Expert: Ettina - 5/11/2009

Question
My son was diagnosed with ADHD,Autistic,Developmentally delayed,PDD,Occ. I list all the labels because my son has never been diagnosed with one specific
label,due to the fact he displays some of the characteristics of each of those
diagnosis.He has been on ritalin since he is 4 years old, he is now 16 and he is
taking concerta 54 mg daily which helps him stay focused during school hours.He
is in a great program in an special ed school where he is in a culinary program
where he does have a para to help assist him to stay on task,he has always had a
para his lifetime in school.additionally he sees a social worker at school once
a week. He does okay academically and very few instances of displaying
aggression in school.He is well liked and somewhat of the mayor in the school he
belongs to.He is generally happy and loves school.

However, most recently he has been becoming more intensely destructive and
violent at times when things just don't go his way at home,and when any holiday
comes to an end.I am afraid of him hurting himself or someone when he is in that
explosive aggressive outbreak ,its like he turns into the hulk,I'm a large man
6ft 220 he is 5'3 180 almost equal in strength.When he gets that way the only
resolution I have is to restrain him,with all my might I have to hold him down
until me and my wife talk him out of this fit of explosive aggression.He does
show some remorse when he gets this way afterwords,but I'm left disturbed after
this has happened.I understand that his hormones are rageing and would expect
typical teenage like behavior but I am really concerned that this is not going
to get better,only worse.Recently it has been occurring more frequently.

I want to have hope that he will grow out of this phase but I feel like I need
to get him some help and I feel more medication is not the answer. I am
constantly trying to be conscious of my tone, verbal cues,timing etc in those
explosive instances or when I see it coming. Frustrated,exhausted and really
concerned for my sons ability to cope when things come to an end and when they
don't go his way.I hope that maybe you have some suggestions for me to help me
help him through this crisis  

Answer
Hormones are often the suggested explanation for this kind of behavior change, and no doubt do play a role in some cases, but in my opinion there's also a lot of situational factors that can explain deteriorating behavior in adolescence. Especially when it's an older adolescent, because the hormones are stronger when the kid's just starting puberty.
The thing is that a lot of significantly developmentally disabled people (especially those with skill scatter) are much more aware of their circumstances than many people expect. Just like many parents of severely disabled kids start to worry about their children's future during adolescence, the kids themselves might worry as well. For example, Amanda Baggs said:

"As I got a little older, I saw people who moved and sounded familiar, like me in some fundamental way that other people were not. Inevitably they were being walked around in a line by staff, and coming from the nearby state institution or some of the group homes in the area. I found this ominous."
http://ballastexistenz.autistics.org/?p=218
(note: This is a lengthy article, scroll down to 'cure or...' to find this quote.)

There's also the fact that many developmentally disabled people are given very little power in their everyday lives. Their wishes, even if they manage to communicate them, often don't have that much impact on what happens - even if they're with someone who is sensitive to their communication and cares about them a lot. A lot of teens start rebelling because they want more independence, and when you have a teen who has much less independence to start with, and less options for how to express rebellion, aggression is a common result.
I can't say for your son if either of these issues explain his aggression, but I do know that these are common problems for kids like him, and very often overlooked. (Indeed, I've often seen parents talk in front of their children about issues likely to be very upsetting to them, as if they can't hear it.)