I have two daughters, 5 years old and 21 months old each. My 5 year old was like any normal child, she met all her milestones on time, started walking at 10 months and talking at 12 months. She potty trained at around 3 years of age and started school at 3 and a half. She'd listen and respond and react just as one would expect any kid her age to. Last February, my DH moved from our home country (Pakistan) to UAE, as he'd gotten a good job offer. Soon after that my kids and i moved to my home city to spend a few months with my parents before we joined my DH. Up till then we were living in a joint family system (as is the custom in our country) with my parents-in-law and sister-in-law. My kids are very attached to them. Each year I would spend a couple of months with my parents in my hometown, so my DD was used to that.
A couple of weeks after my DH left for UAE, when we were still living with my in-laws my 5 y.o. DD started sitting up in bed (while asleep) with a horrified expression on her face. It started out with only a couple of times per week and progressed to the point where it happened every day 4 to 6 times a night. She sits up in her sleep and screams and kick and writhe and sometimes even bite and then it would be over in less than a minute and she goes and she doesn't remember anything in the morning. We thought that it was night terrors but we have just been told by her psychologist that these are seizures caused by epilepsy, which runs in my DH's family. She had an EEG done and it was confirmed.
A few months after these episodes started her behavior started to change. We thought it was because she was missing her father and a settled life and finally in November we joined my DH in UAE but her changed behavior not only continued it started to get worse. Finally I had to send her back to Pakistan with my mother, who was visiting. We had the intention of bringing her back after a few months but my mother took her to a psychologist who diagnosed her with epilepsy, Autism and ADHD. We were already sure that she might have ADHD but had no idea about Autism. Her psychologist said that she does not fit completely under Autism or ADHD but has a few symptoms of both.
She used to be and still is a very confident child. She can walk up to complete strangers and start talking to them. She used to be a very easy and laid back child; she rarely gave me any trouble before all this. She likes to talk a lot and sing, and she even talks to herself while playing.
These are the symptoms that have started since last year at the age of 4:
1. She has stopped listening to/following instructions. I would tell her not to do something but she would still do it, while before she would listen. But this does not happen all the time.
2. She started scribbling on walls (sometimes with my lipstick) which she never did before.
3. She breaks things for no reason at all.
4. She doesn't seem to play with toys. She ignores them or throw them away or break them and would rather play with puzzles or on the laptop or look at books. She enjoys art activities.
5. She started putting everything in her mouth, something she never did when she was smaller.
6. She seems to have lost all sense of fear and would do things which are dangerous or would scare other children but she had always been on the braver side.
7. She sometimes leaves the house alone without telling anyone and sometimes even barefoot.
8. She started hitting her younger sister but that could also be because her sister is getting older and had starting to annoy her.
9. Sometimes she wouldn't respond when we called her name and seemed lost and would respond after a few calls.
10. She started saying inappropriate things to people like "you're so fat" "you're so ugly" "you smell bad".
11. She learnt a couple of bad words and uses them repeatedly.
12. She doesn't like being hugged too much and would say she doesn't like it and ask us to stop, but she likes being cuddled when she's sleeping. She does give brief hugs when asked. And she says "I love you" a lot and is always counting the people she loves (she has a list) and would even tell people that she doesn't love them.
13. Sometimes she doesn't make eye contact or look at someone when she talking to them. This has started happening more frequently.
14. She had been dry for 2 years, till last month at the age of 5 she started losing control of her bladder to the point where we sometimes have to put a diaper on her. When she's wearing a diaper she sometimes poops in it as well, but rarely.
15. She has recently started playing with her poop as well, squishing it between her fingers.
16. Although it doesn't happen too often, she sometimes bites people around her without any provocation.
17. We're homeschooling her for now and it would sometimes be very difficult to get her to sit and study. Sometimes she does her work without any problems and sometimes she scribbles in her books and be very uncooperative and/or distracted.
18. She's always biting her nails, also something she started doing last year.
19. Sometimes she doesn't seem to know the difference between right and wrong, for instance she goes up to complete strangers and ask them to give her whatever they're eating or drinking. We explained a lot of times that its wrong and that she should only ask us for things but she doesn't seem to understand.
