Is This 3 Year Old Child ADHD, Autistic, or Bipolar?

Reader’s Question

My beautiful 3 year old grand daughter is such a handful! Her mother and dad are exhausted, and I can’t watch her for more than 2 hours without feeling somewhat trapped! My daughter says she will eat her own stools! I’ve not witnessed that but what she has done is strip in public, and holler “I’m naked”! She will sometimes tell you she has to “potty” but most of the time it’s more “I’m wet, will you change me?” Also along those lines, when you do get her to “Potty”, it’s as if she aims her flow of urine like a boy…it goes everywhere! At one point in time she was making a humping movement…as if she had seen someone having sex! She has been examined to make sure she hadn’t been molested. By the way, she has been spending extended periods of time with her paternal grandparents since birth…she is with them every other weekend and for a week at Christmas and any other time they have some sort of family event going on. I don’t believe they try to comply with my daughter’s wishes to limit things like french fries and sodas or to avoid smoking around her (she has bad ear infections on a regular basis).
My question is could this be bipolar, ADHD or a sign of Autism? If so how do we convince the pediatrician to test her? Most day care providers won’t accept them if they are not potty trained and my daughter and her husband both work.

Our Consulting Clinical Psychologist’s Reply

Children who are “a handful” are often ADHD rather than autistic. Their energy level and rapid changes in mood and behavior are exhausting. Pediatricians often refer children to other professionals or programs for medical, psychiatric, and/or psychological assessment. You can ask the pediatrician for a referral or in most areas, you can make your own referral for assessment.

We we evaluate children, we take several approaches:

1. Is their behavior appropriate for their age? Are they capable of doing what other children of their age are doing?
2. Do they exhibit behavior that might suggest poor modeling or poor adult examples in their environment? Many children mimic behavior they’ve seen in person or on television/movies. These behaviors are inappropriate but not a sign of a psychiatric disorder.
3. Do they have symptoms and behavior that might suggest a psychiatric or neurochemistry condition? ADHD and Bipolar Disorder children, for example, exhibit physical signs of excessive energy, sleep problems, aggressiveness, etc.
4. Can behaviors be related to age rather than a psychiatric or medical condition? As an example, all three and four year old children are disorganized, aggressive at times, have temper tantrums, can’t concentrate well, etc.

The behaviors you describe may be related to ADHD, Bipolar Disorder, inconsistent parenting, inappropriate exposure to adult behavior, an uninhibited or rowdy environment, and a host of other situations. I’d recommend both a pediatric as well as a psychological assessment. We may also want to evaluate the differences between the home environment and that of the grandparents. As you suspect, inconsistencies between home and the grandparents can produce a disorganized and uninhibited child who doesn’t know or remember what behavior is appropriate in what location.