Your child is majorly upset over something - but is it a meltdown, shutdown, tantrum, or full-blown panic attack?
As a parent of a child with High-Functioning Autism (HFA), you know that your child is capable of having a meltdown occasionally. We’ll describe a meltdown as “an over-reaction to environmental stimuli designed to give HFA children a sense of control when they feel that their world is out-of-control.”
Let’s also make the distinction between a meltdown and a temper tantrum. We’ll describe tantrums as “normal acting-out behaviors designed to help children assert their independence as they learn they are separate beings from their parents.”
Having defined meltdowns and tantrums, parents need to know that there are times when their “acting-out” HFA children are having neither a meltdown nor a tantrum; rather, they are in the throes of a legitimate panic attack. Let’s describe panic attacks as “periods of intense fear and apprehension that are of sudden onset and of variable duration of hours to days.” Panic attacks usually begin abruptly, may reach a peak within 10 minutes, but may continue for much longer if the child had the attack triggered by a situation from which he or she is not able to escape.
In panic attacks that are triggered by a situation from which the HFA child desires to escape, he or she may make frantic efforts to escape, which are often violent – especially if parents attempt to contain the child. Often, the child suffering from panic attacks will experience significant “anticipatory anxiety” in situations where attacks have previously occurred (e.g., a child having a panic attack after the neighbor’s dog jumps up on him, resulting in the child fearing ALL dogs in ALL situations after the initial incident).
Experiencing a panic attack is one of the most intensely frightening, upsetting and uncomfortable experiences in a child’s life and may take days to initially recover from (unlike meltdowns, which usually only last a few minutes to a few hours). Repeated panic attacks are considered a symptom of panic disorder.
Children with HFA are prone to anxiety, which in extreme situations can lead to panic attacks. Panic attacks are a terrifying experience where the body reacts as if it is in immense danger, in a situation where most children would not be afraid. A small number of HFA children will go on to develop panic disorder, whereby panic attacks are intense and occur frequently. If left untreated, panic disorder can be a debilitating condition, severely restricting the quality of life for the youngster.
In between attacks, the affected child often feels intense anxiety, worrying when and where the next one will strike. Panic attacks are accompanied by the unpleasant physical symptoms of anxiety (e.g., heart palpitations, hyperventilation, muscle pain, dizziness, sweating) along with the fear that the attack will lead to death or a total loss of control.
HFA children suffering from panic attacks need to be taught that the physical symptoms they experience with an attack are just extreme versions of normal bodily responses to danger. For example:
Pupils dilate for more acute vision, and this can cause difficulty with bright lights or vision distortion.
Blood is diverted away from non-essential areas including the stomach, brain and hands, resulting in digestive problems, dizziness and tingling or numbness in the hands.
Adrenaline being released into the blood stream causes the heart to beat faster and the breathing rate to increase in order to supply major muscles with more oxygen.
Sometimes it may appear that the walls are folding in, or in extreme cases, inanimate objects may appear to move.
During an attack, the affected child can become convinced that the symptoms are caused by a major health problem (e.g., heart attack, brain tumor) or that he or she is going crazy. This fear causes more adrenaline to be released. Thus, a worsening cycle can be generated.
Panic attacks can be accompanied by other conditions (e.g., depression), or they can give rise to the development of phobias. If, for example, the HFA child has a panic attack during his first day of school, and then associates panic attacks with “the classroom,” he or she may refuse to go to school. Some of these children’s lives become very restricted, and they avoid normal, everyday activities. Some may even refuse to leave the house unless they are accompanied by a parent (i.e., agoraphobia).
Treatment—
There are a number of treatments for panic attacks, with research showing cognitive behavioral therapy to be the best practice. Some parents may choose to combine a number of treatment options for their child, for example:
1. Relaxation techniques/meditation: These can be useful to reduce acute anxiety or to help the child cope during a panic attack. There are numerous books, CDs and DVDs which can help the child learn these techniques.
2. Medication: Some of the anti-anxiety drugs are very potent and some produce severe side effects in some kids. While medication can give short term relief to the symptoms, it is important that other strategies are used as well, including counseling and learning more about the condition.
3. Diet and exercise: Physical fitness and a good balanced diet are essential for emotional well being. Many young people find that doing something physical helps reduced the “keyed up” feelings often associated with anxiety. For some children, high caffeine drinks and chocolate can act as a trigger to panic attacks, probably because caffeine can cause bodily changes (e.g., increase in heart rate), which can be misinterpreted as the start of a panic attack. The fear this causes can then trigger a real panic attack.
4. Complementary therapies: Some parents report that the use of herbs, vitamins, and homeopathy have been effective with their child when either used alone or in conjunction with other treatments.
5. Cognitive behavioral therapy: CBT is very effective for treating panic attacks. It teaches affected children how to identify their anxiety and how to change anxiety-generating thoughts. The underlying belief with CBT is this: It is not so much “events” that are a cause of anxiety, but what the child “thinks” about the events.
6. Parental instruction: Teach your child to avoid fighting the panic. When experiencing a panic attack, affected children need to remember the following: It does not matter if they feel frightened, unreal or unsteady, because these feelings are just an exaggeration of normal bodily reactions. The feelings are unpleasant and frightening, but not dangerous. Teach your child to face the symptoms and not run from them. Tell your child to not add to his or her panic with scary thoughts about what is happening or where it might lead. Instruct your child to allow time to pass, and for the fear to fade away. He or she can use one or all of the following positive statements:
“I can be anxious and still deal with the situation.”
“I’ll just let my body do its thing. This will pass.”
“This anxiety won’t hurt me, even if it doesn't feel good”.
“This feeling isn't comfortable or pleasant, but I can accept it.”
