My son is having a very hard time right now. Need advice.

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My son is 17 and quite autistic.
The last year in school he has become more and more depressed, and we have now done quite a few things to make real changes to his school situation.
This came late, though.
He became so stressed out by how deeply he disliked going to school, that he developed this idea that he has something caught in his throat, and that this is causing him to have breathing problems. He also has a hard time swallowing his saliva, causing him to collect saliva in his mouth and then spit and dribble constantly.


His claims have been taken seriously. We have had his throat examined in all sorts of ways, including x-ray and ultrasound scans, and there really is nothing that the physicians can see. These are symptoms of his state of mind.

He is seeing a psychologist and he is in contact with a youth psychiatric service, and they are trying to help him out of this situation, but it seems hard. He is severely sad and depressed, and the breathing and saliva issues, although clearly an effect of that, seem to get in the way of dealing with the central things.


Is this something anyone recognizes?
How can I talk to him without giving him the impression that I think he is lying or making things up? How can I encourage him to work on his thinking?

He never used to have issues with saliva. This is new.

This is overwhelming to us, and it is devastating for him. The descent into this dark, sad state of mind is heartbreaking to watch, and the breathing and spitting issues are simply baffling and get in the way of trying to work with the more basic things.

The changes in school situation seem to be positive, but the sadness (and the spitting) seems to have such a hold on him I don't know what to do.

Any thoughts?

I can only speak from my own experience here, but there have been times when I have been very stressed and that has given me difficulties in swallowing and a feeling of there being a lump in my throat. Even just typing this now makes my throat feel tight, and swallowing a conscious effort.

I am a 44 year old, professional woman with no diagnosis of autism.

You say that the throat and saliva issues are getting in the way of the basic things. I think that what he is experiencing is a physical manifestation of very profound, and basic in a way, psychological stresses and traumas. I wasn't affected as badly as your son is, but it was extremely distressing, and the kind of thing that gets worse the more you focus on it. It is really important that he receives help to address the issues which making this happen. It is not uncommon, and not restricted to autism, so hopefully there should be a lot of information out there, and professionals with a good understanding of how to approach this ver complex issue.

It sounds like psychosomatic symptoms. Years ago when I was a hypochondriac and had panic disorder I would actually have all sorts of symptoms of things that I was afraid I had. Xanax helped me. I have AS but wasn't diagnosed back then.

I don't know how well explaining to him that there is nothing in his throat will work. Can he understand the logic and anatomy if the doctor explains it to him and maybe shows him the xrays? I'm assuming that he's eating, and you could explain to him that if he can swallow food he can swallow saliva and since he can swallow food, there isn't anything in his throat, but that might make him not eat anymore.

Xanax helped me calm down and not have panic attacks anymore and also realize that I didn't have the things that I was afraid I have. Have you asked him where he got the idea? I remember once, after I read about epiglottitis I was terrified that I had that. Has he read anything that might stick with him?

I don't know what else to suggest, but I wish you luck.

_________________
I'm giving it another shot. We will see.
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Thanks.
I know this isn't necessarily an autistic issue(s).

Yes, he is able to understand the x-rays and the anatomy, but that has not seemed like all good news. I think he is appalled at the very idea that this might be "all in his head".

He has problems with food, too. Not all food, and not all the time.

I'm placing a healthy dose of trust in the professionals involved, but I also need help to figure out how to relate to him in this situation.
It is, like I said, quite overwhelming.

While we haven't had your particular issue, once DS choked on a piece of shredded lettuce, and once on a piece of finely-sliced cured ham. Even though both incidents were fairly normal childhood experiences of not chewing your food properly and swallowing too fast, they were traumatizing for him. He now is convinced he could be killed by either shredded lettuce or that style of ham and avoids them scrupulously.

When he does eat either thing, he is highly likely to panic and start choking even if he is chewing carefully. Yes, it's in his head because it only happens with these two foods (although he is slightly uncomfortable with any food that's hard to chew for this reason) but it might as well be a physiological problem for all the success we have with it. If it were about food in general, and not just two easy-enough-to-avoid foods, we'd be right there with you.

