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Personality Types in ASD Level 1: Fixated, Disruptive, Approach and Avoidant

Fixated Personality--

The fixated personality type can be characterized by a preoccupation with orderliness, perfectionism, and the need to control one’s environment (e.g., to have things in a particular order).

Some of the symptoms of the fixated personality type may include:
  • compulsion to make lists and/or schedules
  • feelings of excessive doubt and caution
  • obsessive need for cleanliness
  • perfectionism (that may sometimes interfere with task-completion)
  • preoccupation with order and organization
  • preoccupation with remembering and paying attention to minute details and facts
  • rigid following of rules and regulations
  • rigidity or inflexibility of beliefs
  • stubbornness
  • unreasonable insistence that others submit to his way of doing things

Some of the specific behavioral manifestations of the fixated personality type among ASD children and teenagers may include:
  • repeatedly checking homework
  • cleaning rituals
  • counting rituals
  • grooming rituals (e.g., hand washing, showering, teeth brushing)
  • hoarding and collecting things
  • ordering or arranging objects
  • repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting)
  • rituals to prevent harming self or others
  • rituals to undo contact with a "contaminated" person or object
  • touching rituals

Parents can look for the following possible signs of the fixated personality type:
  • continual expressions of fear that something terrible will happen
  • dramatic increase in laundry
  • persistent expressions of fear of illness
  • sudden drop in test grades
  • exceptionally long amount of time spent getting ready for bed
  • high, unexplained utility bills
  • holes erased through test papers and homework
  • raw, chapped hands from constant washing
  • reluctance to leave the house
  • requests for family members to repeat strange phrases or keep answering the same question
  • unproductive hours spent doing homework
  • unusually high rate of soap or paper towel usage

Environmental and stress factors can trigger fixated personality traits. These can include ordinary developmental transitions (e.g., starting school) as well as significant losses or changes (e.g., death of a loved one, moving to a different home or city).
 

It can be helpful to keep family routines as normal as possible, and for all family members to learn strategies to help the ASD youngster. It is also important to not let the “fixations” be the boss of the house and regular family activities. Giving in to fixations does not make them go away.

“Fixated” Aspies become less fixated at different rates, so try to avoid any day-to-day comparisons and recognize and praise any small improvements. Keep in mind that it's the disorder that is causing the problem, not the child. The more that personal criticism can be avoided, the better.

Treatment for the fixated personality type can involve the following:
  1. Behavior therapy: Discussing with a psychotherapist ways of changing compulsions into healthier, productive behaviors. An effective form of this therapy has been found to be cognitive analytic therapy.
  2. Cognitive behavioral therapy: A systematic approach to changing unwanted thoughts, feelings and behaviors.
  3. Psychopharmacology: A psychiatrist may be able to prescribe medication to facilitate self-management and also enable more productive participation in other therapies.
  4. Psychotherapy: Discussion with a trained counselor or psychotherapist who understands the condition.


 Disruptive Personality--

The disruptive personality is:
  1. a type of cognitive-behavioral style in which the "Aspie's" way of thinking, perceiving situations, and relating to others is sometimes destructive
  2. often comorbid with ADHD and/or ODD
Autistic children and teens with disruptive personality typically have little regard for right and wrong. They may often violate the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. Also, Aspies with disruptive personality may not be able to fulfill responsibilities to family, school, or work.

Disruptive personality traits may include:
  • Aggressive or violent behavior
  • Agitation
  • Impulsive behavior
  • Intimidation of others
  • Irresponsible school-related or work-related behavior
  • Lack of remorse about harming others
  • Persistent lying or deceit
  • Poor or abusive relationships
  • Recurring difficulties with the parents and teachers
  • Repeatedly violating the rights of others
  • Using charm or wit to manipulate others

There may be a link between an early lack of “empathy” (i.e., understanding the perspectives and problems of others) and later onset of a disruptive personality style. These personality problems may be inherited, and identifying them early may help improve long-term outcomes.

Complications and problems associated with the disruptive personality include:
  • Aggression or violence
  • Alcohol or substance abuse
  • Anxiety
  • Depression
  • Reckless behavior
  • Relationship difficulties
  • School and work problems
  • Social isolation
  • Strained relationships
  • Suicidal behavior

Psychotherapy is the main way to treat a child or teen with a disruptive personality style. Types of psychotherapy may include:
  • Psycho-education: This education-based therapy teaches coping strategies and problem-solving skills.
  • Psychodynamic psychotherapy: This approach aims to raise awareness of unconscious thoughts and behaviors and — by bringing them to light — change their negative impact.
  • Cognitive behavioral therapy: This type of therapy helps to uncover unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.

Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The right type of psychotherapy depends on each person's individual situation. 
 