Symptoms of panic attacks include the following:
chest pain or discomfort
chills or hot flushes
depersonalization (i.e., being detached from oneself)
derealization (i.e., feelings of unreality)
fear of dying
fear of losing control or going crazy
feeling dizzy, unsteady, lightheaded, or faint
feeling of choking
nausea or abdominal distress
palpitations, pounding heart, or accelerated heart rate
paresthesias (i.e., numbness or tingling sensations)
sensations of shortness of breath or smothering
sweating
trembling or shaking
Many children being treated for panic attacks begin to experience “limited symptom attacks” (i.e., fewer than four bodily symptoms listed above being experienced). It is not unusual for the affected child to experience only one or two symptoms at a time (e.g., vibrations in the legs, shortness of breath, an intense wave of heat traveling up the body).
Some symptoms are sufficiently different from any normal sensation such that they clearly indicate panic disorder. Panic disorder does not require four or more symptoms listed above to all be present at the same time.
Pure “causeless” panic and the racing heart beat that panic causes are quite sufficient to indicate a panic attack. But, with proper treatment and parental-coaching/encouragement, affected children can go on to live very normal lives.
Resources for parents of children and teens on the autism spectrum:
"For those parents of both neurotypical kids and children on the autism spectrum, do you basically parent the same - or is there a big difference in your approach with the autistic child?"
There are basically two types of parents who are raising Aspergers and High-Functioning Autistic (HFA) children: (1) those who use "traditional" parenting techniques with ALL their children - including the one with Aspergers, and (2) those who have learned that you simply can NOT parent Aspergers children and "typical" children in the same way.
Why? Because the mind of a child on the autism spectrum is wired differently than that of a "typical" child.
Think of it like this: Let's say you have 3 children. Two of them only speak English, and one only speaks German. You, as a parent, have learned to speak both languages. So, which language will you use when you are trying to get your point across to the German-speaking child? German, of course! But too many parents are speaking a foreign language to their Aspergers or HFA child, and then they wonder why the kid "doesn't get it."
It's not that your child "doesn't hear" you; rather, he or she "doesn't understand" you. When you, as a parent, try to teach your child how to behave, you must know how he or she thinks and what language he or she understands. Don't speak "neurotypical" to a child on the spectrum.
When helping these special needs children to learn new behaviors (e.g., positive social skills, taking “no” for an answer, doing chores, completing homework, etc.), parents can use a combination of parenting strategies that work well with nearly any child, but that seem to work especially well with the child on the spectrum, including:
being a positive role model
consistently following through with positive and negative consequences
continuous reinforcement
developing and clarifying clear expectations
modeling
praising the youngster for his or her behavior
prompting
rehearsing appropriate behavior
role playing corrective behaviors
staying calm in the midst of meltdowns when your youngster gets upset
Let’s take a deeper look at some of these strategies:
1. "Target Behavior of the Day" is a technique used to help Aspergers and HFA children think about good behavior on a daily basis. Parents can introduce this exercise by asking the child to make a list of specific behaviors that are desirable (e.g., listening when parents talk, waiting your turn, speaking with an inside voice, cleaning up the bedroom, not picking on the younger sister, etc.). These behaviors are then written on large strips of poster-board and displayed everyday on the "Target Behavior of the Day" bulletin board. During the day, the mother or father records a mark on a tally card each time the child displays the desirable behavior. If the child modeled such behavior throughout the day, the parent praises (e.g., “You did a great job of being responsible today”) and rewards (e.g., “As a reward, you can have an extra 15 minutes of computer time tomorrow evening”) the child at day’s end.
2. “Do what I say and not what I do” is a common phrase that is often repeated; however, it only confuses kids on the autism spectrum. These young people will not do what the parent says, rather they will do what the mother or father has modeled. Kids model the behaviors that the parent has presented to them time and time again. Looking at the messages you send your youngster is easily seen by analyzing your own behaviors. Your main goal is to always set a positive example that your child can model.
3. Before parents concentrate their efforts on disciplining their youngster for misconduct, they must have a strategy, or game plan, for teaching their youngster how he or she is expected to behave. Moms and dads must model the appropriate behavior for their child if they want him or her to be successful in behavior modification.
4. Continuous reinforcement is an “operant conditioning” principle in which the child is reinforced every single time he or she meets parental expectations. For example, you, as a parent, might offer an extra 15 minutes of computer time every time your child completes his or her homework before dinner. However, one of the biggest dangers when using this type of reinforcement is “saturation.” For example, the child basically gets full – you keep offering that extra 15 minutes of computer time if homework is completed, but it’s no longer a motivating force for the child. In other words, NOT doing homework before dinner has more value for the child than extra time on the computer. Thus, the idea that “giving reinforcement in the same way all the time” is the best way to teach/learn is NOT necessarily true. Instead, you will want to periodically offer other reinforcers that have equal value (e.g., the child can have his or her favorite food item for dinner if homework is completed on time).
5. Developing clear expectations of what both parents want is crucial. Depending on the background, or what is deemed as right and wrong, parents, within reason, should plan and communicate their expectation to each other. Creating a list of expectations (e.g., social, academic, religious, family oriented, personal appearance and hygiene, etc.) for different settings and activities will help moms and dads to be very specific and concrete in teaching their youngster. Some expectations are certainly more demanding than others; however, moms and dads must take into consideration the youngster’s age, ability, developmental status, and resources that are available to the family. Have you, as a parent, taught the expectation to your child? Can your child clearly understand the expectations given? Can your child model and perform what you have expected? Answers to these three questions will determine whether or not your expectations are realistic.
6. Negative consequences are defined as “adding a negative consequence to prevent or decrease a certain behavior that is problematic, or taking away something that the youngster holds dear.” Doing extra chores and/or taking away a privilege are examples of negative consequences. Aspergers and HFA kids will soon realize that the behaviors that are causing these consequences are to be avoided.
