Should my daughter be evaluated for ADHD?
February 16, 2017 12:19 PM   Subscribe

My daughter is six years old. She's in grade 1. Over the past month or so, I've started to wonder if I should consider having her screened for ADHD.

Here are some of the things that concern me, in no particular order:

- The neighbor even noted it the other night as we were having dinner with them - she can't sit still. This goes for eating at the table and sitting at the piano. She's always wiggling and changing positions and making excuses to get up and do something or get something (although she can sit still on the couch while watching tv, for what it's worth).

- Unless it's macaroni and cheese (which she loves) it takes her at least half an hour and sometimes an hour to eat a meal. You have to hound her, repeatedly, to take bites. It's not because she doesn't like the food, or that it's a power struggle. I just don't know what it is. We have given up on eating meals together at the table; it's just too stressful trying to get her to speed things up.

- She seems to have poor focus. She takes piano lessons. When we're practicing piano, with much pleading I can get her to play a song she's learning, but as soon as she's done it's like she completely forgets what she's just learned, she fools around for a few minutes so it doesn't gel in her head.

- She is very inconsistent - sometimes with reading and piano she does just fine and other times she makes very simple errors that she's never made before.

- She gets very upset and gives up on things that she finds hard.

- She resists sounding out words (as she's learning to read). She looks at the first letter and blurts out a word that starts with that letter.

- I got quite made at her for being impatient/rude with me the other night and she started to cry and said she couldn't help it - she said "I feel like I just want it NOW".

- As with eating, she's extremely slow getting out the door. It doesn't matter how much I try to explain that we are running late and we need to go, she will dawdle throughout the whole process and will stop after one step (boots are on, let's say) and not continue until I remind her - "Ok, now put on your coat." And sometimes I need to ask several time before she does it.

There's more, but I am finding it really hard describing these behaviors correctly. Before recently, I never would have considered this, but it's like all of a sudden I am noticing things like poor behavior and very short attention span in piano class...I'm afraid her reading level is a bit below average. And I think these things are getting worse. And I have a nephew with very severe ADHD who is very delayed because before he started taking medication, he was simply unable to process and learn language. I don't want learning to be difficult for her. That's what I'm worried about the most.

I am going to speak to her teacher about it and see whether the teacher thinks she needs an evaluation, but I would like to hear what you think, what I should watch for, etc.
posted by kitcat to Health & Fitness (21 answers total) 1 user marked this as a favorite
*I am not a child therapist (although I am married to one) . But I do have two kids, one about this age.

She sounds 6.

Literally everything you've described, if this was a "guess this kids age" puzzle, I'd have guessed 6. Literally all the things.

I would adjust expectations about this and don't give up on things like family dinner, don't do things for her when shes getting out the door, just schedule enough time.
posted by French Fry at 12:31 PM on February 16, 2017 [21 favorites]

I mean, some of this stuff sounds like normal 6-year old behavior. But what's the harm in getting her screened? Might as well, and if she doesn't receive a diagnosis, maybe the practitioner will be able to point you to some useful resources otherwise.
posted by greta simone at 12:32 PM on February 16, 2017 [2 favorites]

She's six! It's crazy to me that anyone would diagnose a literal child with ADHD.

At least until they reach the part of their life where they start to have actual responsibilities (maybe middle school, high school). (And I'm a big believer in the diagnosis + medication of it, as an adult).
posted by so fucking future at 12:32 PM on February 16, 2017 [4 favorites]

I'm a special ed teacher and I've seen kids do 180 turnarounds when medication works. Having said that, she sounds like a typical six year old. I would NOT advocate you consider medication at this age.

Now -- I'm going to give you a sideways answer to a question you didn't ask. I apologize if you think I'm prying and a being a jerk.

You've asked a few questions that all point to your own anxiety about your perfectly-normal child and your own child-rearing abilities. I hope that you are really careful about not passing along that anxiety about her behavior and development. It's one thing to be concerned about our kids, but I detect a bit of a running theme that your daughter isn't performing to your own expectations.