If you have a child or teen with a disruptive personality style, it's critical that you also get help for yourself. Mental health professionals can help teach you skills to protect yourself from the aggression, violence and anger common to this personality type. They can also recommend strategies for coping.

Parents can help their child with disruptive personality traits in the following ways:
  1. Always build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.
  2. Take a time‑out or break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if he decides to take a time‑out to prevent overreacting.
  3. Pick your battles. Since this particular child has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time‑out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."
  4. Set up reasonable, age appropriate limits with consequences that can be enforced consistently.
  5. Maintain interests other than your "disruptive" Aspie so that managing your child doesn't take all your time and energy. Try to work with and obtain support from the other adults (teachers, coaches, and spouse) in dealing with your child.
  6. Manage your own stress with exercise and relaxation. Use respite care as needed. 
  7. Come up with a specific parenting-plan to address the behavioral problems associated with a disruptive personality.


Approach Personality--

This type usual occurs in the ASD child who also has ADHD, although this is not always the case.

The two primary characteristics of the “approach personality” are (a) excessive talking about one’s special (or obsessive) interest, and (b) significant violations of other’s personal space.

Excessive Talking About Special Interests—

Excessive talking in the Aspie can present a number of problems. No one particularly likes to be referred to as a "motor-mouth," but they can be exactly that. While some people have much to say of value, excessive talkers usually do not. They talk either because they can't help it due to “mind-blindness” (i.e., they are unaware that the listener is both bored and annoyed with the one-sided conversation), or because they simply love to tell others about their favorite hobby/activity out of a huge sense of passion about that particular hobby/activity.

Aspies who talk excessively can sometimes get along well with one another, probably because neither is paying much attention to what the other is saying. For those with normal speaking habits however, excessive talking often borders on being socially unacceptable. We are brought up to be attentive to what others are saying, to speak mainly when spoken to, while at the same time hoping that when we do talk, we sound intelligent and say the right things in as few words as possible.
 

Excessive talking in the Aspie often translates into an inability to understand or follow instructions. The very act of learning can be seriously impeded, and the chattering Aspie may be unable to concentrate on those things where concentration is vital to success.

Those Aspies who persist in excessive talking about their obsessive interest are more apt to be victims of another type of disorder, the Obsessive-Compulsive Personality Disorder (OCPD). Not all of those with OCPD are excessive talkers – it is just one of the symptoms. You can usually spot those with OCPD, because they tend to be preoccupied with perfectionism and orderliness, pay excessive attention to detail, and are most comfortable in an environment where there are rules to follow, schedules to meet, and an organizational structure in which they know their place.

The drive for perfectionism often results in such individuals being unable to complete certain assigned tasks, or being unable to follow rules which don't conform to their own strict standards. Some OCPD Aspies are extremely introverted (living in their own carefully regulated and orderly world) while others can be quite extroverted (these are the attention seekers, the ones who violate your personal space, and who often over-dramatize any and every situation). It is from among this group that excessive talking is apt to be one of the more noticeable symptoms.

Tips for the excessive (obsessive) talker:

1. Appreciate what others have to say. Listening to other person’s viewpoint allows you to permit him or her to express an opinion.

2. Be a good listener. People like to be listened to.

3. Be more conscious of your behavior patterns. Acknowledge that you speak too much and behave accordingly.

4. Do not talk for the sake of talking. Restraint is good.

5. One can take up courses in being a good conversationalist.

6. Seek professional help if excessive talking is a compulsive behavior. Often people speak due to some psychological disorder or problem. A person with a nervous disposition will speak more.

7. One need not express everything on one’s mind. Certain things you must keep to yourself.

8. One should always have something important to contribute. Whatever you say should have an impact on others. They should want to listen to you. Conversation should be interesting.

9. One should avoid being pushy or aggressive while conversing. Try to convey things in fewer words. Be brief in what you say.

10. Think before you speak. It may be difficult if you are nervous. But it is better to be aware of what you are saying. You need not regret later.

11. Try not interrupting another person’s conversation as far as possible.

12. Try to allow the other person to say something. It may be difficult, but one needs to practice self-control. A good conversation is a two-way process. All of those taking part in the conversation have much to contribute. Each person must get a chance to say something.

Violating Personal Space—

Interpersonal space refers to the psychological "bubble" that exists psychologically when one person stands too close to another. There are four different zones of interpersonal space:

1. Intimate distance: ranges from touching to about 18 inches (46 cm) apart, reserve for lovers, children, close family members and friends, and pets.

2. Personal distance: begins about an arm's length away starting around 18 inches (46 cm) from the person and ending about 4 feet (122 cm) away. This space is used in conversations with friends, to chat with associates, and in group discussions.

