Gifted Issues Discussion homepage Forums Twice Exceptional Tell me about your child with anxiety

DD's second-grade teacher has referred to DD as "high-anxiety" and "very anxious" more than once. We have wondered off and on about a possibly anxiety issue, but have never felt it quite fit. I am wondering what this diagnosis looks like in your gifted child.

DD is high on "approach" and likes new places, people, activities, and things. Though she has been afraid of thunderstorms, tornadoes and other disasters off and on, she does not have any other fears. She enjoys performing and being in front of people and makes friends easily. However, she is also very controlling and highly emotional. She also seems deeply disturbed by inaccuracy and always has to know what is "going on"--she really hates to be low on information or to not understand a situation fully (I think this may be what her teacher is seeing). School performance is important to her, though I would not call her a perfectionist.

Well, you have described my dd pretty closely. She is amazingly social and loves new places, people, activities and things just as you described above. She was never a fearful kid - always willing to jump off a diving board, ride a roller coaster, speak or perform in front of (very) large crowds, etc. She did become a bit more fearful, though, as the anxiety developed and was afraid of thunderstorms this past summer. Your description of needing to know what is going on and being frustrated by lacking information also hits the nail on the head.

Her anxiety developed last year while in a terrible school situation. Not only did her teacher penalize her for being unable to do tasks which a documented disability prevented her from completing, she also had other kids in the school making hurtful comments and physically hurting her. (The injuries were not the result of bullying - there were a number of kids in the class with behavior issues and the teachers were totally incapable of maintaining any sort of appropriate classroom environment.) She begged for me to change her school and I worked relentlessly to try to improve her situation. As she felt more and more vulnerable the anxiety moved in. She eventually became very clingy and would beg me to stay with her and not leave the classroom in the morning. She began having almost daily stomachaches and I was picking her up from the nurse's office several times a week by the end of the school year. She felt so vulnerable that an accidental bump in the hallway resulted in her crying in a heap on the floor as if she had been hit by a baseball bat.

She was constantly afraid that she would disappoint her teachers or get in trouble for something that she didn't do. Her teacher assigned a student each day to be the "color changer" so she never knew when or if her color would be changed off of green, so she developed a paralyzing fear of the stupid color charts. As she got more and more anxious she began with repetative thoughts. i.e. as we were driving for her visit at a private school we planned to transfer her to she kept saying over and over "Do they have a color chart there?" "If they don't have a color chart I definitely want to go to school there." "I really hope they don't use color charts there."...

The good news is that once school ended the anxiety abated. Now that she is in a positive learning environment there have been no signs of anxiety. Her IEP has her meeting with the school social worker each week to develop coping mechanisms but there has been very little need for it in the new environment.

Hope this helps answer your question.

I have two children with anxiety, one who has been described as the "total teflon personality - everything slides off"! My oldest has been officially diagnosed with anxiety disorder, my youngest has no diagnosis but clearly is a highly anxious child. FWIW, both my ds who has the diagnosis and my teflon-child developed fairly severe anxiety in 2nd grade, and with *both* children it was due to having an undiagnosed challenge that no one was aware of give them a challenge that was too large for them to continue compensating for at school as the work and expectations at school ramped up - yet the challenges didn't manifest in a way that we (parents and teachers) easily recognized what was up, and neither did my kids. My ds has a fine motor disability and expressive language disability, and my dd has vision challenges - it wasn't until their anxiety ramped up sky-high and we went through neurospych evals that we realized what was really going on. Both kids' anxiety levels went *way* down after we understood what was at the root of their anxiety - ds is still clearly a child who reacts to stress with anxiety, but once we understood his disability, implemented acccommodations at school and made a teacher switch, his anxiety went way way down and even in tough times since then has never ramped up again. After a few months of vision therapy the teflon child's ability to read suddenly took off, and as far as I can tell she hasn't had an ounce of anxiety invade her teflon world since then.

One thing about ds - he's our exceptionally gifted child - he does feel things in an extremely sensitive way, much deeper than I think most kids. He also appeared to be a perfectionist, which many gifted kids are, and which all of us thought was part of the issue (parents and teachers) - turns out we were mistaking clues about his fine motor struggles as perfectionism.

