Tantrums and meltdowns at nine years old

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Jessjy
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13 Oct 2012, 11:10 am

My son with Aspergers just turned nine. Over the past 6 months or so his meltdowns, which were in some sort of remission for a while, have come back full force. He is extremely defiant, to the point thatif I don't say yes to his every demand and request he throws himself around,s creams, calls me horriblenames, etc. Walking away works for a moment, but once he calms down he asks me for the same thing and it all starts over again. His persistence is killing me! There is also an extreme amount of backtalk, mimicking, etc. going on. It's very hard to care for my other children this way, let alone work with him when he won't even look at me or try to be reasoned with.

Please help. I am at such a loss. His psychiatrist switchedhim from risperidal to Abilify yesterday, and we are adding ritalin after school to get through the homework hump. he also takes concerta every morning and melatonin to help him sleep.



DannyRaede
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13 Oct 2012, 4:13 pm

Just wrote this for my blog, but it looks like you could really use it as well, so I am posting it below:


90% of all behavior that someone with Aspergers does is because they have a psychological need they are filling. For example, children do not generally scream because it is fun and they want to. They are trying to communicate something. The first step to identifying why a particular behavior is happening is to figure out which need they are trying to meet. To make it clear, these are NEEDS, not WANTS. There is actual pain involved if ALL of these needs are not met. Thus, the brain figures out a way to meet these needs, even if it is highly destructive. There are 4 basic needs that all people with Aspergers have:

1. Comfort – Everyone with Aspergers and Autism has an extreme need for comfort. The world is a very scary place to them, and they need something to feel secure. That could just be your home, a special stuffed animal, or a stim (repetitive behavior). Anything that doesn’t change and they can control could fall into this category.

2. Connection – We all need to feel connected in some way, but it is amplified in people with Aspergers. Since society tends to reject anyone that is different, people with Aspergers tend to have a hard time making friends. This causes an extreme need to feel included. This can manifest itself in behaviors of screaming, yelling, and harassing. This is simply due to the frustration of not having friends, and trying to establish ANY type of connection, even if it is a destructive one.

3. Uncertainty – Doesn’t this contradict #1? No! People with Aspergers also need some sort of new activity or experience as well. That is why new behaviors will manifest, and why they will do things “out of character”. Imagine if you knew what was going to happen every moment of every day and had complete control over every aspect of your life. It would get boring pretty quickly. Video games, movies, and other forms of entertainment all fall into this category.

4. Significance - This one builds on #2, not only do people with Aspergers need to feel connected, they also need to feel like they are significant in some way. This can be manifested through low self-confidence, depression, anxiety, etc. You can easily cure this by showing the particular person that they are significant through lots of encouragement and praise, paired with very little criticism.



Bombaloo
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13 Oct 2012, 5:15 pm

I would suggest you get off the melatonin it can cause extreme irritability. There are some other herbal sleep remedies but with the other meds def talk to the doc first.



bjtao
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16 Oct 2012, 10:11 am

IDK what dose of Abilify the doc put him on, but this is very strong medication. A change of .5mg either way can make a huge difference. Also, it is often helpful to reduce Abilify rather than increase if any issues get worse. My son ended up being on 2.5mg. We increased in .5mg doses and ended up having to decrease rather than increase at some point.

Another thing about the Abilify - taking it in am vs. pm or breaking up the dose (part am part pm) can make a huge difference in a person's response to the medication. We found for my son that he responds much better to it when taken in the am. It is trial and error. A friend of mine that is bipolar found that she must split up the full dose and take half in am, half in pm and found much more relief rather than taking it in the am only or pm only, but it's different for everyone.

My son has been on Abilify since he was 9. He is now 12 and weaning off of it. He is now on 2.5mg five days a week (vs. 7 days previously).

I agree w/ the OP about the melatonin. Even in NT population, melatonin can cause depression, irritability, etc....especially after long term use. Melatonin is another one where a decrease is sometimes more effective than an increase. I know it sounds counterintuitive.

Other than the medications, your son is starting puberty. It stars around age 8 for boys. Not in the sense of 'getting hair down there' and all that, but as in hormonal changes.

Also, ADD/ADHD in PDD population are usually symptoms and not really ADD/ADHD so they won't respond to the meds as a child with ADD/ADHD would because they don't really have it. Just as OCD in PDD population is not really OCD, but a symptom that mimics it (it's really 'inability to handle change, sensory issues, or stimming). It cannot be treated like the actual disorder of OCD.

Just some things to think about.



Mama_to_Grace
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16 Oct 2012, 1:53 pm

Ask yourself what changed between the time he was meltdown free and now. Every last little thing, whether it seems relevent or not-list it. Then work through the list 1 by 1, and find out what the issue is. I'd be willing to bet something is going on to cause the new meltdowns. It's proably not going to be obvious so you are going to need to do some detective work to figure it out.

Personally, I wouldn't be changing the meds at this time, as it is just going to further complicate things and make them harder to figure out.



Sweetleaf
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16 Oct 2012, 2:08 pm

Some medications can cause irritablity....so that might be something to look into.


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DW_a_mom
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18 Oct 2012, 12:02 am

Mama_to_grace is right, look at what has changed, and include things he wanted to do or seemed to be handling well. AS kids don't always react in the moment in ways that reveal their true needs.

A big key for me with my son when he was 9 was realizing that the more stubborn, persistent or demanding he got, the more he was NOT handling day to day life. Trying to control his world, find some power, was his reactive, defensive response to feeling things in his life were out of control. Either overwhelmed, or just under a lot of stress. I would start easing the stressful things in his life until I saw him pull back on the negative behavior. Worked every time. It isn't about his whim in that moment (even though he'll believe it is), it is about some day to day stress factor he finds himself unable to escape and may not be able to name. It really sounds to me like that is what is going on with your son.

This is also a key age for him to learn how to mitigate and avert his own meltdowns, if possible. For him to learn to recognize the signs in himself, and know how to self calm. To advocate for himself, telling you he is reaching tipping point. Not all AS kids are capable of it at that age, but if they can acquire the skill (which takes years to learn) before hormones hit full force and physical strength increases, those teen years will be soooo much better.

I don't know how medication plays into it because we never went that route. We had amazing, albeit slow, success controlling our son's environment and really figuring out where these behaviors came from. He has skills and awareness for a lifetime, and doesn't need us to run interference on anything anymore. Medication is a bridge, not a cure, a way to move through the moment so your child can focus his efforts on what he needs to do. Learn your child's triggers so you can help him learn to control them. Learn how your son shows stress, and what he needs to mitigate it. Follow the protocol. It takes time, but you get there.


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