3. Social distance: ranges from 4 to 8 feet (1.2 m - 2.4 m) away from the person and is reserved for strangers, newly formed groups, and new acquaintances.

4. Public distance: includes anything more than 8 feet (2.4 m) away, and is used for speeches, lectures, and theater. Public distance is essentially that range reserved for larger audiences.

Aspies with approach personality traits tend to be mostly in the “intimate distant” mode (i.e., they will stand within arm’s reach – even with strangers). It goes without saying that most people are taken aback by such behavior.

The absence of strong emotional responses to personal space violation is, again, the result of the Aspie’s “mind-blindness” (i.e., an inability to develop an awareness of what is in the mind of the other person). If you, as a neurotypical, did an experiment in which you purposely stood excessively close to a stranger to read his/her reaction, you would readily notice a pained expression on the other person’s face, sending you a very clear non-verbal message that he/she is alarmed. The mind-blind Aspie with approach personality traits does not receive this non-verbal cue – even though the cue was indeed sent.

Tips for the personal space violator:

1. Understand that (a) people have certain expectations about verbal and nonverbal communication behavior from other people, and (b) violations of these expectations cause arousal and distraction in them.

2. Only stand or sit within arm’s reach of close family members and romantic partners.

3. With your friends, stand or sit no closer than arm’s length.

4. With all others, stay at least 4 feet away.

5. Pay attention to the facial expressions of those you stand or sit close to. Are they grimacing, for example? If so, then you may be too close.

6. Pay attention to whether or not the other person moves away, creating addition distance between the two of you. Does he/she seem to be taking steps backwards during the conversation? If so, you may be too close.

7. If you are uncertain, ask the other person “Am I violating your personal space?” Most people will respect that question and answer honestly.

Some of the behaviors exhibited in the “approach personality” have a good side to them when these behaviors can be correctly channeled. There are many activities in which paying greater than normal attention to detail can be a definite plus, and those with a short attention span often find a place in activities demanding creativity and thinking outside the box. As far as excessive talking is concerned, it is best that it be treated with counseling (usually in the form of “social skills training”), although there are occasional openings for stand up comics and radio talk show hosts. As far as personal space violations are concerned, it is best to reserve close proximity for those who enjoy being close to you (e.g., your mother, girlfriend, cat, etc.).
 

Avoidant personality is characterized by a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. This type of autistic child is often described as being extremely shy, inhibited in new situations, and fearful of disapproval and social rejection. Avoidant personality becomes a major component of an Aspie’s overall character and a central theme in how he relates to others.

Aspies with avoidant personality tend to do some of the following:
  • Views self as socially inept, personally unappealing, or inferior to others
  • Stays quiet or hides in the background in order to escape notice
  • Shows restraint within intimate relationships because of the fear of being shamed or ridiculed
  • Is unwilling to get involved with people unless certain of being liked
  • Is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing
  • Is preoccupied with being criticized or rejected in social situations
  • Is inhibited in new interpersonal situations because of feelings of inadequacy
  • Drinks before social situations in order to soothe nerves
  • Avoids social situations to a degree that limits activities or disrupts life
  • Avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection

The following situations are often stressful for Aspies with avoidant personality:

• Attending parties or other social gatherings
• Being called on in class
• Being teased or criticized
• Being the center of attention
• Being watched while doing something
• Eating or drinking in public
• Going on a date
• Making phone calls
• Making small talk
• Meeting new people
• Performing on stage
• Public speaking
• Speaking up in a meeting
• Taking exams
• Talking with “important” people or authority figures
• Using public bathrooms

Emotional symptoms of avoidant personality include:
  • Excessive self-consciousness and anxiety in everyday social situations
  • Extreme fear of being watched or judged by others, especially people you don’t know
  • Fear that others will notice that you’re nervous
  • Fear that you’ll act in ways that that will embarrass or humiliate yourself
  • Intense worry for days, weeks, or even months before an upcoming social situation

Physical symptoms of avoidant personality include:

• Feeling dizzy or faint
• Racing heart or tightness in chest
• Red face, or blushing
• Shortness of breath
• Sweating or hot flashes
• Trembling or shaking (including shaky voice)
• Upset stomach, nausea (i.e. butterflies)

For kids and teens with avoidant personality, evaluating for the presence of psychiatric disorders, particularly major depression, substance abuse, and other anxiety disorders, is extremely important. Because “social anxiety tendencies” are often found in other family members, a family psychiatric history is beneficial. 
 

Help for Children with Avoidant Personality—

1. Avoid or limit caffeine. Coffee, tea, caffeinated soda, energy drinks, and chocolate act as stimulants that increase anxiety symptoms.

