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Aspergers and Separation Anxiety

Question

Our son Jack, who is turning 6 next week, and has Aspergers is not coming to terms that mum and dad will be going away for 4 days for a holiday in January (20th to be exact). It is my and my husband 1st year anniversary (strange as it seems after being together for almost 12 years). It is important for us as a couple to have this time away, and a friend in our compound has agreed to look after Jack. She also has a boy who is 6 1/2 years old. I have two other sons who will be going to other houses in the compound whilst we are away. The kids will still be close to each other but not in each other’s pockets.

I tried to explain to Jack via using a calendar of the days we will be away, but he had a complete meltdown. Not sure if this is just a manipulation game but I will admit I haven't left him with anyone for a very long time. Their father leaves a lot for travel for work but mum is always home.

Are you able to provide me with a strategy to discuss with him of our leave away? Should I not go? My only concern with this is that then I will never be able to have time away with my husband and sometimes things get strained as it is.

Is the change too much? We do have a nanny, but not to sound rude, the nannies here in Ghana are not a western nanny and she simply can't cope with Jack - let alone with 3 boys by herself. I can have the option of the nanny staying in the house here with the three kids, but last time we were out and Jack vomited, she left him in his vomit (so not exactly reliable).

Has any other parents asked you this question before? I will admit to you our relationship is not going the greatest so I am hoping that having time away from the kids may help.


Answer

Separation anxiety is a problem for many kids, but with an Aspergers (high functioning autistic) youngster, the situation is even more serious due to sensory issues, poor social skills, and the need for structure and routine.

Separation anxiety is defined as excessive anxiety about becoming separated from mother, father, and any siblings that might be in the home. Aspergers kids experiencing separation anxiety often exhibit generalized fear, anxiety over the possibility of death, and recurrent nightmares. Unlike the occasional worries that kids may feel at times of separation, separation anxiety causes fears that may limit a youngster’s ability to engage in ordinary life.

Normal separation anxiety and “Separation Anxiety Disorder” share many of the same symptoms, so it can be confusing to try to figure out if your youngster just needs time and understanding—or has a more serious problem. The main differences between healthy separation anxiety and a disorder are the intensity of your youngster’s fears, and whether these fears keep him from normal activities. Kids with separation anxiety disorder may become agitated at just the thought of being away from his parents, and may complain of sickness to avoid playing with friends or attending school. When symptoms are extreme enough, these anxieties can add up to a disorder.

Kids with Separation Anxiety Disorder feel constantly worried or fearful about separation. Many kids are overwhelmed with one or more of the following:

• Kids with anxiety disorder may fear that once separated from mom or dad, something will happen to keep the separation (e.g., they may worry about being kidnapped or getting lost).

• Kids with separation problems often have scary dreams about their fears.

• The most common fear a youngster with separation anxiety disorder experiences is the worry that harm will come to his mother or father in the youngster's absence (e.g., the youngster may constantly worry about a parent becoming sick or getting hurt).

Separation Anxiety Disorder can get in the way of a youngster’s normal activities. Kids with this disorder often:

• Shadow you around the house or cling to your arm or leg if you attempt to step out.

• Complain they feel ill.

• Anxiety may make these kids insomniacs, either because of the fear of being alone or due to nightmares about separation.

• A youngster with separation anxiety disorder may have an unreasonable fear of school, and will do almost anything to stay home.

Here are some tips to help your Aspergers youngster deal with his separation anxiety:

• Allow your youngster to call once each evening to reassure him that you will be home soon.

• Anticipate separation difficulty. Be ready for transition points that can cause anxiety for your youngster. If your youngster separates from one parent more easily than the other, have that parent handle the separation.

• Develop a “goodbye” ritual. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss.

• Educate yourself about separation anxiety. If you learn about how your youngster experiences this condition, you can more easily sympathize with his struggles.

• Give your child a calendar with the days that you will be gone circled. Call daily and have him put a big ‘X’ inside the circle that corresponds to the current date, bringing him that much closer to your return home.

• Have a consistent primary caregiver. If you hire a caregiver, try to stick with this one person for as long as possible.

• Help him practice relaxation. Your youngster can control stress levels with relaxation techniques like yoga, deep breathing, or meditation.

• If possible, try to arrange it so that the anxious youngster and his brother or sister stays with the same caretaker while you’re gone. In this way, the anxious youngster will still be in the presence of a family member throughout your absence.

• Keep a sense of humor. The act of laughing helps the body fight stress in a number of ways.

• Keep calm during separation. If your youngster sees that you can stay cool, he is more likely to be calm, too.

• Keep familiar surroundings when possible. Have the caretaker come to your house.

• Leave him with a picture of you and a personal item of yours before you leave.

• Leave without fanfare. Tell your youngster you are leaving and that you will return, then go—don’t stall.

• Listen to and respect your youngster’s feelings. For a youngster who might already feel isolated by his anxiety, the experience of being listened to can have a powerful helping effect.

• Make new surroundings familiar. When your youngster is away from home, let him take a familiar object with him.

