomeschoolers.org/resources/twice-exceptional/
posted by Michele in California at 11:51 AM on August 20, 2013 [1 favorite]

Best answer: Speaking as someone who does assessment and diagnosis in kids, I don't know that you absolutely need to read anything before the appointment. I've found that in a lot of cases it ends up clouding the information you present to make it "fit" into a diagnosis you think might be appropriate and you might inadvertantly leave out information that it would be important for your provider to have.

What is really, really helpful is to just put together your thoughts about your kiddo and your concerns before the visit. You are the expert about him and what his particular strengths and weaknesses are and you are going to be the main source of information for that person to make the appropriate recommendations.

Some things to think about: What are your main concerns about him? When did you first notice those concerns? How often do they happen and how severe are they when they do? What have you or others done already to try to address them? How has that worked or not worked for him and for your family? Also, try to have at least the basics about his early development in mind. How was the pregnancy with him? Any concerns/complications? Anything about his medical history that stands out (injuries, illnesses, seizures, headaches, sleep, appetite?). How was his early development? Any problems with things like learning to speak, learning to walk?

If you have that information, the person you're meeting with will have an open field to really think about all of the diagnostic possibilities and will know what follow up questions to ask and what additional assessment you might need to get.

I'd be happy to answer any other questions, feel free to meMail.
posted by goggie at 12:13 PM on August 20, 2013 [14 favorites]

Please listen to the responses above and don't try to pre-diagnose your child. Every child (and I do mean every child) checks off some boxes for some disorders some of the time.

You're doing the right thing by consulting a pediatrician, and you're better off not trying to "figure things out" in advance. Please be firm about your concerns - you think there's something wrong, and you should have your concern taken seriously. Get a second opinion if you need to. But please do not push a diagnosis on them.

(As an aside, I'm not sure why you've seen an OT. Was this a referral from a pediatrician in the past?)
posted by RedOrGreen at 2:01 PM on August 20, 2013

I agree with the others that you shouldn't read up ahead of time, and I say this as someone whose child was exactly as you describe at that age (although OT has been great for us). Instead spend your time writing down a history of your son, so you're not on the spot when you get into the office. Things like when he first spoke, when he first walked, how his sleeping patterns are, if he can read or not, how he interacts with peers. Maybe look through your old e-mails to your friends or extended family to see if there are comments you wrote when he was a toddler that seem relevant now.

It's unnerving, how well they expect you to remember your child's life.
posted by The corpse in the library at 3:26 PM on August 20, 2013

Best answer: > Autism spectrum stuff? If so, are there particularly good web resources?

No, in my experience, not general ones. Sorry. But I stumbled across this glossary, which might be a good prompt for some of the questions I think you should be asking yourself now.
posted by The corpse in the library at 3:28 PM on August 20, 2013

How much experience does he have with other adults?

I know a kid who is a holy terror to his mother, slightly less with his father, and is an absolute angel in preschool. There is nothing wrong with him. Just that he feels like he has different boundaries with different caregivers.

Yeah, don't try to pre diagnose. If you judged a normal 2 year old by adult, DSM-IV standards, they would have nearly every disorder in the book. Some kids are just a little slower with developmental milestones.

Don't worry about a diagnosis, just try to get advice on how to deal with the behavior/reactions. That's the goal- to figure out what works for the kid so he can be happier.
posted by gjc at 4:53 PM on August 20, 2013

I'll nth gic... I've seen this as a nanny. They'll be great for me, and a nightmare for the parents, like flicking a lightswitch. It's astonishing. Not saying a diagnosis won't be involved, but either way, be prepared to change the way YOU do things and interact with your kid. Be open and follow through. My mom is an ABA therapist...memail me if you have questions. Good luck!
posted by jrobin276 at 5:40 PM on August 20, 2013

Best answer: If you haven't integrated the therapist's recommendations, think about how and why they were difficult for you. Knowing what you can and can't do, off the bat, might help your kid's doctor in figuring out what other types of intervention might be more effective.
posted by spunweb at 5:53 PM on August 20, 2013

Oh and in case this wasn't clear: I'm not dogging you for not incorporating the therapist's suggestions. But if the difficulty was something like, we couldn't put him to bed early because he screams when he's in the dark or flips his shit about the blanket being too tight or he has insomnia or whatever, that info could be helpful to your doctor.
posted by spunweb at 6:13 PM on August 20, 2013

Response by poster: Thanks, all, for the excellent suggestions. Making a list of behaviors etc pre appointment will be a big help.
posted by colin_l at 7:21 PM on August 20, 2013

Chiming in to say that you also may want to mention those little things that are quirky about him that you've noticed other kids will do but your kid doesn't. For instance, he screams when you put him in socks, he can't seem to do a very basic puzzle, he is very scared of loud noises like vacuums, he refuses to draw or color, won't join other kids on the play structure...stuff like that. I don't know how much your pediatrician knows but all of these details give clues about what's going on.
posted by biscuits at 11:21 PM on August 20, 2013

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