Severe aggression while happy/excited?

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Last night, I ended up taking my severely autistic 16 year old son to the ER because we could not get him to stop self-injuring. He will sometimes get in a mood where he starts to hurt himself (head bang, bite his hands, scratch himself, etc.) and seem to be really excited- he starts laughing and jumping. Last night though, he got a hold of a screw driver and was trying to stick it in his eyes and scraped his face drawing blood, and because he is so strong now, it took us a long time to get it from him. In the process, my husband and I both got beaten up. He threw me against the wall and broke my arm and dislocated my shoulder. He's been aggressive before but not that aggressive, and never in the presence of his father, who is also very big. The really weird part he appeared to be a great mood- he was laughing the whole time as he stabbing himself in the eye with a screw driver. Today, he seems back to normal and nothing unusual happened yesterday.

He was on no medication but obviously that has changed. Last night, they gave him thorazine and he has been prescribed risperidal (which he has been on before... yes I know it was dumb of us to ever take him off it, clearly... hindsight is 20/20). We ended up calling an ambulance because we realised we could not get him the car- so they came and restrained and sedated him. Words can't describe how terrible the whole thing was.

Can anyone provide insight? There must be a reason. Nobody seems to particularly interested in finding out, they'd rather just drug him to make sure it doesn't happen again- I'm on-board with it never happening again, but I would like to know what he's thinking. What would you do? I'm at a complete loss.

I'm so sorry Holland, that is awful!

In a way it doesn't matter why but I would want to know too, and it would make me feel safer if I did. You may never figure it out, but I guess I would make two columns on a piece of paper and just brainstorm in one the possible internal factors (headache, eye hurting, curiosity) and on the other, possible external factors (saw a fight in real life or virtual, saw news footage of something scary, someone at school hit or threatened him, something was taken away etc).

You and your husband must be exhausted, and devastated. And I don't see why you should be angry with yourself. How could you really have known he would do this?

I guess also I might try to sort out whether I thought he was angry or afraid when he did this. Just because if you have a guess, it would give you a starting place for thinking about what else might help. He can't tell you but maybe you can guess.

I'm sorry I don't have more to offer.....I hope other people see your post and can offer their ideas soon. Be careful, it all sounds very painful. But you will get through this.

Are you OK now, Holland ? How is your shoulder ? I am so sorry .. I don't know what else to say.

I think Waterfalls has a good idea. Make a list of all known internal and external triggers, as she suggested. That might help you zero in on what triggered his SIBs and aggression. Does he suffer from migraines ? I know that when I have migraines, my eyes really hurt and warm pressure helps - but obviously not to the extent of poking them with a screw driver. But if he has sensory processing issues, then he may have needed a lot more input than just mild pressure applied to the eyes.

Regarding external stressors, did something happen during the day that triggered this ? Such as him witnessing someone else engaging in similar SIBs and this being a form of delayed imitation ? What about a violent scene in a movie that he watched earlier that day ?

Don't beat yourself up over the Risperdal. I know of other parents who don't want their kids on it, and work hard to wean them off. You don't have a crystal ball that allows you to see possible adverse results, and there is no telling that this would not have happened even if he had been on medication (especially if he seemed to be in a good mood).

This is why I hate the lack of language in our children. If he could communicate and tell you why, you would at least be able to know his thoughts / feelings. I am so sorry. I don't know what else to say but I do want to send you a hug.

Hang in there.

BTW, how is the little one ? Did he witness this ? How is he doing now, if so ?

Welcome to Holland:

I hope you are doing better.

This may or may not be helpful, but I am going to throw it out there. Is it possible he was not at all upset, and he was stimming in an injurious way to calm the general excitedness down--It is possible that he just got too full of (positive) energy and didn't know what to do with it.

Alternately, he could have been in a grand mood and then leaped from thought to thought and ended up with a bad thought, and then melted down. If he has ADD/ADHD tendencies plus an excellent memory this can very easily happen. On thing reminds him of another, and then another, and then it ends up with an unhappy thought.

