Expert: Norm Bishop - 9/15/2009

Question
QUESTION: I am the mother of a 3-year-old girl. We have gone through a lot of transitions in her life for multiple reasons.
First off, my daughter is extremely smart... she has the vocabulary of many 5 and 6-year-olds I know. She has an amazing memory and can remember things I would forget. (Where people live who she met only once, who got her a certain shirt/pair of shoes, things I or others have said that have little or no importance to them, etc.) She has good motor skills, loves to climb and jump. Which leads me to the problem...
She has always displayed some "quirky" behaviors. Most people just called her a "free spirit" or "lively," but I have been feeling like theres a lot more to it then that.
Recently, some of the behaviors have been getting in the way of our daily living; and more specifically, her daycare arrangements.
Some of the behaviors are:

-Sleep (doesn't seem to need to... sleeps about 6-8 hours on a good night, sometimes sleeps only 3 hours and she doesn't seem to be exhausted the next day)
-Licking She licks everything: windows, blankets, recently even people (not fun to have to tell other daycare parents my daughter was licking their child...)
-She seems like she has to touch EVERYTHING. If we are in a store she runs her hands along everything we pass, almost as if exploring the textures of everything.
-Impulsive with her actions
-Seems to be a dare-devil and seeks out thrilling and risky situations (jumping down stairs, climbing ANYTHING, etc.)
-Lack of attention. She blurts out answers before a question is finished, only seems to hear some of what is said to her before moving on to something else.
-Constant movement. She is always on the go (and she only runs, skips, jumps, dances... never walks) and can't sit still. Even when she's eating, a part of her body MUST be moving.
-She pushes/bumps/hits others, without seeming to realize she's hurting them.
-She is too rough with animals (pats too hard, holds them wrong) and again, doesn't seem to grasp that she is being rough.
-She seems to want constant touch, whether it's her to someone/something; or someone/something to her

Those are just SOME of the issues. My main suspicions are either a Sensory Issue (sensory-seeking) or ADHD(which runs in both parents families...). But is it possible to be both? Or can one be mistaken for the other? I have scheduled an appointment with her Dr. to vocalize my concerns, but was hoping you could give me a little more insight on this. Any ideas/suggestions?

ANSWER: At your daughter's age it would be very difficult to state that she clearly has sensory integration problems or ADHD...although, based upon what you have described one or the other is creating an early problem.  

We are discovering in recent research that sleep is very, very, very important to children.  Those who don't get 8 to 10 hours a night, until after the teen years, seem to have more impulsive behaviors, sensory problems, and focus less on one task at a time.  I would have the doctor either order a sleep study or try some interventions that may help her sleep.  The critical part to sleep is the deep sleep cycle, call REM (Rapid Eye Movement)...without that certain problems with focus and concentration will follow.

I would also closely examine her eating habits and how what she eats effects her behavior.  Some children are extremely sensitive to processed sugar and as they consume it, their behavior escalates, others have similar reactions to the glutton in wheat, while others find dairy products their root cause.  I would suggest that you do this fairly systematically, so that you don't have multiple foods and assuming that it is singular.  So, for a week I would give her a processed sugar desert after lunch, then see what happens to her behavior.  If I don't see anything, then try another week.  If nothing, then move to wheat products, especially those that are processed, like white bread, or inexpensive pastas...etc.

I think I would start there...if none of those seem to be the culprit, then I would see a good Physical Therapist or Massage Therapist who has trained in sensory issues...start her on a regular routine of touch therapy.  

Let me know what the doctor says.

Norm

---------- FOLLOW-UP ----------

QUESTION: Sugar and wheat don't seem to be affecting her one way or the other. I am willing to try ANYTHING.
We went to the Dr. and she agreed on a referral for a Behavioral Assessment. So we started calling the people in our area and only 3 accepted my insurance. Out of those three, only 1 was willing to see my daughter due to her age. Most neuro-psych centers (at least in this area) won't begin servicing a child until the age of 4 or 5.
The one that is willing to see her is just counseling, and I am going to them just for lack of options, but I'm feeling like there are no resources outside of the school system.
I would be able to get her a SPED assessment if she was in preschool, but it is almost impossible to get a typical 3-year-old into preschool without a diagnosis of some kind due to the fact that there are only so many "typical" slots available.
She still isn't sleeping and is still being very busy and creating chaos at daycare and home. I'm at my wits end and feel like all doors are closing on me. What do I do?

Answer
Sounds like many doors are closed to you.  Counseling is a good idea, someone who is knowledgeable about young children would be the best.  

Some physical therapy clinics specialize in sensory integration, I think that might be worth evaluating.  It does sound like she has some sensory integration problems, and with the right direction, that may correct most of the behavior.  In fact, the sleep problems might be due to the sensory integration difficulties as well.  Unfortunately, you need a real experienced, well trained therapist (related to sensory integration) and they are not easy to find.  If you can find someone in a clinic that meets the bill, then an initial evaluation followed by regular therapy may help, if not, you will know after a few sessions.  I am not certain that insurance would pay for this sort of therapy, but it will take a doctor referral to even open the door.

Added to the sensory integration therapy, message seems to help with those who are tactilly defensive, but I don't hear that in your concerns.  I don't think I would go there right now.

This is very complex, and it is pretty rare to see what you are seeing at such a young age.

I would complete the behavior assessment and try to find some Sensory Integration Therapy...if not, then structure as much as you can, try to replace the negative behaviors with less offensive ones.

Norm