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Severe behavior problems in ADHD / Aspergers son
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Severe behavior problems in ADHD / Aspergers son

We have a twelve-year-old son who has been diagnosed with ADHD at age six and Aspergers at age ten. His primary problems have been hyperactivity, severe impatience (can't even wait in a simple line for a few minutes without a lot of flak), and severe social skill deficits. He is a self-described loner who will tell you: "I hate people." He enjoys little to no interaction with his peers, prefers solitary play often involving entertaining "inanimate" friends - e.g. got on a waterfall kick.

Now, things have taken a turn for the worse. Claims to have looked in the mirror one day and decided he was no longer going to take people's ****. He has since become hard to control, refusing to do chores and often just wanting to stay in his room and play by himself. We can't discipline him without a rage - will often go for things made of glass, throwing and shattering stuff. Punching walls, kicking doors, etc.. Can't reason with him, and he will say he is in control of himself, wants people to leave him alone, etc.. I threatened to call the cops at one point, and he ripped the phone out of our wall, etc. Is now abusive to my husband for reasons I can't fathom, and has become protective of me. Will rage during arguments that don't involve him. Claims my husband is a jerk for having opinions he doesn't agree with, accusing him of brainwashing me. For about a year it was mostly at home with social skills problems at school.

Lately, this behavior is occuring at school. I am called down like once a week. He does his work and all, but instead of playing with kids at recess - he hides in the bathroom to read books. They confronted him about it last week, told him that he is expected to be outside, and apparently spit in the principal's face and said: "I will do whatever I want. Get in my way, and I will hurt you." Well, he is now suspended pending an eval by a doctor. It led to an argument at home in which he ended up spitting at my husband and knocking over our kitchen table.
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521840_tn?1348844371
Hello,
    this sounds like an awful time for your family, but there are things you can do right away. With respect to your concerns about Ritalin, although Ritalin is a stimulant, it is not associated with violent behavior. Usually stimulants help children  to increase their level of self-control. If you gave the Ritalin and noted a significant, unexpected, shift into aggressive behavior, then contact your prescribing physician immediately. Fortunately, even time release stimulants are processed by the body by the end of the day, so you should be able to tell if there is a marked difference in behavior, mood, or quality of thinking on or off the drug. If you note this, tell the physician.

I strongly recommend you proceed immediately to a pediatric psychiatrist and request an urgent evaluation. Your son's behavior and mood symptoms should be evaluated by a psychiatrist, not just your primary care physician. A psychiatrist is a medical doctor and a specialist in medical management of psychiatric disorders. I would keep a journal of symptoms and unusual behaviors prior to the appointment, and if you can, try to video what your son is like during an outburst. Make the psychiatrist aware if you observe symptoms such as: disordered thinking, strange ideas or delusions, mood swings, periods of reduced need for sleep, extreme changes in energy level, hypersexuality and suicidal or homicidal ideas.

The very first priority is everyone's safety--yours and your son's. You and the psychiatrist may need to consider if your son needs a higher level of structured care than you can provide at home or in the regular public school setting. The doctor may recommend that your son spend some time in a day or overnight treatment program where they can help get him stabilized. This will give professionals a chance to try different medications and to conduct a thorough psychological assessment. I know that may sound scary for you to hear as a parent, but having specialists give him treatment is so much better then waiting for the police to be called at home or school.

Your son's behaviors are more than just expected features of Asperger's disorder, but they may arise from the characteristics of people with Asperger's. People with Asperger's have difficulty tolerating some types of stimulation and social demands. Middle school can be an almost painful setting for them to endure with all of its noise, chaos and how hard it can be to navigate peer relationships. It is not surprising that he is having increased difficulty at age 12. Early adolescence can be a time of increased stress for children, particularly if they have a disability. Your son sounds like a very anxious child who feels so out of control he is going to extremes to try to control the world around him.

You and your husband will want to find behavioral therapy to help you stabalize your son's behavior at home. This is tough work, but there are very effective tools you can learn to use that will make things better. I recommend you find a psychologist or behavioral specialist who can provide Parent Management Training (PMT). This form of therapy has been shown to be very effective for reducing aggressive behavior. If you can not obtain PMT, ask for training in behavior modification techniques. Find a psychologist who has experience with young people with Asperger's so that they can tailor the behavior plan around your son's special needs. Finding therapy for your son will be important, but most important right now is getting you and your husband help in managing the aggressive behavior. Just trying to get tougher, make threats, or use more punishment is most likely to make the situation worse.