My youngest dd, who also has extreme anxiety, has a high need to control everything, which is (I think) her way of dealing with stress. We suspect she's at least highly gifted based on her achievement and ideas, but she hasn't been tested at this point. She's in 2nd grade this year, soaring in math/science, but having some challenges with other school work for the first time and that's really ramped up her tantrums and need to control things.

polarbear

This all sounds a lot like my daughter. In addition, she is a hypochondriac and worries constantly about getting sick. It has reached the extreme at times where she will actually throw-up. She had a total panic attack and threw up twice during a hurricane recently. In the past she has also had issues with fear of bugs and ghosts.
Her teachers have said in the past that she seem anxious and is running to them a lot to "check" to make sure she is doing things correctly. She has made herself physically ill before when she had to give a presentation.
She has to have everything done her way and at times struggles to complete tasks which she doesn't feel are done correctly. She melts down when we try to get her to move on.
She also has body issues. She thinks she is fat (which she is not) and dresses very modestly to try to camouflage her imperfections(no tight clothing etc).
I could go on..but hopefully this will give you some incite. We have taken her to psychologists in the past and she just recently started seeing one again last week. In a word living with her can be exhausting.

Really appreciate the posts so far. My DD also does have issues with being fearful about sickness, especially vomiting. I would also say she asks again and again about things that concern her, like Pemberley mentions with the color chart.

She does have also some slight ASD-looking , also some things that look a little ADHD, but no dx ever seems like it's quite "right." Although she seems to be doing fine at school (she goes to a gifted magnet), struggles at home continue. We are at the point where we think an outside consult might be of use, but are not sure of first steps.

Ultramarina, a couple of thoughts coming from where I am (DS9 has AS).

I really trust cognitive behavior therapy for working on anxiety. It is great for smart, verbal people-- they learn how to reason their way out of their anxiety in a way that is meaningful for them.

My preference is also to have as much information as possible-- anxiety that comes from Asperger's (because you can't quite figure out other people) is different from the kind that comes from ADHD (because you can't quite trust yourself to do the right thing). If you can get to a neuropsych (it'd have to be just the right one, with particular expertise) they may be able to confirm a source for the anxiety, and with that give you a path forward on how to treat it.

Best,
DeeDee

I second all of this. Except that my DS with AS is 14.

How do I find a good neuropsych and what do I look for? Is this sort of thing usually covered by insurance? I guess it's probably time. *sigh* We have worried off and on about her since she was a small toddler. The thing is, I am just not sure if she is diagnosable with anything. She may just be HARD. Up to this point we seemed to be the only ones who felt there was a problem, so the comments from her teacher are making me take notice. She is functioning perfectly well in school despite this.

Hi, Ultra--

We found our neuropsych through a children's hospital. By then we suspected autism, so we chose one who'd seen lots and lots of autistic kids. We were not fussy about whether they'd seen gifted kids; we felt then and still feel that the disability was driving the major issues we saw rather than the giftedness. In your case, I'd want to make sure they've seen lots of girls with ADHD and/or AS and are able to recognize those even in gifted girls--because girls are under-diagnosed.

We went through the hospital's autism diagnostic program, but they were fully equipped to come out with some other diagnosis too. I'd definitely choose a neuropsych rather than a regular psych; they are more finely tuned. Ours happened to work with a developmental pediatrician as a team, screening for lots of physical and developmental things all at once, which worked fine for us. Insurance covered the evaluation, which was long (6+ hours).

If you can, start keeping a journal of behaviors that seem unusual or troubling. That gives you evidence, and keeps your mind from going blank at a key moment in the evaluation process.

On the therapy side: it can be hard to find a cognitive-behavior therapist who works with kids. Here's a "finder" as a place to start: http://nacbt.org/searchfortherapists.asp

DeeDee

p.s. about insurance: ask the neuropsych's office how people usually fund evaluations. There may be options other than your private health insurance available in your area, especially since you suspect there could be a developmental issue.

Hi,

Our child has had anxiety issues that sound fairly similar to those you have described. Our child gets very worried about doing well at school and feels she will never do well or progress. Her teacher has said that in one or two subjects she could do a bit better (but is still good) but for the most part she is at the top of her class (especially in Maths and Science).

She also worries about adverse weather conditions and the recent Tsunami in Japan seemed to make matters worse for a while. I was told by a friend that maybe she worries about things she doesn't feel she can control, I have tried to keep an eye out for this and he may be right. Is this common?

Her teacher recommended a book called The Anxiety Free Child Program as she was told by a colleague that it successfully helped a child in the year below my daughter. After reading the reviews on http://honest-health-product-reviews.com/reviews/the-anxiety-free-child-program-review we decided to buy the book. I haven't had a chance to read through it yet but from what I have read so far it looks pretty helpful.

We found that it was helpful to ask our pediatrician for recommendations when our children were struggling - that's how we found our neuropsychologist. If you're in a much larger area than we are, you might also be able to find advice online or by networking among other parents (we have limited choices here, so networking was helpful but we don't have a lot of folks to choose from!).