7. Positive consequences are used to increase or encourage desirable behaviors. Catching your youngster doing good acts and following directions are great examples of when to apply a positive consequence. Positive consequences can range from short-term rewards (e.g., candy, extra play time, etc.) to long-term rewards (e.g., trips and gifts). Parents should use positive consequences that will work for their youngster, and use consequences that don’t cost money.
8. Providing constructive feedback to the child is important. Many parents have devised an approach for helping their “special needs” son or daughter to demonstrate positive behaviors, For example, every Saturday, one mother writes a brief progress report on the child, describing his behavior (both good and bad), effort (or lack of effort), chore and homework completion (or lack of completion), and the total number of parental requests that were accepted (or rejected). Then the mother meets with the child to discuss the comments in the progress report. During this meeting, mother and son work together to problem solve and suggest alternatives where needed.
9. Role playing with your youngster is great method to teach proper behavior without resorting to the use of punishments or consequences. Each and every time you practice doing the right thing in a situation with your youngster, you increase the chances for his or her success and decrease the likelihood that he or she will engage in that problem behavior in the future. Here is a simple four-step role playing format:
narrate the situation that occurred for your youngster
swap roles with your youngster
begin the role play
give critiques by giving feedback on the performance, using praises when needed
Role playing can help an Aspergers or HFA youngster to think in advance and rehearse adaptive responses to potentially frustrating situations, thus developing a more thoughtful and flexible response to the everyday problems that he or she faces.
10. Staying calm is an important part before applying any positive or negative consequences to your youngster’s behavior. Kids with autism can be sarcastic, defiant, rebellious, and even violent. Moms and dads have to prepare themselves for times like these and learn to keep their cool. There are times when these special needs kids will make their mother or father so furious that the parent gets caught up in the moment, and as a result, is not able to think clearly. Parents must be aware of what is going on around them. They need to know their limits to which the youngster pushes, and redirect situations back in focus to respond properly.
11. Verbal prompting has been found to help these children better understand the “house rules.” For example, one mother helps ease transitions (generally a very difficult time for many children with Aspergers and High-Functioning Autism) by telling the child when there are "3 minutes to go before ______." Even younger kids who might not comprehend time can benefit from the cue, which alerts them of the approaching change.
12. Praise, praise, and then praise some more. Here is the “how and when” of praising an Aspergers or HFA youngster:
Always give a rationale of why you approve of your child's positive behavior. It is always good for the youngster to know why that specific positive behavior benefits him/her or others, since this helps the child to understand the relationship between certain behaviors and the outcomes. Sometimes you can add-in a reward, which reinforces the behavior that you have approved of, described, and given a rationale of why you approve of it.
Describe the positive behavior that you want the child to continue. This lets him or her know what behaviors to keep doing in the future.
Praise your youngster when he or she makes positive “attempts” at new skills or tries new tasks.
Praise your child at tasks he or she is already doing well at, but that you may have taken for granted.
Praise your child when he or she makes improvements on current skills or tasks.
Try action praises like giving a hug, a kiss, a high five, nodding in agreement, or the clapping of hands.
Try vocal praises like “wow”, “keep it up”, “amazing”, “super”, or “that’s a great job.”
Here are some parenting tips that are very specific to children with Aspergers and High-Functioning Autism:
1. “Typical" children and those with Asperger’s Syndrome may have very different ways of communicating their feeling about life events, including: managing emotions, learning from life events, incorporating rituals and traditions for managing life events, dealing with dying and death, and coping with illness, injury or recuperation. Just because children may process and communicate their feelings differently, though, doesn't mean it's right or wrong. It is best to be honest and literal to help “special needs” children to manage major life events. Provide information and allow them time to process it.
2. A child with AS may have difficulty understanding clichés or expressions and interpret a phrase literally. By speaking directly and factually, like saying "It's easy" as compared to "It's a piece of cake", the child is more likely to understand the line.
3. Aspergers and HFA children have difficulty with transitions. So, don’t surprise them – let them know your plans.
4. Being met with an individual in a dark uniform can be intimidating to a child on the spectrum, particularly when he or she has been a crime victim or is injured. Police and emergency responders may become frustrated, not knowing that the child they're talking to has an autism spectrum disorder. Responders need to communicate in a way that will create understanding and make the situation less stressful.
5. Body language, facial expressions, gestures, and turning away from someone may be cues that are missed by an AS child. When this happens, it is another opportunity for parents to be direct and factual, realizing that their body language or social cues may not be picked up by their child.
6. Children with Asperger Syndrome can manage situations by being aware of what they're feeling and thinking and expressing their thoughts to important adults in their life. Being aware of when they need help - and asking for it - is a good skill to have.
7. Children with AS take in information from their five senses as do “typical” children. The difference is that AS kids are not able to process it as quickly and can become overwhelmed by the amount of information that they are receiving. As a result, they may withdraw as a coping mechanism.
8. Due to the break of routine with family vacations, many parents of Aspergers and HFA children may avoid taking vacations. Steps can be taken to help make for a successful family vacation. One is sharing information with the child, like pictures or internet web pages. There are organizations that will make accommodations, if requested, to better manage uncertainty, crowds, noise disruption. This includes theme parks who allow “special needs” children to skip long lines and airlines or airports that may allow for a dry-run prior to the trip. Also, prepare prior to the trip so that there is a plan for managing boredom.
9. Environments with the least amount of disruption will help AS students remain calm. Speak in a quiet, non-disruptive tone and utilize a physical space that has a low level of disruption.
10. Many children with an autism spectrum disorder are hypersensitive to changes in sight, touch, smell, taste and sound. The sensory stimulus can be very distracting and can result in pain or anxiety. There are other autistic children who are hyposensitive and may not feel extreme changes in temperature or pain. Each of these has implications for making an autism-friendly environment.
