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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