medication

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My son is 8, and he's been having a really tough time - and by now I'm crawling the walls too! He has HFA, is great at maths, has a huge interest in words and language, but has started having HUGE meltdowns - mostly after bedtime - he rises like phoenix from the ashes and all hell is loose. He screams, bites and kicks. This can last 3 hours (! !). Then he gets afraid, and finally really unhappy. It's a living nightmare.
It's worse at the weekends, although I try and make them predictable and quiet.
I'm usually really good at understanding what's going on with him, but I'm stumped. He flips out so bad I'm terrified he'll go through a window or really hurt someone.

A psychiatrist suggested risperidal (antipsychotic - but he's not psychotic) or ritalin (but he doesn´t have ADHD). Also suggested getting him checked for ADD, epilepsy and savant syndrome. Does anyone out there have any experience with medication? I've always felt strongly against it, but I'm in over my head!

Hi Katrine. The behaviour you've described has the meaning: "I'm anxious! Help me!" and requires tightening of structure across all settings your son is expected to function within. There needs to be an immediate and active change in strategy to manage and improve this situation as something's obviously amiss. Children require safe and predictable settings and routines in order to keep anxiety to a minimum. Reassuring words will have no effect, but running your son through known routines and activities will grant him a sense of security from the performance of these activities and from your resolute determination as you do it. At the age of 8, your son hasn't learned to master his anxiety and his only concern is that you/staff make him safe when he is confused and anxious. Important to remember not to raise your voice as this will heighten anxiety and only serve to escalate behaviour.

I'm not aware of your son's school situation(ie whether he is home educated or in school) and how his ability to communicate with you/staff is. I'd be looking for any changes that may have brought this extreme behavioural change on(be it change in staff member/routine, lack of consistency, structure, etc) as at the moment medication would merely mask the problems, not eliminate the source of your son's anxiety which needs to be resolved. The clearer the control you take over the boundaries or edges of your son's life, the safer and happier he will feel.

We also have an 8 year old son who went through the same though at the age of 5yrs. I was able to determine the cause, though it took some time. I feel for you and wish you all the best.

I don't know your child at all, but I can tell you from my experience that medication can help. My son's meltdowns were just awful..for him and for us. It was embarrasing and frightening. When they were over, we'd both cry. An anti-depressant worked for him. I've heard some pretty good things about Risperdal, even for kids who are not psychotic. Check the side effects...I've heard weight gain can be a problem. My advice is simply that you shouldn't dismiss medication without careful consideration. We treat lots and lots of problems with medication and if it helps, it can reduce at least a little of the pain and increase the pleasure for your child.

Change in sleep habits without any other "behavior" change can be a sign of stress, especially if your child is "managing" his stress during the day. (Juliette is right on)
When my son "didn't care" about controlling his temper, it was pretty even and his sleep patterns were regular. But when he started school and really paid attention to controlling his temper and paying attention to teachers, he slept a lot. He would take 3 hour naps right after school and still sleep 9-10 hours at night.
Before he was verbal and able to communicate his needs and wants, sleep time was very stressful. He skipped naps and was hard to put to bed. It would take up to 3 hours every night to put him to sleep (sitting with him) and he'd still crawl in bed eventually with us.
He only recently stopped waking up to crawl in bed-in the past few months. (he's almost 7)

I don't believe in medicating when it's not necessary. His routine needs to be very regular and consistent and calming. he needs to know it's okay. You really need to identify if something really stressful is going on at school and if this stress can be alleviated. He may be expected to do something that is very difficult or embarassing. He may be experiencing some confusing emotions or bullying.
Medicating doesn't make this go away. Communicating does.

Thanks for your replies. My son is at a special school, because although his intellectual skills are good, he is "severely autistic" at the same time. He goes to a school for children with HFA and Aspergers, with really small classes (6 kids in each).The problems started at school. The school couldn't the cope, and as we had never seen behaviour problems this bad, we assumed they weren't reading him right. After an emergency meeting, the school decided to place my son in his own classroom, with other kids visitting when he has the excess. Everything is planned - down to what sentences are used when the teacher leaves the room, entry and exit through alternative doors and at different time from the other kids to minimize stress, ect. Pretty extreme.
After these changes, my son started doing much better at school. Maybe the contrast to our home enviroment then became too large - we use schedules, and are very aware of the need to be structured and predictable, but we have two other kids, and they are, of course, unpredictable, mill around, and make a lot of noise (he could cope with this before). He started flipping out at home, and we were really shocked. We have, through the years, become experts at identifying situations and stimuli my son can't cope with, and aren't used to not being able to analyze what is going on!
Reading your replies, I wonder whether we should structure even more - I find it a hard balance, because I want the other two kids to have as "normal" a life as possible, and I am wary of turning our family into "project autism".
Additionally, because of my son's good intellectual skills, we have always wanted to keep a door open to "the normal world", hoping he one day will be able to work ect.
Also, I wonder whether my son has started feeling really lonely and maybe that is part of the problem. He has always been very socially interested, but totally lacks the skills required (breaks my heart). He has never been a child who "went into himself", but always acted "out" - the autistic variant of an extrovert!! At school, he doesn't see the two kids, he actually gets on with, very often. At home, his bigger brother is becoming much more independent and has suddenly realized there is "something wrong" with his brother - not that we have ever been secretive about it, I just don't think it mattered before. Up until last year, the two boys were really close, like twins. They are only 14 monthes apart.
His sleep patterns have definately changed - a regression to how he was BEFORE the diagnosis aged 3, when he was stressed out of his head.
Previously, everything was fine at home, so I wonder why he can't cope with an enviroment he knows so well any more.

Well, I can't help with the sibling situation. Before autism entered our minds, I knew my son would be an only child.
But it seems that school is stressing him out. You may need to step back and question whether the school structure is really helping him or not. My son is also an extrovert and wants friends really badly. But with his special needs and the way people react to him, he is vulnerable to the "Stockholm Syndrome" or just turning into a tantrumer. (that is, either buckling under pressure or lashing out)
The isolation may just bore him, shame him or make him wonder what he's doing there?

Does he have structure exercise or sports? in school or at home?

Excercise is a problem - last year we went to swimming classes, but the moment he decided he could swim, they were over. At school he goes walking twice a week. At home, at the moment, it is hard to motivate him to go outside. for any reason (walking, movies ect.) so we have minimalized outings, which may not be helping him. He starts getting anxious when we say we are going out - running round in circles, taking his clothes off ect.
We make a list of what we are going to do while we are out, it helps during the actual outing, but not when we are trying to get out the front door! This is a real pity, as I think you are right, some of this is due to a build up of energy, and when he is functioning well, he runs, cycles and plays a lot.
He sometimes will use my step machine It counts steps, times and kcal., just up his ally!
As to his communication skills - he is very verbal and has a large vocabulary, but doesn't communicate well about emotions, or even pain. His voice is a little peculiar, and he has some pronounciation problems. Last weekend, however, he talked about missing his brother and his friend at school. He was also had an incredible need for my company - the WHOLE time.
Until recently, we used the boardmaker system for schedules, but changed to writing lists on my son's demand. (AFTER all of this started!) He is happy about this, but it worries me some, as his cognitive style is acutely visual. He can glance at a page of pictograms and memorize them in less than a second, but I don't think he can do the same with written words (yet)!
One thing is for sure - his meltdowns leave him, and the rest of us, miserable.