11. Providing the best outcomes for a child with AS may be difficult, complicated by each youngster's unique way of managing communication and interaction with others, associated disorders that make each youngster's situation unique, and emerging understandings of neuro-diversity. Teacher effectiveness can be optimized based on an awareness of the differences along the autism spectrum, acceptance that each youngster is unique, engagement of the youngster in social and educational activities, and employment of teaching methods that are found to be helpful with kids who have developmental disabilities.
12. Since change of routine can be quite anxiety-producing for many AS children, a structured, predictable routine makes for calmer and happier transitions during the day.
13. Social stories have been a great method to communicate ways in which my Aspergers child can prepare herself for social interaction.
14. Talking about - or engaging in - activities that the AS child cares about is a great way to bond with him or her.
15. When you find out that your child may not be able to look you in the eyes, realize that he or she is not trying to be rude. It’s simply uncomfortable for some of these children to do.
More resources for parents of children and teens with High-Functioning Autism and Asperger's:
Anonymous said... After years of trying and my mom telling me not to "give in"- it was such a relief and a reward to know it wasn't that I was doing it wrong. I didn't even know the rules!
Anonymous said... Amen to that! It just does not work. They dig in like a tick. Resistance is futile, you have to move to them rather than pull.
Anonymous said... Even parenting 2 aspergers kids is not the same for both, as the same straigies for the same behavior doesn't always work.
Anonymous said... Now, if only we can get the schools to understand this!
Anonymous said... So agree especially with schools my son in mainstream and having daily struggles teachers don't understand and don't want to it seems
Anonymous said... So true x
Anonymous said... This is so reassuring. I read it often and I KNOW I cannot parent them the same way but it feels good to see it in black and white sometimes! My kids are two entirely different entities and one can handle one thing and the other can't. Thankfully, my NT daughter seems to understand the difference! When I tell people my son is stubborn, they brush it off saying all kids are. They have NO IDEA. My daughter is stubborn. Thank goodness. We all should be to a point. My son takes it to a whole new level!
Anonymous said... too true.
Anonymous said... That picture is EXACTLY how I feel every day this year as I homeschool our daughter!! I thought the problems she was having in school were causing her extreme resistance and that schooling at home would help. Wrong. I feel absolutely, totally, completely hopeless and can not STAND it anymore!!!! I do try many of these things, but there are more that I can do. My husband and I will look at this article and come up with a game plan for the rest of our school year (we have to go through June because of all the time my daughter's impossible behavior has stolen from learning). If things don't change, I'm going to send her back to public school just so I can get a break - she is stubborn and impossible no matter where she is at. At least if I can share the burden, maybe we can all be a little calmer and more patient. I had to ask her 15 times, very calmly and patiently to read back her word so I could check the spelling(the verbal exchange is part of the learning and I find skipping it hinders her learning - even though she hates the verbal). She explained very well (and I praised her for it) that when she has to do something that she doesn't want to do, she has a little war or argument in her head and it hinders her ability to speak - she is distracted by the argument. I get that, but when I threaten to take away her DS, she is able to overcome the argument and answer. I have told her that her task is to figure out ways that she can overcome the argument quicker without there being a threat from me. I have tried to give her ideas and I have told her that if she overcomes the argument with only three requests and then compliance she will receive a reward that she chooses ahead of time. That strategy is completely not working! I just want to throw up my hands and let my husband raise her for the next few years. I am all emptied out (and I am NOT one to give up easily - where do you think dear daughter got some of her "stick-to-it-ive-ness?). Ugh!
"How have some of you dealt with a depressed teenager? My autistic son is 16 (high functioning) and a loner. His self-esteem is shot, and we're worried. Any advice is greatly appreciated!!!"
Adolescents suffer from depression more often than any number of grown-ups who live their entire lives with it. Moms and dads are generally dismissive of their child’s low moods, because they think that ALL teenagers are simply moody, hormonal, or tired and cranky.
This dismissive attitude generally results in teenagers being even more depressed, because they think their mother or father doesn’t care. Take that in combination with adolescents with High-Functioning Autism (HFA) or Asperger’s (AS) who have very little impulse control as it is, and you have a horrible combination.
Depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenage son or daughter thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders like depression can occur at any time in life, symptoms are significantly more pronounced in adolescents than grown-ups. To make matters worse, the HFA/AS teen’s depressive symptoms are usually more pronounced than that of a “typical” teen.
Issues such as peer pressure, peer rejection, bullying, academic expectations and changing bodies can bring a lot of ups and downs for HFA and AS adolescents. But for some of these young people, the lows are more than just temporary feelings — they're a symptom of depression. Adolescent depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most HFA and AS adolescents, depression symptoms ease with treatment (e.g., medication and psychological counseling).
Adolescent depression signs and symptoms include changes in your HFA/AS adolescent's emotions and behavior, such as the examples below. Be alert for emotional and behavioral changes, such as:
Agitation or restlessness (e.g., pacing, hand-wringing or an inability to sit still)
Changes in appetite (e.g., decreased appetite and weight loss, or increased cravings for food and weight gain)
Disruptive or risky behavior
Extreme sensitivity to rejection or failure, and the need for excessive reassurance
Feelings of sadness, which can include crying spells for no apparent reason
Feelings of worthlessness, guilt, fixation on past failures or exaggerated self-blame or self-criticism
Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
Frequent thoughts of death, dying or suicide
Insomnia or sleeping too much
Irritability, frustration or feelings of anger, even over small matters
Loss of interest in, or conflict with, family and friends
Loss of interest or pleasure in normal activities
Neglected appearance (e.g., mismatched clothes and unkempt hair)
Ongoing sense that life and the future are grim and bleak
Poor school performance or frequent absences from school
Self-harm (e.g., cutting, burning, or excessive piercing or tattooing)
Slowed thinking, speaking or body movements
Tiredness and loss of energy
Trouble thinking, concentrating, making decisions and remembering things
Use of alcohol or drugs
It can be difficult to tell the difference between (a) ups and downs that are just part of being a young person and (b) full-blown depression. Talk with your teenage son or daughter. Try to determine whether your youngster seems capable of managing challenging feelings, or if life seems overwhelming. If depression symptoms continue or begin to interfere in your HFA/AS adolescent's life, talk to a physician or a mental health professional trained to work with these teens. Your adolescent's family physician is a good place to start. Your adolescent's school may recommend someone as well.