I wouldn't worry about whether or not she's "diagnosable" - she seems to be struggling and you want to help by having more information about what's driving her behaviors - that's what's important. You might go through an eval and find out there is nothing to diagnose - that's a-ok! Or you might find out that there really is something up and that will be a point to start from and move forward from. In either case, you'll most likely learn a lot about your dd which will help, whether or not there is anything to diagnose. And, fwiw, we've had two or our children go through neuropscyh evals and in both cases, what we learned was entirely different from what we'd suspected, so we are very VERY glad we went through the eval process.

Best wishes,

polarbear

Her pediatrician is not a great resource, perhaps, because she thinks DD is just bright and delightful and no problem at all. (She's never seen the behavior we see.) But I guess I can ask.

I do have a friend who is a child psych, but when I had a long conversation with her about DD, her opinion was that it was giftedness and nothing else. She also does not really believe in therapy for children under 10. (Interesting position for a child psych, but she is also a professor.)

Does she do talk therapy? If so, then I'd agree. ("Tell me about your childhood." "Uh, this is my childhood.") Seriously, we found talk therapy to not be at all useful for DS.

However, there are lots of kinds of therapy that can be highly useful, and the elementary years kids are still laying down a lot of basic thinking processes--IMO it's the time to nip issues like anxiety in the bud, before kids get to be teenagers and everything is blown further out of proportion. Cognitive-behavior therapy is very good for this, and I'd say even a bright 6-year-old could use basic CBT strategies.

Our DS has also benefited from Applied Behavior Analysis, therapy targeted to giving him the skills he was missing due to his autism. Very beneficial, especially when done early in life.

DeeDee

I think that many of the problems that child psychiatrists see involve dysfunction the entire family (poor coping skills) and are not just a child problem.

Our pediatrician had also never seen the behaviors we were concerned about with our ds - in fact, the first time around in 2nd grade when we called for a referral he didn't require that we make an office visit to get the referral. What we did was to call (or fax) in a request explaining the behaviors we were concerned about, when/where they were happening, the causes that we could see of stress in ds' life (school issues), and how they were significantly impacting his life. We asked the dr for the type of professional he recommended we see and for names of the professionals he would suggest.

So it's worth a try at least even though the ped hasn't seen the behaviors.

polarbear

DD has a ped visit scheduled and I'm going to ask for a referral. The hard part is that I don't really want DD to listen to this conversation.

I've taken some notes on DD to help me clarify my concerns. I'm just going to post them in here in case anyone has thoughts. The three things I consider possibilities are ADHD, ASD, or anxiety (or more than one), but nothing ever seems quite right from my layman's perspective.

Concersn:

very defensive, victim mentality
argumentative, reflexively negative
rude in tone
obsessed with accuracy; corrects others
high anxiety�upset by things like smoke alarms, unexplained sounds, others� injuries, mentions of bad topics; worries about death, war, disease, natural disasters
some immature social behavior; seems to act more like a boy in the grade below her; occasional failure to read social cues
very literal, does not like to be teased even when it�s friendly, dislikes exaggeration
nonsense talk and inappropriate laughter when excited
highly emotional, cries easily, highly sensitive to sad stories or themes
easily overstimulated
has nervous habits such as nose picking, throat clearing
loves spinning, swinging, scary rides
mild motor clumsiness
becomes enraged easily and is unable to respond rationally or think clearly in that state�escalates small things into huge ones. When angry seems very unaware of what others are thinking or feeling, though when calm shows excellent comprehension of this.

Things that point against a diagnosis in my mind:

no obsessions
no issues with pretend play
holds a conversation very well
highly imaginative and artistic, excellent fine motor skills
does very well in school�no behavior problems
no issues with attention to work�very long attention span
not physically hyperactive
has many friends
interests (chess, birding, drawing, books) are mature and change often
able to understand what friends may be thinking or feeling
mature reading comprehension
even skill profile, processes fast

Other:
says she dislikes being a child
highly independent
high degree of internal motivation
says she is bad and that she doesn�t like herself
says it is hard to behave well even though she really wants to

Except for the high anxiety and even skill profile, you've described my DD8 almost perfectly. She was diagnosed with SPD, which explains most of her behavior. We're in the process of trying to figure out if the rest of her behavior and uneven test scores (from below to way above grade level) are just part of her quirks, or if they're something else.

Except for 'does very well in school - no behavior problems' (DS has lots of behavior problems) and 'has many friends', your list sounds exactly like my son. He was originally diagnosed with ADHD, but DH and I are skeptical of that now and are planning on having a neuropsych eval done.

You can offer the ped. the list you've given here, in writing-- so your DD is not overhearing a list of faults. I'd even expand on them, giving examples. This is a very good sort of thing to keep in writing, so that when you get the referral and the eval is long and complicated you don't lose track of any information.

