Does this suggest ADHD / ASD (9yo girl)?

[wtftodo]

My 9yo DD (year 4) is very emotional, highly strung, and anxious and I increasingly think something more is going on than personality/behaviour. Would really appreciate any insights.

At school she is very capable, apparently works fine, has friends (tends to have intense close friendships with high conflict triggered by/in her) and seems popular. No behaviour concerns.

She’s a dry, sarcastic, loving, sensitive teenagery enigma (has always been a kid that people remarked was v teenage, even as a preschooler!)

But some things we see:
very anxious which plays out as aggression and meltdowns about doing things;
massive medical anxiety eg vaccines (spent an hour weeping under a chair at covid jab clinic), dentist phobia etc;
self care ropey eg hates brushing/washing hair.. improving on where it was when she was younger though;
needs teeth pulling out because doesn’t brush, holds food in her mouth etc and wouldn’t let anyone look in her mouth for ages;
very shy - wouldn’t talk to any adults other than parents or teacher for years;
very sensory seeking eg licking, tapping, stroking etc;
had always hated transitions (45min+ meltdowns as a toddler) and being told or asked to do something she didn’t want to do… eg now she might suddenly have a 30-60min total meltdown if asked to do instrument practice, though another day it might be ok;
resistant to homework;
blows hot and cold with her sister - extreme sibling rivalry, lots of love and thoughtfulness then will turn on her and freak out/meltdown if we pull her up on it.

Last year we did speak to school as she was refusing ever to do homework (lots of tears). I’m planning to speak to them again soon but would appreciate any thoughts from people with similar kids about what might be going on.

At the time I first spoke to school I thought maybe ADHD as she is very bright and imaginative but careless, bored, daydreamy, makes silly mistakes, but forgetful, scruffy, etc. I thought ASD ruled out by her friendships but maybe this is my own misunderstanding. plus, she has started having issues with some friends where they don’t want to be her friend anymore for a bit; she says she doesn’t know why but I think she may be lashing out at them and then too ashamed to tell me.

Sorry this is so long… does it suggest ADHD? ASD? A complex NT kid? Thanks for reading..

I'd definitely ask for a referral. I think there is more going on, but an expert is the one to take the information and diagnose or not. With my DD I didn't know what to think, after hours of questions and an assessment, it's ASD, but keeping an eye out for ADHD as some impulsive/hyperactive behaviour.

My year 4 daughter has just got an autism diagnosis and yes some of this sounds similar.

To really drill down I think you need to think of the clincial guidleines. Does she have problems with communication..ie. tone and facial expressions not always appropriate. Does she initiate conversation or less so than other children
Is she coming across as rude
Do other adults and children think she is odd some of the time or all of the time
Does she have issues with eye contact when nervous
does she have any repetitive behaviors or interests

These are all part of the assessment

Im happy to share more about thr process as our daughter is similar age with similar presentation

Finding group play difficult? Another big issue for us

I spend time with a lot of asd girls at the moment and none of them would be described as popular and having lots of friends so that would definitely be unusual.

Some of them are capable of being social and having friends but they are all the quirky odd snd on the edge of things rather than popular. By 9 the social understanding that girls need is a lot more intense and the asd girls really start to fall behind

Thank you, both, really helpful. Yes she does struggle with group play in the sense there'll be conflict as she just wants to play one on one (not sure how typical that is?) - at one stage she had a very complex self-inititiated time table of who could play with who on which days to keep everyone happy (ie her). But I agree, generally her friendships haven't been a big concern, so I thought unlikely to be ASD. I'd say the biggest issue is self-regulation - with friends and in general - which is why I think maybe more ADHD boxes are ticked.

I've not noticed her tone etc being unusual (other than a bit rude). She doesn't have repetitive behaviours or interests, she gets very into things eg a particular toy or cartoon, and she's becoming more attached to specific soft toys etc as she gets older, not less. But none of this to a degree that makes me concerned.

I don't think people think she's odd... she's sarcastic and dry, so they think she's cheeky (I'm sure some adults find her rude), and she's very understated; she will say hi to adults she knows if prompted but very low key and usually without looking directly at them. She doesn't initiate conversations with adults, she's very shy. She was selectively mute at the start of school. To the extent we stayed with family for two weeks and the only time she spoke to adult relatives was on the last day, driving in a car, without eye contact. This has improved and of course could just be shyness not anything else. All together though it feels like it may add up to more.

Because she's tall, and one of the oldest in the year, I think she's always come across as being a bit aloof / indifferent rather than shy and timid. And now it definitely feels like she sort of masks her shyness with teenager-ish behaviour, if that makes any sense?