If problems increase at school, and you do not already have an IEP or 504 plan, this may be time to start working with special education staff to get accommodations and supports for your son. It sounds like he is overwhelmed by the demands of his current setting, and needs help coping. You may not want to see him classified as a child needing special education, especially if he is smart and academically on target, but keep in mind that if the school does not have a plan for hwo to help him, they are going to treat him like any other disruptive, aggressive child (suspending him, calling police, using restraint etc). This is most likely to make the situation far worse.

The following resources may be helpful:
The Kazdin Method by Dr. Alan Kazdin (excellent behavior management guide)
National Alliance on Mental Illness http://www.nami.org/
Asperger's Association of New England guide to online resources
http://www.aane.org/index.html
The Council for Exceptional Children www.cec.sped.org
Look Me in the Eye, My life with Asperger's by Paul Robison (autobiography of a man with Asperger's-both funny and sad, but overall very uplifting)

Best wishes
Dr. Rebecca Resnik

Disclaimer: This post is written for informational purposes only. It is never intended to replace face to face medical or psychological care. This post is not intended to create a patient-clinician relationship, nor to give or rule-out a diagnosis.
4 Comments
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Avatar_m_tn
What I meant to say at the end is whether or not this is ADHD / Aspergers, a hormonal imbalance, or as my husband thinks - the prescribed Ritalin may have something to do with it. But my son takes Ritalin, and if my husband ever differs from the doctor - well, my husband is a jerk in my son's eyes. "Doctors know best, you don't," my son claims. I am wondering too if the Ritalin might be contributing to this. Or if he needs something else. He is on Ritalin, but it is doing absolutely nothing and maybe it's making it all worse.
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Avatar_n_tn
Hi
I just wanted to say that I have ADHD and am now 36.
from my personal experience ADHD can make you feel very isolated and out of sync with people. As a child every day I felt that I was trying and trying and always messed up. In the end I was just so frustrated (no ones fault i know).
In the end I just exploded and became a rebel.
I am also on ritalin. I have found that if you don't have a break it kind of stops working. Does your son have breaks?
I really hope you can find some peace in your house. I'm sure your son loves you and your husband ( he may feel that Dad can take the aggression?)
Best wishes
Lisax
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470168_tn?1237474845
I am a mum with a child on the autistic spectrum.
I am surprised that his school is expecting him to "go outside and socialise", when part of his diagnosis says that he will have difficulties with both language and social interaction and play skills.  If the school don't have a Social Skills Group, and he doesn't have a programme put together by a Speech and Language Therapist, and they don't have dinnertime clubs and they don't have structured activities that he can join, and he doesn't have an adult key worker helping him to use the skills he has been taught by the SALT, then how are they expecting him to socalise?  If he could do it by himself he would lose his diagnosis!
It sounds like he is aware of his difficulties and rather than keep trying and failing he has just given in and has withdrawn from social interaction.  Who can blame him?
Does his school have experience and expertise in meeting the needs of children with aspergers?
He may also have literal and concrete thinking which will result in him believing that there is only one way to do things, or a doctor is always right and anyone who disagrees is wrong etc.  This is inflexibility of thought, and again this is something an Educational Pscyhologist would be aware of, and would be something to work on in school.
Google Semantic Pragmatic Speech Disorder to see if that sounds relevant?
There is alot that can be done - but don't medicate to save the school having to put in some work and support him and meet his needs.  Your son has a dual diagnosis and the difficulties you mention are probably down to his diagnosis.  If your son was blind there would be all kinds of supports available to help him navigate his way around school, social activities would be planned around his difficulties etc.  You wouldn't turn a blind child out onto the playground and expect them to join in.  Just because your son's difficulties are invisible doens't mean they aren't real.
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521840_tn?1348844371
Rebecca Resnik, PsyDBlank
MindWell Clinical Psychology
Bethesda, MD
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