If you suspect your “special needs” son or daughter is depressed, make a physician's appointment as soon as you can. Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed adolescents may be at risk of suicide, even if signs and symptoms don't appear to be severe. If you're an adolescent and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your physician or school nurse. Share your concerns with a mother or father, a close friend, your pastor, a teacher or someone else you trust.
If your teenage son or daughter is having suicidal thoughts, get help right away. Take all talk of suicide seriously. Here are some steps you can take:
Seek help from your physician, a mental health provider or other health care professional.
Reach out to family members, friends or spiritual leaders for support as you seek treatment for your HFA/AS adolescent.
Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor or encourage your HFA/AS adolescent to do so.
If you think your teenage son or daughter is in immediate danger of self-harm or attempting suicide, make sure someone stays with her or him. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your HFA/AS adolescent to the nearest hospital emergency department.
It's not known exactly what causes depression. A variety of factors may be involved. These include:
Learned patterns of negative thinking. Adolescent depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.
Inherited traits. Depression is more common in individuals whose biological (blood) relatives also have the condition.
Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
Early childhood trauma. Traumatic events during childhood (e.g., physical or emotional abuse, loss of a mother or father, etc.) may cause changes in the brain that make a teenager more susceptible to depression.
Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms.
Many factors increase the risk of developing or triggering adolescent depression, including:
Abusing alcohol, nicotine or other drugs
Being a female (depression occurs more often in females than in males)
Being bullied or rejected by peers
Being gay, lesbian, bisexual or transgender (becoming socially isolated or experiencing bullying may increase the risk of depression)
Having a chronic medical illness (e.g., cancer, diabetes or asthma)
Having been the victim or witness of violence (e.g., physical or sexual abuse)
Having certain personality traits (e.g., low self-esteem or being overly dependent, self-critical or pessimistic)
Having few friends or other personal relationships
Having issues that negatively impact self-esteem (e.g., obesity, peer problems, long-term bullying or academic problems)
Having other conditions (e.g., anxiety disorder, anorexia or bulimia, attention-deficit/hyperactivity disorder or learning disabilities)
Family history and issues with family or others may also increase your HFA/AS adolescent's risk of depression:
Having a dysfunctional family and conflict
Having a family member who committed suicide
Having a mother or father, grandparent or other biological (blood) relative with autism, depression, bipolar disorder or alcoholism
Having experienced recent stressful life events (e.g., parental divorce, parental military service or the death of a loved one)
Untreated depression can result in emotional, behavioral and health problems that affect every area of your HFA/AS adolescent's life. Complications related to adolescent depression can include:
Academic problems
Alcohol and drug abuse
Family conflicts and relationship difficulties
Involvement with the juvenile justice system
Low self-esteem
Social isolation
Suicide
You may choose to start by contacting your HFA/AS adolescent's family physician. In some cases, you may be referred directly to a mental health professional, such as a psychiatrist or psychologist.
To the extent possible, involve your teenage son or daughter in preparing for the appointment. Then make a list of:
Questions that you and your HFA/AS adolescent want to ask the physician
Key personal information, including any major stresses or recent life changes your HFA/AS adolescent has experienced
Any symptoms your adolescent has had, including any that may seem unrelated to the reason you scheduled the appointment
All medications, vitamins, herbal remedies or supplements that your HFA/AS adolescent is taking
Basic questions to ask the physician include:
Are there any possible side effects with the medications you're recommending?
Are there any printed materials that we can take home?
Are there any restrictions that my adolescent needs to follow?
How will we monitor progress and effectiveness of the treatment?
Is depression the most likely cause of my youngster's symptoms?
Is there a generic alternative to the medicine you're prescribing?
My adolescent has these other health conditions. Could they be linked to depression?
Should my adolescent see a psychiatrist or other mental health provider?
What are other possible causes for my youngster's symptoms or condition?
What are the alternatives to the primary approach that you're suggesting?
What kinds of tests will my youngster need?
What treatment is likely to work best?
What websites do you recommend?
Will making changes in diet, exercise or other areas help ease depression?
To make the most of the time allotted, make sure your HFA/AS son or daughter is ready to answer questions from the physician, for example:
Are you using any mood-altering substances, such as alcohol, marijuana or street drugs?
Do you ever have suicidal thoughts when you're feeling down?
Do you generally always feel down, or does your mood change?
Do you have a history of significant weight gain or loss?
Do you have any biological (blood) relatives — such as a mother or father or grandparent — with depression or another mood disorder?
Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
How long have you felt depressed?
How much do you sleep at night? Does the amount change over time?
How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
What is your diet like?
What other mental or physical health conditions do you have?
What, if anything, appears to worsen your symptoms?
What, if anything, seems to improve your symptoms?
When did family members or friends first notice your symptoms of depression?
When adolescent depression is suspected, the physician will generally do these exams and tests:
Lab tests. For example, your HFA/AS adolescent's physician may do a blood test called a complete blood count, or test your teen’s thyroid to make sure it's functioning properly.
Physical exam. The physician may do a physical exam and ask in-depth questions about your HFA/AS adolescent's health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem.
Psychological evaluation. This evaluation will include a discussion with your son or daughter about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.