She's very intelligent (she makes intellegent observations) and is very good with puzzles of all kinds. She likes to swim, sing and bake. One more thing I'd like to add is that she does this thing since she was around 2, which we assume is masturbation. She sits on the floor with her legs behind her and rocks continuously until someone stops or distracts her...she sometimes even hides to do this.
Sorry for such a long post but I'm very confused. Does she really have Autism and/or ADHD? What's going on? How can a child suddenly develop Autism like that. Her psychologist says that it was triggered by the epilepsy but even then I'm confused. What are the chances my younger daughter will also develop these problems. Like her older sister, she is not displaying any symptom right now. Thank you in advance. Any help and advice would be deeply appreciated.
I'm sorry I don't know very much about the relationship between epilepsy and autism, but I do personally know a child who had very mild social delays as a young child, but also had epilepsy, which has, over time, caused minor brain damage, making his autism symptoms much more pronounced. So I do believe there can be a connection and that seizures can increase symptoms of autism.
I personally wouldn't just take the advice/diagnosis of a single evaluation, especially from a psychologist rather than a developmental pediatrician or pediatric neurologist who can look at the larger medical picture.
If I were you I would definitely take her to a respected pediatric neurologist as soon as possible.
I second fizgig, you need to present your child to a neuropaediatrician. There are a lot of diseases of the brain that can make symptoms like that, and many are treatable. Did you present her to a pediatrician at all yet?
I don't believe autism can start that late, but a couple of diseases can cause regression, and that might look like autism.
Trin with DH , DD(7) and DS(5) , DD(2) , , (due 5/14)
I am not regularly online at the moment due to the above ...
I think an unexpectedly high number of kids with autism have seizures. All three, autism, epilepsy, and adhd are disorders where the brain, and it is not unusual to have more than one. My ds has epilepsy, adhd, and dyslexia. This is a good article discussing behavior and comorbidity of epilepsy and other disorders: http://professionals.epilepsy.com/page/e_b_neuropsychiatric_aspects.html Keep in mind, though that because they are disorders of the brain that can have similar symptoms, it is also easy to misdx.
Sana Masab, if you have not done so, seek out a pediatric epitologist or a pediatric neurologist specialized in epilepsy. Neither a pediatrician or a psychologist is specialized in epilepsy. You might, however consider having your dd see the psychologist regularly to work on both behavioral and social issues that arise. Seizures can manifest in some very unexpected ways, and you need to share your list of concerning behaviors with your dd's neuro. In addition to eeg, she should have mri or ct scan and also blood work because these rule out other potential causes of the seizures. http://www.ted.com/talks/aditi_shankardass_a_second_opinion_on_learning_disorders.html
Is your dd on medication to treat the seizures? Each medication has potential side effects and some kids are more sensitive than others. The Epilepsy Therapy Project has a list of medications and side effects and how they effect kids. Look under the intermediate or professional settings. Ds has been on medications that have caused anger/aggression, inattentiveness, hunger, hyperactivity, excessive talkativeness, incontinence, random violence, suicidal ideation, dizziness, and tummy aches.
I agree with all the suggestions above. Epilepsy, and medications could certainly be affecting the kinds of symptoms you describe.
Also, the stress and changes over the last year or so could certainly exascerbate autism-like conditions. The need for a predictable routine is a common facet of autism spectrum disorders - so gentle quirks may become serious issues in times of stress or unpredictable (from the child's point of view) change. Regression is not an uncommon response to stress.
Diagnosis in matters of children's mental/neurological/behavioral matters is an inexact science. There is much overlap in the symptoms of all the conditions you have mentioned. And so much depends on the child's mood and appearance that day, the doctor's viewpoint, so many factors. Please continue to seek answers and solutions, but don't put too much worry into the opinion of any one doctor, especially if it doesn't feel right to you. Remember, you are the ultimate expert on your child - no one knows her as well as you do, or cares more about her.
Rhu - mother,grandmother,daughter,sister,friend-foster,adoptive,and biological;not necessarily in that order. Some of it's magic, some of it's tragic, but I had a good life all the way (Jimmy Buffet)