If it is the first thing, then in addition to the meds, maybe an OT can get him to redirect energy into something harmless?

I don't know what else to say, and know whatever I say is insufficient, but I am very sorry, and I hope you can find the answers you need to keep everyone safe.

Thanks. I am fine. I am worried about my son though.

I scheduled an appointment with his ophthalmologist for next month (for no reason other than that's the earliest available) to make sure his eyes are ok. He might get migraines. I wondered that too. I'd also like to get a brain scan but I'm not sure how I'm going to swing that one.

We sat down yesterday and went through everything he did and ate yesterday. I like your idea, Waterfalls, I will do that.

Risperidone makes my son tired and sluggish, but it'll have to do.

HisMom: By some miracle, my younger son wasn't there. He and I were out of the house when this began and I left my son with my friend to go back to the house to help when my husband told me what was going on.

ASDMommy- that's right along the lines of what I was thinking. He regularly self-injures when he really likes something, but not this bad, and also usually it stays directed at himself. I will ask his OT about that. Last time I mentioned this idea, I got some funny looks though. What kind of things do you think could do to help with this at home?

We have a swing which usually helps him calm down. There is a room that has mats on the walls that I usually stick him in when he's having a SIB moment, and he likes to crash into the walls in there. He can still bite his hands though so when it's really bad sometimes he will wear a helmet with a visor, he hates it though so that's a last resort thing (it hasn't been used in around a year). For the biting, we have found that he will bite straws for a bit instead of his hands (he won't bite designated chew toys for some reason) but only for a while.

But you are not fine. Your arm is broken and your shoulder is dislocated.

I want to say this even though it might seem out of place and wrong. I think words serve little role in this sort of thing. I think something was bothering your son and even if you don't ever figure out what it is, he was in some way not feeling right. I know that I wasn't there and I know I could be wrong but I don't think he felt right and don't think words can solve this. I do think some part of your son's mind registered the impacts you took and some part registers any cast or brace or sling you are using as well as any discomfort you may show.

I think also that it is very important what your child SEES you do now because I believe some part of him likely registers the not rightness about you. I believe that your actions, attitude, and behavior that his eyes see may penetrate and create or modify his understanding of how we act when hurt. I think his seeing you rest, ask for help, accept help, and display relief when you are helped or when you take pain medication may be understood in a concrete way that your and everyone else's words can never achieve.

This could be way off, but I think right now you are possibly a role model and if you show him options for what you do when upset and hurting that he can use you never know if that may penetrate deeply. And although I do not think he should necessarily see you scared of him (even though I would be anyway) he probably should see you crying because that is a social cue to be gentle and he deserves and you deserve and the world deserves he have a chance to learn. Maybe he can catch on to how you handle hurting, being upset, etc, without you breaking yourself, or anyone else. You never know. Maybe something can click.

My son had an MRI under general anesthesia. There was NO other way that we could get it done, so that is an option for you. I would also look into getting a 24 hour EEG, unless you've had it before.

BTW, dry eyes can feel very itchy, and annoying. He may have been poking his eyes to cause tears to overcome that dryness ? Also, does he suffer from sinuses infections ? If he was getting any sort of relief from SIBs to his face, then I'd rule these out. Is there another ophthalmologist that can see him sooner ?

ASDMommy-I am interested in the how does your engine run thing, thanks for mentioning that! He does have some self-control; he has never attacked his brother, which is astonishing because his bro does everything he hates. Nobody can touch him w/o him freaking out, but his bro can climb on him and hug him and he tolerates it. This, I assume, shows that he does have self-control. I'm not sure how he decided his bro was off limits and nobody else is. He will go to his room (where his bro is not allowed to go, for various reasons) to get away from him. He does this independently...

