HELP FOR PARENTS OF CHILDREN WITH ASPERGER'S & HIGH-FUNCTIONING AUTISM

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Mood Disorders in Children with Asperger’s and High-Functioning Autism

Mood disorders are mental health problems (e.g., depression, bipolar disorder, dysthymic disorder, anxiety disorder) that can occur in anyone, including young kids and teenagers. The cause of mood disorders is not fully understood, but an imbalance in brain chemicals play a role.

It is normal for a child’s mood to change, and most kids go through times of feeling sad. However, when these feelings last for a very long time or interfere with daily functioning, he or she may have a mood disorder.

Symptoms of mood disorders include:
  • an elevated mood (i.e., mania) that is accompanied by feelings of grandiosity, extreme energy, and heightened arousal
  • changes in appetite
  • difficulty concentrating
  • fatigue
  • feelings of inadequacy 
  • feelings of sadness
  • guilt
  • helplessness
  • hopelessness
  • irritability
  • suicidal thoughts
  • trouble engaging in daily tasks
  • trouble in relationships

When considering the diagnostic criteria for Asperger’s (AS) and High-Functioning Autism (HFA) – and the effects of the disorder on a child's adaptive functioning in a social context – we can expect such children to be vulnerable to the development of secondary mood disorders. Research suggests that about 65% of adolescents with AS and HFA have a mood disorder that includes depression and anxiety. There is also evidence to suggest an association with conduct disorders, delusional disorders, and paranoia. It appears that comorbid mood disorders in adolescents with AS and HFA are the rule rather than the exception. Thus, a good question to ask is: “Why is this population more prone to mood disorders”?

Research has been conducted on the family histories of young people with Autism, AS, and HFA and has identified a higher than expected incidence of mood disorders. Children with AS and HFA may be vulnerable to a genetic predisposition to mood disorders. However, when we consider their difficulties with regard to empathy, profile of cognitive skills, sensory perception, social reasoning, and verbal communication, they are clearly prone to considerable stress as a result of their attempts at social inclusion. Chronic levels of stress can contribute to a mood disorder. Therefore, there may be circumstantial factors that explain the higher incidence of mood disorders in this population.

Theoretic models of Autism developed within cognitive psychology and research in neuropsychology also provide some explanation as to why these children and teens are prone to secondary mood disorders. The extensive research on “Theory of Mind” skills confirms that young people with AS and HFA have considerable difficulty identifying and conceptualizing the thoughts and feelings of others – and themselves. The interpersonal and inner world of emotions seems to be uncharted territory for these kids.

Research on executive function in individuals with AS and HFA suggests characteristics of being disinhibited and impulsive, with a relative lack of insight that affects general functioning. Impaired executive function also can affect the cognitive control of emotions. Among young people on the autism spectrum, clinical experience suggests that there is a tendency to react to emotional cues without cognitive reflection. Research on individuals with Autism using new neuroimaging technology also has identified structural and functional abnormalities of the amygdala, which is known to regulate a range of emotions (e.g., anger, fear, sadness, etc.). Therefore, we also have neuroanatomic evidence that suggests there will be problems with the perception and regulation of the emotions.

Treatment for mood disorders depends on the evaluation of a professional. Behavioral therapy, cognitive therapy, lifestyle modification, and medication may all be used. It is crucial to get early treatment for a mood disorder to reduce the severity of symptoms and manage any complications.

Cognitive Behavior Therapy (CBT) is the primary treatment for mood disorders. CBT has been designed and refined over several decades and has proven to be effective in changing the way an individual thinks about and responds to uncomfortable emotions (e.g., anxiety, sadness, anger, etc.)  This therapy focuses on aspects of cognitive deficiency in terms of the maturity, complexity, and efficacy of thinking, and cognitive distortion in terms of dysfunctional thinking and incorrect assumptions. Therefore, it has direct applicability to young people on the autism spectrum who are known to have deficits and distortions in thinking.

CBT has several components:
  • an assessment of the nature and degree of mood disorder using self-report scales and a clinical interview
  • mood education with discussion and exercises on the connection between cognition, affect and behavior, and the way in which people conceptualize emotions and construe various situations
  • cognitive restructuring (cognitive restructuring corrects distorted conceptualizations and dysfunctional beliefs; the child or teen is encouraged to establish and examine the evidence for – or against – his thoughts and build a new perception of specific events)
  • stress management (stress management and cue-controlled relaxation programs are used to promote responses incompatible with anxiety or anger)
  • self-reflection (self-reflection activities help the child recognize her internal state, monitor and reflect on her thoughts, and construct a new self-image)
  • a schedule of activities to practice new cognitive skills (a graded schedule of activities is developed to allow the child to practice new abilities that are monitored by the clinician)

The neurology of AS and HFA makes life more demanding. Young people with the disorder are often disconnected from what they themselves feel, leaving them ill-equipped to make sense of their daily experiences. In addition, the nature of their social and communication deficits creates its own challenges. These kids are often deprived of the social rewards, support, and validation that “typical” kids know and take for granted – leading to even greater frustration. Many AS and HFA kids know constant criticism and rejection, which can result in a harsh self-judgment that they are failing others.

