Expert: Catherine Ridenour - 9/25/2008

Question
My daughter is 6 and was diagnosed with PDD at the age of 2. Last year right
after she turned 5 she had the first of many seizures and was diagnosed with
epilepsy 2 months later. She took Trileptal for about a year and then was
switched to Tegretol, 1 tsp 3xdaily, 5 weeks ago. She's had some significant
behavior changes in the past couple of weeks, all of them negative. She's
become very defiant, yelling at me and her teachers at school, screaming
when she gets upset. She was also diagnosed with SPD when she was 3 and
she absolutely does not like to be touched, it's worse when she's upset. She
has begun to just refuse to do things that she's asked to do and she has
become physically aggressive toward her brother, he's 3. My husband moved
out in March and she doesn't get to see him much so I thought maybe that
was the cause of the changes in her but it's only been in last couple of weeks
that I've seen it. She has seemed fine until now. Could it possibly be a
reaction to her medication or should I just chalk it up to her having to adjust
to a new living situation? We also moved from the house we've lived in since
she was 2 months old into an apartment at the beginning of the month. Lots
of changes for her.

Answer
Hi Tracy,

Epilepsy is, as I'm sure they have told you, more common in children on the autistic spectrum. I don't know enough about epilepsy to comment on the medication. However, since the medication change is so recent it certainly could be a contributing factor. It is definitely worth discussing with her doctor.

I suspect that the medication is only part of the picture. As you tell me, there is a huge amount of change happening in her world all at once.

Let's add up the stressors in your daughter's life at the moment. Her daddy is gone, her house is gone, and that "adorable" baby brother is walking, talking and getting into her stuff. The new school year has just begun. She knows she's different from the other kids and I suspect they are not bashful about letting her know they know it too.

Sensory processing disorder compounds all of this because it is difficult for her to process incoming information. She is also limited by her age and her disabilities from being able to predict the outcome of situations or her behaviors and the behavior of others.

I believe she is trying to exercise control over her life in the only way she can. By refusing to do what she's told, she feels empowered. By physically attacking her brother, she gets to be the boss. Again, this helps her feel more powerful.

If this were my child, I would work to give her some power by allowing her choices instead of giving her orders. It seems small but to her it will be important. Here are a couple examples: "Suzy, do you want to wear the pink skirt or the blue one to school today?" rather than "Put on your blue skirt." At the dinner table, rather than, "Eat your peas!" try "Would you like to eat those peas with your spoon or your fork?" Notice, she does not have the choice of NOT getting dressed or eating the peas.

In dealing with the violence toward her brother, it must not be tolerated. She does not understand that others have feelings and thoughts. That is a part of the autism. Neither does she realize that he can be injured by her behavior. As soon as you see it coming, take her to her room. tell her hitting is not allowed. She must stay for five minutes then be allowed to come back and try again. Don't yell, don't spank. She will not respond positively to either. You will have to enforce the "time out" regimen many, many times. Aggression toward younger siblings is a problem most parents of autistic children face. Once little brother gets big enough to defend himself (probably when he's about 6), let him do so. Intervene only if someone is in danger.

I'm going to give you a list of web sites to explore. Find out if "social stories" are being used on her school program. If not, you can use them at home. Basically, they take one situation or issue and tell a story from the child's perspective and giving them a script of how to behave in that situation. They can be very effective with behaviors like fighting with siblings.

http://www.polyxo.com/socialstories/ (a site where you can see some sample stories and learn about them)

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.ninds.nih.gov/disorders/asperger/asperger.htm (the definitions and
government links)

Again, do talk to the doctor about the change in behavior, if it's the meds, that's an easy fix.

Best wishes,
Catherine