“How should I handle my teenage son’s emotional instability? Specifically, how can I tell the difference between 'normal' moodiness that occurs in adolescence and depression? My son seems to have significantly more ‘downs’ than ‘ups’. He’s usually very grouchy and pretty much stays to himself. Is this typical for teens with Asperger syndrome? Should I be concerned? What can I do to help?”
Moodiness and depression are common among teens in general. And young people with Asperger’s (AS) and High-Functioning Autism (HFA) are at even greater risk for these comorbid conditions. Teens on the autism spectrum have a “developmental disorder,” which means that their emotional age is significantly younger than their chronological age. For example, the teenager may be 16-years-old, but still have the social skills of a 9-year-old. This dilemma causes problems for the teen due to the fact that he or she experiences great difficulty in relating to same-age peers, which in turn may result in rejection from the peer group – and this contributes largely to the AS or HFA teen’s lack of self-esteem and depression.
In addition, cognitive control systems lag behind emotional development making it hard for AS and HFA teens to cope with their emotions. Furthermore, beyond the biological factors, a lot of other changes are occurring during adolescence (e.g., experiencing first loves and breakups, butting heads with parents, start of high school, etc.). No wonder some teens on the spectrum struggle through this time in their life.
Unfortunately, other complicating factors are at play during the teenage years:
Difficulty with transitions— Largely due to the uneasy transition toward adulthood, most teens on the spectrum experience an increase in anxiety. It is during this time that they are dangling between the dependency of childhood and the responsibilities of adulthood. It can feel intimidating to prepare to leave high school, head off to college, or into the job market. All these factors induce more mood swings and anxiety in AS and HFA teens.
Peer-rejection— Many teens on the spectrum are deliberately excluded from social relationships among their age group. As a result, they often choose to isolate themselves, which makes a bad problem worse. A teenager who feels rejected often spends too much time playing video games and on social networking sites, thus losing touch with peers even more. Teens who are ostracized by their peers also tend to underachieve academically.
Poor social skills— Most young people with AS and HFA experience social skills deficits. As a result, interactions with peers become very unpleasant. The more they “fail” in connecting with peers, the more they isolate. They want to “fit-in” and be accepted, but simply haven’t figured out the social politics needed to find and keep friends.
Low self-esteem— Peer-group rejection results in a decline in their self-image, a state of despair, behavioral difficulties, loneliness and seclusion.
So as a parent, how do you know when to wait out the moods – and when to worry? The truth is that it's difficult to know, because every teenager is different. Rapid physiological changes are occurring during adolescence. Therefore, a degree of vacillation between "ups" and "downs" can be expected. However, there is big difference between teenage mood swings and genuine depression. The major symptoms of depression may include:
- changes in appetite
- episodes of moping and crying
- loss of enthusiasm or interest in favorite activities
- mood swings that seem out of proportion to the circumstances
- negative self-concept
- outbursts of anger
- painful thoughts that manifest themselves in relentless introspection
- persistent anxiety
- persistent sadness
- poor school performance
- sense of hopelessness
- withdrawal and isolation
If an AS or HFA teenager is suffering from depression, parents can expect to see the following symptoms unfold in three successive stages:
- Inability to concentrate, withdrawal from friends, impulsive acts, and declining academic performance
- Acts of aggression, rapid mood swings, loss of friends, mild rebellion, and sudden changes in personality
- Overt rebellion, extreme fatigue, giving away prized possessions, expressions of hopelessness, and suicidal threats or gestures
Other common symptoms of depression in adolescents include: eating or sleeping too much, feeling extremely sensitive, feeling misunderstood, feeling negative and worthless, poor attendance at school, self-harm, and using recreational drugs or alcohol.
Symptoms caused by depression can vary from child to child. To discover the type of depression your AS or HFA teenager has, your physician may add one or more “specifiers.” A specifier simply means that your teen has depression with specific features, for example:
- Seasonal pattern: depression related to changes in seasons and reduced exposure to sunlight
- Mixed features: simultaneous depression and mania, which includes elevated self-esteem, talking too much, and increased energy
- Melancholic features: severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, major changes in appetite, feelings of guilt, agitation or sluggishness, and worsened mood in the morning
- Catatonia: depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
- Atypical features: depression that includes the ability to temporarily be cheered by happy events, increased appetite, sensitivity to rejection, a heavy feeling in the arms or legs, and excessive need for sleep
- Anxious distress: depression with unusual restlessness or worry about possible events or loss of control
1. Psychotherapy: Different types of psychotherapy can be effective for depression in AS and HFA teens (e.g., cognitive behavioral therapy). Psychotherapy can help your teen:
- regain a sense of satisfaction and control in his or her life
- ease depression symptoms (e.g., hopelessness and anger)
- learn to set realistic goals for his or her life
- identify negative beliefs and behaviors and replace them with healthy, positive ones
- identify issues that contribute to his or her depression
- change behaviors that make depression worse
- find better ways to cope and solve problems
- explore relationships and experiences
- develop positive interactions with peers
- develop the ability to tolerate and accept distress using healthier behaviors
- adjust to a crisis or other current difficulty
2. Alternative Therapies: Therapies other than face-to-face office sessions are available and can be highly effective for teens on the autism spectrum (e.g., as a computer program, by online sessions, or using videos or workbooks). These can be guided by a therapist or be totally independent.
3. Social Skills Training: Teens on the autism spectrum experience depression largely due to their awkwardness in interpersonal relationships. Thus, social skills training is perhaps the best method for combating depression in these young people. A major goal of social skills training is teaching AS and HFA teens:
- how to understand verbal and nonverbal behaviors involved in social interactions
- how to make "small talk" in social settings
- the importance of good eye contact during a conversation
- how to "read" the many subtle cues contained in social interactions
- how to tell when someone wants to change the topic of conversation or shift to another activity
- how to interpret social signals so that they can determine how to act appropriately in the company of others in a variety of different situations
Social skills training assumes that when “special needs” teens improve their social skills and change selected behaviors, they will raise their self-esteem and increase the likelihood that others will respond favorably to them. The AS or HFA teen learns to change his or her social behavior patterns by practicing selected behaviors in individual or group therapy sessions.
4. Medication: Many types of antidepressants are available, including:
- Atypical antidepressants (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL, Remeron, Trintellix)
- Monoamine oxidase inhibitors (Parnate, Nardil, Marplan, Emsam)
- Selective serotonin reuptake inhibitors (Celexa, Prozac, Paxil, Pexeva, Zoloft, Viibryd)
- Serotonin-norepinephrine reuptake inhibitors (Cymbalta, Effexor XR, Pristiq, Khedezla, Fetzima)
- Tricyclic antidepressants (Tofranil, Pamelor, Surmontil, Norpramin, Vivactil)
Other medications can be added to an antidepressant to enhance antidepressant effects. Your physician may recommend combining two antidepressants or adding medications (e.g., mood stabilizers or antipsychotics). Anti-anxiety and stimulant medications can also be added for short-term use.
Other things that parents can do to combat moodiness and depression in their AS or HFA teenager include: encouraging physical activity; praising the youngster's skills; promoting participation in organized activities; reminding your youngster that you care by listening, showing interest in his or her problems, and respecting his or her feelings; and setting aside time each day to talk to your youngster (this step is crucial in preventing further isolation, withdrawal, and progressive depression).
==> Discipline for Defiant Aspergers and High-Functioning Autistic Teens