• Make sure he gets enough sleep. Feeling tired will only increase stress, causing him to think irrationally or foggily.

• Make sure your youngster eats right. A well-nourished body is better prepared to cope with stress, so be mindful of what he eats.

• Make sure your youngster exercises regularly. Physical activity plays a key role in reducing and preventing the effects of stress.

• Minimize scary television/movies. Your youngster is less likely to be fearful if the shows you watch are not frightening.

• Offer choices. If your youngster is given a choice or some element of control in an activity or interaction with an adult, he may feel more safe and comfortable.

• Practice separation. Leave your youngster with a caregiver for brief periods and short distances at first.

• Praise your youngster’s efforts. Use the smallest of accomplishments—going to bed without a fuss, a good report from school—as reason to give your youngster positive reinforcement.

• Provide a consistent pattern for the day. Don’t underestimate the importance of predictability for kids with separation problems. If your family’s schedule is going to change, discuss it ahead of time with your youngster.

• Reassure your youngster that you will return and at what day/time.

• Schedule the separation in the morning right after breakfast. Kids are more able to deal with separation anxiety if they are rested and fed.

• Set limits. Let your youngster know that although you understand his feelings, there are rules in your household that need to be followed. And one of the rules is “mommy and daddy go on trips together sometimes.”

• Spend a considerable period of time with your youngster before you leave and upon your return.

• Support the youngster's participation in activities. Encourage your youngster to participate in healthy social and physical activities while you’re gone.

• Talk about the issue. It’s healthier for kids to talk about their feelings—they don’t benefit from “not thinking about it.” Be empathetic, but also remind the youngster—gently—that he survived the last separation.

• Try not to give in. Reassure your youngster that he will be just fine—setting limits will help the adjustment to separation.

If you see any of the following “red flags” and your interventions don’t seem to be enough, it may be necessary to get a professional to diagnose and help your youngster:
  • Age-inappropriate clinginess or tantrums
  • Constant complaints of physical sickness
  • Excessive fear of leaving the house
  • Preoccupation with intense fear or guilt
  • Refusing to go to school for weeks
  • Withdrawal from friends, family, or peers

Therapists can address physical symptoms, identify anxious thoughts, help your youngster develop coping strategies, and foster problem solving. Professional treatment for separation anxiety disorder may include:

• Counseling for the family. Family counseling can help your youngster counteract the thoughts that fuel his or her anxiety, while you as the parent can help your youngster learn coping skills.

• Medication. Medications may be used to treat severe cases of separation anxiety disorder. It should be used only in conjunction with other therapy.

• Play therapy. The therapeutic use of play is a common and effective way to get kids talking about their feelings.

• Talk therapy. Talk therapy provides a safe place for your youngster to express his or her feelings. Having someone to listen empathetically and guide your youngster toward understanding his or her anxiety can be powerful treatment.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

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

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
By

Aspergers and Enuresis

"We have experienced unusual urination issues with our 'aspie' daughter. She wears pull-ups at night and has never had a dry night, but she will also urinate in containers, bags, purses and even in her play tea set. It doesn't happen as often any more, but has happened as recently as a month ago. She doesn't do it out of anger - it's more like a compulsion and she can't explain why she does it. (She also has a wide variety of other compulsive behaviors we're trying to work though.)"

Enuresis is diagnosed when kids repeatedly urinate in inappropriate places, such as clothing (during the day) or the bed (during the night). In most cases, the youngster's urination problem is involuntary in nature, and is perceived by the youngster as an unavoidable loss of urinary control.

There are three subtypes of Enuresis:

• Nocturnal (night-time) Only
• Diurnal (day-time) Only
• Nocturnal and Diurnal

The DSM criteria for diagnosis state that the urination problem (whether involuntary or intentional) must occur with regularity, at least twice a week, for three consecutive months before the diagnosis applies. The diagnosis cannot be made unless there is evidence that the urination problem causes distress or impairment in the youngster's social or academic functioning.

In Nocturnal Only Enuresis, the most common form of enuresis, kids wet themselves during nighttime sleep. Typically, wetting occurs during the first third of the night, but it is not uncommon for wetting to occur later, during REM sleep. In this latter case, kids may recall having a dream that they were urinating.

Diurnal Only Enuresis, where kids wet themselves only during waking hours, is less common than nighttime bedwetting. This type of enuresis is more common in females than in males, and is uncommon altogether after age 9. Kids who are affected by this type of disorder will typically either have urge incontinence (i.e., they feel a sudden overwhelming urge to urinate) or voiding postponement (i.e., they know they need to urinate, but put off actually going to the bathroom until it is too late).

As the name suggests, kids with Nocturnal and Diurnal Enuresis suffer from a combination of the two scenarios described above.

Predisposing factors that contribute to increased risk of developing enuresis include:
  • abnormal urinary functioning
  • delayed or lax toilet training
  • psycho-social issues (e.g., social anxiety)
  • reduced bladder capacity
  • unstable bladder syndrome (i.e., a condition wherein the youngster's bladder contracts involuntarily, resulting in sudden urine leakage)

Enuresis is most frequent in younger kids, and becomes less common as kids mature. According to the DSM, while as many as 10% of five year olds qualify for the diagnosis, by age fifteen, only 1% of kids have enuresis.