When thinking about her, it may help to take a step back and ask yourself if your concern is possibly your anxiety that you're projecting on to her. Maybe try to let go of what you think she should be doing and embrace who she is and what she does. She sounds like a really unique and cool little kid.
posted by yes I said yes I will Yes at 12:45 PM on February 16, 2017 [35 favorites]

Some of it sounds like six, but I always say err on the side of caution and trust your parental instincts; if you think something is off, better to have an evaluation.

It sounds like her hearing is okay, but you might have it checked. If she's having trouble reading music and reading books, you might have her vision checked.

If she's having trouble eating, you might consider whether she has some sensory issues. Sometimes kids with sensory issues have trouble with food because of the different textures.

Finally, do an ADHD evaluation if you'd like. But I ask you this - are you willing to medicate her? Do some reading on the subject. But be aware, when you buy the diagnosis you buy the cure - so if you're not willing to medicate you're going to have to be prepared to push back with her doctor, and to find some alternative coping strategies.
posted by vignettist at 12:47 PM on February 16, 2017 [3 favorites]

One question to ask yourself is, what would you do if she DID have ADHD? Give her drugs? Surely not. Ask for curriculum mods in the first grade? Seems extreme until a teacher notifies you she's having trouble in class. Be more patient with her behavior? You don't need a diagnosis for that. This is not the kind of problem that, if not caught at age six, will only get worse. Wait until there's a real problem before you get her assessed.
posted by ubiquity at 12:48 PM on February 16, 2017 [2 favorites]

This can also be related to anxiety or sleep deprivation.

I'd ask her old daycare teachers what they think and whether they noticed anything. If not, I'd consider that her current educational situation isn't working for her. If she's being asked to sit all day, for example, she might come home with the wiggles and have a hard time concentrating on one more sitting-still lesson. That would be pretty normal 6-year-old stuff.

You might also consider switching out piano for something active, like swimming. Some kids have more physical energy, and that can be a gift for them if they're allowed to use it.
posted by Rock 'em Sock 'em at 12:50 PM on February 16, 2017 [3 favorites]

Off-topic, but eating a meal slowly is actually a healthy habit, as maddening as you might find it. Eating at the table together could still be a good thing, just let her do it at her pace and y'all can leave when you're done and she can finish up on her own?

This all sounds pretty normal to me too. Nthing more exercise of some kind or more sleep.

Another idea: if you know it takes her forever to do X, is there any way you can adjust your planning around that? Why stress out about something when you can just take more time for it? It takes me forever to get ready in the morning even as an adult and no amount of someone else stressing about it or trying to help actually *helps* or makes it move faster. I just need more time. Maybe she does too.
posted by purple_bird at 1:18 PM on February 16, 2017 [5 favorites]

Awww, that sounds tough regardless of whether she is diagnosed with adhd or not. My kids are hard to parent in similar ways and I sympathize. I have a middle schooler with attention issues. I spent years - since the he was 8 - wondering whether he had adhd. Unlike your situation, he was an early reader (they vary so much within normal for reading as everything else!) so that further masked issues ("he's doing fine! of course he doesn't have adhd!"). That's so you know where I'm coming from - a parent with attention-issue children. I just have a couple points:

- Unless your neighbor has kids or works with kids, they have no idea what is standard sitting behavior for a six year old. (My 14 and 11 year old have trouble sitting through long dinners. So do I sometimes.)
- If you think she has some type of attention issues or learning issues then she probably does ... to some extent and in her unique way, diagnosed or not.
- So, regardless of whether you assess now or later or never, think about and research what you can do to help her with the attention she has. I found the "Smart but Scattered" (for 4 - 13 year olds) workbook to be immensely useful for my situation. There may be other books that are helpful to you - regardless of whether there is an adhd diagnosis. Looking on amazon at "Smart but Scattered" leads to other titles. Even if you are really busy, "Smart but Scattered" can be used in modular fashion so you can choose to look at the tools and checklists for time management or organization or emotional control or whatever is most pressing.
- So, regardless of what you do, consider talking to the teachers she has: I think she has some attention issues that may be interfering with her reading (piano, etc), what can we do? what can I do at home? (I'm sorry I didn't say early on to private lesson music teachers or coaches - hey, he may not look like he is paying attention but he is trying and interested or he wouldn't be here so please give him the benefit of the doubt and maybe try x,y,z to grab his attention when he appears to have drifted off.)
- (Depending on your school, the teacher may almost have to say that she/he does not or is not qualified to see those issues in the children as that is the province of special ed. It can cost the school a lot to screen and then to support children with extra needs. Schools can be notoriously bad at helping you with dealing with these issues. You are your child's best advocate.)

