Depression and/or anxiety attacks?

[miranda]

Something new is afloat with DS. I have noticed he doesn't have the same enthusiasm for his current "special interests", YouTube videos, Ipad games, and any live sports on TV. Then last Thursday night he regressed into an anxious episode of sorts; perseverating over the eruption of a volcano in Yellowstone. He's had these episodes before but it has been a couple years and they have been almost nonexistent with the anxiety meds he's on. Then Friday morning I witnessed what I assume was a full-blown anxiety attack- it came out of nowhere and he was sobbing and shaking uncontrollably about the volcano. I spoke with him for about 45 minutes and then he was fine, as if it didn't happen. We kept him home from school. We're seeing the doctor next week. She didn't think this was a medicine-related episode and will refer us to a therapist. I declined Valium for him.

This weekend he was acting differently- he watched only a little football (unheard of!) and was listless. He begged DH and I to watch movies and play board games with him (usually it's the other way around!). He complained of being bored (also unheard of). Then last night as I was tucking him in he asked me if I've ever had depression. He said he feels like he has depression. I let him sleep in our room in his sleeping bag.

Sorry, maybe this is just a vent. Any anectdotal advice? The problem we've had with therapists is that DS has to be in the mood to talk. I could ask him about volcanoes right now and he'd shrug and say it was no big deal. But two hours later he'd be sobbing crying. He's been on fluvoxamine for anxiety for almost 3 years. We did just up his dosage a few weeks ago due to comments we received from his teachers about increased anxiety over his schoolwork. His doctor doesn't think these recent developments are related to the increased dosage. And the depression I feel like might be a product of his interests changing. He cycles through different things and I don't think he's found that one thing yet. He doesn't want to do the old stuff, but he doesn't know what to move on to.

Could be a social thing, too. His friends are surpassing him, as expected (4th grade). DS had been posting YouTube videos of himself on his channel, unbeknownst to me. They are extremely crude compared to his friend's videos. I took them down. (E.g. a video of him begging for subscribers and then a rap about how he drinks Mt. Dew all day because "he does what he wants!") If his friends saw the video, I'm sure they gave him an earful.

[akafred]

Have you tried any ERP related to the volcanoes? That might help get through this particular issue.

[miranda]

Nov 20, 2017 12:45:04 GMT -5 akafred said:

Have you tried any ERP related to the volcanoes? That might help get through this particular issue.

No, had to google it. Interesting. Illustrates the point of contention between DH and I- when he dealt with the first episode (I wasn't home) he thought "not talking about it" would help. He just hugged DS and told him it would be okay and told him to "stop thinking about it." When I dealt with it, I got out the laptop and started looking for some statistics. This backfired somewhat because DS was watching my search results and screamed when he saw facts he didn't like. Once I finally landed on a fact he liked (chance of volcano erupting is 1:730,000) he immediately calmed down, and even laughed at himself for getting worked up.

[akafred]

I've been listening to a podcast called "AT Parenting Survival Podcast", which is done by a child therapist who specializes in anxiety and OCD, and she talks about ERP a LOT. All 3 of her kids have anxiety and one has OCD tendencies. She would set up a challenge like have the child say the word "volcano" like 50 times until it doesn't bother them anymore, then listen to the word, then look at a picture of a volcano, maybe all the way up to building one for a science project. The child can win a "challenge prize" also. This seems like the perfect opportunity for that kind of thing. Not saying you should try it; maybe ask his psychologist or listen to the podcasts and think about it, but in general avoidance is not helpful.

[auntie]

Nov 20, 2017 11:06:21 GMT -5 miranda said:

Something new is afloat with DS. I have noticed he doesn't have the same enthusiasm for his current "special interests", YouTube videos, Ipad games, and any live sports on TV.


This, along with irritability, is generally what depression in a tween boys looks like. 4th grade was the 9th circle of hell here. Typically developing kids have recently made a huge leap in maturity in terms of autonomy and independence. With an ASD dx, however bright he is, he is probably not feeling anxious about not being up to the expectations of boys his age.


The other piece is that this is an age when typically developing kids start to become hardwired for conformity and wary of kids who behave or think in ways that are alien to the tribe. If your DS is reasonably self-aware, as some are, he will be more aware that he isn't like other kids even if they aren't saying so. 


Then last Thursday night he regressed into an anxious episode of sorts; perseverating over the eruption of a volcano in Yellowstone. He's had these episodes before but it has been a couple years and they have been almost nonexistent with the anxiety meds he's on. Then Friday morning I witnessed what I assume was a full-blown anxiety attack- it came out of nowhere and he was sobbing and shaking uncontrollably about the volcano. I spoke with him for about 45 minutes and then he was fine, as if it didn't happen. We kept him home from school. We're seeing the doctor next week. She didn't think this was a medicine-related episode and will refer us to a therapist. I declined Valium for him.