It strikes me simply as logical that your son could be reaching a state of panic: he is almost 18, and everyone around him is trying to set a path for their adult future, but there he is, possibly realizing he is nowhere near ready to do the same, and thus totally unsure of what the future may hold. Whether or not he is even aware he is feeling this, there is probably something going on along those lines.

I think you work on figuring out the things that could be causing him stress, and continue to research possible physical causes, but mostly work on getting inside his head and figuring out why he would start to panic so much that it has a physical manifestation.

When I get very stressed, I become hyper aware of the folds around my tonsils. Sometimes there's a little ridge in the skin, and that makes it feel like something's caught in my throat. Meidcal exams- and poking at it myself- just tend to make the area more inflamed and sensitive. I usually just drink a lot of water for a couple of weeks and eat many frozen confections.

And the being very stressed- it always strikes after the worst of the stressors are removed. You can't stop swimming until after you make it to the shore. If it was a long swim, you're going to need to rest on the beach for a while.

I wonder if it could possibly be a tic brought on by stress?

My guess would be extreme anxiety caused by all of the changes ongoing and upcoming in his life.
The way you describe it: the anxiety sounds bad enough that meds might be an option.

It is actually common for people with anxiety disorders to have difficultly breathing, or have a "lump in the throat", chest pains, heartburn etc. Anecdotally, I have noticed that autistic persons tend to describe things very concretely and explicitly focusing more on details than emotion.

My experience:
I had three major panic attacks when I was in my 20s and ended up in the emergency room. Everyone was telling me I had anxiety issues when I was obsessively focused on my heart rate and respiratory rate. I am that out-of-touch with my feelings.

A lot of changes are happening to him. Changes (good or bad) means stress and no it doesn't matter how positive they are. The fact that it is progressive and "the sadness has a hold on him" indicates that things are getting bad. From what you say I don't see any indication that anybody is making things up (in other words no one is lying or malingering).

Oftentimes dealing with psychologists are hard because they insist on defining the world in terms of feelings (whereas for me, feelings are poorly defined). With a lot of luck you might find a solutions-based concrete thinker for a therapist and not one of those touchy-feely kinds.

In short:
Things will get better eventually, but it will take some time and perseverance.
His symptoms are normal for what is happening to him. It is real.
I would strongly recommend continuing with therapy, but only if it helps. If it doesn't find someone else.
The goal of therapy would be to learn not to overfocus on the symptoms and learn that that "feeling" is anxiety and is transitory and anxiety will not hurt you.
I would also recommend some meds since it will take a while before things are fixed and it sounds like he is suffering.

I hope that helps and I hope things get better.

This makes me think of my partner who has anxiety issues. He frequently while in a deep sleep will sit up and act as if he were choking on something ... he even sleep talks in a twilight state and will say absurd things about it before fully waking up like "OMG honey, I think I just swallowed one of (our son's) toy cars!". I imagine whatever he was dreaming about made him anxious and that set off the choking response. When it comes on drinking water helps him, he keeps a bottle of water by the bed. Or there could be some other issue the doctors just aren't seeing, I have had more than my fair share of doctors dismiss what turned out to be very real problems in my life.

Question: Is the excess salivary flow prettymuch constant?
Is the "lump feeling" associated (timewise) with the saliva?

Proposal: The lump is likely his normal throat, with sensation heightened or irritated by the excess saliva.
Question: Why the crap are the doctors looking at his THROAT? They should be doing [tests specific to] an examination of his salivary glands; abcess, tumour, etc in the salivary glands may be causing this issue ESPECIALLY if the drooling/discomfort is every day. Not every doctor knows every thing. Trust me on that - I once had a guy tell me there was no test for celiac disease right to me face; I made him call the lab and ask.

Edit:
If you HAVE had his salivary glands tested for reasons of overabundance then yes, psychosomatic is probably the way to view the issue. The thing to remember about psychosomatic is that the effects are REAL, the lump and saliva actually are there - just that they are caused by mind over matter, rather than root physical cause.

