With developmental, behavioral, and mental conditions, many classic symptoms (inability to finish tasks, failure to sit still, mood swings, reluctance or inability to make eye contact) are also typical behaviors, notes Enrico Gnaulati, Ph.D., author of Back to Normal: Why Ordinary Childhood Behavior Is Mistaken for ADHD, Bipolar Disorder, and Autism Spectrum Disorder. Dr. Gnaulati fears the paranoia many of us feel (Is this "normal"? Is that "normal"!?) could be fueling an epidemic of overdiagnosis.
One mom says she began spying on her preschooler in the playground after her teachers announced the little girl might have autism. "They said she wasn't initiating play or answering questions well during show-and-tell," she remembers. "I have an autistic brother and I didn't see any of the signs in my daughter." She told herself that her little girl, just shy of 3 and still in her first month of preschool, was the youngest in her class. But a few weeks later, she spent $550 for a professional evaluation. The diagnosis: pretty much your typical almost-3-year-old.
Still, it's important to listen to your gut if a voice inside is telling you something's not right. To help you sort through it all, we've compiled these key questions.
Where Is My Child on the Age Scale?
Thanks to the "red-shirting" trend (holding preschoolers back an additional year) a kindergarten classroom "could have as much as an 18-month spread between the youngest and oldest," says Marcy Guddemi, Ph.D., executive director of the Gesell Institute of Child Development, a nonprofit in New Haven, Connecticut. Consider this in the context of a Michigan State University study showing that the youngest kindergartners are 60 percent more likely to be diagnosed with ADHD.
Does Your Classroom Skew Female?
Dr. Gnaulati points to data showing that boys tend to be more physically aggressive than girls. In fact, play fighting is how many boys bond with one another. Meanwhile increasing numbers of teachers report shutting down rough play as early as kindergarten and rewarding self-regulation -- which typically comes much earlier for girls. Is it any shock that first- and second-grade boys are three times more likely than girls to be medicated for a range of mental-health issues?
How's Your Bedtime Routine?
Ashley Merryman, coauthor of Top Dog and NurtureShock, recounts a story about a boy who was about to be medicated because he was always bouncing in class. When someone finally asked him why, Merryman says he answered, "I'm so tired, I bounce so I can stay awake." There's hard science to back up her anecdote: A University of Michigan study of kids who were having their tonsils removed for sleep apnea found that, among those who qualified for a diagnosis of ADHD before the surgery, roughly half no longer fit the condition's profile a year later. Researchers say this finding supports previous studies connecting breathing-related sleep problems with poor daytime behavior. (Think of the last time your toddler missed his nap and you'll see the connection.)
How Long Was that Pediatrician Visit?
Less than 20 minutes, according to 80 percent of parents surveyed for a recent Pediatrics article. Which means, even if your doctor has deep training in mental health and child development she's only getting part of the picture. You should fill out a developmental questionnaire at each well visit and review it with her, but that doesn't always happen. "Bring up any concerns right away," insists John Duby, M.D., chief of developmental and behavioral pediatrics at Akron Children's Hospital, in Ohio. "Most kids do much better if identified earlier."
What Does Your Gut Say?
A child who doesn't make eye contact with her doctor could simply be ... a child who doesn't make eye contact with her doctor. But you know your child better than anyone, and it's your job to fight to get the help she needs or even question someone who suggests something might be wrong.
"Don't give up if your child's doctor reassures you that it's just a phase, when your instinct is telling you otherwise," cautions Melissa James, of Yorktown, Virginia, who was told by her doctor to "wait and see" when she brought up having her 3-year-old son evaluated. She followed her gut; soon after, her son was diagnosed with a speech disorder and, three years later, with ADHD.
Childhood and parenthood come with challenges. This is normal. To those fretting about whether a current rocky patch could point to a larger, more serious condition, Dr. Walter Gilliam urges us to pause and watch our children. If they're largely content and able to participate in daily life on their own terms, enjoy. Chances are they will too.
Originally published in the April 2014 issue of Parents magazine.
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