2. Challenge negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.

3. Drink only in moderation. You may be tempted to drink before a party or other social situation in order to calm your nerves, but alcohol actually increases your anxiety in the long run.

4. Face the social situations you fear in a gradual, systematic way, rather than avoiding them.

5. Get adequate sleep. When you’re sleep deprived, you’re more vulnerable to anxiety. Being well rested will help you stay calm in social situations.

6. Learn how to control the physical symptoms of social anxiety through relaxation techniques and breathing exercises.

7. Quit smoking. Nicotine is a powerful stimulant. Smoking leads to higher, not lower, levels of anxiety.

8. Take a social skills class or an assertiveness training class. These classes are often offered at local adult education centers or community colleges.

9. Volunteer doing something you enjoy, such as walking dogs in a shelter, or stuffing envelopes for a campaign — anything that will give you an activity to focus on while you are also engaging with a small number of like-minded people.

10. Work on your communication skills. Good relationships depend on clear, emotionally-intelligent communication. If you find that you have trouble connecting to others, learning the basic skills of emotional intelligence can help.


Resources for parents of children and teens on the autism spectrum:
 

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

Why Your Child on the Autism Spectrum Experiences a Significant Degree of Anxiety

“Why does it seem to be the case that many (if not most) children with ASD also suffer from a significant degree of anxiety?”

Kids with High-Functioning Autism (HFA) and Asperger’s (AS) are indeed particularly vulnerable to anxiety. This vulnerability may be an intrinsic feature of the disorder through a breakdown in circuitry related to extinguishing fear responses, a secondary consequence of their inability to make social judgments throughout development, and specific neurotransmitter system defects.

Specific reasons for experiencing high degrees of anxiety include the following:

1. Limitations in generalizing from one situation to another contribute to repeating the same social errors.

2. Limitations in their ability to grasp social cues and their highly rigid style act in concert to create repeated social gaffs as well.

3. The lack of empathy severely limits skills for autonomous social-problem solving.

4. The social-skills deficits of HFA and AS make it difficult for kids with the disorder to develop coping strategies for soothing themselves and controlling difficult emotions.

5. There is the discomfort that comes from “somatic responses” (i.e., relating to the body, especially as distinct from the mind) that are disconnected from events and experience.

6. They are frequently victimized and teased by their peers and can’t mount effective socially adaptive responses.

7. With these “special needs” children, there is sufficient grasp of situations to recognize that others “get it” when they do not.

Several medications have been tried for treatment of anxiety in young people on the autism spectrum. There is no reason to suspect that kids with the disorder are less likely to respond to the medications used for anxiety in “typical” (i.e., non-autistic) children. 

Therefore, selective serotonin reuptake inhibitors (SSRIs), buspirone, and alpha-adrenergic agonist medications (e.g., clonidine or guanfacine) all have been tried. The best evidence to date supports use of SSRIs.

Note: Kids with HFA and AS may be more vulnerable to side effects of medications - and many exhibit unusual side effects. “Disinhibition” (i.e., a lack of restraint manifested in disregard for social conventions) is particularly prominent and can be seen with any of the SSRIs. 

Similarly, excessive doses may produce  “amotivational syndrome” (i.e., a lack of desire to complete tasks, a sense of apathy about the future, poor concentration, and decreased interest in social and other activities).

By

Children on the Autism Spectrum and Tips for Completing Assignments

Question

"Can you offer tips for completing assignments?"

Answer

Children with High-Functioning Autism (HFA) have the same motivational needs as other kids. Sometimes less, and other times, a lot more motivation is needed to accomplish the same assignment. However, children on the autism spectrum will always have the need for a little extra help due to the challenges associated by the disorder.

Because HFA affects functional skills in socialization and communication, teachers and parents will need to get creative in order to find ways to help these kids succeed.

Here are a few tips to help with school assignments:
1. Children on the spectrum crave order, structure and routine. These desires can be utilized to help with assignment completion. Classroom time for the "special needs" child must be an organized and structured environment. Consistent structure will provide comfort, allowing the child to make progress on his assignments.

2. Use visual schedules. These young people need a balanced schedule that will alternate core subjects with chances to de-stress, usually with structured down time. For example, the student may be scheduled for an hour of math, thirty minutes for lunch, and then an hour of music. Assuming that music is a class he thoroughly enjoys, that hour would be his time to de-stress.

3. Allowing further breakdown of assignments into mini-assignments will also help ensure successful completion. This breakdown will appeal to the child’s sense of order as he sees each step is simply written and manageable.

4. The breakdown of assignments into steps leads to another suggestion. Additional time is useful when assigning work to the student. Children with HFA may find additional time helpful to complete their assignments. Meeting a deadline on an assignment can create stress that causes the child to become completely overwhelmed, wiping out any chance of completing the assignment.