I have over time gotten less cautious about talking about these issues in front of my DS. I am careful about how I say them-- choosing "DS worries a lot about small things, and that concerns me" rather than "DS is too anxious," where the latter wording might imply "something wrong with him."

I think it is actually helpful for DS to hear me say to a doc, "I think this is a problem for him, and I'd like your help in solving it"-- it gives him the perspective that what's going on now is not forever, and that problems can be solved with the right help, and it's OK to ask a professional for help. I want him to know these things, so I model it.


Many items on your list, taken together, do raise the possibility of ASD/Asperger's. Keep in mind that a person doesn't have to have every symptom on the list to be diagnosable, just a cluster of them. Gifted kids usually compensate like crazy, girls especially often try to sleuth out social cues so they'll fit in, so they are harder to diagnose. I think you're right to ask for a referral-- let the best neuropsych you can find sort it out.

Kudos to you for pursuing answers. No matter what, I think having answers is better than not, because I trust informed decisions.

DeeDee

So--can SPD explain all this? I really thought she had SPD when she was a toddler. She chewed on stuff, bumped into things, craved stimulation, etc. Then a lot of the obvious symptoms went away when she hit around K age, though I still see some. Can SPD extend this far into other behavior?


At times I really think she is closer to ADHD than anything else, but she lacks the core aspects of either distractability or hyperactivity. She really has no issues at all with either. I mean, perhaps mildly distractible, but it seems well within the range of normal to me. Yet everything else sounds like her! Frustrating.


I do know this. But the part that doesn't seem ASD to me (and I agree, there are flags) are that she actually does quite well socially (though sometimes I feel surprised by this given her tendency to be somewhat inappropriate in many ways) and that she has never had obsessions. She also shows good theory of mind in terms of understanding characters' motivations, etc. last night we had a whole long conversation about how she was worried about what her one friend feels because she knows that friend feels hurt that she still wants to be friend with the other friend who she thinks doesn't like her and...it was pretty sophisticated. Yet look at that other stuff--the rigidity and literalism in particular look awfully ASD to me.

You see why I think she is a confusing kid! Fortunately, I do live in a university town with many specialists. But.

Ultra, I'm sure the standardized tests by specialists will help you sort it out. See if you can make sure they do the ADOS-- it's relatively systematic and provides a way to measure "spectrumish" behavior. It's not perfect, but it's much more useful than lists of symptoms for ruling ASDs in or out, because it seems to look at the overall aggregate of symptoms.

Sympathizing with you on the confused part... for sure...
DeeDee

Honestly, using high verbal reasoning skills to dissect a social situation, analyze it, and decide what the appropriate social behavior should be because you aren't sure what you are expected to do and how it will turn out is a strategy we see used around my house pretty often, frequently to good effect. It is one of the ways that bright, verbal people with AS compensate for their deficits.

I may not have explained it well. She perceived that one friend's feelings were likely to be hurt and wasn't sure how to not hurt her while also staying friends with the other girl, who wants her attention as well. I think my reaction as a child would have been "Um...these two friends both want to be friends with me and they don't like each other. Oh well." I really had no idea how to advise her!

You may sense some resistance to ASD as a diagnosis for her. That's because I have some. I see some traits, but it's shadowy and gray. How can a child with no social difficulties with peers be ASD? Isn't social impairment almost the primary symptom? At times I suspect the issue may be more our parenting or something, since most of the problems are seen at home only. It may be that we need better training as parents more than anything. Yet I feel we deal with DS, who is more typical, just fine.

The other issue I always have with high-functioning ASD discussions is that the conversation, especially in GT kids, always seem to end up being along the lines of "Well, that doesn't rule it out...that doesn't rule it out, either..." I then think--is there anything that DOES rule it out, or in? What is this diagnosis really about anyway? It seems highly fuzzy. I know the DSM stuff has been changed lately...

Ultra, you referred earlier in the thread to her tendency to do socially inappropriate things, the tendency to misunderstand social cues, to become enraged where others would not-- these are social issues. Does her dislike of teasing and tendency to misconstrue affect her relations with peers?

Often a child with ASD is sheltered in the early grades by some "mothering" peers who steer the child about what to do-- and then in 4th grade, when things become infinitely more complicated socially, the mothering stops and you see that the child doesn't have the social radar to keep up in that environment.

I frankly find it unlikely that you are an inattentive or otherwise inadequate parent. More likely that something is going on that makes her more difficult to parent.

