High-Functioning Autistic Teens and Emotional Dysregulation

“My teenage son with ASD (high functioning) is out of control, don't know what to do? I tried every option available to me with the exception of bootcamp. I just can't afford to put him in a bootcamp or military school. But that's the only solution that I see. He’s 17 and is on pot every day. He has a hair trigger and will go off big time whenever he is the least bit irritated over something… fits of rage over little things that most people would just ignore. Has threatened to kill himself when he’s upset. Please help!!!”

Emotional Dysregulation (ED) is often found in young people with Asperger’s (AS) and High-Functioning Autism (HFA), and is a term used in the mental health profession to refer to mood swings and emotional reactions that are significantly “out-of-control.” Examples of ED include destroying or throwing objects, angry outbursts, aggression towards self or others, a decreased ability to regulate emotions, an inability to express emotions in a positive way, smoking, drug and/or alcohol abuse, eating disorders, self-harm, and even threats to kill oneself or others.

These reactions usually occur in seconds to minutes – or hours. ED often leads to behavioral problems for the individual, which can interfere with his or her relationships at home, in school, or at place of employment.

ED in AS/HFA teens can be associated with “internalizing” behaviors, for example:
  • becoming avoidant or aggressive when dealing with negative emotions
  • being less able to calm themselves
  • difficulty calming down when upset
  • difficulty decreasing negative emotions
  • difficulty understanding emotional experiences
  • exhibiting emotions too intense for a situation
  • experiencing more negative emotions

ED can also be associated with “externalizing” behaviors, for example:
  • being impulsive
  • difficulty calming down when upset
  • difficulty controlling their attention
  • difficulty decreasing their negative emotions
  • difficulty identifying emotional cues
  • difficulty recognizing their own emotions
  • exhibiting more extreme emotions
  • focusing on the negative

ED in adolescents with AS and HFA can be made worse by difficulty in communicating feelings of annoyance, anxiety, depression, or worry. ED may be a common reaction experienced when coming to terms with problems in relationships, friendships, school, employment, and other areas in life affected by autism spectrum disorders.

There can be an “on-off” quality to these strong emotional reactions, where the affected individual is calm minutes later, while those around are stunned and may feel hurt or shocked for hours – if not days – afterward. Moms and dads struggle to understand the out-of-control behavior of their “special needs” teenager, with disappointment and resentment often building up over time. Once they understand that their teen has trouble controlling his emotions or understanding its effects on others, they can begin to respond in ways that will help manage these flare-ups.

In some cases, AS/HFA adolescents may not acknowledge they have trouble controlling their negative emotions, and will blame others for provoking them. Again, this can create enormous conflict within the family. It may take carefully phrased feedback and plenty of time for these adolescents to gradually realize they have a problem with how they express themselves.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

AS/HFA Teenagers and Their Struggles—

As previously mentioned, many individuals with ED have an autism spectrum disorder. But, when the typical problems associated with adolescence are added to the equation, parents have a real challenge on their hands. Here are just a few of the struggles associated with being a teen on the spectrum:

• The teen years are more emotional for everyone. Yet the hormonal changes of adolescence, coupled with the problems associated with AS and HFA, might mean that the adolescent becomes emotionally overwhelmed. Childish tantrums reappear. Males may act out by physically attacking a peer or teacher. They may experience "meltdowns" at home after another day filled with harassment, bullying, pressure to conform, and rejection. Drug addiction becomes a real concern at this age (most notably, marijuana use).

• Teens with AS and HFA - with their distractibility and difficulty organizing materials - face similar academic problems as students with ADHD. A high school term paper or a science fair project becomes impossible to manage, because no one has taught the AS or HFA teenager how to break it up into a series of small steps. Even though the academic stress on an AS/HFA adolescent can be overwhelming, school administrators may be reluctant to enroll him in special education at this late point in his educational career.

• Some teens with AS and HFA remain stuck in grammar school clothes and hobbies instead of moving into adolescent concerns (e.g., dating). AS/HFA males often have no motor coordination. This leaves them out of high school sports (typically an essential area of male bonding and friendship).

• Many teens with AS and HFA - with their average to above average IQs - can sail through grammar school, and yet hit academic problems in middle and high school. They now have to deal with 4 to 6 teachers, instead of just 1. The likelihood that at least one teacher will be indifferent - or even hostile - toward making special accommodations is certain. The AS/HFA student now has to face a series of classroom environments with different classmates, odors, distractions, noise levels, and sets of expectations.

• Many AS/HFA adolescents are stiff and rule-oriented and act like little adults, which is a deadly trait in any teen popularity contest. Friendship and all its nuances of reciprocity can be exhausting for an AS or HFA teenager, even though she wants it more than anything else.

• In their overwhelming need to fit in and make friends, some teens on the spectrum fall into the wrong high school crowds. Adolescents who abuse substances may use the AS or HFA teen’s naivety to get him to buy or carry drugs and liquor for their group.

• In the teen world where everyone feels insecure, adolescents that appear different are voted off the island. Teens with AS and HFA often have odd mannerisms. One adolescent talks in a loud un-modulated voice, avoids eye contact, interrupts others, violates others’ physical space, and steers the conversation to his favorite odd topic. Another appears willful, selfish and aloof, mostly because he is unable to share his thoughts and feelings with others. Isolated and alone, many autistic teens are too anxious to initiate social contact.