Enuresis is typically experienced as an embarrassing and shameful condition, particularly if the affected youngster is older. Kids with enuresis may be ostracized, teased and bullied by peers. In addition, they may face caregivers' anger, rejection and punishment for not meeting developmental expectations. Prompt treatment for enuresis can help to head off potential self-esteem problems associated with the condition.

Treatment involves a range of strategies including:
  • cleanliness training (kids help thoroughly clean the bedding and mattress when accidents occur)
  • family encouragement of good toilet habits and successful progress.
  • mild punishment (primarily disapproval when accidents occur)
  • nighttime waking (kids learn to wake themselves in the night to use the restroom)
  • positive practice (parents help their youngster to develop the habit of going to the bathroom at regular intervals during the day, just before sleep, and during the nighttime in order to avoid accidents)
  • positive reinforcement (rewards or praise) for urinating appropriately
  • urine retention control training (strategies to promote better bladder control)

Success rates associated with this Enuresis treatment appear to be around 85%, with relapse rates falling between 7%-29%.

Some physicians may suggest a pharmacological treatment for Enuresis. The most commonly prescribed drug is imipramine (Tofranil) which is an old-style tricyclic antidepressant. Imipramine treatment is often a successful treatment in the short term, with between 40 and 50 % of kids showing improvement. However, when the drug is discontinued, about 2/3 of kids show a relapse and begin enuresis behavior again.

Alternatives to antidepressant therapy for enuresis exist. Desmopressin (DDAVP) is a synthetic form of a natural pituitary antidiuretic hormone which reduces urinary production by instructing the kidneys to retain water inside the body rather than excreting it. Administering Desmopressin to kids reduces their urine output dramatically, making it easier for them to maintain continence. Between 10 and 60 % of kids with enuresis taking DDAVP show improvements. However, as is the case with Imipramine, relapses back into enuresis are common when the drug is discontinued.

Due to their better side effect profiles and longer lasting effects, behavioral treatments for enuresis are usually recommended over medical ones with rare exception.  

Highly Acclaimed Parenting Programs Offered by Online Parent Support, LLC:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

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

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

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Can children with Aspergers also get diagnosed with Bipolar Disorder?

Question

Could you tell me if some children with Asperger's also get diagnosed with Bipolar Disorder? Our daughter has always had mood issues but we can usually identify causes, such as sensory issues, anxiety or overstimulation. We have just had an IEE FBA done on my daughter at school. The school has not been implementing her BIP, and she has been running the show. She is in 7th grade. The school district is so out of compliance with IDEA 2004. None of the Teacher's or staff are trained.

This behavior specialist wants us to go to a Psychiatrist to get a "clean diagnosis." We have had numerous testing done on her over the years. She was diagnosed at 4 years with ADHD, then at 5 with PDD-NOS. We took her to University of Texas Health Science Center and they diagnosed "High Functioning Autism" at 6 years. The doctor told us that it was essentially the same as Asperger's.

Answer

A diagnosis of both Aspergers and Bipolar is especially problematic because there are fundamental differences between ‘Aspergers mood states’ versus ‘mood states of a child without Aspergers’. Four specific domains need to be considered in the process of diagnosis:
  • ‘Psychosocial masking’ make some unusual behaviors seem like disorders when they are not.
  • ‘Intellectual distortion’ involves confusion in communication; a person may say he is afraid instead of angry.
  • ‘Cognitive disintegration’ may interfere with proper diagnosis since a child may exhibit odd behavior in response to seemingly insignificant occurrences.
  • ‘Baseline exaggeration’ differences suggest that unusual base behaviors can interfere with proper diagnosis.

Bipolar Disorder (BD) can be misdiagnosed as Aspergers (AS) because BD can present itself via symptoms such as obsessive compulsive behavior, odd habits, and bouts of rage. Children with BD and AS both have symptoms that lead to lacking social development skills, educational issues, behavioral issues, and anger issues.

BD can also be present in conjunction with AS. Typically, this is the case. It is unknown, however, if the BD is a result of the AS, or if the same neurological issues that cause AS are related to the chemical imbalances in the brain thought to be the cause of BP. Answers to these questions will likely come to light as research in neurological, technological and psychiatric areas continue to progress.

Medication treatments for BD and AS are quite similar. There are no medications for AS; however, medications exist to treat the symptoms of AS. Since the symptoms of AS (e.g., depression, obsessive compulsive disorder, and anxiety) are the same symptoms often experienced with BD, the medications used in both instances are the same.

Counseling treatments are also commonly used for both BD and AS, used in conjunction with medication or alone. Most AS children do not need medication. Counseling is required, however, to help the child cope with her disability. Counseling treatments for BD are considered necessary, with or without medication. These treatments can help the child learn to recognize and correct irrational emotions or behavior.

My Aspergers Child: Preventing Meltdowns
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