First I wanted to say that you are in my thoughts!! This is so tough to go through, because no matter what you do you can't fix things for your child. My daughter has OCD, anxiety and depression (15 yrs). She recently has a lot of stress (grades, jerks at school, etc. ) and has ended up with this new ailment of her feeling like she is going to throw up all the time. She describes it as a lump in her throat. She describes it like she when she is going to throw up. We have gone to the doctor and he could not find anything wrong with her yet. Her therapist was brought into the loop, and thinks that it is partially due to her psychological reasons. She probably starts out with a small upset stomach (stress related, ate something, etc) and then starts to worry about to the point of making it 100 times worse. This feeling then creeps up to her throat, because she is associating it with the upset stomach and throwing up. In any event, her doctor put her on zofran. It is an anti-nausea medication. It seems to help her when she gets that feeling.

My son sometimes gets fixated on things. He was hospitalized for severe depression and now takes meds for anxiety and depression. He's doing really well.

But the one things that's helped him the most is his therapist. She's a cognitive therapist which means she doesn't sit back in a chair and say "how did that make you feel". You get my point.

His therapist works with lots of Asperger patients. She can break down stressers and give him concrete things to do when he's feeling depressed, stuck on an OCD thing, etc...

There are lots of cognitive therapists out there. It's sort of the new thing in therapy and it really works.

Another idea is to check out Dialectical Behavior Therapy. It is fantastic. You can get a workbook online that teaches how to deal with life. What do you do when you're feeling angry? You check the facts first. Is your reason valid? Then you spend some time thinking about how to address the issue.

Another skill from DBT is if you're feeling blue, do "opposite action". Write down a list of things you like to do that make you happy or calm you down. Then you go to that list when you're feeling depressed and choose one. Get out of the house and go for a walk. Make a playlist of soothing music, lay down and focus on breathing.
There are classes in DBT, if he's able to go. Or both of you could go.

Finally, I think that medication would also help a lot. My personal favorite is Lamictal, but I'm not a doctor.

I'll be praying for you and your son. I hope this helps a little.

This has never happened before in any other situations during his life? You believe that his recent experience in school is the issue that has set this off, so have changed that situation (though 'this came late' were your words...) His situation at school has been changed to address his problems, but the problems persist?
Have there been any other changes in his life? Anyone around him stressing out that he might be sensitive to other than school? Are you a single dad? Any problems with you and his mother at home? Has she got a job or is paying less attention to him? (you say 'us' and 'we') It has been my experience, if someone an autistic person relies upon suddenly dies or has, in other ways, taken away their stability or feelings of security, they can suddenly freak out and not really have any words for it. They will become more reclusive and more withdrawn and may exhibit psychosomatic symptoms that are new or exaggerations of issues they have had before. While what ever is triggering the anxiety is being dealt with, don't rule out medication to help ease it, especially if it causing acute problems like panic attacks and interfering with things that are normally day to day.

OddFiction, He didn't say the issue was excess saliva. He said it was a swallowing issue. The son feels like he is choking on something or something is caught in is throat. This has led to a reluctance to swallow. Not swallowing will lead to holding spit in one's mouth which may lead to the need to spit or ending up drooling.

Do not give any impression that you are disappointed in him or angry at him. Disappointment from a parent can be absolutely deflating when it is something he feels he has no control over. Only let him know that you are on his side and you believe he is feeling this way, but you and his mother/(your partner or wife?) are going to figure out a way to help him through this difficult time.

I don't know what the youth psychiatric services are like by you or if they are used to dealing with autistics but I really hope they have the skills to help. You are your best advocate for your child, so remain proactive in his care. I see too many parents get lost in the mazes and waiting for the right person to come along. Waiting is exactly what parents of autistic kids shouldn't be doing.

I hope this issue is resolved quickly for your son and he can find a way to carry on with a new school situation that doesn't result in these types of reactions.