I have a 5 year old ds who is starting kindergarden this year. I have observed some behaviors in him, which before I just thought were part of being a kid, but now I'm not so sure. First of all, academically he is doing very well, already able to read, loves school, loves learning, especially anything to do with books and letters. However, his pre-k teachers always complained to me that he cannot sit still, for example when all the other kids were asked to stand, he would jump, when everyone was supposed to be sitting, he would try to get up. He is the same way at home! When he is eating, he is in constant motion, jumping, running around, I have to remind him few times to not get up while he is eating. Every time. He is always jumping and running around. But what really caused my concern is his inability to follow directions. For example, we went to his kindergarden's open house yesterday. Each child was individually asked to get up and stand in front of a wall with a little sign with their name on it, to get picture taken. I was watching all the other kids who were able to follow this simple direction and just have the picture taken. My 5 year old was acting like he did not understand what we were asking him to do! The teacher had to give him 3 sets of directions and I had to prompt him "go to the wall", "hold up your sign" "smile". That was also another thing thing pre-k teachers told me about, my ds does great academically, but when they ask him to "pick up your art work and place it in your folder", he just stands there like he doesn't know what is asked of him. And when we do homework after school, he seems to need a lot of prompting, a lot of instructions, he looses interest, he doesn't do a good job, even when I know he knows what to do! So the 2 main things I notices are his inability to sit still during sit down activities such as meals, and his difficulty in following directions. The only other problems that my ds have are food related, he has texture/oral aversions and eats a very limited diet (eats only about 5 real foods). We had an unrelated check up at a new pediatrician's office and he asked my ds "how old are you?", first my son wouldn't even answer , then after more questioning he answered "fine, thank you", like he did not even understand the question! So this really what raised a big red flag and now i am here trying to figure out what is going on. I always assumed my son was fine because academically he did so well, he is reading very well by now, only just now turning 5, but now I am not so sure. My next check up is at the end of September, my pediatrician was all booked until then, so please, any advice would be greatly appreciated! Am I oversensitive or is this something I am right about. Is 5 too young to diagnose a child, is there something I can be doing ? Maybe I should get his hearing checked... He passed the 4 year old check up, but he did have a lot of ear infections as a child... Thank you for your advice!!!
It actually sounds more like a sensory process issue than ADHD. Being in a new environment - especially a classroom with kids, parents, teachers, florescent lights, air conditioning going, chairs scraping on the floor (sound can be a huge trigger) can cause a child with SPD to exhibit signs of ADHD. The food thing also falls into that category. As most schools do not (have to) recognize SPD, you would probably do well to have him checked by an OT who specializes in SPD.
A lot of people with ADHD also have sensory issues. My ds' sensory issues were more prominent at 5yo; loud environments (like PE and the lunch room) would provoke misbehavior; the sound of the fire alarm would cause him to climb the wall to get away from it. That your ds' issues are present in more than one location and are of long standing doesn't seem to support a 'new environment' theory.
Though an OT could offer a helpful evaluation and treat the sensory issues, I wouldn't stop there. There are several medical or developmental issues that can cause (or worsen) ADHD symptoms; a comprehensive medical/developmental evaluation would give you more to go on. We had ds evaluated at a children's hospital clinic by a team consisting of a dev-behavioral ped, SLP, psychologist, and social worker. ADHD is not related to intelligence. The precocious reading ability and particular interest in letters could be a sign of hyperlexia. What appears to be a hearing deficit may be CAPD (central auditory processing disorder), which is diagnosed by an audiologist and is one of those conditions that can be mistaken for ADHD (or co-morbid). If he has a limited diet he may be lacking in certain vitamins and minerals which can affect behavior; the cause of the limited diet may not just be about texture but could also be due to food sensitivities.
Google search: "ADHD and food sensitivities" http://www.google.com/search?q=ADHD+and+food+sensitivities&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a
If you decide to request the school do an evaluation, you need to "start the clock" in your letter of request; the school has 60 days from the date they received parental consent for evaluation to do the evaluation and 30 days from the evaluation to present it at an IEP meeting (your state may have stricter requirements); your written request should note that this letter is the consent for evaluation. (And, if you did not do it in writing, it never happened!).
Determining Eligibility: How Many Days is 60 Days? - Wrightslaw
The Art of Writing Letters by Pam and Pete Wright - Advocacy ...
The precocious reading ability and particular interest in letters could be a sign of hyperlexia. What appears to be a hearing deficit may be CAPD (central auditory processing disorder), which is diagnosed by an audiologist and is one of those conditions that can be mistaken for ADHD (or co-morbid).
I agree with a SPD consult/eval and also to initiate an eval once school starts.
A word on CAPD- we suspect my DD has this, but both the Speech/Language Teachers in the school, her private and school OT, and the local Childrens Clinic will not test (nor will insurance cover it) until age 7 since there a wide range of developmental norms for 0-6.
That said, my DD displayed much the same attributes minus the constant motion aspect. She is/was an early reader, high academic skills, had SPD (had OT from 3-5 both through our insurance and the schools), and a few other things. The most glaring trouble when she started preschool was the 'hearing' issue (yes, her hearing is fine we had that checked). Every year her teachers ask if she has had her hearing checked.
She does not seem to filter background noise so she is either hypo or hyper aware of sound/noise. It is hard for her to follow verbal directions, she says "Huh?", What? a lot. In noisy environments she cant focus and seems unaware of what she should be doing and where she should be (in line, or waiting, or singing along, etc). In quieter settings it is not a problem.
We have had used a weighted blanket, earphones, and small things (sit near teacher, low visual distractions, touching her shoulder and making eye contact prior to oral directions, etc). She does well in school academically and will be in 2nd grade now. She no longer gets OT services since it does not impact her academic skills (I am sure it does, but she is at or above grade level in all areas) and socially she is awkward- but not a behavior problem.
Her pedi and various OT workers over the years think it is combo of SPD and auditory processing difficulties.
I would call your local school services for ages 3-21 and ask for an eval and/or contact your insurance and see if they cover OT/PT/etc for an eval.
FWIW: 5 is borderline. Yes, it can be diagnosed at 5- but often school like to wait until 6/7 to do so. You could also consult a local behavioral/child psychologist for a thorough eval that would help you decide if it is ADHD/ADD , SPD, or a combination of various things. If you do get an ADD/ADHD diagnosis ask for a 504 plan (check for info at www.wrightslaw.com) for school for accommdations to help make sure he is successful at school.
Our school has the school social worker work with a small group of kids with ADHD for social skills, it is great! With or without a diagnosis you should meet with the principal ahead of time and express some concerns and be able to be proactive in making sure your DS has the best start for K as he can!
**edited to add: get a vision check! My DD has good traditional vision but has some double vision upon a thorough eval they will treat it with prisms in glasses (but no visual prescription). You can notice an increase in her ability to focus has increased!