• AS/HFA is characterized by poor social skills. These include a lack of eye contact during conversation and body language that conveys a lack of interest. The teen years revolve around social interaction, and an adolescent on the spectrum may be ostracized and mocked by his class mates because of his lack of social skills.

• AS and HFA adolescents are often more immature than their peers and may be naive when it comes to puberty and sexuality. If they have not been taught about sex, they may pick up information from pornographic material. This can lead to inappropriate behavior and touching that could land them in trouble.

• Fashion is important to “typical” teens (especially girls), but teens with AS and HFA have little dress sense. If they do not attempt to conform to their peers' standards, they will often be mocked and left out of social events.

• Depression often results from the social skills deficits that adolescents with AS and HFA commonly experience. They may feel worthless, and in extreme cases, may consider suicide as an option.

• Bullying is a big challenge in the lives of many autistic teens. Because of their unusual behavior, they tend to attract bullies and are less likely to report this than their peers. In some cases, the AS or HFA teen may respond with violence and end up in trouble at school.

Common causes of ED in autistic adolescents include other people’s behavior (e.g., teasing, bullying, insensitive comments, being ignored, etc.), intolerance of imperfections in others, having routines and order disrupted, difficulties with academics despite being intelligent in many areas, peer-relationship problems, a build-up of stress, and being swamped with sensory stimulation or multiple tasks.

Identifying the cause of ED can be a challenge.  It is important for parents and teachers to consider all possible influences relating to the environment (e.g., too much stimulation, lack of structure, change of routine, etc.), the adolescent’s physical state (e.g., pain, tiredness, etc.), his or her mental state (e.g., existing frustration, confusion, etc.), and how well he or she is treated by peers.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

How Parents and Teachers Can Help—

The first step is for the AS or HFA adolescent to learn emotion-management skills. A good place to start is identifying a pattern in how the strong reactions are related to specific frustrations. Such triggers may originate from the environment, specific individuals, or internal thoughts.

Steps to successful emotion-management include the following:

• Self-awareness— The AS/HFA adolescent can be instructed to become more aware of personal thoughts, behaviors, and physical states which are associated with ED. This awareness is important for the adolescent in order for him to notice the early signs of losing control of his emotions. He should be encouraged to write down a list of changes he notices as he begins to feel the need to over-react to something.

• Levels of anger and coping strategies— As the adolescent becomes more aware of situations associated with ED, she can be instructed to keep a record of events, triggers, and associated levels of frustration. Different levels of disturbance can be explored (e.g. mildly annoyed, irritated, very frustrated, angry, a sense of rage).

• Develop an emotion-management record— The adolescent may keep a diary or chart of situations that trigger strong reactions. List the situation, the level of frustration on a scale of 1 to 10, and the coping strategies that help to overcome or reduce feelings of frustration.

• Becoming motivated— Parents and teachers can help the AS or HFA adolescent to identify why he would like to manage his emotions more successfully. He identifies what benefits he expects in everyday living from improving his coping skills.

• Awareness of situations— The adolescent is taught to become more aware of the situations that are associated with outbursts. She may want to ask other people who know her to describe situations and behaviors they have noticed.

Self-Help Strategies—

The “stop – think” technique:

As the adolescent notices the troubling thoughts running through his mind, he can learn to (a)  stop and think before reacting to the situation (e.g., “Are these thoughts accurate or helpful?”), (b) challenge the inaccurate or unhelpful thoughts, and (c) create a new thought.

The personal safety plan:

A personal safety plan can also be developed to help the adolescent avoid becoming upset when she plans to enter into a situation that has a history of triggering strong reactions. Here is a real life example of a plan used by a 17-year-old girl with Asperger’s for using the “stop – think” technique when approaching a shopping center situation that is known to trigger frustration:
  • My goal: To improve my ability to cope with frustration when I am waiting in long lines.
  • Typical angry thoughts: “The service here is so slow. Why can’t they hurry it up? I'm going to lose my mind any moment now.” – Stop thinking this! 
  • New calmer and helpful thoughts: “Everyone is probably frustrated by the long line – even the person serving us. I could come back another time, or I can wait here and think about pleasant things such as going to see a movie.”

Possible steps in a personal plan can include the following:
  • Plan ways to become distracted from the stressful situation (e.g., watch a YouTube video or read an e-book on my cell phone, carry a magazine)
  • Phone my friend to talk about the cause of frustration
  • Make changes to routines and surroundings (e.g., avoid certain people that are prone to teasing me)
  • Leave the situation if possible
  • Explain to another person how he or she can help me solve the problem
  • Avoid situations that are associated with a high risk of becoming frustrated

Other possible components to a personal plan can include the following:
  • Use visual imagery (e.g., jumping into a cool stream takes the heat of anger away)
  • Self-talk methods
  • Relaxation techniques
  • Anger-control classes in my area
  • Creative destruction or physical activity techniques to reduce anger

Dealing with the emotional problems in teens with AS and HFA is not easy for parents, and it can be hard to trace back the original causes of problematic behaviors. If parents are concerned about their child’s anger, rage or aggression, they should seek advice from a professional. Oftentimes, young people on the autism spectrum who demonstrate emotional problems simply need help developing some coping, social and communicating skills.

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