Waterfalls- he definitely does need to be taught morals, I agree. I can't be super upset though because then my younger son would be- he is affected by my moods more than my older son is. My older son hasn't been interested in the cast at all. My younger son has- he has been absolutely fascinated by it, in fact, and keeps saying "Hurt? Hurt?" and then "Flowers?" because I told him once we were bringing flowers to someone because they were hurt, LOL. Well, at least one of my kids has learned something. It's really hard to know what to do with my older son because he's so disconnected from the world. I feel like he really does live in "his own world". Sometimes I think maybe he does understand, but just doesn't show it? I don't know. The kid's a mystery.

He signed 'eat' spontaneously today. I almost fell off my chair in shock. I remember when I was a kid and did something bad, I'd try to make up for it by being really good the next day... maybe him using sign language his version of that? Maybe I'm reaching. Either way, yay for progress.

HisMom- the ophthalmologist is the same one he has seen since he was 2, so I'd rather not switch- plus, I doubt we could get sooner anyway. If there is something new wrong with his vision, it could cause headaches or straining perhaps. regarding MRIs/EEgs, he has never had anything like that because he doesn't have seizures and is very healthy. But I think based on some recent bizarre behaviours, it's definitely something I want to do.

It could also be that he sees you as a "safe person" (to attack / take his frustrations out on). He may realize, however, that there may be severe consequences (from you or his father) for attacking his brother. This may also explain why he does not attack you in the presence of his father -- he probably knows / realizes / understands that his father is not a "soft target" and will not allow him to target you, either.

All in all, very hopeful and great signs of cognition. I hope your neuro sees him next week and orders an immediate 24 hour EEG (don't settle for anything less, including purely day time EEG). My son's daytime EEG - knock on wood - is OK BUT his brain goes nuts during the night . We would never have learned just how horrible his sleep EEG was - we would have thought there was ZERO problem - had I not fought his neuro for a 24 hour one. Mother's gut, you know ? I do wish I'd been dead wrong, though.

I agree with you, Holland and ASDMommy, this sounds like excitement stimming. I hit myself though not enough to injure when happy or excited. I also hit my face and the locus of this excitement in expressing it is like "noodling" my eyes with my fingers. It comes out that way. The other thing is that I have a tendency to smack and hit my husband. He goes along with it. I do it with no one else. I am attached to him and feel safe with him. It's an expression and it's like transmitting my feelings to him. I don't know that sometimes it hurts him. To me it feels affectionate towards him but he doesn't get the affectionate feeling from it. I don't do it with my kids because they aren't my equals and bad or not, my emotional expressions are not for them. They are between me and one other person, my husband. I also never had this with my parents and didn't do it with them. I acted like someone else around them because I was embarrassed and we didn't have a relationship that fostered my expression. I certainly never shared my joy with them or my sister the way I do with my husband. To me, your son's behavior suggests that he is attached to you and can share his excitement with you, even though he does not know his own strength and does not know it hurts you because it feels good to him. It feels good to him and it is him expressing his excitement. I don't think he doesn't have this with his brother out of fear of punishment. I think it's more that he doesn't have the positive connection with his brother that enables it. His brother also isn't as big and the sensory input back of hitting something larger and heavier than yourself isn't there.

I don't know how to show your son that his expressions are physically hurtful to you or others. Perhaps if you tell him or show him that the wall hurts your shoulder, he might be able to avoid making you go against the wall. I don't think in the moment that he knows you will hit the wall or other objects. I don't when I get excited. I don't see consequences or chains of events and he likely has no intentions of harming you and so how his actions affect you may not even occur to him until afterwards, like the next day.

I crave physical stimulation and also auditory stimulation at these times. Do you have one of those giant exercise balls that you blow up? Not the ones with a handle but the kind used in gyms? That can provide more self-controlled pressure and that thing in your chest that needs to be "swung" forcefully by laying on the ball and bouncing or rolling on the ball. You choose the size of ball based on height of the person using it. It provides a feeling of tension and stuff too. I would think better than a swing for above reasons. Beware of him throwing or bouncing it too as that could damage stuff in your house. See if you can use it somewhere free of breakables like in a garage or something.

