3.9.09

Aspergers Q & A: "My step-son has had numerous meltdowns off and on for most of his life..."

Question

My step-son is about to turn 12. He has been diagnosed with Asperger's Syndrome. He currently lives with his mother and step-father and half sister. My husband and I live with our son and my two daughters. My step-son has had numerous meltdowns off and on for most of his life. He seems to pick one thing out of his life and fixate on it until he is so afraid of it that he has a meltdown. These fixation normally last for six months or more until all of a sudden, he is no longer afraid of it but finds a new thing to fear. Currently, he is fixated on being scared of coming to visit his dad and is constantly making up excuses not to visit. We have tried to explain to him that there is nothing to be afraid of. We love him very much. He told me that he is afraid that his dad will yell at him or get on to him. Now, I have been with my husband for 7 years and I have seen that the only thing he gets in trouble for is the normal everyday stuff that children get into trouble about. We treat him as we do the other three. From everything that I have read I feel that he should face his fears in order to get past it. But, me being just a step-mom, anything I say doesn't matter or is taken the wrong way. We are getting no help from his mother or any of the other family members who all feel that if he doesn't want to visit, then it must be something that we have done to cause. But, last year when he freaked out about going to school every morning, did they just let him quit? NO! I know this is a tough one. Any opinions would be greatly appreciated. This is not only affecting my husband emotionally, but also my son. He misses him terribly too!


Answer

What you are dealing with here is anxiety. Although little is known about what anxiety symptoms look like in kids with Aspergers, the following symptoms, which overlap with Anxiety Disorders, indicate anxiety:

• Avoidance of new situations
• Irritability
• Somatic complaints
• Withdrawal from social situations

Another set of anxiety symptoms may be seen and may be unique to kids with Aspergers:

• Becoming "silly"
• Becoming explosive easily (e.g., anger outbursts)
• Increased insistence on routines and sameness
• Increased preference for rules and rigidity
• Increased repetitive behavior
• Increased special interest

Cognitive behavioral therapy, a time-limited approach designed to change thoughts, emotions, and behaviors, has been shown to be successful in treating Anxiety Disorders in kids.

For kids with both anxiety symptoms and Aspergers, an innovative group therapy program using cognitive behavioral therapy has been developed. The program includes specific modifications for working with kids with Aspergers and Anxiety Disorder and consists of both a child component and a parent component.

Modifications designed to address the cognitive, social, and emotional difficulties include:

1. More education on emotions—Activities such as feeling dictionaries (i.e., a list of different words for anxiety) and emotional charades (i.e., guessing people's emotions depending on faces) are helpful in developing emotional self-awareness.

2. Greater parent involvement—To build on the attachment between youngster and caregiver, it is important to have moms and dads learn the techniques and coach kids to use them at home.

3. Games and fun physical activities are important to include in group therapy to promote social interactions.

4. Combining visual and verbal materials—Use of worksheets, written schedules of therapy activities, and drawings can be added to increase structure in therapy sessions.

5. Behavioral management—Addition of a reward and consequence system maintains structure and prevents anger outbursts.

6. "Individualizing" anxiety symptoms—Kids should be helped by the therapist to identify what their own anxiety symptoms look like as anxiety symptoms may present differently.

There is some early evidence to suggest that cognitive behavioral group therapy with specific modifications can be successful in treating anxiety symptoms in kids with Aspergers. In a study involving kids with both disorders, most benefited from their participation in the group therapy program and showed fewer anxiety symptoms after 12-weeks of consistent attendance. Future research is being done to get stronger evidence for the effectiveness of the group therapy program.


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