Expert: Dr Billy Levin - 5/15/2006

Question
My daughter is three and will be turning four in July.  There are "things" in her life that are leaving me so confused and very worried.  

At first I wondered if she could be autistic.  However, I have been told by a ped. neuro. that she is not.  Her father (who has never been involved with her life) has a strong history of ADHD in his family.  He was never diagnosed but he and I both think he is ADHD.  

This is her story.

She was born on time and healthy.  She was a normal infant although she was very active and from early on she did not need much sleep.  She rarely napped and if she did it was not for very long.  She was very happy, she was always smiling and she was very playful.  It almost seemed like she enjoyed being "bad" at times.  She would do something she knew she shouldn't and it would be so funny to her.  She was always looking for chaos.  She sat up, crawled and walked at appropriate times.  

When she was about 7 months old I did notice that she would do something with her hands.  She would open and close them whenever she was excited.  I never thought anything about this movement until she was older.  Over time it shaped into a finger wiggling movement and when she would do this, she would also grimace her face and grind her teeth.  This would happen several times, every day.  She is still doing this as of now but not as much as she did last year.  Her ped. neuro. said this was a “stereotypical movement.”

Aside from the movement, she was slow in learning language.  She did say her first word on time but language never really picked up until she was three.  When she was two she could say things but she really didn't seem to grasp using language.  She would communicate in one word phrases.  She would say "Wiggles" if she wanted to watch them or "airplane" if one flew over.  She also started echoing at about 2 1/2.  She would repeat things we said but she would mostly repeat herself.  For example, if she saw a dog she would say "a dog" over and over again.  When she was three she finally started piecing things together but pronouns where really difficult for her.  She would reverse "you" and "I", and "he" and "she."  She knew the meaning of them, if we said it, she understood but when she said it, it came out wrong.  This lasted a few months and as of now, she is no longer confusing them.  Today, she can say sentences as long as "mom, I am thirsty, I need some water."  She seems almost caught up.

Aside from those issues, these are the only signs of autism.  This is why the ped. neuro. ruled it out.  She seems very friendly and he said most importantly she does not live in a world of her own. She does not have any need for routine and she does not throw any intense tantrums.  She has excellent eye contact and is eager to please.  She loves company; she never wants to be alone.  She plays with toys, although she is like a tornado.  She will dump things over to look at them for a minute and walk away to something new.  It is rare for her to play with something for more than a few minutes.  She will want me to put on a movie for her, it will start to play and usually within minutes she is off creating a new mess.  She is always on the go, she loves running around and playing rough but at times she will enjoy dress up and other things little girls enjoy.  Now that she talks, it is never ending.  She just keeps going and going.  She never seems to tire out.

Anyway, my question is, where is the line between ADHD and autism?  I read about the red flags for both and she has a bit of each.  For ADHD, there is the family history as well as many of the traits but because she has traits of autism as well (the stereotypical movement and pronoun reversals) does that mean she is both or just one?  Can a child with ADHD have communication issues like children do with autism?  Are pronoun reversals only identified with autism?  I have researched stereotypical movements and have seen that non autistic children can develop these and there is a link with ADHD.  Do have any knowledge of these movements and ADHD?  If so, is it common?  Do they go away?

I would love your take on all this, I feel so lost and would appreciate anything you can share with me.  

Thank you so much.


Answer
Obviously without examining your child I can only comment on the facts you have presented. Almost all suggest your duaghter has ADHD. My suggestion you see a medical expert who will examine, advise and treat if neccessary. It is my opinion never neccessary to wait until she is older to confirm a diagnosis or treat medically. There is a vast difference between ADHD and Autism, although they do have some overlapping symptoms. As your huband might have ADHD, it would seem possible for your daughter to also have it.