I have to go so I'll have to stop here. Hope this helps.

QuiversWhiskers,

That was a very useful post. Thank you very much for your insight.

We have an exercise ball (I forgot about that when talking to the OP b/c, well, we have to get another one b/c our son is rough on those and sometimes crashes into things on it that are not designed to be run over by exercise balls) and I will say my son will sit and bounce on it while excited. He won't necessarily transition to it on his own and it is hard to transition him in the heat of things. I think the OP has that issue too.

Is there anything that you can suggest that would help you be able to transition to something else in the heat of an excitement stim: Like if your husband suggested it either verbally, or with a PECS or written card, if you can't parse the auditory information at that time? Some of the problem, in our case, is that it is like a meltdown in that even if we have gone over that something is uncomfortable ahead of time, it is hard to get an actual shift to something else while it is going on.

Yes thank you Quiver Whiskers! Very insightful and helpful! I'm going to get an exercise ball.

We do have a hard time getting him to do things. It's hard enough when he's calm. When he's not, it's hopeless. The best we've found is to put things out in obvious places for him to find and hope he uses them (eg swing). Often he does. He does not pay any attention of pecs. He tends to calm down when on his own but when he's so self-injurious, he can't be, in case he damages himself in some way (like gouging out his eyes). The helmet would help except he hates the helmet so that kind of makes things worse.

I don't really know how to answer this question about transitioning other than what Holland said about leaving stuff out and around for him to find. It may be that any suggestions you try to give him will be rejected just because you are his mom or dad or maybe because other people suggesting and giving ideas feels controlling or like being in a pressure cooker, or even condescending. Maybe it just has to be his own idea and his own volition.

My husband can tell me something hurts or that some part of his body is injured from something else and I still forget even within minutes and end up smacking him again. I know it's probably not so funny on your end. But anyway, often, it does help sometimes to not just say, "hey, remember I have a cut on this hand!" If I banged his arm because it doesn't register that the cut actually hurts him. I don't know why, but I can be told someone has an injury and then have no idea it hurts. And I forget frequently. It's horrible. Maybe it has something to do with mirror neurons or something mentally where I don't think that far. It isn't restricted to just high happiness times either; it's fairly constant. With my kids I do retain the knowledge that I need to be gentle but as far as imagining pain or feeling it with them, I don't have that. I just intellectually know how to act to respond. With my husband, my guard is down.

Perhaps writing it down is better as it provides a visual to remember. I remember written words better than heard words at the times I need to remember them. I have somewhat of an eidetic memory for words and text.

The other thing with excitement is that it can become physically uncomfortable. Sometimes I have my husband lay on me on the bed because it can quash the physical discomfort of uncontrolled happiness. It is kind of like a meltdown. It seems that I can go either way: to a happy fit or to a meltdown. It can occur from the same or similar events as a meltdown. Sometimes it has to be pressure on my legs too so he lays directly on top of me, legs on mine and all and he vibrates my forehead. He is a lot heavier than me. I hold onto the collar of his shirt, so I am on my back with my elbows bent with hands near our shoulders. Sometimes I cry a little bit. Not really from sadness. It's just weird. If he can't handle being touched as you lay on him or maybe for deeper tension/pressure to the chest, if you get or have an exercise ball, you could try putting the ball on top of him and then putting your weight on the ball. That's all if he is okay with being touched back by you.

Another thing I do is listen to this one thing on YouTube repeatedly. Does he have any music, sounds, or videos he can zero in on?

I know this might sound counterintuitive, but for me at these overexcitement times, more stimulation is sought. It kind of has to be fed and stoked until it burns out. With him though this might not be an option as his stims are so much more self-injuring than mine are and because of the executive control issues.

I wish I could offer more practical advice or do more.