To be diagnosed with depression, your teenage son or daughter must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Symptoms can be based on your HFA/AS adolescent's feelings or on the observations of someone else. For a diagnosis of major depression, the following symptoms must occur most of the day, nearly every day, during at least a two-week period, and be a change or worsening in the adolescent's usual attitude and behavior.
Your adolescent must have at least one of the following:
Diminished interest or feeling no pleasure in any or most activities
Depressed mood, such as feeling sad, empty or tearful (in adolescence, depressed mood can appear as constant irritability)
Your adolescent must also have four or more of the following:
Fatigue or loss of energy
Feelings of worthlessness, or excessive or inappropriate guilt
Insomnia or increased desire to sleep
Recurrent thoughts of death or suicide, making a suicide plan or a suicide attempt
Restlessness or slowed behavior that can be observed by others
Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in adolescence, failure to gain weight as expected can be a sign of depression)
Trouble making decisions, thinking or concentrating
To be considered major depression:
Symptoms are not caused by grieving (e.g., temporary sadness after the loss of a loved one)
Symptoms are not due to the direct effects of something else (e.g., drug abuse, taking a medication or having a medical condition such as hypothyroidism)
Symptoms aren't due to a mixed episode, which is mania along with depression that sometimes occurs as a symptom of bipolar disorder
Symptoms must be severe enough to cause noticeable problems in day-to-day activities (e.g., school, social activities or relationships with others)
Other types of major depression include:
Psychotic depression. This is severe depression accompanied by psychotic symptoms, such as delusions or hallucinations.
Dysthymia. Dysthymia is a less severe, but more long-term form of depression. While it's usually not disabling, dysthymia can prevent your teenage son or daughter from functioning normally in a daily routine and from living life to the fullest.
Atypical depression. In this type of depression, key signs and symptoms include increased hunger, weight gain, sleeping a lot, feeling that your arms and legs are heavy, and difficulty maintaining relationships.
There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so that your HFA/AS adolescent gets appropriate treatment. Your physician or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:
Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect feelings, thoughts and behavior.
Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression.
Cyclothymia. Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder such as depression.
Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.
Many types of treatment are available. In some cases, a primary care physician can prescribe medications that relieve depression symptoms. However, many adolescents need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychotherapy is very effective for most HFA/AS adolescents with depression.
If your teenage son or daughter has severe depression or is in danger of self-harm, she or he may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.
Antidepressants and increased suicide risk— Although antidepressants are generally safe when taken asdirected, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, kids, teens and young people under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, individuals in these age groups must be closely monitored by parents and health care providers. If your son or daughter has suicidal thoughts while taking an antidepressant, immediately contact your physician or get emergency help. For most HFA/AS adolescents, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.
Antidepressants and pregnancy— If your teenage daughter is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing youngster. If your daughter becomes pregnant, make certain she talks to her physician about antidepressant medications and managing depression during pregnancy.
Finding the right medication— Everyone's different, so finding the right medication or dose for your HFA/AS son or daughter may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts. If your adolescent has bothersome side effects, she or he shouldn't stop taking an antidepressant without talking to the physician first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression. Encourage your adolescent not to give up. If antidepressant treatment doesn't seem to be working, your adolescent's physician may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available.
Hospitalization and other treatment programs— In some HFA and AS adolescents, depression is so severe that a hospital stay is needed, especially if your son or daughter is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your adolescent calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control.
Managing medications— Carefully monitor your HFA/AS adolescent's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for adolescents with depression, your adolescent's physician may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your son or daughter does not have a large amount of pills available at once.
Medications— Because studies on the effects of antidepressants in HFA and AS adolescents are limited, physicians rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for adolescent depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with grown-ups, other medications may be prescribed at the physician's discretion (off label), depending on your HFA/AS adolescent's needs. Talk with your adolescent's physician and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication.
Psychotherapy— Psychotherapy is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members, or in a group. Through these regular sessions, your teenage son or daughter can:
explore relationships and experiences
find better ways to cope and solve problems
learn how to identify and make changes in unhealthy behaviors or thoughts
learn about the causes of depression
set realistic goals
Psychotherapy can help your son or daughter regain a sense of happiness and control, and help ease depression symptoms like hopelessness and anger. It may also help your HFA/AS adolescent adjust to a crisis or other current difficulty.
You are your adolescent's best advocate to help her or him succeed. Here are some steps you and your “special needs” child can take that may help:
Encourage communication with your HFA/AS adolescent. Talk to your son or daughter about the changes you're observing and emphasize your unconditional support. Create an environment where your youngster can share concerns while you listen.
Help the HFA/AS adolescent avoid alcohol and other drugs. Your son or daughter may feel like alcohol or drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat.
Learn about depression. Education can empower your teenage son or daughter and motivate her or him to stick to a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression and understand that it's a treatable condition.
Make sure your HFA/AS adolescent adopts healthy habits. Even light physical activity can help reduce depression symptoms. Sleeping well is important for all adolescents, especially those with depression. If your teenage son or daughter is having trouble sleeping, ask the physician for advice.
Pay attention to warning signs. Work with your HFA/AS adolescent's physician or therapist to learn what might trigger depression symptoms. Make a plan so that you and your child know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
Stick to the treatment plan. Make sure your HFA/AS son or daughter attends appointments, even if he or she doesn't feel like going. Even if your adolescent is feeling well, make sure he or she continues to take medications as prescribed. If your child stops taking medications, depression symptoms may come back. Quitting suddenly may cause withdrawal-like symptoms.
Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for professional care. But some mind-body therapies may help.
Complementary and alternative medicine practitioners believe the mind and body must be in harmony to stay healthy. Examples of mind-body techniques that may be helpful for depression include:
Acupuncture
Guided imagery
Massage therapy
Meditation
Music or art therapy
Relaxation techniques
Spirituality
Yoga or tai chi
Relying solely on these therapies is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy.