Good luck!
posted by RoadScholar at 1:22 PM on February 16, 2017 [2 favorites]

- She gets very upset and gives up on things that she finds hard.

This is incredibly common in bright kids.

Also, ADHD is a diagnosis of elimination. After you rule out all other possible explanations, they call it ADHD. You should not start there and look to confirm the assumption.

I suggest you join a gifted parents list. You may find a jillion pertinent resources that help with various pieces of it until you no longer think she needs a diagnosis.

posted by Michele in California at 1:24 PM on February 16, 2017 [5 favorites]

She also sounds six to me. Has anyone besides the neighbor mentioned anything to you? School teachers? Piano teacher? Screening can give you some understanding and peace of mine, so I think it would be totally reasonable to have her screened. That being said, do consider what you will do with the information you may receive back and what choices you may need to make.

I think there are some other things you can work on in the meantime. Mainly, altering your expectations on the time it will take to accomplish tasks. Set her up to succeed, and set you up to have less frustration. Those tasks may still be incredibly slow, but if you aren't stressed about time everyone will be happier. 30 minutes for dinner isn't much, expecting less than that for a six year old to eat dinner is something you should reconsider. 1 hour, ok, that can make the end of the day difficult, especially when most of that is not actually eating. (i'm right there with you trying to get my kid through dinner!) You should be expecting things to take the time it takes and plan your time accordingly. Also, you can end dinnertime when it is too late, even if she didn't finish.

Things that stand out to me: six years old and in Grade one, learning to read!, learning piano! This is her first BIG year in serious school! She is learning a lot (even if she is reluctant to show you) and spending her day working all these new processes into her brain and life. There are higher expectations of her at school, and if you haven't had any feedback from her teachers she is meeting those expectations! Her home time is decompression time, and she needs it to really fully absorb all the info she is processing in the day. Sometimes with big leaps in learning comes a few steps back with behavior. Just like when babies start crawling and then have a sleep regression. Big kids have the same thing!
posted by Swisstine at 1:27 PM on February 16, 2017 [2 favorites]

Re: eating-- 30 minutes to an hour to eat seems healthy to me. I've read it's recommended to not take less than 20 minutes to eat a meal. Eating too fast can disrupt digestion- I think people, especially Americans, are just used to the unhealthy habit of eating too fast.

As for the other stuff, it sounds well within the range of normal to me (admittedly I'm not around 6 year-olds a ton but I have taught preschool and kindergarten, and I remember being 6 pretty well).
posted by bearette at 1:32 PM on February 16, 2017

So I don't have a ton to add other than having had two kids, this basically sounds like par for the course for that age. Is it bad to get your kid evaluated? Not at all. Just don't be disappointed if they tell you there's nothing to do about frustrating behaviours.

That said, there is a bias towards finding problems with doctors sometimes. Some doctors think that if you want a prescription that you should have a prescription and will give you one just to "make you happy". So there can be a risk of a false positive diagnosis. Medical screenings are not always a net positive.

Personally my opinion is that unless there are really severe symptoms - complete inability to read, etc - that you should probably wait until grade 2 or 3. There's a really wide variation among kids in grade one that decreases quickly as they get older. Like you mention it is good to try to catch problems early, but sometimes you kid is just a little behind the curve and will catch up given a little time.
posted by GuyZero at 1:33 PM on February 16, 2017

I distinctly remember being six - my mom remarried around that time, I was living with my grandparents, I loved being in school.

That said, many of your complaints could have been my teachers' remarks in my report card. I was fidgety (my mom would wonder aloud quite frequently if I had "ants in my pants"), when it came to eating and getting dressed and generally anything boring and mundane I would "dilly-dally" (again, my mom's exquisite British vocabulary had quite the impact in my memory), I would give up very easily if something didn't work/ come to me quickly (I was labeled impatient), I was inconsistent (top of the class one term, second or third the next), I would rush through my homework and make mistakes (I was labeled careless and my mistakes were "stupid".) All my report cards would end something like, "Everydayville is very bright, and she would be a phenomenal student if she would only apply herself and not be lazy."

