My daughter is five years old. I also have a three-year-old daughter. As our girls have gotten older my husband and I have come to realize that our eldest responds very differently to many situations than our youngest. Since she was very small she has had a tendency to throw "fits". They’re basically tantrums, and she usually does this when she doesn't get her way, if we express disapproval, etc. Although we have parented both her and her younger sister in the same way, her younger sister doesn't engage in this behavior. These "fits" are still a frequent occurrence (they weren’t just limited to her "terrible twos").
As our eldest child has gotten older we have also noticed other characteristics. We have always commented that she is a "drama queen" - she obviously engages in outrageous behaviors to get attention, and exaggerates her reactions when we disapprove or don't pay "enough" attention to her. She is emotional and also extremely concerned with her outward appearance. All kids like to dress up, but she wants to play with makeup and dress up very frequently, always asking us if she looks "pretty". Basically, we have come to the conclusion that her reactions are so different than her sisters' that what we view as some of her behavioral problems must have something to do with her specific personality traits or some other traits she has had since birth. She is still a great kid, very loving, and extremely creative. She wants to be an artist when she grows up and is artistically gifted, drawing and painting in more advanced ways than many kids her age and also very frequently. She has friends and has done well in playschool. But these "fits" and the outrageous behaviors cause a lot of strain, and have us questioning whether she has ADHD or possibly Histrionic Personality Disorder.
How do I deal with this as a parent? Much of what I have been reading about Histrionic Personality Disorder relates adult problems to bad childhood experiences/parenting. In our case, our daughter had not been abandoned and in fact, I have stayed home with her these early years and she has a very loving father as well. Neither of us are alcoholics and we try to parent as best we can. But it still feels as though we are not parenting her adequately to help her deal with these issues, and we are concerned it could affect her relationships/success later on. It is also stressful for us quite often.
Can a diagnosis of Histrionic Personality Disorder be made as early in life as five years old? If so, is there potential for confusing it with ADHD and how can we tell the difference? If our daughter does have Histrionic Personality Disorder or could potentially have it, how can we effectively help her to make it a personality style rather than a disorder later in life? Obviously, not reinforcing the behavior is important, but we would like more specifics. Are there any resources out there we can access, and in particular can we avoid drugs or medication? She is so young and we feel these characteristics could be her biggest strengths if she can deal with them properly.
While it is true that the younger the child is the more difficult, if enough information is gathered a diagnosis can be done fairly accurately. It is also true that the younger a child is, the more a clinician needs to be careful and use due diligence. This is a result of the many variables present with younger children, such as their immaturity, the possibility of family dynamics, and the child’s limitations as a reliable historian. Young children can’t give many verbal cues and therefore the cues have to be more behavioral in nature.
ADHD is difficult to diagnose in a child before the age of 10, unless the symptoms are quite severe. Most of the symptoms do not fully appear before age 10, but progress further with age. There are six different types of ADD according to Dr. Amen, the leader in the field. A child suffering from this disorder shows marked inattention. This would be more pronounced with someone with ADD than in other children. Children in general show a short attention span.
Often, a child with ADD misbehaves, and throws more prolonged tantrums than other children. They often seem precocious in intelligence and can get lost in activities such as video games and television. They become so absorbed that they do not hear what someone is saying to them. They exhibit difficulty getting to sleep and it is hard to wake them in the morning. They are often irritable in the morning. They often are overly active and often react poorly to sugar. Their behavior is erratic and often displays poor social skills. They have a hard time attending limits and hearing the word “no”. Other symptoms frequently appear later in life.
It is true that in those with Histrionic Personality Disorder, it is a problem learning to truly grasp that other people in the world are important in their own right. This can develop as a result of parents who either abandoned their children or were too indulgent. However, even if the parents are great role models, what matters is a child’s perception of their place in the world. A child often perceives that they are being treated unfairly when they are not. They can often feel abandoned when a new child is born.
They might not understand that attention to the new baby is natural and might not realize that they are still loved and treated fairly. It is important to remember that this is rather common and does not necessarily indicate a personality disorder. The characteristics of Histrionic Personality Disorder are: a pervasive need to be the center of attention, extremely seductive behavior, a shallow expression of emotions, a great need to draw attention to self, a lack of empathy, overly dramatic behavior, being easily influenced by others, and seeing relationships as more intimate than they really are.
These behaviors are also common in children and as a result, would need to be very extreme before this diagnosis should be considered. I would suggest that you seek out a competent family therapist who is adept with both diagnosis and general family dynamics, to make a differential diagnosis.
If she has ADHD, medication would eventually be needed but diet, exercise, vitamins, supplements, and self-disciplinary activities such as yoga or martial arts are a must. If it is either normal sibling rivalry or Histrionic Personality Disorder, both reassuring your love and modeling good empathetic behavior is helpful.
I hope this has been helpful. Take care.
Jef Gazley, M.S., LMFT
This question was answered by Jef Gazley M.S. Jef has practiced psychotherapy for twenty-five years, specializing in Love Addiction, Hypnotherapy, Relationship Management, Dysfunctional Families, Co-Dependency, Professional Coaching, and Trauma Issues. He is a trained counselor in EMDR, NET, TFT, and Applied Kinesiology. He is dedicated to guiding individuals to achieving a life long commitment to mental health and relationship mastery. His private practice locations are Scottsdale and Tempe, Arizona. You can also visit Jef at the internettherapist, the first audiovisual mental health online counseling center on the net.
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