Q and A Tuesday: childhood depression + adult autism spectrum diagnoses

Two very different questions from readers this time. One about a situation involving childhood depression. The other about determining when adults should seek an ASD diagnosis. Thanks to everyone for their questions, it gives all of us a way to discuss and think about these challenging issues; it is much appreciated.

The questions:

Q: Our 7 year old with autism spectrum disorder is taking Abilify for his outbursts of irritability. Lately, he can become extremely upset and ask things like, “Do you want me to kill myself?” We know not were he even got these words nor the concept of the words. Should we be concerned about this? And should we notify his doctor about this? He does have sensory issues and expressive language delay.

A: I would say a few things. When children are experiencing extreme discomfort, they can often have extreme reactions, so it does happen that kids will make statements like this; it’s just important to know that these are very likely moments of pain or discomfort. Many people with ASD have sensory issues…so one possibility is that when he is agitated, it is due to a sensitivity of some kind (to lights, sound, tactile sensations, etc); also, I have read about a lot of situations where children are having reactions to something in their diet…they can become physically uncomfortable, and then lash out.

Yes, it’s a cause for concern. The primary goal should be to identify the trigger for these outbursts. Since many kids are not able to find words for what is happening internally, you basically have to become a detective and puzzle out what is going on. I would look for sensory triggers, or dietary triggers…and it could be something else all together (depression, anxiety), so just work on ruling out causes, narrowing down the list of suspects. When a child has trouble verbalizing what, specifically, is troubling them, they will often use behaviors to communicate. There is a good chance that these outbursts are his way of saying, “I am in pain”. I can’t know that for sure, but I would definitely begin to determine whether or not something specific, like a sensory issue, is causing him discomfort.

And yes, do share these experiences with your doctor. Maybe they can help you determine what is going on in these moments when your son is so anguished. It helps enormously if your doctor has experience with ASD…if your doctor does not have a great deal of ASD experience, it’s okay to ask for a referral and try to see someone who does. The Abilify your son is taking may help manage emotions, but it will not treat potential underlying triggers like sensory issues or dietary issues, so hopefully you guys can make a game plan and find out what is happening there.

Also: on the blog Diary of a Mom, there is a section where parents can ask other parents for advice…I would ask this question there, maybe some of the parents will have useful feedback. Click here to check that out.

Parents who have been through this will have better answers than I could offer. All I can provide are my opinions, I am not a mental health professional, so I think finding a doctor/therapist with ASD experience could make a difference. Best of luck, my thoughts are with you guys.

Q: Was getting an adult autism spectrum diagnosis beneficial? Was there a single thought that reinforced your decision to go to therapy that first time?

A: So, to answer your second question first: getting a diagnosis was definitely helpful. I had struggled for a lot of years and had no idea why the majority of social experiences in my life were difficult, confusing. Once the diagnosis was in place, I was able to finally make sense of what was happening, in very specific terms; and I was then able to make a game plan based on an accurate sense of self. Before the diagnosis, all of my attempts to “get better” did not go well, all because I did not really have a solid understanding of my mind, the way it worked.

Another way to put this, and I think this is really the main point: without a diagnosis, it’s very easy to develop coping strategies that work against you. I put a lot of effort into understanding how other people thought, acted, all so that I could learn to seem normal. This did lots of harm, and zero good. There’s really no way to have positive experiences if your sense of self is distorted, off-base. So the diagnosis was what finally allowed me to develop coping strategies that were a good fit for my life.

As for why I finally decided to go to therapy: once I hit the age of 30, there was no longer any doubt that life was off track…I think some part of me felt that eventually things would just improve on their own…but I finally had to admit, I needed help making sense of things. I was depressed. I was deteriorating in a broad range of areas. And my social deficits has been life-long, were not improving. And again, my own efforts to get better had always backfired. So, there was a point when I finally just had to swallow my pride and admit that I needed help.

Check out these other Q and A posts: ASD and alternatives to small talk; the IDEA Act and sensory issues; and body language and small talk. You can also find more Invisible Strings on Twitter and Facebook.
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  • http://www.autism-mom.com Elizabeth

    My son started threatening self harm when he was 7 as well. Yes, we sought assistance from a psychologist who determined that he did not actually want to hurt himself. He was frustrated and overwhelmed and did not have the tools to a) manage his intense feelings when faced with challenges, b)accurately identify the relative size of his problems and b) find solutions for himself. It is something we work on daily.

    • http://theinvisiblestrings.com m kelter

      Thank you for this Elizabeth; so glad you guys found a therapist who could zero in on what was happening, hope you guys are in a better place, I know it’s a constant challenge.

  • Kim

    My 7 year old son has also been talking about killing himself. It seems to be the only way he knows to express his intense emotional pain right now. He is on risperidone, and that has helped a lot – it seems to decrease the anxiety caused by the daily sensory onslaught he faces.. He also sees a therapist twice a week, but those visits, and the push to discuss emotions, seem to make him angrier and more miserable. I wish I knew how to help him. I keep hoping time and maturity will help him understand his feelings better, and learn to moderate them..

    • http://theinvisiblestrings.com m kelter

      Thx for the comment Kim, sorry the therapy meetings are going so poorly; it’s always hit and miss with therapy, the right person can be a lifesaver, if the connect with the person, listen, but it can also go the other way, become frustrating, hope you guys can find a way through all of that. thx again, Kim.

  • Bánki Bálint

    My 5 year old AS daughter often says dark sentences when she is anxcious or frustrated or perplexed or full of anger or whatever. Such as “I wish I hadn’t been born on this planet”, or “I wish I would be dead”. When she wants to hurt me or her mum she sometimes says things like “I hope you die earlier than daddy.” or “I don’t wan’t to be buried in the same grave with you.” On the other hand she is functioning very well. She has normal IQ, she speaks 2 languages, she keeps eye contact, she smiles amd laughs a lot, she expresses her emotions (her huge hugs and kisses are the best things ever). As for me, I don’t know an answer for sure, but I guess AS is to blame for this extreme behaviour. When she is happy, she is in the clouds, when she is upset she is at the bottom of the darkest ocean. Everything is black and white, there is no gray option. She is coping with the world around her, and she is trying to understand what makes the wheels in motion in her surrounding society with little success. There are two possible outcomes to handle her failures. 1. Turning inside and burying your pain in your heart. 2. Burst it out on the ones you think will forgive you for it – your loving parents. Actually, I am happy that she lets the steam come out, even if it is shocking for us sometimes. As Shrek said: “It is better out than in” :)

  • ischemgeek

    If I may on this issue: Consider also bullying. Kid maybe getting told to kill himself at school. I was 6 when other kids started telling me to kill myself. Just saying – if he used to be happy and is now very upset and you’ve ruled out health problems and sensory stuff, bullying might be it.

    Make sure the doctor is aware that Abilify can cause suicidal thoughts and actions in people under 25. It’s something the doctor will want to consider, particularly if these dark thoughts started only after he began the medication. You might be dealing with a serious medication side-effect.