Showing interest and the desire to understand your HFA/AS adolescent's feelings lets her or him know you care. You may not understand why your adolescent feels hopeless or why she or he has a sense of loss or failure. Listen to your “special needs” child without judging and try to put yourself in his or her position. Help build your child’s self-esteem by recognizing small successes and offering praise about his or her competence.
Encourage your HFA/AS adolescent to:
Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your son or daughter to talk to a family member or other trusted adult whenever needed.
Connect with other adolescents who struggle with depression. Talking with other adolescents facing similar challenges can help your son or daughter cope. So can learning skills to manage life's challenges. Local support groups for depression are available in many communities. And support groups for depression are offered online (but check them out to make sure they're credible and trustworthy sites).
Encourage your HFA/AS adolescent to keep a private journal. Journaling may help improve mood by allowing your child to express and work through pain, anger, fear or other emotions.
Have realistic expectations. Many adolescents judge themselves when they aren't able to live up to unrealistic standards (e.g., academically, in athletics, in appearance, etc.). Let your teenage son or daughter know that it's OK not to be perfect.
Make and keep healthy friendships. Positive relationships can help boost your HFA/AS adolescent's confidence and stay connected with others. Encourage her or him to avoid relationships with peers whose attitudes or behaviors could make depression worse.
Simplify life. Encourage your son or daughter to carefully choose obligations and commitments, and set reasonable goals. Let your child know that it's OK to do less when she or he feels down.
Stay active. Participation in sports, school activities or a job can help keep your teenage son or daughter focused on positive things, rather than negative feelings or behaviors.
Stay healthy. Do your part to make sure your child eats regular, healthy meals, gets regular exercise and gets plenty of sleep.
Structure time. Help your child plan activities by making lists or using a planner to stay organized.
There's no sure way to prevent depression. However, these strategies may help. Encourage your HFA/AS adolescent to:
Boost low self-esteem by recognizing small steps toward getting better.
Get treatment at the earliest sign of a problem to help prevent depression from worsening.
Maintain ongoing treatment, if recommended, even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.
Reach out for friendship and social support, especially in times of crisis.
Take steps to control stress, for example, not committing to too many obligations at once.
Resources for parents of children and teens on the autism spectrum:
"My son (high functioning autistic) tries to make friends, but seems to not have the social skills to do it. He really wants to relate to his peer group, but is usually shunned by the kids he tries to bond with. How can I help?"
The "Outcast”
There are 3 basic subtypes in children and teens with Asperger's (AS) and High-Functioning Autism (HFA):
The Actor: This child desires inter-personal relationships with others and has learned enough social skills over time to pass as a "neurotypical" (i.e., he or she can "act" like someone who is not on the spectrum).
The Loner: This child does NOT desire inter-personal relationships (except with a very safe/close family member or friend) and could care less about "fitting-in" with "the group."
The Outcast: This child desires inter-personal relationships with others, but has difficulty finding and maintaining friendships due to a lack of social skills. He or she really wants to "fit-in," but usually gets ostracized from "the group" due to "odd" behavior.
In this post, we will look at the "Outcast"…
No youngster with AS or HFA deserves to be ostracized from his or her peer group. But, many of these kids regularly act in ways that make it hard for other “typical” children to accept them. Helping kids on the autism spectrum to recognize and change negative, self-defeating behaviors can make it less likely that they will be ostracized. Although negative behaviors often lead to peer-rejection, the reverse is also sometimes true: Being ostracized can bring out the worst in AS and HFA children, which leads to even more ridicule and rejection.
To find – and keep – a friend, a youngster needs to avoid or resolve any disagreements, behave in ways that the other youngster enjoys, and communicate about likes and dislikes. There are many ways this can go wrong for the child. For example, yelling at or hitting the other youngster, snatching toys away, refusing to share, ignoring or walking away, bossing the other youngster around, etc. All of these interfere with shared fun and lead to the child being ridiculed and rejected.
Here is how parents can help their peer-rejected AS or HFA youngster to “fit-in”:
1. Compliments are an easy way to win a friend. Brainstorm with your youngster some ways to compliment peers (e.g., “Your shirt is cool!” for a youngster wearing a new outfit; “Nice shot!” for a kid playing basketball; “I like the way you drew the mountain!” about a classmate’s artwork, etc.).
2. Fan the flames of a budding friendship by helping your youngster arrange a one-on-one, activity-based play date. Plan ahead by talking with your youngster about how to be a good host (e.g., good hosts stay with the guest rather than playing with someone else or wandering away and leaving the guest alone; good hosts make sure that their guest has a good time; good hosts go along with what the guest wants and try not to argue, etc.). If your youngster has special digital gadgets, games or toys too precious to share, put those items away before the guest arrives.
When the guest arrives, your youngster can start out by offering several choices of activities (e.g., watch a movie, ride bike, pop some popcorn, play basketball, play a video game, go bowling, bake cookies, etc.). If the shared activity is fun, the other youngster will associate your youngster with fun, which moves them toward friendship. (Note: Keep an ear out for conflicts that aren’t quickly settled. If your youngster seems to be getting angry, pull him aside quietly and, while out of earshot of the guest, help him figure out how to move forward.)
3. Kids with AS and HFA are often oblivious to others' reactions, which can lead them to persist in doing unwanted and inappropriate behaviors. For example, they may continue rambling on and on about a favorite topic long after their friends have lost interest, or they may repeatedly tap a peer on the shoulder to get his attention long after they've been asked to stop. This can be aggravating for peers.
Help your youngster learn to recognize “social stop signs” (e.g., when the other child looks away, walks away, says “Stop it” …and so on). See if your youngster can make a list of “social stop signs.” Also, help her come up with a plan for stopping (e.g., asking, "What would you like to do instead?" or physically moving farther away).