5. Teachers of children with the disorder should also keep in mind the need to use straightforward instructions stated simply and clearly. Language is difficult for kids on the spectrum. Sarcasm and slang go right over their heads. Remember that they need to know what, when, and how. Basic instruction goes a long way.

6. Some homework assignments will be of no interest to the youngster. In this case, there may not be any clever tricks to get him or her to complete the assignment. Thus, when possible, it will be helpful if the teacher tailors the "boring" assignment to the individual needs of the HFA student.

Most teachers welcome feedback and want to assign homework that children can complete successfully. Most teachers try to structure assignments so that a wide range of children will find them interesting (e.g., they may offer options for different approaches to the same topic, give extra assignments to those who want more of a challenge, or give specialized assignments to those who are having trouble with a particular subject).

7. Finally, praise the student for the work that is completed. Praise from his teacher will motivate the child with HFA - and the typical child alike. Teachers should always praise their students if possible. Children with the disorder may have weaknesses to battle, but praise is a weapon that can be used successfully in the classroom.


Resources for parents of children and teens on the autism spectrum:
 

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

Problems with Depression in Teens on the Autism Spectrum

All teenagers experience depression from time to time due to the normal pressures faced during adolescents. Also, young people with ASD level 1, or High-Functioning Autism (HFA), experience depression occasionally due to dealing with the symptoms associated with the disorder. So, little wonder why a teenager WITH the disorder may have more than his fair share of depression symptoms.

Depression in HFA teens is a serious condition – it affects emotions, thought and behaviors. Although adolescent depression isn't medically different from depression in grown-ups, HFA adolescents often have unique challenges and symptoms. Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for these adolescents. But for some, the lows are more than just temporary feelings — they're a sign of depression.

Depression is these teens is not a weakness or something that can be overcome with willpower. Like depression in grown-ups, adolescent depression is a medical condition that can have serious consequences. However for most, adolescent depression symptoms ease with treatment such as medication and psychological counseling.

Adolescent depression symptoms include:
  • Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
  • Anxiety, preoccupation with body image and concerns about performance, particularly in girls
  • Changes in appetite. Depression often causes decreased appetite and weight loss, but in some individuals it causes increased cravings for food and weight gain
  • Crying spells for no apparent reason
  • Disruptive behavioral problems, particularly in boys
  • Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
  • Feelings of sadness
  • Feelings of worthlessness or guilt, fixation on past failures or self-blame when things aren't going right
  • Frequent thoughts of death, dying or suicide
  • Insomnia or excessive sleeping
  • Irritability, frustration or feelings of anger, even over small matters
  • Loss of interest or pleasure in normal activities
  • Slowed thinking, speaking or body movements
  • Trouble thinking, concentrating, making decisions and remembering things
  • Unexplained physical problems, such as back pain or headaches

Adolescent depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD). 
 

What's normal and what's not:

It can be difficult to tell the difference between the ups and downs that are just part of being an adolescent and adolescent depression. Talk with your adolescent. Try to determine whether he or she seems capable of handling his feelings without help, or if life seems overwhelming. If adolescent depression symptoms persist or begin to interfere in multiple areas of your adolescent's life, talk to a doctor or a mental health professional trained to work with adolescents. Your adolescent's family doctor or pediatrician is a good place to start. Or, your adolescent's school may have a recommendation.

Warning signs that your HFA adolescent could be struggling with depression:
  • An ongoing sense that life and the future are grim and bleak
  • Conflict with friends of family members
  • Extreme sensitivity to rejection or failure
  • Loss of interest in family and friends
  • Neglected appearance — such as mismatched clothes and unkempt hair
  • Poor school performance or frequent absences from school
  • Reckless behavior
  • Sadness, irritability or anger that goes on for two weeks or longer
  • Talking about running away from home or attempting to do so
  • Use of alcohol or drugs

When to see a doctor:

If you suspect your adolescent may be depressed, make a doctor's appointment as soon as you can. Depression symptoms may not get better on their own — and may get worse or lead to other problems if untreated. Adolescents who are depressed 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 doctor or school nurse. Share your concerns with a parent, a close friend, a faith leader, a teacher or someone else you trust.

Suicidal thoughts:

If your adolescent is having suicidal thoughts, get help right away. Here are some steps you can take:
  • Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor or have your adolescent talk to someone.
  • Contact a family member or friend for support.
  • Contact a minister, spiritual leader or someone in your faith community for advice.
  • Seek help from a doctor, a mental health provider or other health care professional.

When to get emergency help:

If you think your adolescent is in immediate danger of self-harm or attempting suicide, call 911 or your local emergency number immediately. Make sure someone stays with him or her until help arrives.

