We had the evaluation Monday to see if my daughter has selective mutism. I went in with worries that she would be mislabeled as high functioning autistic/asperger’s syndrome. Well, I was relieved to find out that wasn’t at all a concern, but there were some other areas of concern.
But let’s start at the beginning.
My 4.5 year old daughter was allowed to play in an area close to where I was talking with the pediatric neuropsychiatrist, but off to the side, where the doctor can watch her. The doctor wanted to see if she could get cause and effect by hammering pegs into a board, then turning the board over and doing it again (she did that a few times). She also played with some sort of board where you can move the animals to their homes. And she also drew lots of pictures on a magnadoodle and also came up to me and whispered what the pictures were (like Santa’s bag full of presents). Oh, and there was a frog puppet she played with. I also brought my digital camera of her speaking and doing things at home so she could see she is capable of speech and can do things.
Some of my suspicions were confirmed. The doctor said that while there is no question that my daughter is bright, she feels that she has sensory issues and anxiety and it’s the sensory issues that are leading to the mutism and other behaviors she exhibits (like the meltdowns and some problems with transitions she had in the past). She had said that not only did she think my daughter is oversensitive in some areas, in other areas she was undersensitive (that she didn’t seem to register or notice something that she should have been able to – and I don’t know what that should have been). She also feels there are some strong anxieties (including separation anxiety), but overall my daughter tolerated the session very well (though she hardly spoke and it was mostly only in whispers to me) and I know I was a little surprised that she didn’t just freeze up while we were there. As far as the sensory issues goes, she mentioned that there are a “bundle of early reflexes that need development” (I wasn’t clear that if it was specific to my daughter or to the age group she is in). But she did go on to say that she felt that some of them could go away on their own, especially since I have seen some improvement over last year. However, I also do know that if they don’t, they could impair her development in other areas. She also told me some of the things I’ve seen like the clicking sound she makes sometimes recently, the lip licking and pulling in of her lower lip she did before indicates oral reflexes that could either be a nervous habit, or they could be an actual tic (it’s hard to say at the moment).
As far as her cognitive abilities go, she said her higher brain function is definitely advanced for a 4 year old. She is capable of planning her play and executing it out. Meaning, she’s just not randomly doing things, she has a plan in her mind and then executes the plan.
But, and even though this seemed like not a big deal at the time, she mentioned she noticed my daughter’s attention start to drift. She kept asking me questions about whether or not I noticed if she could sustain her attention. I was kind of at a loss of what to say, because I have 3 children at home and we are busy a lot and it’s not like I was timing her activities. And I’m not sure exactly what she meant. In thinking about it now, I’m wondering if it was that she moved from activity to activity quite quickly – but really they were “baby toys” and not going to engage her attention for very long. I mean, she can come up with complex play with dolls and playmobil pirates, play games like Sorry! and Clue Junior and dominoes with me, and make up stories about the pictures she’ll see in a book from beginning to end. Not a baby book either, but she did this with her sister’s Arthur book. She also kept looking up to see what was going on with me and the doctor – I mean, my daughter is not stupid – she knows we were talking about her. I forgot to tell the doctor these things while I was there because I was trying to figure out what she was implying from what she was saying and I honestly couldn’t think of examples off the top of my head.
Because of the drifts in attention that concerns her, the doctor did recommend we get her tested further. I am now realizing as I’m talking about this, she probably thinks my daughter might have an attention deficit disorder. Except honestly, even though she may seem to, I think she’s just very bright and gets bored because she needs to be challenged. I mean, how exciting is it to master something quickly and then do it over and over and over and over again? Quite honestly, I don’t know many 4 year olds that can sit to do many things for longer than 10 minutes anyway. If she thinks my daughter has an attention problem, then a lot of friends of mine should really worry about their kids, because she can sustain her attention much longer than they can. My gut instinct – she’s gifted and just bored and needs to have more complex things to do in order for them to hold her attention. I know gifted children are OFTEN mislabeled adhd, when in all actuality, they are simply not challenged enough. I know my husband was identified gifted as a child, and I know I was always in advanced and honors classes. It would not surprise me if daughter is gifted too. I know her older sister (6) is already breezing rapidly through reading right now, and in other ways showing signs of being gifted.
Anyway, I did think further testing was in our best interest, simply because what she told us wasn’t really a formal diagnosis (I don’t think). After a few (5 more) testing sessions she will sit down with my husband J and I and give the full appraisal of her.
The bottom line was that she sees my daughter is bright, creative and imaginative, with sensory issues that are leading to selective mutism in school and she may possibly have attention issues.
Since I’m fully aware this time is a sensitive period for neurological growth, I agree that I want her to look further into the sensory issues (which are highly treatable) and also look more into the attention drift too (to confirm or rule out ADD), because this is the right time to be working on those issues. Oh, and just to be sure she doesn’t have a hearing problem she suggested I go for a full audiological screening too. It probably wouldn’t hurt, because she does have trouble enunciating words. She says things like purfose (instead of purpose), and “sliver” when she meant “slither”. (yes, as in the snake “slithers”).
I need to remember to bring in a list of things I forgot to tell the doctor. I also want to start an time log to show how long she can keep at something. I don’t know if that would be helpful, but it seems like it would be.
Needless to say, I have more questions than answers right now. I am really making myself agitated thinking about everything going on with my girls: I’m stressing a bit (in both a good way and a bad way) that my 6 year old daughter is rapidly progressing through her reading skills (she’s at mid-second grade level now, when she couldn’t read when she first started kindergarten) and other skills that she seems to master quite easily make me wonder how smart she is and if the school will be able to keep up (there is no gifted program until 4th grade); and about the issues with my 4.5 year old – also bright with these sensory issues. If you have ever read up about gifted children, you may have learned about emotional overexcitabilities. And you may know how easy it is to pathologize the traits of gifted kids – the very things that make the children gifted are often the things that also appear to be negative traits.
This is making for one very anxious mama. But for now, I’m going out to play with my girls. Because it’s a beautiful day and I’m not going to waste another minute of it when we could be outside playing the way children are designed to.