Here a few tips for parents of AS and HFA children with mood disorders:

1. All children have bad moods sometimes. That’s nothing to be worried about. However, a mood disorder deals with problematic behavior caused by chemical imbalances in the brain. Many moms and dads are in denial that their AS or HFA youngster may have a mood disorder. They don’t want anything to be “wrong” with their youngster, so they chalk up bad behavior to an artistic temperament. A Surgeon General’s report found that 75-80% of kids in need of mental health services don’t get it because of the stigma. So, make sure “denial” is not a factor in your case.

2. An AS or HFA youngster’s dark mood, negative words, and problematic behaviors can be frightening to parents. But, the reality is what it is. Living with AS or HFA is stressful and can invite feelings of despair, hopelessness, and self-disregard. Don’t let your fear keep you at bay or leave your youngster alone with her suffering. Do not shy away from the outside world, isolating yourself as your youngster isolates herself. If her mood concerns you, seek professional help (e.g., counseling, assessment, medication, etc.).

3. AS and HFA kids crave the steady, quiet, self-regulated, unthreatening control of their computer, books, bedroom, etc. They deserve a place of respite that they can count on. Don’t ignore your youngster’s true need for “down time,” maybe even preemptively suggesting at times that she run off to her preferred retreat.

4. Be careful not to take words or behaviors that you don’t understand as being empty and meaningless. Try to discover what your youngster is attempting to convey or express. This teaches her the inherent value of communication and empowers her being an agent in being understood by others. The more clearly and directly your youngster can share what she feels, the less in the dark you will be, and the more information you will have to guide your interventions and actions.

5. Don’t cling to traditional parenting strategies. Traditional techniques will tell you that when your youngster misbehaves, the consequence should be immediate. That’s good advice for “typical” kids. But for an AS or HFA child with a mood disorder – it is bad advice. If a youngster with a mood disorder is acting-out, that may mean he is experiencing a meltdown rather than a temper tantrum (two distinctly different behaviors). And if parents try to impose disciplinary action at that point, it only escalates the meltdown. Therefore, delay the consequences, and don’t engage in the fight. When it’s calm, sit down with your youngster and explain the repercussions of his behavior.

6. Kids with AS and HFA tend to worry a lot. Try not to criticize or show your own frustration over this excessive worrying. Don’t try to rationalize away your youngster’s worry. Invite his expressions of hurt and worry with open arms. This will show him how good and comforting human connection can feel, and how it can alleviate an anxious or depressed mood.

7. Nothing truly comforts an AS or HFA youngster more than being in the presence of parents who feel genuinely at ease, especially when in the presence of his distress. If what you are doing is stressing your youngster excessively, try to back off and speak more quietly, more slowly – or not at all. You can’t shield your youngster from all the stresses of life, but you can be a calming influence from a world that moves too fast and too insensitively.

8. Parents of an AS or HFA youngster with a mood disorder must endure incredible stress – stress that affects the family, the marriage, and siblings. They’re constantly living in an unpredictable atmosphere and walking on eggshells, since they never know what may to set their youngster off. And, there are so many unanswered questions (e.g., Am I doing the right thing? Will my child be able to function as an adult? Will she hurt herself? Will she live a full life? …and so on). Furthermore, emotions like anxiety, despair, fear, hopelessness, and second-guessing yourself are all very common – especially when it seems like everyone around you is judging your parenting skills. Thus, it’s important for moms and dads to talk to a professional who is compassionate and non-judgmental and who provides a safe place to talk honestly and openly. Don’t be too proud to seek counseling for yourself!

9. Raising a youngster with AS or HFA is a lifelong endeavor. Helping him deal with depression and anxiety is a process that can proceed in a positive direction. Stay connected in whatever way you and he can muster and bear. Every molecule of connection parents establish with their youngster helps to protect him from anxiety, depression, self-hatred, despair, and the toxicity of isolation.

10. Lastly, watch for frustration and irritability that can’t be alleviated, that rises fast and frequent. A youngster’s losing interest in – or going deeper into – an obsession can signal depression and/or anxiety. Notice self-derogatory remarks and self-injury. Anxiety can intensify tics and body tension, or cause behaviors to grow more driven and rigid. When these signs reveal themselves, it’s time to reach out to a professional for assistance.

Teaching Social Skills and Emotion Management

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