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Depression in Teenagers with Autism Spectrum Disorder [Level 1]

"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.

==> Discipline for Defiant Aspergers and HFA Teens

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.

 ==> Discipline for Defiant Aspergers and HFA Teens

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:
 

==> Videos for Parents of Children and Teens with ASD
By

Children on the Autism Spectrum: The "Outcast” Subtype

"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):
  1. 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).
  2. 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."
  3. 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.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

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.
 
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

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.



COMMENTS:

*  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 

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Asperger's Subtypes: The "Actor" - The "Outcast" - The "Loner"

There are 3 basic subtypes in people with Asperger's and High-Functioning Autism:
  1. 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).
  2. 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.
  3. 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."

In this video, we will look at the "Loner":



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The Elimination of the Asperger’s Diagnosis

There is a lot of confusion regarding the new Diagnostic and Statistical Manual of Mental Disorder’s (DSM-5) revision to exclude Asperger’s. Hopefully this post will clarify some things…

Taking into account the most up-to-date research, diagnostic criteria in the DSM are revised periodically by a team of professionals. Here are a few of the main changes in the DSM-5 that specifically apply to autism spectrum disorders:
  • Sensory behaviors are included in the criteria for the first time (under restricted, repetitive patterns of behaviors descriptors).
  • The terms used in the DSM-4 are autistic disorder, Asperger’s disorder, childhood disintegrative disorder and PDD-NOS (pervasive developmental disorder not otherwise specified). In the DSM-5, when people go for a diagnosis, instead of receiving a diagnosis of one of these disorders, they will be given a diagnosis of “autism spectrum disorder.”
  • The emphasis during diagnosis has changed from giving a name to the disorder to identifying all the needs someone has and how these affect his or her life.
  • The triad of impairments has been reduced to two main areas: (1) social communication and interaction; (2) restricted, repetitive patterns of behavior, interests, or activities.
  • Also, there are “dimensional elements,” which should give an indication of how much a person’s disorder affects him or her. This should help to identify how much support the individual needs.



The DSM-5 has eliminated Asperger’s as a separate diagnosis and weaves it into Autism Spectrum Disorders with severity measures within the broader diagnosis. In this revision, the individual must meet the criteria in sections A, B, C and D below to receive a diagnosis of Autism Spectrum Disorder:

A. Deficits in social communication and interaction not caused by general developmental delays (the individual must have all 3 of the following areas of symptoms present):
  1. Deficits in social-emotional reciprocity; failure to have a back and forth conversation
  2. Deficits in nonverbal communication (e.g., abnormal eye contact and body language) or difficulty using and understanding nonverbal communication, and lack of facial expressions or gestures
  3. Deficits in creating and maintaining relationships appropriate to developmental level – apart from relationships with parents (this may include trouble adjusting behavior to suit different social contexts, difficulties with imaginative play and making friends, and a lack of interest in others)

B. Demonstration of restricted and repetitive patterns of behavior, interest or activities (the individual must present two of the following):
  1. Repetitive speech, repetitive motor movements or repetitive use of objects (e.g., echolalia, idiosyncratic phrases)
  2. Adherence to routines, ritualized patterns of verbal or nonverbal behavior, or strong resistance to change (e.g., insists on eating the same food, repetitive questioning, or great distress at small changes) 
  3. Fixated interests that are abnormally intense or focus (e.g., strong attachment to unusual objects, restricted interests)
  4. Over or under reactivity to sensory input or abnormal interest in sensory aspects of environment (e.g., indifference to pain, heat or cold, negative response to certain sounds or textures, extreme smelling or touching or objects, fascination with lights or spinning objects)

C. Symptoms must be present in early childhood (although they may not become apparent until social demand exceeds limited capacity).

D. Symptoms collectively limit and hinder everyday functioning.

If your child currently has a diagnosis of Asperger’s – this will not change. In the DSM-5, people will get a diagnosis of “autism spectrum disorder” rather than any of the current DSM diagnostic terms.  The term “Asperger’s” may still be used colloquially by diagnosticians (e.g., for a diagnosis of autism spectrum disorder with similarities to Asperger’s). Also, many people identify closely with the term Asperger’s and may continue to use it in everyday language.

Overall, the changes to the diagnostic criteria are helpful. They are clearer and simpler than the previous DSM criteria. Including sensory behaviors in the criteria is very practical, because many young people with autism have sensory issues which affect them on a day-to-day basis. The emphasis on identifying the full range of difficulties that the person has during the diagnosis process is also convenient.

The DSM criteria are medically-based, and a diagnosis is given when “symptoms together limit and impair everyday functioning.” The criteria create the foundation for diagnostic tools, for example:
  • ADI (Autism Diagnostic Interview)
  • ADOS (Autism Diagnostic Observation Schedule
  • DISCO (Diagnostic Interview for Social and Communication Disorders)

These and other schedules are used to collect information in order to diagnose whether someone is on the autism spectrum or not. Therefore the criteria form the basis for the diagnosis, but the diagnostician’s judgment is very important.