Causes—

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:
  • Biological differences. Individuals with depression appear to have physical differences in their brains from individuals who aren't depressed. The significance of these changes is still uncertain but may eventually help pinpoint depression causes.
  • Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
  • Inherited traits. Depression is more common in individuals whose biological family members also have the condition.
  • 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.
  • Life events. Events such as the death or loss of a loved one, financial problems, and high stress can trigger depression in some individuals.
  • Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.

Risk factors—

Although the precise cause of depression isn't known, factors that seem to increase the risk of developing or triggering adolescent depression include:
  • Abusing alcohol, nicotine or other drugs
  • Being a girl — depression occurs more often in females than in males
  • Being attracted to members of the same sex — which can cause depression linked to negative social pressures and internal emotional conflicts
  • Having a chronic medical illness such as diabetes or asthma
  • Having a family member who committed suicide
  • Having a parent, grandparent or other biological relative with depression
  • Having an anxiety disorder
  • Having been physically or sexually abused
  • Having been the victim or witness of violence
  • Having biological relatives with a history of alcoholism
  • Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
  • Having experienced recent stressful life events, such as the death of a loved one
  • Having few friends or other personal relationships
  • Having strict moms and dads that are quick to blame or punish
  • Obesity, which can lead to judgment by others and to low self-esteem
  • Parental divorce

Complications—

Untreated depression can result in emotional, behavioral and health problems that affect every area of your adolescent's life. Complications associated with adolescent depression can include:

• Suicide
• Social isolation
• Relationship difficulties
• Family conflicts
• Anxiety
• Alcohol and drug abuse
• Academic problems

Preparing for an appointment—

You're likely to start by taking your adolescent to see his primary care doctor or pediatrician. However, when you call to set up an appointment, you may be referred directly to a psychiatrist or psychologist — mental health professionals who specialize in diagnosing and treating mental health conditions. 
 

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea for you and your adolescent to be well prepared for the appointment. Here's some information to help you get ready for your adolescent's appointment, and what to expect from the doctor.

What you can do:
  • Make a list of all medications, vitamins or supplements that your adolescent is taking.
  • Write down any symptoms your adolescent has had, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes your adolescent has experienced.
  • Write down questions to ask your adolescent's doctor.

Your time with the doctor is limited, so preparing a list of questions ahead of time will help you and your adolescent make the most of your time. List your questions from most important to least important in case time runs out. For problems related to depression, some basic questions to ask the doctor include:
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
  • Are there any possible side effects or other issues I should be aware of with the medications you're recommending for my adolescent?
  • Are there any restrictions that my adolescent needs to follow?
  • 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. How can he or she best manage them together?
  • Other than the most likely cause, what are other possible causes for my youngster's symptoms or condition?
  • Should my adolescent see a psychiatrist or other mental health provider?
  • What are the alternatives to the primary approach that you're suggesting?
  • What kinds of tests will he or she need?
  • What treatment is likely to work best?
  • Will making changes in diet, in exercise or in other areas of my adolescent's life help ease depression?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time during your adolescent's appointment.

What to expect from your adolescent's doctor:

The doctor is likely to ask your adolescent a number of questions. Making sure he or she is ready to answer them may reserve time to go over any points you or your adolescent wants to spend more time on. Your youngster's doctor may ask your adolescent:
  • Do you ever have suicidal thoughts when you're feeling down?
  • Do you have any biological relatives — such as a parent or grandparent — with depression or another mood disorder?
  • Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
  • Have you experimented with alcohol or illegal drugs?
  • How long have you felt depressed? Do you generally always feel down, or does your mood change?
  • How much do you sleep at night? Does it change over time?
  • How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
  • 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 your family members or your friends first notice your symptoms of depression?

Tests and diagnosis—

When a doctor suspects an adolescent has depression, he or she will generally ask a number of questions and may do medical and psychological tests. These can help rule out other problems that could be causing symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to your adolescent about his thoughts, feelings and behavior patterns. The doctor may have your adolescent fill out a written questionnaire to help answer these questions.

• A physical exam. This generally involves measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.