Here are the DSM criteria for Asperger's (copied from a site not the DSM's because I'm short of time, but I think they're correct)--with my notes--

A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction [NB includes things like not picking up on others' nonverbal cues or looking in the right place to gauge facial expression]

(2) failure to develop peer relationships appropriate to developmental level [may include getting by through very conscious compensation-- doing with great effort what other children do naturally]

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

(4) lack of social or emotional reciprocity [my DS desperately wants good relationships; but he tends to make mistakes that annoy others]

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus [in my DS these are academic interests, and change frequently-- chemistry, astronomy, math-- this seems typical for gifted/AS]

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals [can be repetitive writing, desire to pursue academic interest in a repetitive way, a love of categorizing information exhaustively]

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

(4) persistent preoccupation with parts of objects

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.


So yes, these are judgment calls-- the presence or absence of any one observed trait doesn't rule ASD in or out. But if enough of these features pile up (not necessary to have all, but some) a diagnosis is considered appropriate.

There's also PDD-NOS, which means a person has some but not all of the features for AS or autism, but that those features are enough to affect that person's functioning.

The ADOS is the best test I know of to systematize these judgment calls.

HTH,
DeeDee

I do think she is socially inappropriate at times, especially compared to girls her age, but for whatever reason she still seems to do fine socially. She makes friends easily in a variety of settings--she is very outgoing, which may help. I would say that she is immature for age; to me she seems more similar to a first-grade boy than second-grade girl (in fact, one of her best friends is a first-grade boy). But it's not that she is STRANGE, exactly. She just acts young and sort of goofy. I used to think this was because it was the only way she had found to engage with kids her age, but now I'm not sure about that.

She did have some friend drama this summer at camp, and it was hard for her. However, it seemed to be queen-bee girl stuff ("You're my best friend/now you're not my friend"), not actual ostracism.

Also, the rage is never at peers. It is exclusively at us or her brother--in other words, it does not manifest outside the home.



A. Qualitative impairment in social interaction, as manifested by at least two of the following:

(1) marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction--Maybe. POssibly. Yet I would expect to see more issues elsewhere if this were really bad.

(2) failure to develop peer relationships appropriate to developmental level--I don't think so, but possibly this is slightly impaired.


(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)--no, never

(4) lack of social or emotional reciprocity --I am not exactly sure what this means...

B. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:

(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus--I don't think so. She has intense interests, but never monologues about them, and they seem normal to me for a GT kid.

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals--No

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)--No

(4) persistent preoccupation with parts of objects--No

C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

F. Criteria are not met for another specific pervasive developmental disorder or schizophrenia.

I was interested in your comment about these girls doing fine till 4th grade. Honestly, I have sort of been waiting for her to develop social problems but it never seems to happen. It would appear that she is an appealing friend to many in spite of her quirks.

BTW, another thing that felt ASD-ish to me was that her sense of humor seemed sort of...behind, for years. Then she spent a bunch of time reading comics like the Far Side and Peanuts and it was like she "got it" overnight. She now writes and illustrates her own comics, and they're quite funny. She is much funnier in conversation, too. I suppose this could be taken as more evidence that she is compensating by being a very quick study?

She is also a good actress--theater is a strong interest. I would think that this would be hard for someone with ASD.

ETA: I should look into PDD-NOS more. I thought that maybe that had been eliminated with the new DSM, though? Isn't Asperger's now eliminated or something too?

ETA: We have both ADHD and (undiagnosed, but strongly suspected) Asperger's in the family. I have mild prosopagnosia (face blindness) AND topographic agnosia (severe problems with direction-finding), which seem to be sort of related to ASD. I don't think anyone who knows me would say I am AS, though. There is some kind of brain misfiring in that area, for sure.

The home/school thing: a close relative of mine, girl with AS, is much too scared to break a rule by having a tantrum at school-- rule-breaking terrifies her. She feels safer at home, so she lets loose there. In public she presents as kind of dreamy, and hides the fact that she isn't always picking up on the social fine points by going along with other kids.

The proposed revision to DSM puts all autism spectrum disorders into one category. It's controversial. (I suspect people will still continue to informally use the label "Asperger's" to identify kids who have no cognitive deficits.)

The latest revision I know about is here-- still "proposed," not adopted AFAIK.

http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#

DeeDee

That's my dd11. She has both an ADD dx and an anxiety disorder dx. When she was IQ tested at 7, the tester wrote that she seemed upset by failure but didn't react much at all to success. She is defensive: if we try to show her how to do something, she cuts us off (even if she has asked for us to help), refuses to listen, and gets angry. She alternately claims to know how to do everything and is highly offended with any instruction and is paralyzed by fear that she is doing it wrong or poorly. She erases things over and over and wants other people to do everything for her.