The DSM-5 is an American publication. Most diagnoses in the UK are based on the International Classification of Diseases (ICD), published by the World Health organization. The current ICD (ICD-10) is virtually the same as DSM. The next version of the International Classification of Diseases (ICD-11) is due to be published in 2015. The authors of the ICD will consider the changes made to DSM-5, but their descriptions are often slightly different. Currently, there are no plans to change the label of Asperger’s during the next revision.

Diagnoses using the DSM criteria should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. If a person gets a diagnosis of an autism spectrum disorder, it is likely to mean that he or she would benefit from support or services. However, the diagnosis is not directly linked to whether someone is eligible for support and services. Decisions over support and services are generally made by social service agencies and education professionals (often based in the local authority). The DSM-5 introduces levels of severity into the diagnostic process, to indicate how much support a person who receives a diagnosis may need. 

It is possible that fewer people – particularly at the higher-functioning end of the autism spectrum – will be diagnosed as having autism spectrum disorder in the DSM-5. However, the DSM team believes that this is not the case. Diagnoses should always be based on a clinical decision about whether an individual has an impairment which has a disabling effect on his or her daily life. Diagnoses will be given where symptoms cause impairment to everyday functioning. Many individuals with Asperger’s and high-functioning autism may continue to meet the proposed diagnostic criteria for autism spectrum disorder.

The removal of Aspergers Syndrome from the Diagnostic and Statistical Manual of Mental Disorders has been controversial, because it is commonly used by health insurers, researchers, state agencies, schools, and people with the disorder.  Many parents – and professionals – are concerned that eliminating the Asperger’s diagnosis will prevent mildly affected children from being evaluated for Autism, which may result in the ineligibility of much needed services.


Comments:

•    Anonymous said... I am in Liverpool uk, and I often find it really hard to get professionals to take his needs seriously, he can often seem very typical and many people tell me that there is nothing to be concerned about. It's not until they spend some time with him that they can see more of what's going on and how he finds little things so difficult.
•    Anonymous said... I found an autism "center" in monroe. Gonna try as and get info from them. My heart just breaks for parents and the autistic children who are in the dark about autism. Thanks to you, Stephanie  and Patrick, for making me see how awesome these kids are. I hope to at least be able to help the patients we have learn more.
•    Anonymous said... I found it hard having teachers and school psychologists get to have the final say (without going to due process, that is) on whether my son needed certain interventions. The people who deal with Asperger's and HFA every day can make suggestions, but the school doesn't have to follow them...never mind that they have seen fewer total aspie students than our medical providers, and studied asperger's less (or not at all...I met a special ed teacher once who found out my son had Asperger's and asked me to explain it to her). We need a new model of educational intervention.
•    Anonymous said... I have to say, I'm glad they have changed the diagnosis to ASD, I was so sick of people saying to me, "its only aspergers, or it's just aspergers" so I was kind of relieved when we got the diagnosis letter and it said ASD.
•    Anonymous said... I'm in BC and, while my guy has Aspergers, the diagnosis states ASD. It's hard with Aspergers isn't it, at first glance many seem neurotypical and hard to have their special needs taken seriously. I'm worried my guy will lose funding as seems so high functioning but a deeper look show his needs r actually quite high.
•    Anonymous said... Our local council in Cornwall UK are using DSM4
•    Anonymous said... sadly, many with Aspergers will no longer meet the criteria for Autism based on the changes. Boo.
•    Anonymous said... This scares me but knew it was coming.
•    Anonymous said... What is the difference if you dont mind me asking between asd and Aspergers
 
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Assisting the Peer-Rejected Student: Tips for Teachers of Kids of the Spectrum

Playing and conversing with classmates is a daily routine for school-aged kids. But children with ASD (Aspergers, High Functioning Autism) are often isolated and rejected by their peers. Their problems making and keeping a “buddy” are exacerbated by their poor social skills.

The sensitive educator should realize that kids go to school for a living. School is their job, their livelihood, and their identity. Thus, the crucial role that teachers play in the youngster's social development and self-concept should not be under-estimated. Even if a youngster is enjoying “academic success,” her attitude about school will be determined by the degree of “social success” she experiences.



There is much that the educator can do to promote social development in the special needs child. Kids tend to fall into four basic social categories in the school environment:
  1. Children who, although not openly rejected, are ignored by peers and are uninvolved in the social aspects of school.
  2. Children who have successfully established positive relationships within a variety of social settings.
  3. Children who “fit-in” with a peer-group based on common interests, but seldom move beyond that group.
  4. Children who are consistently rejected, bullied and harassed by peers.

Many children with ASD find themselves in the rejected/bullied subgroup. Their reputations as being rather “odd” plague them over the years. It is important for the educator to assist the youngster’s peers in changing their view of this boy or girl.

Discipline is a rather ineffective method of correcting bullying or rejecting behavior. For example, if the teacher disciplines Michael for insulting Ronnie, she only increases Michael's resentment of Ronnie. But, the teacher can increase Michael’s level of acceptance in several ways. Here’s how:

1. Assign the youngster to work in pairs with a “socially skilled” youngster who will be accepting and supportive. Cooperative activities can be especially effective in the effort to include the rejected youngster in class. These activities enable the youngster to use her academic strengths while simultaneously developing her social skills.

