Would you be concerned about this 10 yo?

[Coordinatesofthemoon]

She permanently has a stuffed bear in her arm that she believes is real, she talks to it and claims it replies. You’d assume she has a great imagination and is playing make believe but this isn’t the case here.
If the bear is taken away for school for example, she will talk to herself instead and often replies outloud.
Everything is narrated. You could all be watching the same thing and she will loudly announce what is happening, for example that dog is walking past us/that’s a red car/ that person looked at me/I’ve got my hat on. Obvious things you wouldn’t expect to be said. Sometimes said several times to ensure everyone heard.
She is capable of chewing your ear off by speaking without even stopping for a breath. When asked why she can’t keep still or stop talking for a while she says that there is a lot in her head and she has to say it out loud.
school haven’t got any concerns as she’s an a+ student who absorbs everything like a sponge and passes all tests with full marks.
possibly not relevant but to also add, she is extremely rude and never says please or thank you, she is demanding and expects whatever she wants, she’s been spoilt for many years and has no respect for people or their belongings. She complains about absolutely everything and judges people a lot - i dont like this flavour/that tastes horrible/ what brand is it/ you didn’t cook that long enough/ why haven’t you got a carpet/ is that dust on the window. No one enjoys her company sadly. Yet no one will correct this behaviour. She is an only child which probably makes her feel lonely. She is passed pillar to post as she drains the life out of her parents.
I personally feel there is an underlying mental health issue here or perhaps ADHD? I want to help but I’m not sure where to start. Can anyone share their experiences or suggestions please.
(I won’t disclose my relationship to her for obvious reasons)

Well, she is not a small child and hasn't been for several years, and that is the basis of OPs concerns.

Schools are not good at picking up ADHD or ASD on girls at all. Unless children are disruptive and/or not academically thriving they don't particularly care.

Having a ND 'label' can help massively in terms of support with parenting, a child understanding themselves and also the school if they do struggle, girls tend to come unstuck in secondary school.

ADHD and autism are largely genetic so if there are no signs of autistic traits in her family tree then that is unlikely. Referrals for either on the NHS is many years long if you hit the bar and around £2.5 -3k privately. However signs traits for both have to exist from toddlerhood.

Talking through things and narrating can be a way of processing what is happening. Being forgetful can be a sign of executive function / working memory issues. These things have nothing to do with intellectual ability.

If it's suddenly surely less likely to be ND - though worth looking at lists of symptoms more widely to see if she displays any others.

It likely is worth getting on list at 10 - even if it a few years on lists secondary school often when ND hits worse so getting ahead is worth it.

I don't think usual in a ten year old - but I'd ask school if they have concerns or consider if she been distressed or upset by some recent change in her life.

If is sudden - how long it been going on for - if it's been a while so it's now persistent I think I'd be wondering and asking more questions - school definitely GP possibly.

Obviously can only talk to school and GP if you have PR.

At this age (I have several around this age) it screams neurodiversity to me. But the sudden onset is strange - I would have expected there to be a series of ongoing, though ever-evolving, signs and symptoms over time.

If it's a very sudden change in behaviour this is quite concerning and it needs proper medical investigation. This is important before focusing on any other conditions like autism.
Parents should take her to the GP in first instance.

Would the sudden onset not suggest a head injury?

Has she been clonked on the head with a swing or something OP?

I completely agree.

This is very unlikely to be ND if this is a relatively new thing.

It’s hard to say without knowing who you are but I wonder how often you see her and whether this colours your view of her.
E.g. She may talk your ear off because she doesn’t see you very often.

How often do you see her?
Is it like a grandparent and it’s less than once a week?

You say she’s passed pillar to post but also that she’s spoilt.
That suggests she’s given material possessions and has very few rules but also has very little emotional support - so of course she’s going to be struggling a little bit.

I would be more concerned about the parenting, rather than her behaviour which is likely to be a result of parenting.

As PPs have said it could be a medical issue too.

A very sudden change is more concerning than if it was ever changing quirks which would be more likely to indicate a ND condition.

It's more likely to be linked to a head injury, or depending on what you mean by "issues with parents" and "passed piller to post" the teddy attachment could be her Transitional Comfort Object much more common with young children but if she is at a stage of constant transitions then using that to adjust and narrate through what is happening is her way of coping and processing.

If you are in a position of offer more stability then do, if you are close enough to offer to arrange and pay for art or play therapy that might be beneficial too regardless of the source of the problem.

As soon as I started reading this post I wondered if she was an only child and so wasn't surprised when this was confirmed a little way down.
Growing up I knew a child exactly like this, also an only child. She was very lonely. No siblings or cousins nearby, older parents who were very busy running their business so often didn't have time to take her to play with friends etc when she was small. She lived in her own little imaginary world.
She's a perfectly normal adult now.

It could just be an observation of the truth.