Asperger/bipolar teen is hearing voices urging aggression

Our 17-year-old son was diagnosed with PDD at age 3.  Bipolar disorder was suspected at age 5 because of seasonal mood swings, intermittant explosive aggression and substantial family history of the disorder.This diagnosis was changed to Asperger Syndrome/HFA and bipolar disorder with psychotic features at age 10, when he was hospitalized briefly due a psychotic belief that he was a dinosaur on a mission to kill all humans.  (Dinosaurs have been his area of narrow focus since early childhood.)  He typically feels and expresses great remorse after a rage and notices when those around him seem upset.  After many changes of medication, therapies and special school programming, his impulsive aggression had become rare and he has been able to consider consequences and calm himself in most cases.

However, in the past two weeks, he has begun to hear what he calls "a deep, scary voice in my head" that tells him to do things or accuses him of things.  After a rage (when he had calmed himself with great difficulty) he admitted to me that the voice had been telling him to kill me, and this scared him.  (Me, too.  After a recent growth spurt our son is suddenly 5 inches taller and 40 pounds heavier than me!)  Today, he suddenly became angry at school, punched one teacher and try to bite another (behavior we had not seen in years.)  He admitted to me later that the "deep, scary voice kept calling me a coward for not fighting and I didn't know what to do."  He lives in fantasy a lot based on the dinosaur documentaries and Disney-type animated films he loves, but it is unlikely he picked this idea up from one of those sources.   He is remorseful after each episode, but very discouraged--and has seemed to have a decline in both cognitive and motor skills.  Is some kind of degeneration occurring in our son's mind?  Is he heading into another psychotic episode?  

[ames67]

Does your son see a developmental pediatrician along with his psychiatrist? Since he has the diagnosis of bipolar with psychotic features it sounds like this is another episode. The psychotic features are usually present during a manic episode as well as the rages. Being 17 puts him in a rough place, there are lots of things going on developmentally and with the brain that can influence him having an episode, not to mention the stress of being a teenager in general. That may be why you are seeing this behavior now. Sounds like he needs a medication adjustment. In terms of the cognitive and motor skill decline I would make sure the psychiatrist knows this. I am wondering if it could be a side effect of some of his medications. Please take care of yourselves.

[DLA]

Sometimes mentally ill children go through puberty later than the other children, and since you said he just went through a major growth spurt I'm wondering if this could have anything to do with it.  I remember well when I was a teenager and the boys all hit puberty.  Apparently the influx of testosterone made them really agressive b/c they fought over EVERYTHING.  Of course, I'm not a dr just a person on the outside looking in.  ;-)

Hope you and him find answers soon.  Am praying for you both.  And am really praying that the scary voice leaves him soon.  How terrifying that must be for him.

[mostlovablemom75]

Hi My name is Raney and I am going though some things just like yourself. I have 15year old daughter who has aspergers/bi-polar. she was very young when I was told she has pdd as well now they say it is aspergers and bi-polar, it is so painful to see her suffer. she does not here voices however, she tries to hurt herself. in the last 6months she has been inpaitent. How do you deal with not blaming yourself?? I feel so alone in this battle. I am scared for when she becomes an adult, will this stay just mental health or will become crimal due to the fact others just don't understand her. she doesn't want to be this either, but this raging is out of her control. Where did I go wrong. I will pray for you and your son please pray for my daughter and I as well. They say God never gives us more then we can handle I think I am at my limit.

[monkeyc]

There is a basic reality here.

Psychiatrist.  See one.  You son is having psychotic elements and he needs effective management of these episodes, he is already lashing out at people and having developmental problems and fantasies - sooner or later he is going to hurt someone badly in one of these episodes.

He needs to get treatment - my first advice would be take him to hospital for assessment - with the right drugs he will be fine.

As to mostlovablemom75  - Your daughter also needs some better care - the belief she will become a criminal is somewhat misfounded, Im mentally ill and Im not a criminal si there's that one put to bed and none of the people I know who are mentally il are criminals - being mentally ill does not make one a criminal and where that comes from I do not know.

She is cutting herself and self harm needs psychiatric care not prayer  - this can be controlled.

[LeftCoastChick]

Self-injury, rage and/or psychotic behaviors in teens usually need to be addressed in a hospital situation. If you don't it will only get worse as an adult. My brother is a prime example. He got hydrocephaly just after birth (water on the brain), and because the shunt wasn't put in in time, he has 40-50% of his brain damaged. He was diagnosed as having severe ADHD as a child, none of the adhd drugs worked. They would put him into violent rages, which I was at the other end of. It was traumatic, well beyond traumatic for me.

It's believed by my pdoc that the continual abuse I received is more then likely the main reason I have BP,  a predisposition that was triggered. My parents refused to deal with the situation seriously. He has been in trouble with the law, unable to manage keeping a job, hasn't worked in over 5 yrs. He has also raged at my parents, whom are in their 80's. I told him directly if he did that again, I will call the police and have him hospitalized. My brother was violent in school and at home. He hit a few teachers and many kids in his class. He stopped hitting me when I turned on him.

The only way one can deal with this is to hospitalize as soon as these issues come up. It only gets worse with age. Coddling a child only precipitates the issues.

My brother is now 42, and when my parents pass I will have to put him into a supervised setting, I don't have much of a choice, he can't handle any responsibilities but simple things like taking the trash out. I am the executrix of the will, he was taken off as co-excutor, as they can't trust him to not use drugs when he gets the money.

Prayer can help you, but in reality you have to make choices which may seem hurtful at the moment to your child, but in the long run, very very helpful.

[ILADVOCATE]

Asperger's is a developmental disability and that's there for life. Behavioral therapy can help but medication can't change it. However, what you are describing is probably bipolar with psychotic features. People can have both issues at once. And the onset date as the one post said (personal experience as well) is typically around that age. Yes if its that severe perhaps he does need to be hospitalized but the hospital should be equipped to deal with the behavior from his autism which is seperate from any psychiatric issue and can't (other than destructive behavior which can be stopped through specific constructive targeted behavioral therapy) be stopped. If the violent episodes stem from psychosis or an aspect of bipolar that can be treated. His various fixations from autism are there for life. Find a child psychiatrist who specializes in autism and let them make the referral.