Diagnostic criteria for depression:

To be diagnosed with depression, your adolescent must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of major depression, your adolescent must have five or more of the following symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Symptoms can be based on your adolescent's feelings or may be based on the observations of someone else. They include:
  • Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in adolescents, depressed mood can appear as constant irritability)
  • Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
  • Either restlessness or slowed behavior that can be observed by others
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
  • Insomnia or increased desire to sleep nearly every day
  • Recurrent thoughts of death or suicide, or a suicide attempt
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in adolescents, failure to gain weight as expected can be a sign of depression)
  • Trouble making decisions, or trouble thinking or concentrating nearly every day

To be considered major depression:
  • Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one
  • Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism
  • Symptoms aren't due to a mixed episode — 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, such as school, social activities or relationships with others

Other conditions that cause depression symptoms:

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so your adolescent can get the appropriate treatment. Your doctor or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:
  • Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.
  • Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
  • Psychotic depression. This is severe depression accompanied by psychotic symptoms such as delusions or hallucinations.
  • Postpartum depression. This is a common type of depression that occurs in new mothers. It often begins four to eight weeks after delivery and may last for months.
  • Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent your adolescent from functioning normally in his daily routine and from living life to its fullest.
  • Cyclothymia. Cyclothymia (si-klo-THI-me-uh), or cyclothymic disorder, is a milder form of bipolar disorder.
  • 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.
  • 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 your feelings, thoughts and behavior.

Make sure that you understand what type of depression your adolescent has so that you can learn more about his specific situation and its treatments. 
 

Treatments and drugs—

Numerous treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most adolescents with depression.

In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many adolescents need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist or psychologist). Some adolescents with depression also benefit from seeing other mental health counselors.

If your adolescent has severe depression or is in danger of hurting himself or herself, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Medications:

A number of antidepressant medications are available to treat depression. There are several different types, categorized by how they affect the naturally occurring chemicals in the brain linked to mood.

Because studies on the effects of antidepressants in adolescents are limited, doctors 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 doctor's discretion (off label).

Types of antidepressants include:

• Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to another antidepressant to help with sleep.

• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), isocarboxazid (Marplan) and phenelzine (Nardil) — are generally prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because they may cause life-threatening high blood pressure if combined with certain common foods such as aged cheeses, pickles and chocolate. They can also interact with some medications, including decongestants. MAOIs can be very dangerous in overdose. Selegiline (Emsam) is a newer MAOI that's applied to the skin as a patch rather than swallowed as a pill. It may cause fewer side effects than do other MAOIs.

• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. At high doses, bupropion may increase the risk of having seizures.

• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment in adolescents by prescribing one of these medications. SSRIs are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). These medications can cause side effects. These may go away as the body adjusts to the medication. Side effects can include digestive problems, jitteriness, restlessness, headache and insomnia. These medications have a low risk of death in overdose.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. Individuals with liver disease shouldn't take duloxetine.

• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. Examples include amitriptyline, imipramine (Tofranil) and doxepin. Because they can have side effects, they generally aren't used in adolescents. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain. These medications can be very dangerous when taken in overdose.

• Other medications. If your adolescent's depression isn't getting better with one antidepressant, the doctor may recommend adding another antidepressants or another type of medication for better effect — such as a stimulant, mood-stabilizing medication, anti-anxiety medication or antipsychotic medication. This strategy is known as augmentation.

Managing medications:

Carefully monitor your adolescent's use of his medications. In order 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 doctor may prescribe only small supplies of pills at a time, or recommend that you dole out your youngster's medication so that your adolescent does not have large amounts of pills available at once. Be especially careful if you think your adolescent is at risk of suicidal behavior and is taking a tricyclic antidepressant or an MAOI — these medications are more dangerous than other types of antidepressants when it comes to overdose.

Finding the right medication:

Everyone's different, so finding the right medication or dose of medication for your adolescent 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, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered down. Quitting suddenly may cause a sudden worsening of depression.

If antidepressant treatment doesn't seem to be working, your adolescent's doctor may recommend a blood test to check for specific genes that affect how his body processes antidepressants. The cytochrome P450 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well the body can or can't process (metabolize) a medication. This may help identify which antidepressant might be a good choice for your adolescent. These genetic tests aren't widely available, so they're an option only for individuals who have access to a clinic that offers them.

Antidepressants and pregnancy:

If your adolescent is pregnant or breast-feeding, some antidepressants may pose a health risk to her unborn youngster or nursing youngster. If your adolescent becomes pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy.

Antidepressants and increased suicide risk:

Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) warns that in some cases, kids, adolescents and young people ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. This risk may be highest in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, individuals in these age groups must be closely monitored by while taking antidepressants.

While this warning may seem alarming, for most 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.

If your adolescent has suicidal thoughts when taking an antidepressant, immediately contact his doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get depression symptoms under control.

Psychotherapy:

Psychological counseling (psychotherapy) is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about depression and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy. Psychotherapy may be done one-on-one, with family members or in a group format.

Through these regular sessions, your adolescent can learn about the causes of depression so that he or she can better understand it. He or she will also learn how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your adolescent regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your adolescent adjust to a crisis or other current difficulty.

Cognitive behavioral therapy is one of the most commonly used therapies for adolescent depression. It helps a person identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other individuals or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other examples of counseling commonly used to treat depression. There are a number of additional types of psychotherapy that can be effective. Many therapists use a combination of approaches.

