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Well, if they said, sure, it'll get better, and then it doesn't, then they're negligent.

And it's true that intervening to correct these behaviors is likely going to be more effective than doing nothing, IMO. But choosing the intervention is going to be important.


Also: those questionnaires don't ask the teacher "do you think it's autism?"-- they ask for observed behaviors, many questions, some of which are irrelevant. It's entirely believable to me that your DD acts differently with different teachers across the day based on what demands are placed on her, how she feels about the teacher, etc.


My feeling is that you are starting to get data on relative lows; that's useful. I'd work on those spots and see how it goes.

I have a very high opinion of CBT as a method. It does require willingness on the part of the patient, so if she's oppositional with everybody but you and gram, that may be difficult to do at age 5. (5 is also very young for CBT; but if you found the right person, her strength in theory of mind is an asset there too.)

What does the neuropsych think will improve the oppositional behavior? That seems like an important element to making her life smoother overall.

DeeDee

Not discounting DeeDee's excellent input, but--

Task initiation is getting going on a task; very hard for people who have ADHD, not usually impaired in people with anxiety AFAIK. People who have impaired initiation often show a frustrating gap between the time they are given an instruction and the time they actually acknowledge it or start to complete it. It can make a child look oppositional even if it's really a processing glitch.

Hmmmm... well, not necessarily true that task initiation is uniquely correlated with EF deficits. There are a number of other explanations which involve anxiety directly.

Significant socially prescribed perfectionism can trigger task/performance-avoidant behaviors (basically, procrastination and anxiety).

You can't "do it wrong/imperfectly" if you don't do it at all, basically.

BTDT, this is precisely the pattern that we see in our DD, who has no other indicators of anything non-NT. But those things can reach a level that they'd lead to a (mis-)diagnosis-- probably of ODD/ADD-inattentive. Neither of which is at all applicable when separated from the anxiety and perfectionism. Things which are not subject to objective or subjective "grading" or standards, we simply never see this.

The thing is, the "punishment" for non-compliance has to reach a point where it becomes > the 'reward' for not risking failure/taking action... and that can cause delays in "processing" directions/tasks or starting them. What I realized at some point is that what my DD is actually processing is which is the better alternative-- to do what she's being asked to do? Or to refuse and not 'risk' imperfect performance? Lots to consider when making that determination, including who you're dealing with and how they are likely to respond to a refusal, what other stuff you'd like to be doing, etc. You'd think that it would be easier to just do what you're asked, right? But apparently not.

You really hit on a big point there. Also, since perfectionism type anxiety often has some self-loathing mixed in, punishment can also be a relief because it reinforces self-concept. Doing things at the last minute also means you can blame failure on the procrastination.

so true! with my kid, the key to cutting through the perfectionism turned out to be explaining how much more her brain grows when she makes a mistake, vs. when she gets something right vs. when she doesn't try. her true currency is apparently her own development (!)

it's not a panacea, but it has significantly improved the cop-outs in the past few weeks and we're hoping it will eventually translate into a new sense of resilience and thereby reduce the self-loathing, which is just... the worst.

How does he recommend you treat the anxiety? Certainly CBT should help. Medication?

DeeDee

Just a thought,
and my own opinions of course, and all that....

but if the teacher reported all that "negativity"- do they then in course of the day perhaps somehow convey their thoughts to your child? I mean, if a teacher thinks she showing Conduct Disorder issues- which btw is VERY serious and many think the worst pediatric mental illness to be diagnosed-- (((I am currently learning all about ODD and Conduct b/c my DS6 BF is very ODD/adhd and possible Conduct in future if current issues not dealt with- and it is scary stuff

ok, so if Teacher etc, think such thoughts- your child may pick up on this and of course she would have cause to be upset/anxious- what the adults at school are thinking, may affect the way they treat her, respond to her, etc etc!

DS6 picked up on the teacher felt he was "stupid" b/c she wouldn't teach him new things. Fact is she came across this way to him, and to me- She basically doesn't feel a child who is Autistic can also be possibly gifted.

so again, that's my opinion, but I just feel-- it can't possibly be helping your child if this is how the adults at school observe her to be. I am assuming they "observed" her, and wrote their observations down?

(((interestingly enough, DS's BF's teachers all wrote wonderful "observations" down, so yes, all the problems were sort of listed, but they "loved having him in class" yadayada and he is adorable kiddo but neuropsych felt that they were not Objective ENOUGH! compared to what they finding with kid.)))

my point I was trying to make above was that I'd be concerned if teachers saw such things, and Dr. isn't picking up same stuff, or at least contributing to the long list of Dx they could be, and

if your dtr is anxious? then if she picks up on any of it, even the very subtle bits... this could just increase her own anxiety ?

and the giftedness part comes into play with many are more sensitive, so that itself increases the anxiety levels.
idk.

Sorry if I am completely off base.
Just a thought as I said....
I will go finish gardening!

Was there any suggestion that this might be the result of inappropriate educational environment/fit?

Seems odd that it's so highly situational. I guess I'm wondering if that isn't a red flag.

We chose not to take our DS10 out to HS. He was very difficult as a kindergartner, tending to melt down, act on impulse, be off track, focus on his own interests, distract the class etc. But we wanted him to learn the skill of interacting with others in school and elsewhere. We wrote tons of behavior goals into his IEP and made sure they were worked on. At 10, he can participate meaningfully at school, has friends, and is doing pretty well overall. We are glad we stuck it out, even though it meant a couple of impossibly hard years early on. Had we homeschooled him, he would probably not have learned all these soft skills that we believe will be necessary for him to hold a job down the road.

Moomin, is your DD in public school? If so, have you started the "educational evaluation" process (called RTI or ETR in most places)? I would bet that if your DD is going to master these participation skills, she'll require management and direct instruction in those skills, as well as sophisticated thinking about how to make it worth her while to participate. (For that job, a behavioral psychologist can be useful.) An IEP is probably necessary in order to get those services deployed in a school setting.

DeeDee

That's the key, I think. We can get a lot of things for DD because she has a 504 plan. Now, some of those things aren't things that would garner any accommodation otherwise... and have, simultaneously, NOTHING to do with her qualifying condition...

What that means, unfortunately, is that without a qualifying diagnosis or evidence of impairment that impacts major life activities, you may be relying on largesse alone to mitigate the poor fit.

It's not how it should be, for sure-- because if your neuropsych is correct, this is pretty profound impact from a situation that the school is setting up, but I'm not sure (short of an IEP/504) what you're going to be able to do about it. KWIM?

Some anxiety diagnoses can be qualifying for section 504-- but the impairment probably has to be a lot more global.