2. Assign the rejected youngster to a leadership position in class wherein his peers become dependent on him (e.g., line leader). This can serve to increase his status and acceptance. However, understand that this may be an unfamiliar role for the student, and he may require some guidance from the teacher in order to ensure success.

3. Attempt to determine specific interests, hobbies or strengths of the rejected youngster. This can be accomplished through discussions, interviews or surveys. Once the teacher has identified the youngster's strengths, celebrate it in a very public manner. For example, if the child has a particular interest in Indian wood carvings, find a ‘read-aloud’ adventure story in which an Indian plays an important role in the plot. Encourage the youngster to bring a couple of his Indian wood carvings to class and show how they were made. By playing the expert role, a rejected youngster can greatly increase his status.

4. Board and card games can be used to foster social development in class. These activities require children to utilize a variety of social skills (e.g., voice modulation, taking turns, sportsmanship, dealing with competition, etc.). These activities can also be used to promote academic skills. Since games are often motivating for children, this activity can be used as positive reinforcement.


 

5. Educators at the high school level must be particularly aware of the teen that is being rejected by peers. During the teenage years, it is very important that the youngster be accepted by his peers. The rejection suffered by teens with social skill deficits often places them at risk for emotional problems.

6. The child with social skill deficits invariably experiences rejection in any activity that requires children to select classmates for teams or groups. This selection process generally finds the rejected youngster in the awkward position of being the "last one picked." Avoid these humiliating situations by pre-selecting the teams or drawing names from a hat.

7. The educator can assist the youngster by making him aware of the traits that are widely-accepted and admired by his peers (e.g., when a particular child converses, extends invitations, gives compliments, greets others, laughs, shares, smiles, tells jokes, etc.).

8. The educator needs to recognize the critical role that the youngster's mom and dad – and even siblings – can play in the development of social competency. Ask the youngster’s mother or father to visit school for a conference to discuss the child’s social status and needs. School and home must work in concert to ensure that target skills are reinforced and monitored. Social goals should be listed and prioritized. Focus on a small set of social skills (e.g., making eye contact, sharing, and taking turns) rather than trying to deal simultaneously with the entire inventory of social skills.

9. The educator should demonstrate acceptance of - and affection for - the rejected youngster. This conveys the constant message that this youngster is worthy of attention. The educator can use her status as a leader to increase the status of the youngster.

10. The socially incompetent youngster often experiences isolation and rejection in his neighborhood, on the school bus, and in peer-group activities. The educator can provide this child with a learning environment wherein he can feel comfortable, accepted and welcome. Coming to school every day can become a helpless event for some kids on the spectrum – unless they succeed at what they do. Educators are shields against that helplessness.




 
 
Comments:

•    Mama said... I have always known this but getting teachers to get on board in public schools is nearly imposible. I'm so happy that Mark Hutten has brought this up. Sincerely, Marie Donily
•    Unknown said... Hello, this website has become one of our most informative sites for information. Our 13-year-old was just "transferred" to an alternative behavior school because of lack of understanding on teachers' parts. Now he is feeling punished because lack of understanding of his diagnosis
•    MartinKids said... I actually have the opposite problem- my 2nd grade son is receiving wonderful support and has plenty of 'playmates' at school. However, all of the children on our block have ostracized him and taunt him whenever he goes out in front(often in front of me!) The parents are either contributing to the stigma or are totally clueless. I would LOVE to read an article on how to handle this situation!
•    MartinKids said... I have the opposite problem with my 2nd grade son. He receives excellent support and has made several playmates at school. However, all of the kids on our block have ostracized him almost since we moved in. They ignore him and taunt him whenever he plays out front (even in front of me!) and their parents either seem to contribute to his stigma or are totally clueless. He seems to be handling this rejection well now, but I worry about how this treatment will affect him in middle school. I would LOVE to see an article offering tips for this situation!
•    Kelly said... You may not get this reply as I see you posted over three years ago but I'm having the same problem. Did you figure anything out?
•    MartinKids said... Unfortunately nothing ever resolved, just time went on, the two families we had the most issues with moved away and the new families have much younger children. My son does not interact very much with the kids that are left as he homeschools now and and they attend public school. Sadly, by the end of fourth grade he was already starting to be excluded and treated differently, so we pulled him out to homeschool him with his siblings. The kids in our main social group are more accepting of him, although he only has one good friend the others don't pick on him. Even more disappointing is his involvement with Boy Scouts, the adults were actually super caring and willing to accommodate his needs but the boys excluded him.:( I am incredibly thankful for our homeschooling friends who love him and have taught their children to be kind even if they aren't super close to him. :)

 
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Crucial Strategies for Parents of Challenging Kids on the Autism Spectrum

    Resources for parents of children and teens on the autism spectrum :   ==> How to Prevent Meltdowns and Tantrums in Children ...