ADHD in girls
Girls with ADHD are diagnosed years later than boys, and often not at all. The reason is simple: the criteria were built around a hyperactive boy. Girls more often present as the daydreamer, the disorganised one, the "so bright but not applying herself" one — or as the anxious perfectionist who holds it together at school and falls apart the moment she gets home.
By the time many girls are referred, they've collected an anxiety or depression diagnosis first, and the attention piece was never examined. We look at the whole history, gather rating scales from home and school, and take seriously the presentation that doesn't look disruptive.
Twice-exceptional — gifted, and also struggling
A twice-exceptional child is intellectually gifted and has ADHD, autism, or a learning difference. The two mask each other. The intelligence compensates for the difficulty, the difficulty suppresses the achievement, and what a school sees is a bright kid performing at exactly average — so nobody qualifies them for anything.
These children are frequently told they're lazy for years before anyone tests the hypothesis that two things are true at once. The exhaustion of compensating is real, and it shows up as anxiety, refusal, or a sudden collapse in middle school when the compensating stops working.
Demand avoidance
Some autistic children experience ordinary requests — get dressed, come to dinner, start your homework — as genuinely intolerable, and respond with panic, negotiation, avoidance, or explosion. This profile is often described as pathological or persistent demand avoidance, or PDA.
An honest note: PDA is not a diagnosis in the DSM-5-TR and is not formally recognized in the United States. We use the term because it describes something real that parents recognize instantly, not because it appears in a manual. What matters clinically is that standard behavioral approaches — firmer boundaries, consistent consequences, reward charts — frequently make this pattern worse rather than better. Recognising that early saves families years.
Sleep problems in autism
Difficulty falling asleep and staying asleep affects a majority of autistic children, and it is the single most under-treated problem we see. Everything else gets harder on no sleep — irritability, meltdowns, attention, learning, and the wellbeing of every adult in the house.
Before anything is prescribed for behavior, we look at sleep properly: onset and maintenance, sleep-disordered breathing, restless legs and iron status, medication timing, and the sensory and routine factors around bedtime. It is not glamorous work. It is frequently the intervention that changes the most.
Eating difficulties and ARFID
Extremely restricted eating is common in autism, and it is not the same thing as picky eating or an eating disorder driven by body image. Avoidant/restrictive food intake disorder — ARFID — is driven by sensory experience, fear of choking or vomiting, or simply an absent interest in food.
It matters medically, because it produces real nutritional gaps, and it matters practically, because stimulant medication suppresses appetite in a child who was already eating very little. That interaction has to be planned for rather than discovered.
The first months after an autism diagnosis
A diagnosis arrives with a report, a waitlist, and very little explanation. Families leave with a document they can't fully read and a set of decisions nobody has walked them through: what the services actually do, which ones matter now versus later, what to tell the school, what to tell the child, and what to tell relatives who have opinions.
We don't perform the evaluations that authorise ABA services in Michigan — here's why, in plain language — but we can help you understand what you were handed, treat what is treatable, and work out the order of operations.