This weekend he was acting differently- he watched only a little football (unheard of!) and was listless. He begged DH and I to watch movies and play board games with him (usually it's the other way around!). He complained of being bored (also unheard of). Then last night as I was tucking him in he asked me if I've ever had depression. He said he feels like he has depression. I let him sleep in our room in his sleeping bag.

You might want to run this by a therapist and his psychiatrist. It could be that he needed a higher dose of his SSRI because of growth and increasing social demands. Or it could be the SSRI he's been on has tanked for him for some reason and he'd be better served by a different medication. (It can happen, sometimes as puberty approaches, meds that work previously no long do. Sometimes SSRIs can trigger a kind of bipolar disorder). Or it could be the increased dose is too high and has activated/disinhibited him. The timing of the onset of what you describe as a panic attack may not be coincidental. 

Not sure keeping him home or allowing him to camp in your room is the best approach for developing grit and resilience. School refusal can be a very difficult situation, so it is generally recommended to get the kid back in the classroom asap. DS's psychologist always warns against this. I have a couple of friends whose kids developed school phobia/refusal- it's a friggin' nightmare. 

Sorry, maybe this is just a vent. Any anectdotal advice? The problem we've had with therapists is that DS has to be in the mood to talk. I could ask him about volcanoes right now and he'd shrug and say it was no big deal. But two hours later he'd be sobbing crying. He's been on fluvoxamine for anxiety for almost 3 years. We did just up his dosage a few weeks ago due to comments we received from his teachers about increased anxiety over his schoolwork. His doctor doesn't think these recent developments are related to the increased dosage. And the depression I feel like might be a product of his interests changing. He cycles through different things and I don't think he's found that one thing yet. He doesn't want to do the old stuff, but he doesn't know what to move on to.

4th grade is hard. We did desensitization/exposure to subjects that upset DS, although he was considerably younger than your DS at the time. Generally, it would be something we worked on daily for a time when he was clam rather than trying to put out a fire when it flared up. 

Could be a social thing, too. His friends are surpassing him, as expected (4th grade).

I wonder if the crux of this isn't social. Your son has always been higher functioning with plenty of exposure to typically developing kids. As I recall, he's always identified with the NT members of his tribe and attempts to emulate them. Given his dx, he likely has a social and emotional maturity of a child about 1/2- 2/3 the age of his peers. He sees their interests changing and perhaps he wants to change with them but doesn't have the same maturity or drive to be done with younger kid interests and activities.

DS has always been socially and emotionally less mature than his peers. We confirmed this a few times with BASC and Vineland which helped us see where he was in terms of emotional maturity so we could help him be comfortable in his own skin while encouraging him to grow at his rate. DS functions at about 75% of his chronological age- recognizing that has helped us understand his behavior and decide on when to push toward independence skills at a time that is appropriate for him.  It's a bit like how moms of preemies do an adjusted age- DS got his drivers license 2 days after he turned 21 (age adjusted to not quite 16); last night he had a beer and played some pool with coworkers at 24 (age adjusted to 18 when most kids would be having a beer in college).

It's hard, because from 4th grade this gap in maturity spreads especially at watershed times when peers take another leap ahead. But around 17 or 18, the gap starts to narrow a bit and you should be able to expect growth in this area into his early 30s. 


DS had been posting YouTube videos of himself on his channel, unbeknownst to me. They are extremely crude compared to his friend's videos. I took them down. (E.g. a video of him begging for subscribers and then a rap about how he drinks Mt. Dew all day because "he does what he wants!") If his friends saw the video, I'm sure they gave him an earful.

He probably shouldn't be unsupervised on the internet- especially on social media sites. I kept DS out on the open when he was this age. There are too many ways in which he could misstep or be bullied. 

[miranda]

auntie , thanks. I'll mention the SSRI's to his doctor. FWIW, ITA that letting him stay home is off-limits. He would easily go down the road of school refusal. Right now he's still my rule boy
who doesn't realize it's an option to refuse, so I'd like to keep it that way.

You're also probably right about him being anxious about not keeping up with social progression. Even the things he loves like Minecraft he won't play because he isn't as good as his friends. We're lucky that his (former) BFF has a younger brother who is in 2nd grade; DS still plays with him. I worry about his handwriting, and I know he does too- it hasn't improved since 2nd grade, and I can't imagine him being able to keep up with note-taking in middle school. That's our next challenge- getting him to accept the accommodations he is entitled to. The school has offered writing accommodations but he refuses. For example, SnapType for worksheets.