OCD,AS,ADHD

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Just wondering how to recognise symptoms that are causing the greatest difficulties and know which dx is causing the difficulties, and how can one identify which is the most prominent or can you.

If the OCD is causing rituals that you don't enjoy but feel you need to do it to reduce anxiety, does this effect the Aspergers rituals that you enjoy doing. Or does the ADHD effect you because you get bored and need to constantly move on to different things. How does it work when you have these three dx's.

I think it's completely different for each individual. I also think that rather than worrying about which label is causing the most problems or which symptoms to attribute to which label, that it would be better to take the symptoms as they come and view them all as part of a whole person.

SuperTrouper thanks, how hard is that! or is it?

Well, not at all hard for me, because I don't see myself as "that autistic girl" but just "hey that pretty cool girl, she's a Christian, she loves cats, soon she'll have a service dog too, she's a darn good writer, not a bad poet, she makes a good friend, she can be pretty funny when she wants to be, she's not the most optimistic person, but boy is she loyal... and oh hey, did you know she's autistic?"

I'm guessing you're thinking about how to help your children based on the information in your sig?

I just have AS and I'm not a parent, but I've got immediate family members with OCD, ADD, ADHD, and (what I suspect is) GAD. I've got a little insight, but take this as you will.

If you're concerned about your kid's well-being, I think the best thing you can do is just watch as closely as possible and communicate as best you can. Like SuperTrouper said, I wouldn't get to caught up on the official terms and what is causing what. I think the important thing to focus on would be the literal problem at hand. If you're concerned about your kid's rituals, maybe watch him and identify which ones are worry-based and which ones are interest-based. For instance, if your kid absolutely has to get out his favorite toys and place them in a ten foot long line the moment he gets in the door while drinking a box of his favorite flavor of juicy-juice, this could just be something your kid does because he loves his toys and juice and this is his way of expressing it. However, if he's doing it because he thinks that they'll disappear if he doesn't check and make sure each and every one is OK the very moment he gets home every day, this could be a problem.

From my (admittedly limited) understanding, AS rituals are not really synonymous with OCD rituals, despite the similar naming. With AS, the basis for the ritual is a need for sameness while with OCD the basis is worry. If you interrupt your kid while he's lining up every toy in his closet or if you don't have his favorite flavor of juicy-juice exactly where he expects it to be, your child is probably going to have the same reaction regardless of whether this is an AS or OCD ritual. It is probably not a pretty reaction. But even if the actions are the same, what your child is feeling may be different.

When an OCD ritual is interrupted, the fear the child experiences is often based off of a fear of some kind of consequence. If your child can't complete the ritual something bad will happen, like the well-known OCD example of the person who thinks their house will burn down if they don't check to make sure their oven is off over and over and over. (However, I believe that some OCD rituals can exist without this clear cause-and-effect thinking. Some OCD rituals must simply be completed for the child to "feel right," and if they don't complete them it "feels wrong.")

With AS rituals, the basis seems to be more of a need for sameness. Your child has lined up his toys and drank his juicy-juice for the past two years and if he doesn't do it today it would be bizarre and wrong and scary. AS children (as you probably already know) do not like having their expectations changed. If you scheduled a dentist appointment for right after school and your kid can't line up his toys, that is a major problem because the whole bus ride home he was mentally imagining that box of juicy-juice and his whole closet full of toys just waiting to be lined up. Now he walks in the door and bam! You tell him you've got to go to the dentist. It's like going from a nice, warm bathtub to a swimming pool in January. It provokes resistance from your child not because of a specific need to finish the ritual, but from a change in expectations. He was prepared to go home and line up his toys. His mental train was running full-speed towards this goal and you came along and de-railed it. This causes chaos and it causes confusion, which causes him to resist you.

Flexibility is a necessity, and as the parent of an AS, OCD kid, you're probably going to have to learn how to not just work around your kid's rituals, but also with them and even on them. Just because your kid has an explanation for his rituals doesn't meant that all rituals are good rituals.

Your son lining up his toys may be a harmless ritual or it may be a big issue you and your family need to address. If it's harmless, I would say let your kid have as many rituals as he wants. The rituals give him a sense of security, regardless of the source or the reasons behind them. There's no need to fight them if you don't have to. It will only cause you and your son problems. If you want homework time to be right after school and your son wants to line his toys up, maybe it wouldn't be such a bad thing to relocate homework time to after he's done with his ritual. There will be times when you have to be flexible.