FWIW my DS (w/AS) loved acting camp. He's very outgoing and likes being the center of attention. And being on stage is a highly regulated situation, same every time you rehearse, where a strong memory and sense of pattern really help. He also sings and plays an instrument: performing is an unexpected strength.

Yes, this stuff runs in families, and people who have ASD tendencies also often have something else in the mix (ADD, face-blindness, other quirks).

I'd put the family history in with your pile of other evidence and hand it to the best specialist you can find-- preferably one who's seen lots of girls with ASDs and some gifted/ASD combos. Keep a written record of "odd moments," things that go poorly, things that go well. Give your expert the raw data, tell them your concerns, and let them help you sift. This stuff is hard even for the pros. An amateur (even a devoted one such as myself) cannot diagnose. Especially over the net.

With good wishes,
DeeDee

This sounds like DD. This is an ADHD thing? Where does it "come from," so to speak (like, what is the deficit causing this)? I wondered if this sort of thing was anxiety.

I know no one can diagnose over the Internet, but sometimes comparing cases does help. I see two possibilities that bother me--1) DD gets a diagnosis that isn't really right and it colors our perceptions and others' in ways that affect her negatively; 2) DD does NOT get a diagnosis and therefore is unable to take advantage of accommodations that could help her.

I have thought about looking for a social skills group for her, but am not sure that's really what's needed. It's like she needs...coping class, more than anything. More skills to manage her emotions.

+1,000 DeeDee.

DS8 got an AS diagnosis last year, and I am still, from time to time, picking up those DSM criteria wondering what I missed, and whether we really have the right label.

For example I would have put B1 as a no, but the neuropsych found him to be a "textbook example", the kind of case that she could use to illustrate the symptom in conferences and trainings. She evaluated him smack in the middle of his first real research project for the school's science fair, and true, the only thing he talked about for 6 weeks was his research subject. I never considered his interests (animals, rocks, science...) as abnormal in focus or intensity, but then... I was the one who lived and breathed Greek and Roman mythology for a year at his age. With a GT label firmly established I got approving pats on the head and big proud smiles when I capped the reading with Homer's Illyad and Odyssey (unabridged). Without one... he gets AS and I get lectures on redirecting his interests (apparently asking me to look up information/videos on animals on Wikipedia is a red flag).

B3 was also raised -- I had never noticed (or recognized) hand flapping, but apparently he does it? I have scourged YouTube for examples and observed him, I still see nothing.

I read Misdiagnosis and Dual Diagnosis of Gifted Children and Adults (recommended here, would +1). Valuable read, made me even more confused.

But anyway, the label is (excruciatingly slowly) getting us some help with the social issues at school. So I guess we got what he needed from it.

Oh, and get an eval from somebody who knows both gifted and 2E. Because AS girls are supposedly much harder to ID, and HG girls even more so.

If you find a solution, let us know. It has been a huge issue for my son. His current social skills group actually works on it, mostly through social stories, but I don't think they really teach practical tools for the kids to better regulate their emotions.

We've done a number of things in this regard.

1. The book Parenting Your Asperger Child (Alan Sohn) has a great strategy- I think he calls it "deliberate sabotage." Basically, you take the child a bit further out of their comfort zone, and over time they adapt. (If your child only likes one brand of bread, "run out" of it and offer a different kind, encouraging the child to deal with it; make sure he loses games sometimes, after pre-teaching how to act when you lose; etc.) This is a practical way to teach coping. Most parents adapt to a child who melts down by accommodating the child's preferences-- but in fact, that's not the best route to resilience.

2. DS actually took a course, kind of an "autism and me" thing, at the autism center of our local children's hospital. They taught anxiety management and things like "how to recognize that I'm getting upset, and what I can do about it." It was not a cure-all, but it was important. It also showed DS that AS was not his fault, which was hugely important and eased his overall anxiety about his place in the world. Feeling different can be devastating for an elementary-schooler who doesn't have a context for why he feels that way.

3. Cognitive-behavior therapy seeks to alter how a person responds to given stimuli. We have done a fair bit of this with DS, mostly around things that make him anxious. (Filling out the planner in the morning at school, for instance; we practiced it using CBT strategies and he is much better about it now.) CBT teaches that managing thoughts will also influence feelings, so by changing how you think you change how you feel; and a gifted kid can pick up the strategies fairly easily, though the practice of them takes time.

I never found a social skills group that worked for us; we made our own supported environments by being involved with group activities, always with a parent in tow until DS could handle it on his own.

HTH,
DeeDee

See, I don't know what I think about this! To some extent that sounds like pathologizing a natural behavior of the gifted.