Hospitalization and residential treatment programs:

In some adolescents, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if your adolescent 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 his mood improves. Partial hospitalization or day treatment programs also are helpful for some adolescents. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control. 
 

Lifestyle and home remedies—

Depression generally isn't an illness that you can treat on your own. But there are some steps you and your adolescent can take that may help:
  • Pay attention to warning signs. Work with your adolescent's doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your adolescent know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
  • Make sure your AS or HFA adolescent gets plenty of sleep. Sleeping well is important for adolescents, especially adolescents with depression. If your adolescent is having trouble sleeping, talk to his doctor about what can be done.
  • Make sure your adolescent gets exercise. Even light physical activity can help reduce depression symptoms.
  • Learn about depression. Education about your adolescent's condition can empower your adolescent and motivate him or her to stick a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression. Counseling that focuses on this is known as psycho-education.
  • Help your adolescent avoid alcohol and other drugs. Your adolescent may feel like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.
  • Encourage your adolescent to stick to his treatment plan. Make sure your adolescent attends psychotherapy sessions or 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 adolescent stops taking medications, depression symptoms may come back. Quitting suddenly may also cause withdrawal-like symptoms.

Alternative medicine—

Alternative medicine strategies for depression include supplements and mind-body techniques. Here are some common alternative treatments for depression.

Herbal remedies and supplements:

A number of herbal remedies and supplements have been used for depression. Examples include:

• Omega-3 fatty acids. Eating a diet rich in omega-3s or taking omega-3 supplements may help ease depression and also appears to have a number of other health benefits. Cold-water fish and fish oil supplements are good sources of omega-3s. Omega-3s are also found in flaxseed, walnuts and some other foods.

• SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. As with St. John's wort, SAMe isn't approved by the FDA to treat depression. However, it's used in Europe as a prescription drug to treat depression.

• St. John's wort. Known scientifically as Hypericum perforatum, this is an herb that's been used for centuries to treat a variety of ills, including depression. It's not approved by the Food and Drug Administration to treat depression in the United States. Rather, it's classified as a dietary supplement. However, it's a popular depression treatment in Europe.

Some supplements — including St. John's wort and SAMe — can interfere with antidepressants.

Mind-body connections:

The connection between mind and body has been studied for centuries. Complementary and alternative medicine practitioners believe the mind and body must be in harmony for you to stay healthy.

Mind-body techniques used to improve depression symptoms include:

• Yoga
• Meditation
• Massage therapy
• Guided imagery
• Acupuncture

Make certain you understand risks as well as possible benefits before pursuing any therapy for your adolescent. To be safe, talk to your adolescent's doctor before he or she takes any herbal or dietary supplements — particularly St. John's wort or SAMe. Keep in mind, alternative treatments aren't a replacement for conventional medical treatment or psychotherapy.

Coping and support—

Showing interest and the desire to understand your adolescent's feelings lets him or her know you care. You may not understand why your adolescent feels that things are hopeless or why he or she has a sense of loss or failure. Listen to your adolescent without judging and try to put yourself in his position. Help build your adolescent's self-esteem by recognizing small successes and offering praise about his competence.

Encourage your HFA adolescent to:

• Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your adolescent 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 adolescent 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. One good place to start is the National Alliance on Mental Illness.

• Encourage your adolescent to keep a private journal. Journaling can improve mood by allowing your adolescent 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 — academically, in athletics or in appearance, for example. Let your adolescent know that it's OK not to be perfect.

• Make and keep healthy friendships. Positive relationships can help boost your adolescent's confidence and stay connected with others. Encourage your adolescent to avoid relationships with individuals whose attitudes or behaviors could make depression worse.

• Simplify his life. Encourage your adolescent to carefully choose his obligations and commitments, and set reasonable goals. Let your adolescent know that it's OK to do less when he or she feels down.

• Stay active. Participation in sports, school activities or a job can help keep your adolescent focused on positive things — rather than negative feelings or behaviors.

• Stay healthy. Do your part to make sure your adolescent eats regular, healthy meals, gets regular exercise and gets plenty of sleep. These are priorities — encourage your adolescent not to avoid these things because of social activities, school responsibilities or other demands.

• Structure his time. Help your adolescent plan his activities by making lists or using a planner to stay organized.

Prevention—

There's no sure way to prevent depression. However, making sure your AS or HFA adolescent takes steps to control stress, to increase resilience and to boost low self-esteem can help. Friendship and social support, especially in times of crisis, can help your adolescent cope. In addition, treatment at the earliest sign of a problem can help prevent depression from worsening. Some adolescents with Aspergers need to continue taking medications even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.

Resources for parents of children and teens on the autism spectrum:
 

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