Asperger help

My son, 19, was diagnosed with Asperger's syndrome when he was 10. We tried to find someone who could help him/us and were largely unsuccessful. I have 6 other children younger than my son in the household. At 15 because of his melt-downs, which were displayed as fits of rage and breaking things/yelling, a psychologist told us that we needed to move our son out of the home for the safety of his siblings and to save our family (we were falling apart including marriage). After a violent episode my son moved in with my parents and still resides there.  He has been diagnosed Bipolar because he has some episodes that seem either highly delusional/violent/psychotic (manic)? And on the opposite spectrum has severe depression. My son is not social and struggles (social phobia) around others. He is isolating and refusing to do anything but sit at home in his room. At my parents house there is another adult living there that is mentally handicapped that my Aspie son cannot tolerate. He has become violent towards this man. I have turned him in to DHS because I am a mandatory reporter but assured them that I could seek help for my son (who is resistant to any treatment/meds). Is there any suggestion as to how to handle my son and the situation? He is not fond of me or my husband because he feels like we abandoned him when he was 15. I have to do something because he is out of control at times. He also needs help so that he can lead a more social/less isolated life. He has a therapist that he sees at times but it has not been helpful to this point. I am not trying to simply whine about my situation but wondering where I should turn, and if anyone has any suggestions as to how to deal with my son as an adult? I feel sorry for him because he has not gotten the help that he has needed along the way (we have done everything we knew to do, IEP's, therapist, psychiatrists, diagnosis, neurological testing, etc.) because he is worse now not better. Any advice/thoughts would be helpful.

[Richard B. Graff, PhD, BCBA-D]

Thanks you for taking the time to post your commets on the forum.  Clearly, this is a very challenging situation, and there are obviously no easy solutions.  Because he has been given a diagnosis of bipolar disorder, and the fact that you used terms like "delusional" and "psychotic"', part of his treatment plan needs to include medication.  Of course, this will only be helpful if he takes the medication.

Has you son ever received consultation or services from a board certified behavior analyst with expertise in Aspergers syendome and severe problem behavior (you can search for one in your area at www.bacb.com).  Behavior analysts typically take a different approach towards treating problem behavior than most psychologists.  Behavior analysts operate under the premise that behavior occurs because it has a history of being reinforced, and continues because it is still being reinforced, at least intermittently.  One of the important things that they do is to develop treatments that are based upon the function of the problem behavior.  This process often involves doing assessments to identify exactly why the problem behavior is occurring (e.g., he finds his roommate aversive, so whenever he hits his roomate, the roommate leaves, and the aversive situation is avoided, which is highly reinforcing), and to develop more appropriate ways to access the same reinforcers as he is accessing by engaging in problem behavior.  The other thing that behavior analysts typically do well is to identify reinforcers that will motivate the individual to engage in appropriate behaviors, and then to develop behavior plans that will allow the individual to access those reinforcers when they engage in appropriate behaviors.  Applied behavior analysis is the treatment for individuals with autism spectrum disorders that has the most empirical evidence to support it's effectiveness.  So, you might try to find an expert in your area, and contact him or her, to discuss your son's issues.

Best of luck to you and your family.