What causes behavioral issues in a child?

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Based on the information you provided, I would not conclude that your daughter has ADHD (attention deficit hyperactivity disorder) or autism based on the school observations alone.

The fact that she understands instructions at home, responds to both parents, uses words to communicate, sings rhymes, counts toys, and engages appropriately with family are all reassuring developmental signs.

It is not uncommon for children who are three years and five months old to behave differently in a new or structured environment such as school. Some children need more time to adjust to classroom routines, group activities, and separation from their parents.

However, the concerns raised by her teachers, such as difficulty staying seated, leaving the classroom, and not following instructions, should not be ignored.

These behaviors may be related to:

1. Difficulty adjusting to the school environment.

2. A highly active temperament.

3. Anxiety or discomfort in a new setting.

4. Less commonly, attention deficit hyperactivity disorder (ADHD) or another neurodevelopmental condition.

Since these behaviors are mainly being observed at school and not at home, I would recommend monitoring her over the next few weeks while maintaining communication with her teachers.

If the concerns continue in multiple settings (home, school, and other environments), she should undergo a formal developmental and behavioral assessment by a developmental pediatrician or child psychologist.

In the meantime, please follow the underlying instructions:

1. Maintain a consistent daily routine.

2. Give simple, one-step instructions.

3. Praise and reward positive behaviors.

4. Limit screen time and encourage active play.

5. Ask the teacher to use short, clear instructions and positive reinforcement.

Could you please tell me the following?

1. When did she start attending school?

2. Does she make eye contact and play with other children?

3. Can she sit and listen to a story for five to 10 minutes at home?

4. Have her hearing and vision ever been checked?

5. Do her teachers report any language or learning concerns, or is the concern mainly about her activity level and staying in the classroom?

From the history you have shared, I would not label this as ADHD or autism at this stage. Since her communication and understanding at home are appropriate, careful observation and follow-up are more appropriate than making an early diagnosis.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

I have gone through your query and understand your concern.

Based on what you have described, I think your daughter would benefit from a comprehensive developmental assessment rather than assuming this is simply a behavioral issue.

The concerns you mentioned include:

1. She is three years and five months old but mainly uses single words rather than speaking in short sentences.

2. She communicates by gestures or actions much of the time.

3. She has difficulty responding when asked to stop or come back.

4. She frequently leaves the house to explore nearby places and is attracted to new objects.

5. She becomes upset and cries when told no.

6. At school, she has difficulty staying in the classroom and following instructions.

While her curiosity and desire to explore can be normal at this age, the delay in expressive language combined with difficulties in following instructions across different settings warrants further evaluation.

These behaviors may be seen in children with a speech and language delay, attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, or other developmental differences. It is not possible to make a diagnosis through teleconsultation alone.

I recommend that she be assessed by a developmental pediatrician. She would also benefit from a speech and language evaluation, as early intervention can significantly improve communication and social skills if a delay is present.

In the meantime, kindly follow the underlying instructions:

1. Speak to her in short, simple sentences and encourage her to use two to three word phrases rather than accepting single word requests.

2. Read picture books together every day and encourage her to name and describe objects.

3. Limit screen time and increase interactive play.

4. Use positive reinforcement when she follows instructions or stays with you.

5. Ensure close supervision outdoors, as her tendency to wander may pose a safety risk.

Could you please tell me:

1. Does she make good eye contact when talking or playing with you?

2. Does she point to objects she wants and also point to show you things she finds interesting?

3. Does she play pretend games, such as feeding a doll or pretending to cook?

4. Can she play with other children, or does she prefer to play alone?

5. Has her hearing ever been formally tested?

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for providing these additional details. They help in understanding your daughter's development better.

It is reassuring that your daughter has shown good progress in adjusting to school. She now willingly gets ready for school, goes with her father, finishes her lunch, and has adapted to the daily routine. This suggests that some of her initial crying was related to separation anxiety and adjustment, which is common in children starting school.

However, there are still some concerns that deserve evaluation:

1. At three years five months, she mainly communicates using single words and gestures rather than short sentences.

2. She often leads you by the hand or brings objects instead of asking verbally.

3. She has difficulty remaining in the classroom and following the teacher's instructions.

4. She is very active, likes to explore, and sometimes leaves the group to investigate new things.

Although these behaviors can occur in some children who are adjusting to preschool, the combination of speech delay and behavioral concerns means that a developmental assessment is appropriate. This does not mean she definitely has autism or ADHD. Many children with speech delay or sensory differences show similar behaviors, and only a detailed assessment can determine the cause.

