Expert: Dr. Sharon A. Mitchell - 4/22/2010

Question
Hi Sharon,

I'm the mother of 7 children age-range 20 to 3 years old. The oldest child-aged 20, and a female has ADHD, and the 4th child and oldest male-aged 16 has ADHD and O.D.D. My first 5 children are from my first marriage, the next child from my second marriage and finally the last child-a girl aged 3 1/2 is from my last marriage. I mention this just in case in your answer to me that you know that the are not all from the same 2 parents.

My concerns about my 3 1/2 year old daughter are as follows: she never sits still, is very aggressive--always has to first in everything and will hurt others to get it, is impulsive--will open car door while we're driving, has turned on our stove, unhooked our dog from his chain, has dumped several things down or sinks and toilet-requiring us to make repairs. She's shut door on people, in their faces and locked them out. She has some self-injurious behaviors, such as has bitten herself repeatedly or will out of no where hurt family members or pets--such as pinching, hitting, kicking, slapping, pulling animal's tails. She kicked me one time so hard that I had a huge bruise on my leg for weeks--the kick was unexpected by me and had come a bit later after I wouldn't allow her to stand or go outside of a fast-food restaurant's main doors that open into a very busy parking lot. She poked her 15 year old brother so hard in the eye while he was seat-belted next to her on our way to school, that we had to go the ER because she had cut his cornea with her finger-nail.

She's very sensitive to smells and different types of flooring as well as set in routines that if changed in any way produce huge melt-downs. For example, about 6 months ago we went to an art musuem which had shiny marble floors--upon her seeing them--she became terrified and acted paralyzed to move--she was also screaming unintelligently. We couldn't get her to walk or even to get back into her stroller. Needless to say we left the musuem, but any store like a Wal-Mart or grocery store after that produced the same results in her.

As far as her being sensitive to smells, we went to the humane society to make a donation and upon her entering the building and smelling the animals--she started vomiting. The same thing happened about 2 weeks ago when we took her to the circus. She can not stop herself from touching everything, everywhere we go. And if she's decided to do something--she will do it at the risk of getting a time-out. And all of her time-outs must be done right in front of the person in charge because otherwise she will destroy her bed if she has a time-out in her room, the chair she's sitting on or wall or anything beside or around her. She can't even sit still on your lap or 1-2 minutes without moving or getting on and off or bothering the person whose lap she is sitting on. She will only say sorry if you threaten to take away a privilage or object--that she likes--but you can tell that its only an apology for that reason.

Generally it takes the whole family to take this child anywhere, as it takes all of to help keep her safe from things she impulsively does or tries to do. It's very exhausting. She's also very sensitive to clothing and noises, as well as having her hair brushed. Noises that are normal to everyone else, she will insist are way too loud and demand that we turn them down. Sometimes she will insist that her clothing hurts or is scratchy when we can't see anything like a tag or something that should be bothering her. She has medium length hair with tons of thick, spiral-like curls--which no matter what type of brush or how light you brush it hurts--to the point where she'll scream and crying loudly if you try to even brush through it once. And once she gets screaming, it takes her forever to calm down or stop--could take up to 20 minutes sometimes. Her motor skills are not good--i.e. when running, she'll fall and we have to take her up the slides and go down with her or she won't slide. Sometimes she'll swing. She has trouble cathing balls, and bouncing ball--but can kick them most of the time.

Any information that you can give our family would be helpful--i've tried repeatedly to get her evaluated to see what's wrong with her, but always get the same answers--the let's wait and see due to her young age. She will be 4 in June 2010, and is a very large child--about the size of a 5 year--very tall and her weight is about 93 pounds. She's always thirsty, and has goes to bathroom frequently--even as a baby--I went 2-3 times the amount of diapers with her that I did with 2-3 of my kids at once. She's very social, but in new situations she's very shy. We live in Aberdeen, SD which is the 3rd largest city in our state, but as far as national big cities--Aberdeen is pretty small--so there isn't many options to get my child tested here. My last ex-husband and my daughter's father has ADD, and is from New Zealand, and is of white, European/English/Irish/Scandanavian ancestry--in case you need this information for genetic info.

Thank you,
Rebecca

Answer
Good evening Rebecca,

When I read your first two paragraphs describing the behaviors of your little girl, an autism spectrum disorder is not what first came to my mind. I certainly understand your concerns and worries, but the behaviors you mention could be attributed to many things other than Asperger's or autism.

The sensory experiences you mention in the museum and Humane Society though are something that a child on the autism spectrum might go through. But not only children with autism have sensory sensitivities. Nor do only kids on the spectrum have gross motor coordination difficulties.

I would suggest that an Occupational Therapist may be able to offer you some suggestions to help your daughter feel calmer (which would in turn help the whole family!).

While autism and ADD are not directly inherited there a tendency in families does appear, so I appreciate that you are drawing some connections to other family members who have attentional issues.

For a three year old, your child is certainly off the top of the charts for height and weight. This added to the thirst, frequent urination and behaviors she displays would in my mind warrant further investigation. If you mentioned to a physician that you wondered about Asperger's, I can see the response being to wait a bit, considering her young age. Sometimes it is not easy to detect and diagnosis AS until a child is interacting with kids her age daily in a structured setting such as school.

I would suggest that you begin by contacting Sherron Grote, your school division's Director of Special Education Services at 605-725-7146.

Early Education services are available. You can take a look at South Dakota's policies here: http://legis.state.sd.us/rules/DisplayRule.aspx?Rule=24:14 Ms. Grote should be able to guide you through the steps you'll need to get an assessment and assistance for your little girl.

Best wishes,

Sharon A. Mitchell, B.A., B.Ed., M.A., PhD candidate