However, if your son is lining his toys up down the hall where everyone needs to walk, this could be a problem. If it takes him three hours to get all his toys lined up and it's standing in the way of you picking up your daughter from soccer practice, this could also be a problem. A diagnosis isn't a "get out of jail free" card. Your son is a member of a family, and I believe that he will benefit from being taught that as a member of a family, his wants, needs, and rituals can't always be put first. It's an important lesson I think everyone learns from being a member of a family, and one I don't think you should neglect just because your son does need more accommodations than most other children. Your son will most likely grow up to be someone who will need people to make allowances for him. He will need to surround himself with people who will be flexible when he can't. But if you ask for accommodations, you also need to be capable of giving accommodations to others. I say this as an adult with AS who grew up in a family where I knew I couldn't be put first because other people had needs and problems too.

If lining up toys causes him excessive worry, this might also be a cause for concern. Again, I'm no expert on OCD, but if one of your child's rituals seems to cause him excessive distress, I think it would probably be a sign that this ritual needs to go, or at minimum be addressed.

Changing your son's rituals will no doubt be an incredibly trying process for the both of you, but some rituals may just need to go to improve your son's and your family's quality of life. Change will no doubt be met with startling resistance, and it won't happen overnight. If you stick with it, however, I have no doubts that some negative rituals can be weeded out of your son's life. I think that looking into behavioral therapy (as in reading to understand it and applying it as a parenting method) could be an effective way of eliminating undesired behaviors. The key will be consistency and dedication. You will need to be both to eliminate a behavior well-engraved into your son's life. But at the same time you will have to be careful and conscious of how much change your child can accept at once. There will be a resistance to change along with an inability to change. One can be overcome, the other can't. There is a danger of pushing too hard and too fast. The bottom line is you need to know your son, and you need to know the difference between making your son more flexible and trying to change who he is. One will help improve his quality of life while the other will most likely deteriorate it. The line between the two is hard to define, but the good news is as his mother, you're no doubt the one person who knows him best and is in the best position to see the difference.

As for the ADHD and ADD side of things, think the same basic concepts in reverse. If your child keeps jumping from toy to toy because he can't sit down and focus on one thing, this could be a harmless manifestation of his poor ability to focus. However, if he's got a school assignment to read a chapter and week and he can't get through more than a paragraph in a single sitting, this would be an instance where you will really need to sit down and help your child get through the assignment without getting distracted. Again, the focus will be carefully watching your child. Learn what causes him stress and he needs help with, and let him have a bit of free-reign when it comes to the harmless things.

You can't eliminate the symptoms. You can't eliminate the fact that your child will have rituals or poor focus or hyperactivity or any other symptom. Don't focus on the symptoms. You'd have an easier time trying to change his bone structure. It's just part of who he is. Your focus as the parent should be the behaviors now that your child has achieved a diagnosis. Don't worry about his behaviors being "Asperger's behaviors" or "OCD behaviors" or "ADHD behaviors." All of his behaviors are now just "your child's behaviors." Take each one individually. All of his unusual behaviors do not have to be an issue. If one is a problem, work to eliminate it, but don't wage a war against the fact that your son will have these unusual behaviors. Don't work to make him "normal" to improve his quality of life because chances are you'll only achieve the opposite of what you intend. Work to improve his quality of life as he sees it, but at the same time keep in mind that you are the parent and there will be many, many times when you know what's better for him than he does.

TL;DR VERSION:

- Don't focus on the symptoms, focus on the individual behaviors.
- AS rituals are based on a fear of change while OCD rituals are more typically based on a worry of consequence.
- Learning the difference between AS and OCD rituals will help you understand your child better, but your child's reaction to changing his rituals will probably be the same for both kinds.
- You need to teach your child how to be flexible and accommodating of others as a member of a family.
- Not all rituals are good rituals. Some rituals need to be eliminated for your son's, your family's, and your own quality of life.
- Change won't happen overnight, and it will take firm, consistent parenting to change your child's behaviors.
- Watch your son carefully. Learn when to push boundaries and when you're pushing too hard.
- AS, ADD, ADHD, and OCD are not your child's problems. Your child's behaviors are his problems, and his diagnosis is who he is. Change the behaviors, but don't try to change the child.
- Improve your child's quality of life in his eyes, not to the standards of "normalcy." But know that sometimes mommy really does know best, and sometimes hard changes are for the better.

I've said a whole lot here, and I'm really sorry for the length. I'm an incredibly wordy person. I've also made a lot of assumptions here. (Mainly, I assumed your child was about 8 years old for some reason. I don't really know why. It seemed appropriate. That's why the metaphors and examples are all geared to young children.) I also have a bad habit of talking about things I don't really know about, so if I say something really stupid in all of that, please forgive me. Like I said, I'm not a parent and I don't have the co-morbids. Take this all with a grain of salt.