Expert: Christine D. DeLoatch, MA CCC-SLP - 11/13/2009

Question
I have a 3 year old daughter.  I am concerned that she may have ADHD or a behavior disorder.  I am a teacher and have seen a lot of this and know that early diagnosis is important, but that they usually can't diagnosis at this young of an age.  My daughter is all over the place always.  She is always in trouble in her pre-school program and at the baby sitters for not keeping her hands to herself.  She is constantly pulling, picking up, and messing woth the cat and in not so nice of a way.  She goes to school 2 hours a day in a pre school program at one of our local high schools and seems to have trouble getting along with others and minding.  At home it is a constant struggle for us.  We have used time out, spanking, taking ballet and gymnastic classes away, a reward system.  We have used color charts and check lists and NOTHING seems to work.  Our in-home sitter has been watching kids in her home for 30 years and she even says she is a monster.  She can be very sweet but I dread taking her anywhere due to the behavior issue you never know what you are going to get.  Temper tantrams are not too much of a problem, but she will not give up on an issue.  It is a whining instead of a temper tantrum.  For example, she got in trouble for coloring on the table so we told her she can't color anymore.  The next time her sister was coloring she didn't get to and for over an hour she asked if she could color over and over again.  Everytime her father and I would say no and explain why she couldn't.  So, a few days later she and her sister wanted to color and I let her and discussed that we only color on the paper.  Next thing I know she is coloring on the TV, floors, and table.  This has happened several times.  We have finally just taken the colors away.  Please don't misread that I am not supervising her when she is coloring, but I am usually doing household chores while this is going on and in and out of the kitchen area every few minutes.  I am concerned that she can't seem to make friends and doesn't seem to connect with her peers.  She does however, seem to connect with older peers(teenage ones).  I can't get her to sit long enough to do anything.  I can tell her not to do something and she will look right at me and do it anyway knowing that she is going to get time out or a spanking depending on what the action is.  I am very obsessive with routine and consistency so I know that can't be it.  I am almost too obsessive about that.  Which is a whole other question.  Her dad was given coffee as a young child before school so he could concentrate.  So, I am wondering if had ADHD been around when we were young if he would have been diagnosed.  Her dad constantly has to be doing something with his hands.  I have noticed that she often has her hands in her mouth like dad.  I am very worried.  If something is going on I want to catch it now and hopefully prevent her from being behind in school.  Thanks for all your help.

Answer
Dear Jennifer,

Thanks so much for your question.  I apologize for my delayed reply, my hard drive died in my home computer and I overlooked this e-mail from all experts.

I think you are smart to look at early intervention and the family history.  It does sound like your husband had/has some signs of attention difficulties also.  It is very common for ADD tendencies to run in families.  

Here is what I would suggest concerning the challenges you mentioned.  

I would not discipline her by removing her from ballet nor gymnastics.  The reason is that ballet requires attention to detail and listening.  Gymnastics is a way for her to use energy.  She may be overly wound up, because she is trying to pay attention.  Stimulant medication provides increased blood flow and neurotransmitters without the body moving around.  

I would suggest that when you are ready to try to coloring thing again that you invest in the color wonder markers - so that she can only draw on the paper or the aqua doodle items.  That way water is the only thing on items.  She may even be disappointed if you give them to her and she sees that it won't write on every thing.  I would suggest that you keep all the colors/markers except 1.  She can only have that one, and if she does not write on anything but paper, she can come and ask you for another one.  She has to trade it in.  That's the time you get to check behind her to make sure she is using only paper.  I would also suggest that you build her up.  She only gets to color for 5 minutes.  Keep the timer on.  If in five minutes when the timer goes off, you come to check on her, and she has only written on paper - next time (maybe the next day - maybe after dinner), she get's to color for 6 minutes or 7 minutes. Don't add too much time too quickly.  She really needs to earn this.  

When she gets stuck on wanting to do something.  I suggest that at first you do not answer her questions, but ask her why she can't color.  She needs to be able to say what the problem is.  If she can tell you, then she is remembering.  If she can't - don't assume she is thinking ahead about consequences from last time.  Kids with ADD don't learn that way and even the adults have time-blindness.  It is the now and the not now.  They don't stop and think - "Ohm the last time I did that I got in trouble."  They are saying "Yay,  crayons - pretty colors."  They can't regulate their own behavior if they never think about consequences from last time.  (I hope that makes sense).

Now, to interrupt that whining or persistent question asking, I would simple fain stupidity.  Pretend you are a dumb as a brick.  Ask her 20 questions.  Say, "What did you want again.  I didn't hear you.  You know this washer is so loud, I can't hear a thing.  Wow, will you look at the time.  Dinner is almost ready.  Are you going to help me put the napkins on the table?  Did Mommy remember to buy napkins? Is sissy ready for dinner?  Is daddy ready for dinner?"  

Also you can talk in very silly voices, like Elmo or an alien or even a whisper."  or your could pretend that you don't see her, and walk right past her into the room where her sister is and say have you seen your sister?  I can't find her.  I keep hearing some mouse voice - very squeaky - and imitate her whine, - but I don't hear a big girl voice like your sister.  She may start to figure out that she needs not to whine if she wants your attention.  She may even think it is funny and pretend to hide.  It is a way to make it less stressful and not to keep her locked into the role of whiner.  It also teaches her what you expect - a big girl with a big girl voice.  

If you are in a store, you can ask her what she wants to have on the weekend for dinner or what book she wants read to her at bedtime.  

Now about a bedtime book - it should be one like Green Eggs and Ham so that you can stop and she has to fill in the blank.  That way you make the activity more active for her.  You can also play again - Beat the clock.  If she stays in her seat for 3 minutes - then she gets a mini m%26m.  You may really need to reward her much more frequently - I suggest, teddy grahams, goldfish cracker, mini m%26ms, raisins, little pieces of cheese, mini marshmallows, etc.  I also suggest mini stamp markers.  You can fit about 25 stars on a little hand.  You can catch her being good.  Dad can have one, Mom can have one, Babysitter can have one and the teacher at school can have one.  She can get very proud and excited about doing a good job and showing everyone how she is such a big girl.  I believe she needs more immediate reinforcement.

The structure is good, but she need to be able to interact and do as much as possible.  She needs to be the number one helper at all times.  She needs to be holding something, watering the plants, getting the napkins, getting the basket of hair stuff to get her hair done.  

I would recommend go fish or some other turn-taking games - there is a farm game by fisher-price, but I couldn't locate the name of it on my computer search.  The game time should be supervised with your daughter and a peer or even her sister.  You can give her praise for waiting her turn and not being aggressive.  

One last thing, I would recommend that you seek out an occupational therapist.  Occupational therapist, can do a sensory work-up and suggest exercises for your daughter that may help her calm down.  Do keep your doctor informed of your concerns.  At the age of 5 is when medication usually begins to be helpful for these types of children.  Before then, it is hit of miss.  Behavior modification, like play therapy and counseling may not be very helpful if she is as impulsive as you described here.  

Many Blessings to you for being such a progressive and investigative parent.

Christine