Wait and watch before diagnosing a disorder

DEAR DR. FOURNIER: Our daughter is 5 years old, and we are older parents who waited to have a child until we were ready to devote ourselves completely to her. She is in kindergarten, and the teacher says that at times she does not pay attention to directions or like to play with the other children.She also sometimes has trouble with verbal communication. We notice some of these things at home, but believe much of it is because she is an only child. We think everything is OK, but both of us have histories of autism in our families. We discussed these issues with our pediatrician, and the doctor feels we are being obsessive. What do you think?ASSESSMENT: You are not being obsessive. You are concerned parents whose worries are exacerbated by our culture.Unfortunately, too many children are being diagnosed with conditions that are a mere reflection of a child's developmental pace. Not all children who experience trouble in school have Attention Deficit Hyperactivity Disorder (ADHD) or other over-diagnosed conditions.In reality, most students have problems with attention, communication and socialization at some point during their development, because children progress at different rates. Most students simply need proper instruction and learning strategies to help them during these challenging times.Your child may exhibit a few characteristics of a condition, but that does not mean that she should be diagnosed immediately. Your child must consistently demonstrate many characteristics over an extended period for you to be concerned. I would continue to watch your child's behavior and development with a close eye, but I wouldn't obsessively worry quite yet.WHAT TO DO: Be vigilant and keep a journal of your daughter's behaviors and actions. Be honest with yourself and don't read more into a situation than is evident from her behavior. This can be difficult for parents, but try to approach the situation objectively.Make a chart with the following listed behaviors, which are drawn from the American Academy of Pediatrics. Each day, ask yourself: "To what extent have I noticed each of these?"Remember that all children are expected to exhibit these characteristics sometimes, but she should not demonstrate most of them, most of the time.--7Preference for solitary activities.--7Difficulty making or keeping friends.--7Difficulty understanding non-verbal and social cues (such as understanding when you are upset just by looking at you).--7Obsessive, special interests (such as repeating certain videos, playing certain games, main interest in only one thing, such as trains, animals, the weather, etc.).--7Unusual hand or finger mannerisms that are not tics.--7Perceptions by others that your child may have ADHD, or that she may not be emotionally intact.--7Poor eye contact in most situations with most people, including you.Keep another chart for positive behaviors that exhibit strong developmental growth and contradict your concerns about autism. If you believe you have adequate data suggesting that your child demonstrates numerous symptoms most of the time, for a prolonged time, then you should ask your pediatrician for a referral to a developmental pediatrician.It is important that parents don't set their children up for a self-fulfilling prophecy of their worst fears. Instead, concentrate on the self-fulfilling prophecy of everything you've dreamed about parenthood. Every day, enjoy the wonders and blessings of your daughter, and remind yourself that she is developing at the right pace for her unique rhythm.(Write Dr. Yvonne Fournier, Fournier Learning Strategies Inc., 5900 Poplar, Memphis, Tenn. 38119. E-mail YF7thsense(at)aol.com.)