Well, guess what. I went to high school in the UK, and college in the US. I tested out of my freshman semesters of biology, chemistry and physics. I have a doctorate in biochemistry, a great job, and a beautiful family.

I understand your concern as a mother (I'm Asian and thus your typical Asian tiger mom who watches her son's development with an eagle-eye, and he's only one!), but I truly think your daughter will be fine.

Unless her teachers are bringing up these characteristics with you as concerns regarding her performance in school, or you visibly see a deterioration in her behavior, I would be patient and let it go. Please, please, as someone said upthread... take care to not transfer this anxiety on to her. She is so impressionable, and needs your confidence and support. There are times, looking back, when I wish my mother hadn't been quite so additively critical given my teachers' remarks, and had instead bolstered my confidence while gently helping me to be less [insert complaint here]. Even if she didn't come out and say so to me, I picked up on her criticism pretty easily.
posted by Everydayville at 1:55 PM on February 16, 2017 [2 favorites]

Yes, have her evaluated. A professional may be able to give you specific techniques and strategies not involving medication that can help her control herself, for example, there are certain kinds of rubbery tactile jewelry that can help kids with biofeedback, certain kinds of seating that can improve focus, etc. and if she gets an ADD diagnosis NOW, you will have that in your back pocket if she has issues at school later.
posted by bq at 2:54 PM on February 16, 2017 [2 favorites]

ADHD isn't totally a diagnosis of elimination. There are pretty standard criteria that need to be met for at least 6 months and the Conner's Scale is often used as a diagnostic tool, as is NEBA testing.
posted by yes I said yes I will Yes at 3:13 PM on February 16, 2017 [5 favorites]

As an adult who has had ADHD and sensory issues my entire life, I have mixed feelings about this. I am also the parent of a child, now an adult, for whom undiagnosed, untreated ADHD has caused problems.

In some ways, I don't consider ADHD and sensory sensitivity to be disorders. I do believe that my brain doesn't work the same as most people's, both chemically and in thought processing. I also think that sitting in a classroom with very little time for playing and moving around isn't good for any kids. Increasingly, I see less and less room for kids to be kids, much less to be "different" kids.

I strongly recommend not jumping into evaluation and treatment. I do recommend being aware and trying to learn and understand more about how your daughter experiences things and how her mind and feelings work. You cannot assume that what she hears, what she sees and what she touches are the same for her as they are for you. Please be careful before you mentally and emotionally characterize her behavior as "poor". If you see her that way she will know and may feel like there is something wrong with her. You can help her, but you have to understand first. Her mind may be literally moving so fast that she is distracted by a thought that drives all other awareness out.

Why I say this - my story.

I am 62 and started medication for ADHD in my fifties.

I was the youngest of five children and I was fortunate in some ways to grow up in a time where home life and school were generally well structured, but also more able to accommodate a different child. My parents had very high expectations of all of us.

My mother dressed me for school until I went to second grade. I would get distracted by a thought and lose awareness of anything outside my head. Patience was not my mother's strong suit. I learned to behave in church, because, well, church.

Before I was even school age, I was aware of peristalsis, my digestive system moving, at night. That's not normal. At that age, children typically don't have remotely that level of self consciousness. I couldn't wear anything with lace on it (difficult when you had to wear a slip under your Catholic school uniform.) There were a lot of foods I didn't like. My mother finally talked my father into letting go of making me eat things. We ate dinner every night at the table as a family. No television. It probably helped me that conversation at dinner was important and wide-ranging and we all participated. On the other hand, dinner took as long as it took.

(Is there a reason you have to eat meals fast?)

Both my parents were readers. My father read the newspaper very thoroughly and my mother read books and I did love to read. I remember being very frustrated by not being able to read when I was younger.