4. These young people are rarely able to master the subtleties of humor. They're better off trying to be nice, rather than funny.
Help your youngster brainstorm possible “ways to be nice” to try at school (e.g., sharing a lunch treat, saving someone a seat, lending a pencil to a peer, helping a peer carry something, etc.). Writing down “ways to be nice,” or reporting them at dinnertime or bedtime, can also help your youngster feel good about himself.
5. Kids on the spectrum often have a hard time coping with losing. They may argue, cheat, shove, or have a meltdown if things don't go their way. This ruins the fun for everyone else.
If your youngster struggles in this area, you may want to build-up his tolerance for losing at home. Start with cooperative games or "beat your own record" contests, and then work toward brief and then longer competitive games. Point out that both winning and losing are temporary. Explain to your youngster that he can't always win the game, but he can always "win the entertainment" by enjoying the company of friends.
6. Kids with AS and HFA often have difficulty greeting a potential friend. If another youngster says “Hi!” to them, they tend to look away and say nothing, or just mumble in response. This happens because they feel uncomfortable. But, the non-verbal message that they’re sending to the other youngster is “Stay away, I don’t want to be your friend.”
Help your youngster use role play to practice greeting peers. Explain that a friendly greeting involves speaking loudly enough to be heard, smiling, saying the other person’s name, making eye contact, and so on. After you’ve practiced, help your youngster figure out some peers to practice on in real life.
7. Kids with AS and HFA sometimes think that they need to impress their friends in order to keep them. This rarely works! Rather than trying to impress their friends (which implies, "I'm better than you!"), they need to find some common ground. Children make – and keep – friends by doing things together. Kids are more attracted to other kids that they perceive as similar to themselves.
Help your youngster discover a few things that she has in common with her friends (e.g., invite a potential friend to a fun outing, observe or ask questions to identify shared interests with peers, sign-up for an after-school activity, etc.). Ask your youngster, “How can you figure out what you have in common with someone?” Answers could include observing the other youngster, asking questions, or doing things together to create shared experiences.
Finding common ground doesn’t mean that your youngster has to be a clone of everyone else. It also doesn't mean that your youngster can never become friends with someone who has a different background or different interests. It simply means recognizing that friendships start with common interests. To make friends, kids need to develop or discover those “me too” areas.
No boy or girl deserves to be ostracized from “the group.” It hurts and causes emotional damage – sometimes for a lifetime. This is why it is so terribly important that parents help their child recognize and change “relationship-destroying” behaviors as soon as possible – preferably before he or she enters elementary school.
Resources for parents of children and teens on the autism spectrum:
* Anonymous said... This is so my son, fits into neither the NT crowd nor the crowd of the kids with ASD we also meet with.
* Anonymous said... So true
* Anonymous said... But for those who don't want to mix that has to be OK too right?
* Anonymous said... This is so timely! My son just had a major meltdown after a birthday party yesterday. He feels so rejected and "weird." Thanks for sharing.
* Anonymous said... This is my biggest fear because my son does want to fit in and have friends, any tips to make it easier for him are so greatly appreciated.
• Anonymous said… And he now reverts to formally polite as a default coping mechanism in social situations • Anonymous said… Good read • Anonymous said… I worry about that too. My son is very sociable and tries so hard to make friends but, is more often than not the outlast which forces him to be a loner. Breaks my heart. • Anonymous said… mine has been in all three, outcast at secondary school, reverts to loner when it gets too tough but can maintain a facade as an actor for periods. • Anonymous said… My daughter is/has been all three types... now at 22 she's more the actor, She was the outcast/bullied at school which led to her being a loner, and kidding herself that she preferred it that way. Broke my heart that she was never invited to birthday parties that plainly everyone else had attended. Now she's an assistant librarian, and she 'acts' sociable with the customers at the public library, but it is exhausting for her. If I remind her about manners etc, she will actually say 'it's ok, I can fake it'. She's finding ways to cope. • Anonymous said… My girl is the actor. She adapts so well that it's hard to tell when it's real or acting. • Anonymous said… My son #3 :( • Anonymous said… My son (15) is the same. Started out as the outcast, moved to loner and is now trying to fit in as actor • Anonymous said… My son is definitely a loner & I can't see that ever changing... He has no interest in social relationships & that troubles me as I won't be here forever 😢 • Anonymous said… My son is the actor who eventually becomes the outcast when he acts weird/unexpectedly around potential friends. He just can't handle socializing in a group, but one on one he's good. Once that bad first impression is made, no one wants to try to get to know him better. 😢 * Anonymous said... My child my be autistic, but after reading this and seeing how many parents are trouble by their child not being a typical child has made see that my child is fine the way he is the world may never understand him but I will always love him. Typical children may be considered normal but they are also cruel and should be raised to learn everyone deserves kindness.-Reena
There are 3 basic subtypes in people with Asperger's and High-Functioning Autism:
The Actor: This individual desires inter-personal relationships with others and has learned enough social skills over time to pass as a "neurotypical" (i.e., he or she can "act" like someone who is not on the autism spectrum).
The Outcast: This individual desires inter-personal relationships with others, but has difficulty finding and maintaining friendships due to a lack of social skills. This person really wants to "fit-in," but usually gets ostracized from "the group" due to his or her "odd" behavior.
The Loner: This individual does NOT desire inter-personal relationships (except with a very safe/close family member or friend) and could care less about "fitting-in" with "the group."
As a parent of a child with High-Functioning Autism (HFA), you know that your child is capable of having a meltdown occasionally. We’ll describe a meltdown as “an over-reaction to environmental stimuli designed to give HFA children a sense of control when they feel that their world is out-of-control.” 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder
