Expert: Catherine Ridenour - 7/14/2007

Question
QUESTION: My 11 year old son has autism.  He is verbal and has very good receptive language.  A few weeks ago he started a summer school program.  He started to have trouble falling asleep.  Sometimes not until midnight.  He would then need to wake up at 6:30am for school.  When he is tired he starts to lose his self control and act out.  We have tried to get it under control with such things as the "naughty" chair, but there are times when he becomes very physical.  He will not sit and begins to pinch and hit.  Other times he is as sweet as pie.  He starts to tire about 5pm.  We prepare for bed when it gets dark about 8:30pm.  Even though he is tired, he fights it.  Just as he is about to drift off, he forces himself awake.  He also wakes up with nightmares on occasion.  Everyone keeps saying anxiety, which we know.  The Dr. does not feel meds are needed, just a lot of TLC.  OT when really out of joint.  This is easier said than done.  Any ideas on how to communicate with him regarding his behaviors or ideas on how to get him to get to bed.  He used to be an angel and now is a little demon (although a cute one).
Thanks in advance,
Ellen

ANSWER: Dear Ellen,

Your son has reached the age where his hormones are beginning to rise. Erratic behavior is common at this age even in "normal" children. I will include a link to an article about autism and adolescence at the end of this message.

He is also very likely to be aware that he is not like other kids and to be unhappy with the fact. Have your doctor consider the possibility of depression. It is very common in autistic children, particularly those who are higher functioning and, therefore, aware of their own difficulties.

Depression interferes with sleep in almost all cases. It also increases angry outbursts.

Our daughter has benefitted from the use of anti-depressants since the 5th grade. For her, it balances her brain chemistry so that she can sleep better and be less anxious during the day. I am of the opinion (remember, I'm not a doctor) that part of autism is an imbalance in brain chemistry to begin with.

Hold your ground on discipline. You do not mention how well he thinks but, it may be time to move to a "logical consequences" type management rather than time out. If he understands if/then, it should work. I found the approach of "Love and Logic" to be most helpful. Look them up on the Internet.

In general, you need to prepare for the storms of adolescence that all parents face. As you already know, emotional stuff is overwhelming for him and catches him by surprise. Try to get your OT person to address this by teaching him to recognise the approach of an outburst and techniques to head it off. This is a difficult time for autistic kids.

Here are those Internet links:

http://www.neurodiversity.com/main.html (many links to books, articles and resources)

http://www.patientcenters.com/autism/news/resources.html (books and resources)

http://www.autism.org/temple/meds.html (about medication)

http://www.aspergers.com/Adolesc.htm (adolescence issues)

Best wishes,
Catherine

---------- FOLLOW-UP ----------

QUESTION: Thank for the reply.  Ted thinks pretty well.  In the past if I would cry or get upset, he would get down and kiss my feet and hug my legs!  Now he loves seeing me angry.  We have figured out a bit of the sleep by keeping talking and noise to a minimum.  However, today the outbursts were bad.  Hitting, throwing, screaming.  My little boy used to be like Opie Taylor from Andy Griffith and now I don't know who he is.  He responds better to my husband, but only when my husband resorts to the "drill sergeant" tone with him.
I have an older son who is 14 who also has autism.  We put him on Celexa a year ago for aggressive behaviors in school, never at home.  These really bad behaviors are coming off a week or two of bad sleep and bad parenting.  I am hoping if we can pull things together he will be fine without meds.  We are still going to make an appointment with the psychiatrist however, just to make sure.  So many parents are against medication, and make you feel like a bad parent and a failure when you put your children on them.  Thanks for your encouraging words.  We will do a follow-up internet search on the "Love & Logic" principal.
Thank you,
Ellen

Answer
Hi Ellen,

When people give you hassles about medication ask them if they would think you were a bad parent for giving a diabetic child his insulin. You are giving him the brain chemicals he needs to function in our society. Without them, his life will be more limited.

Best wishes,
Catherine