I was very bright, had an exceptional memory and did very well in school. I did get into trouble for reading when the teacher and the rest of the class were doing something else. That's when I developed one of the most common ways girls cope with ADHD - hyperfocus. Hyperfocus was my blessing and my curse from then on. I can focus on something that interests me for an incredibly long time, forgetting to eat and so on. That made me very good at some things. As is common in an adult woman with ADHD, I was very good in one area of my life, work, and completely disorganized and distracted at everything else. Being different haunted me all my years in school and often in my work life. You are always aware of it.

I never ever sit still. I am always moving something, usually rubbing my feet together. My mind is never, never quiet. I was astounded when my daughter's best friend did not understand that. It never occurred to me that other people don't necessarily have a constant voice and music and other things in their minds. After a conversation with someone, I often continue that conversation in my head for hours.

Because I couldn't be still, physically or mentally, I never slept well as a child. I can't tell you how many times I heard "Lay still!" if I had a reason to need to slip into bed with a parent. I was banned from spending the night at other kid's houses because I would never go to sleep. I was amazed when I got married and my husband was asleep in a matter of moments while I lay there for a half hour or more. Also, I never fully relaxed physically. I would often wake up in the morning with my muscles aching from being so tense.

The smallest noises were deafening. I didn't know when I ran a bath that the noise wasn't overwhelming to everyone else in the house. The textures of certain foods made me gag. I had frequent headaches. I can't grow my fingernails because I can feel their presence at the tips of my fingers and it is like a constant pressure. The sounds of fluorescent lights are like bees buzzing next to my ears. The world is constantly pressing on me one way or another. It is very wearing. I was also extremely emotionally sensitive. I vividly remembered times when I was hurt or frightened by others. Being different didn't help me fit in and not only did I see myself as different; I believed that there was something WRONG with me.

When I was 10, I had a cold/cough. My father kept saying either put on a coat or stop coughing. I suppressed my cough reflex. I didn't cough and wound up with bronchitis and pneumonia. I was into my forties before I regained a cough reflex.

Sensitivity to stress and anxiety runs in my family and I am sure brain chemistry plays a part in my starting to be afraid all the time. I also think that life circumstances can trigger a genetic predisposition. Most of my life I have felt like a rabbit in a dog kennel. I have persistent panic disorder and will have to take medication for it for the rest of my life.

When, after my daughter was diagnosed and started treatment for ADHD, I also started treatment, for the first time in my life, I actually found out what it was like to relax when I went to sleep. Sometimes I have to take my daughter's word for it that the medication helps because I miss the constant hyperfocus. I don't miss living completely in my head and being totally oblivious to everything around me, like unwashed dishes.

The point to this long story is that knowing and understanding that the world your daughter lives in may be radically different than the one you inhabit may help you to help her. Just knowing that being different didn't mean there was something mysteriously WRONG with me would have helped immensely.

Being bright and having a good memory, along with being hyper-conscious and hyper-sensitive are extraordinary gifts. Like most gifts they have a shadow side as well. My life is immensely enriched by my experience. It is also sometimes very painful.

Keep observing your daughter and learn what she is experiencing. Help her understand that there is not something WRONG with her. Help her learn to use the way she perceives the world as a tool rather than a problem. Trust your instincts and if she needs treatment for ADHD or whatever her flavor of perceiving and reacting to the world is, you will know it.
posted by Altomentis at 4:20 PM on February 16, 2017 [8 favorites]

Is it bad to get your kid evaluated? Not at all. Just don't be disappointed if they tell you there's nothing to do about frustrating behaviours.

On the contrary, there are many, many things you can do to improve or manage frustrating behaviors with kids, whether they have clinical ADHD or not. Medication can be appropriate even for little kids. I'm not qualified to diagnosis your kid, let alone over the internet; my strictly civilian take is that some things sound typical, some sound like you're expecting too much from her (like never being rude or being able to sit through a whole piano lesson without fidgeting), some things sound like ADHD. A good evaluation isn't just a yes/no checkbox; it will give you a bunch of information about different areas of her functioning and tell you how she compares to her peers. The key thing, from my perspective, is that even if her issues are subclinical, you will find parenting strategies for kids with ADHD really effective and helpful. Honestly, even typically developing kids don't learn very well through hectoring/badgering. They learn in spite of it.