My DS3 has never inspired even a moment of worry in me that he has an ASD (which is another check in the column of "something is up with DD") but he is currently OBSESSED with deep-sea life. His interest is more all-consuming than DD's have ever been. But really--that kid is not not not ASD. He's just not. He's pretty damn smart, though! So...why is the behavior okay when the child doesn't have other flags and not okay if the child does? How sure are we, really, that these behaviors are part of the problem?

(Some of this is just philosophical musings on my part. I find myself very interested in the question of when brain/behavior differences are pathological and when they're just interesting differences.)

That said, I am interested in CBT and think it could work well for DD. I want to help her with the things that are making her (and us) unhappy.

When DS went to preschool and kindy and tried to make conversational contact with other children on the basis of very weird scientific interests of his, it became a serious social problem for him.

Some socially and intellectually gifted kids I know are better at adapting-- they can turn on the unusual topics sometimes, and they show a good bit of all-around smartness and engagement with the world, but they can turn the unusual topics off when they're among kids who aren't interested, and they know the difference. What DS lacks is that flexibility, and it's a real hindrance. As far as I can tell, that's a big part of the AS in his case, and distinguishes him from non-AS gifted kids.

Some of DS's intellectual interests at various points have been anxiety-driven, as when he learned everything about clouds and weather because he was afraid of storms. In that case it's control-driven, not an abstract interest. But some of them truly are abstract interests, gifted stuff, carried to an extreme degree and less able to regulate or shut off appropriately.

DeeDee

Edited to add: We do not discourage all the special interests as mere "symptoms" (indeed they are pretty amazing and valid interests), but we do encourage "right time and place" for different topics... we do not talk about higher math in Sunday School...

That is the main thing. Send them into the world equipped to use well whatever talents they have, to make themselves and others happy. That's a goal for us too. May we all get there.

DeeDee

Right, right--I see how it could be a problem if it affects socialization negatively. In DD's case, she has never bothered uninterested people with her enthusiasms and seems to know that other kids do not care about warblers. In fact, I would say she keeps her enthusiasms close to the vest.

I'm bumping this up because our appointment with DD's ped is coming up and I want to ask for a referral, but am not sure to whom. Developmental ped or neuropsych or therapist or what? I would say I have Asperger's, anxiety, depression, ADHD, or family/discipline dysfunction (ie, she is just a challenging kid and we need help with strategies) all on the list as potential reasons why DD is struggling. To review, we have no behavior problems at school, lots at home. Naturally, right now we are having a smoother time and now I feel like this is not as needed, but it always goes in cycles. FWIW, she just had a birthday party with some other gifted friends and she seemed so beautifully socially integrated and liked...

A neuropsych can do the widest battery of tests, and that's probably what you want: a wide net to catch anything that's there.

I just posted a list of tests used in AS diagnosis on another thread last night... many of these would also be given if anxiety or ADHD were a concern.

DeeDee

Yes, I would like her to be as thoroughly assessed as possible--wide net for sure.

What is the difference between a neuropsych and a developmental ped?

In my (limited) experience: the neuropsych is mainly for testing. They know all the tests available, decide what to deploy, and are expert in reading the results and diagnostic work. They should be able to sit with you for some hours after the testing, tell you exactly what they found and what it means. They should generate a nice written report that helps you get services if you need them.

We use a dev ped for ongoing skilled care for DS9 with AS. She is in charge of meds, and she is in contact with his case supervisor/therapist to talk about what we are seeing and what needs to be addressed; they work together. She knows things a pediatrician would not dream of, she's seen and treated zillions of kids with DS's type of issues-- she is the ongoing expertise that helps us steer treatment.

In your shoes, for the eval, I'd look for a neuropsych who's seen tons of girls with AS, preferably also gifted and ADHD, so they're used to differentiating. Based on what I've seen in your posts, I'd want someone with lots of AS kids in their experience, as that's the hardest differential diagnosis to make in a gifted girl. (i.e., they get missed/underdiagnosed most). That way, if they rule it out, you're sure.

HTH,
DeeDee

Thanks for your help!

FYI: We are trying to find a play therapist to help with dd's anxiety and it is really hard to get a good referral. Names from pediatrician and neurologist but no parent to give me feedback based on experience. Being burned on a neuropsych eval was bad enough but I can't risk dd seeing the wrong person in this context. Anyone have advice on questions to ask or good ways to vet a child psych? It was suggested that I find someone to do EDMR play therapy with her but I just keep hitting a brick wall trying to find that too. Lots of names on a list but who wants to risk the unknown with your already anxious child?

Pemb, can you get them to give you a parent-only intake interview, so you can evaluate them a bit?

Is there a local parent support group you can turn to? Often other parents will tell you the real deal.

Does your pediatrician have anyone s/he recommends?