I recommend:

1. An evaluation by a developmental pediatrician.

2. A hearing assessment, if not already done, as hearing problems can affect speech development.

3. A speech and language evaluation, since she is primarily using single words and gestures.

Until then:

1. Encourage her to use two- to three-word phrases before fulfilling requests. For example, encourage her to say water, please instead of only bringing the bottle.

2. Continue reading books, singing songs, and talking to her during daily activities.

3. Praise her whenever she uses words to communicate.

4. Maintain close communication with her teachers about her progress over the next few weeks.

A few questions:

1. Does she make good eye contact when talking or playing with you?

2. Does she point to show you interesting things, not just to request them?

3. Does she enjoy pretend play, such as feeding a doll or pretending to cook?

4. Can she follow two-step instructions, such as pick up your shoes and bring them to me?

From the information you have shared, I agree with the teacher that she should be evaluated, mainly because of the language delay and classroom difficulties. However, I would not make a diagnosis of ADHD or autism based on this history alone. An early developmental assessment will help identify her strengths and any areas where she may benefit from early intervention.

I hope it helps.

Thank you.

Hello,

Welcome back to icliniq.com.

The additional history is reassuring. Pretend play is an important developmental milestone. A child who pretends to feed dolls, cooks with toy utensils, or plays imaginatively is demonstrating positive social and cognitive skills. This makes severe autism less likely, although it does not completely exclude mild autism spectrum disorder or another developmental issue.

From everything you have told me so far:

The first are the reassuring signs. If you notice the following signs, kindly tell me.

1. She recognizes and communicates her needs by bringing her bottle, diaper, or taking you to the kitchen.

2. She understands routines and has adapted to school.

3. She finishes her lunch.

4. She sings rhymes.

5. She counts puzzles and toys.

6. She responds to you and your husband.

7. She engages in pretend play.

8. She explores her environment with curiosity.

The major areas of concern are as follows:

1. She is three years and five months old and mostly uses single words instead of three- to four-word sentences.

2. She relies heavily on gestures rather than spoken language.

3. She has difficulty staying in class and following group instructions.

4. She is very active and tends to wander toward interesting objects.

5. She becomes upset when her activities are interrupted.

My impression is that the most significant concern at present is her expressive speech delay, along with possible attention or sensory regulation difficulties. These can sometimes make children appear inattentive or noncompliant in a classroom.

I would still recommend:

1. A hearing assessment, if it has not already been done.

2. A speech and language evaluation.

3. An assessment by a developmental pediatrician, not because I think she definitely has autism or ADHD, but because early assessment and intervention are beneficial if needed.

At this stage, I would not label her as having autism based on the history you have provided, especially since she has pretend play, understands instructions, communicates her needs, and has shown improvement in adapting to school.

A formal developmental evaluation will help determine whether her challenges are due to a language delay, attention difficulties, sensory processing differences, or simply developmental variation.

I hope it helps.

Thank you.

Hello,

Welcome back to icliniq.com.

Thank you for the additional information.

It is reassuring that

1. She passed her newborn hearing screening.

2. She responds when you call her.

3. She comes when she hears songs or cartoons on the television.

4. She responds to the sound of a mobile phone ringing.

These observations make a significant hearing problem less likely. However, if there is a speech delay, I would still recommend a formal hearing evaluation because hearing can occasionally change after birth.

Yes, I do recommend a speech and language assessment. At three years and five months, children are usually able to speak in short sentences and communicate most of their needs verbally. Since your daughter is mainly using single words and gestures, early speech therapy can be very beneficial.

From everything you have shared, I see several positive signs:

1. She engages in pretend play.

2. She understands routines.

3. She follows familiar routines at home.

4. She recognizes family members.

5. She communicates her needs, even if mostly through gestures.

6. She has adjusted well to going to school.

These are encouraging features.

At this stage, I would recommend:

1. Speech and language therapy.

2. Evaluation by a developmental pediatrician to assess her language, attention, and social development.

3. Continue preschool, as interaction with other children often helps language development.

Many children who receive early speech therapy make excellent progress. Therefore, I encourage you to start therapy early rather than waiting.

Please keep me updated after her developmental assessment and speech evaluation. I will be happy to guide you further.

I wish your daughter all the best.

I hope it helps.

Thank you.

Hello,

Welcome back to icliniq.com.

Welcome.

Thank you.