Eg: -make her a visual schedule with pictures for getting ready each morning.
-Break her piano practice into four-five minute chunks with a break in-between chunks. Use a timer and give her a little reward at the end of each chunk and a big reward after three. Stop pleading with her to play a song. If she plays the song, she gets a sticker; if she doesn't, she doesn't. Oh well. Figure out something she likes well enough to play the song.
-Make sure she's not too tired or hungry or worked-up to benefit from practicing or lessons. She might just be exhausted after school and not have any mental energy left. Try practicing in the mornings and lessons on weekends, maybe. Or shorter lessons.

There are lots of resources for parenting kids with ADHD, autism, general quirkiness that will work for most kids. I would absolutely tap into them regardless of what the evaluation says.
posted by Snarl Furillo at 4:59 PM on February 16, 2017 [4 favorites]

> ADHD is a diagnosis of elimination. After you rule out all other possible explanations, they call it ADHD

No, that is not how it works.

Labels are useful when you're dealing with the school, if you think she'll need accommodation. It's something you'd want to have sorted out by middle school, and it can take a year or two for the very slow wheels of IEPs and such to turn. So there's no hurry, but you might want to look into it in a year or three.
posted by The corpse in the library at 5:00 PM on February 16, 2017 [3 favorites]

I don't have enough experience with 6yr olds or ADHD to have any idea if the behaviors you mention could be symptions, but if you are concerned, I think you should absolutely have her evaluated. (Assuming that you can afford it), there is no downside to getting a professional opinion.

If you have her evaluated, there are a few possible outcomes:
- you find out that she does have ADHD or something else, and then can decide how best to proceed (behavioral interventions, coping strategies, medication now, no medication now but keeping it as a possibility for later, etc.)
- you find out that she does not have a diagnosable issue, but there are specific areas to keep an eye on (and perhaps there are specific things you can do to help her in areas where she struggles)
- you find out that she is a typical 6yr old with no signs of a diagnosable issue, which is a relief for you!

I mean, if you're concerned, why not have a professional who has relevant experience with kids her age evaluate her and give you more information? There are lots of potential benefits and no real drawbacks.
posted by insectosaurus at 5:32 PM on February 16, 2017 [1 favorite]

I think she sounds awfully six. A couple of the behaviors remind me of sensory processing issues, but that's totally because I have a kid with sensory processing issues so I'm quick to jump there.

It doesn't hurt to get her evaluated -- if nothing else, it can put your mind at rest. Start with your pediatrician, who may say "yeah this is all totally normal" or maybe "This sounds pretty normal but here are a couple things we can keep an eye on and reassess in six months" or maybe "I think she's probably within the normal realm of variation, but let me send you to a pediatric development specialist for an assessment." And then maybe you see a specialist for a further assessment.

Regarding the slow eating -- I'm a slow eater in a family of fast eaters, always have been, and the drama really ramped down when I started being able to take my food away from the table. Like, we'd sit and eat dinner at the table as a family, practice good manners, etc., but when everyone else was pretty much done, I could take my plate with me into the living room and eat the rest there, instead of forcing the whole family to stay at the table with me while I ate super-slowly, or sitting alone while everyone else went to the living room. These days I'll usually serve myself the hot dishes first (turkey, mashed potatoes) and eat them at the table, and then I'll load my plate up with cold dishes (salad, rolls) to carry into the other room to munch on while everyone else talks. It's just not a big deal anymore; everyone knows I'm a slow eater but that I'll get enough to eat and I don't mind eating half my meal at the table, and then taking my other half into the other room to keep being with the people while I finish. Even at restaurants with my friends when the waiter comes around and is like "Anyone want dessert?" I'm always like, "I'm going to keep working on my entree, but please, bring the dessert menus for everyone else." My friends all know I'm just slow and I'm happier plugging away at my steak than having a dessert anyway.

(The only thing is, when I was little and we were eating family-style, my mom would sometimes put away a portion of the particular goodies for me before serving them at the table, because by the time I slowly ate my way through the entree, all the rolls and cranberry sauce or whatever would be gone. So that was nice of her.)
posted by Eyebrows McGee at 7:14 PM on February 16, 2017 [1 favorite]

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