Our experience with psychologists is hit or miss, sorry to say...

DeeDee

Unfortunately we have totally lost faith in our pediatrician and are looking to make a change so don't really trust her recommendations at this point. No parent support group that I can find. Ironically when we lived in a much smaller community with many fewer resources I knew the good ones because of my job but didn't have a kid. Here there are literally hundreds to choose from and I have no way to tell the good from the bad.

Bleh...

Pemberley, I think you should make your best guess and interview one. You are developing some serious radar. You'll find one who suits; whether it's on the first guess or the last of several, who knows...

DeeDee

Pemberley, it's really tough finding a good fit for a counselor, even when you have recommendations from people you trust - because kids can be so very different, as well as their individual needs. We had a tough time finding a good counselor for our ds - not that we couldn't find good counselors, but he just really didn't like the first two we went to. In each case, we knew other families who'd used the same counselors for their children and had really positive experiences, we met (parents) with the counselors for the first session and had a good chance to think through if this person would work out, and we honestly believed that each counselor we tried would be a good fit for our ds. The first two just didn't work out because ds never found a groove with them and he didn't like to go to his sessions. Finally on our third try we found a counselor ds actually gelled with - but with the others we just had to send ds and find out afterwards that it wasn't going to work.

Ironically, our youngest dd is going through extreme anxiety this year and as we've gone through trying to choose a counselor for her, we finally decided that the best fit for her is... the first counselor we tried with ds and who was just an absolute disaster for him - but dd and ds have two very different personalities, and we think dd will respond to her much better than ds did.

Anyway, I agree with DeeDee - make your best guess and interview.

polarbear

Update: DD's ped gave me two scales for her to complete (the MASC and the CDI) for anxiety and depression. Looking at them, I actually suspect she will score higher on depression. We also have a psychologist referral. I am not sure this is the right direction to go, but the psych should be able to refer us if a broader eval is needed.

also, depression does not seem the right word for DD to me. She eats well, sleeps well, and is active and enthusiastic. I would never describe her as "sad," but I would say she seems angry and low in self-esteem.

This one I'd let a professional sort out. Depression in children can look different than in adults. (In little boys, for instance, it can show as aggression or a variety of other behaviors.) Anxiety, too, comes in many flavors; I'm glad you are getting help in figuring out what's really going on.

DeeDee

I filled out those rating scales as well, and I also thought DD would come out as depressed, mostly based on the frequency of tears. Her neuropsych evaluation came out with anxiety, not depression. The anxiety in our case seems to draw most directly from previously undiscovered learning disabilities. In retrospect, we first started seeing this aspect of the anxiety in second grade. Her personality seems "ripe" for developing the anxiety, with a generally negative affect and emotional states that appear quantized.

I'm doing my first parent intake with a cognitive behavioral therapist tomorrow. I chose someone who appears gifted himself, and has worked with anxiety, ADHD, and learning disabilities. I'm trying to interview a few, but I'm struggling to find info on the psychologists as the telephone gate keepers aren't really that useful.

Hey geofizz, I'd love it if you kept us updated on how it goes.

Another update: DD filled out the MASC and the CDI, with minor assistance from me when she didn't quite understand what was being asked. They have the scoresheets attached, so I scored her (on another sheet of paper!) I thought her scores might look high--after all, she answered she did not like herself very much, often did the wrong thing, often checked to make sure things were safe, etc. But they are not. She scored somewhat high on anhedonia and negative self-esteem and on harm avoidance, but in no case was she above the 65th%. Often she was dead-on average for her age and gender. It's possible I'm doing the scoring wrong, but I don't think so. It's pretty clearly explained.

Huh.

ETA: OKay, did some further research and had a more careful look at the scoring. By one cutoff she is right on the verge of qualifying as depressed; if you go by other, higher cutoffs used by some, she would not qualify. She definitely does not score as clinically anxious. I realize I am not a psychologist and that these are just two scales.

My daughter's score sheets from me and done by her with the psychologist did not qualify as anxious. The self-esteem surveys come out low, but not too far below the low-normal range. The anxiety diagnosis came from observing her during the testing, including several things I do to help her cope with the anixiety without realizing it.

The intake appointment was really encouraging. I wanted to interview at least two, but frustratingly three other people haven't called me back! Anyways, we will likely go with this one. The initial weeks will focus on getting to know each other and teaching her breathing exercises, then CBT to retrain her responses to situations that have previously caused her anxiety.

My DD is older than yours. I don't know how young a child a therapist would do this kind of thing with, but it seems to have a positive track record for depression and anxiety. I suspect my DD's self-esteem will follow with the anxiety.
Good luck finding a way forward to help your DD through this.