Expert: Catherine Ridenour - 12/8/2009

Question
My son was diagnosed about 4 years ago with PDD-NOS. Since then, he's been in specialized programs at school, and we've done numerous therapies, all of which seem to have helped greatly.  He "graduated" to a regular-ed class last year with some one-on-one help, and generally is doing very well in school.

We used to have him on Focalin to help with attention, but discovered it was stunting his growth.  Since we changed diets over a year ago, we found he really didn't need the medication, and were able to stop it back in June.

Things had been going very well until about a month ago.  He started developing a tic where he shrugs his shoulders and rubs his ears against them. Also, he's having a lot more behavior problems at school with impulse control issues.  

Recently, he's been pestering one girl in particular.  I asked him why, and he said she had pretty blonde hair, and he wanted some for her DNA.  I asked him to please leave her alone, that she probably still thought boys were "icky", even though we loved him no matter what.

Could this be the beginning of puberty?  I've read that some autistic boys have elevated testosterone levels.  We really don't like medicating him, and seem to have best results with changing his diet (no gluten, no sugar, no preservatives - nothing processed).

Any ideas would be most appreciated.

Answer
Hi Melanie,

Puberty seems to be happening earlier in all our children. It could be that is his issue, but it may also just be that teasing/bugging girls is something that 9 y.o. boys do. Your son has the added complications of not knowing when to stop and what is appropriate.

Most school districts inform parents before sex education begins (if they have it any more). We decided to get ahead of that curve and educated our children about the facts of life about the age of eight. We wanted them to have the scientific facts before the emotions took over or they heard bad or incomplete information from their peers. I think it's time you offer some basic biological information and tell him he may begin having sexual feelings. The feelings are ok, acting on them requires adult relationships (however you choose to define this). Even if he's not entering puberty, yet, it's right around the corner.

I would start with a return to some social education about polite interactions between boys and girls. He needs to be told that it would seem "creepy" to the girl to hear he "wants her DNA." You and I know that he means nothing threatening by that, but she won't.

The impulse control issue is a harder question. I fully understand your resistance to medication if diet is sufficient. However, you've made about all the modifications you can and still have anything left to feed him. A different medication might not affect his growth as much. Some doctors recommend a summertime medication vacation to allow growth to catch up while using meds during school months. Only you can make this call.

In my experience, drawing attention to tics is a mistake. It tends to increase the behavior. They are usually an unconscious coping mechanism to release tension.

You could ask him what he's feeling when it happens. Direct teaching about emotions is critical. Kids on the autistic spectrum don't realize they have a feeling until it becomes very intense. This is why they can be so volatile. Talk about how his body feels when he begins to get anxious or angry. Tell him how your feelings manifest. "I get sweaty, my throat feels tight when I'm getting scared." Teach him to talk about how he feels in concrete ways. Making it verbal will help him see the emotion coming before it sweeps him away.

I have seen a couple of books that discuss Autism and puberty. Perhaps you should do a search at Amazon or other online bookstore and pick one that focuses on boys. We reared three daughters and I'm pretty sure there are different approaches for boys.

Best wishes,
Catherine