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Showing posts sorted by relevance for query adolescent. Sort by date Show all posts

Problems with Depression in Teens on the Autism Spectrum

All teenagers experience depression from time to time due to the normal pressures faced during adolescents. Also, young people with Aspergers (AS) and High-Functioning Autism (HFA) experience depression occasionally due to dealing with the symptoms associated with the disorder. So, little wonder why a teenager WITH the disorder may have more than his fair share of depression symptoms.

Depression in AS and HFA teens is a serious condition – it affects emotions, thought and behaviors. Although adolescent depression isn't medically different from depression in grown-ups, AS and HFA adolescents often have unique challenges and symptoms. Issues such as peer pressure, academic expectations and changing bodies can bring a lot of ups and downs for these adolescents. But for some, the lows are more than just temporary feelings — they're a sign of depression.

Depression is these teens is not a weakness or something that can be overcome with willpower. Like depression in grown-ups, adolescent depression is a medical condition that can have serious consequences. However for most, adolescent depression symptoms ease with treatment such as medication and psychological counseling.

Adolescent depression symptoms include:
  • Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
  • Anxiety, preoccupation with body image and concerns about performance, particularly in girls
  • Changes in appetite. Depression often causes decreased appetite and weight loss, but in some individuals it causes increased cravings for food and weight gain
  • Crying spells for no apparent reason
  • Disruptive behavioral problems, particularly in boys
  • Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort
  • Feelings of sadness
  • Feelings of worthlessness or guilt, fixation on past failures or self-blame when things aren't going right
  • Frequent thoughts of death, dying or suicide
  • Insomnia or excessive sleeping
  • Irritability, frustration or feelings of anger, even over small matters
  • Loss of interest or pleasure in normal activities
  • Slowed thinking, speaking or body movements
  • Trouble thinking, concentrating, making decisions and remembering things
  • Unexplained physical problems, such as back pain or headaches

Adolescent depression often occurs along with behavior problems and other mental health conditions, such as anxiety or attention-deficit/hyperactivity disorder (ADHD). 
 

What's normal and what's not:

It can be difficult to tell the difference between the ups and downs that are just part of being an adolescent and adolescent depression. Talk with your adolescent. Try to determine whether he or she seems capable of handling his feelings without help, or if life seems overwhelming. If adolescent depression symptoms persist or begin to interfere in multiple areas of your adolescent's life, talk to a doctor or a mental health professional trained to work with adolescents. Your adolescent's family doctor or pediatrician is a good place to start. Or, your adolescent's school may have a recommendation.

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Warning signs that your AS or HFA adolescent could be struggling with depression:
  • An ongoing sense that life and the future are grim and bleak
  • Conflict with friends of family members
  • Extreme sensitivity to rejection or failure
  • Loss of interest in family and friends
  • Neglected appearance — such as mismatched clothes and unkempt hair
  • Poor school performance or frequent absences from school
  • Reckless behavior
  • Sadness, irritability or anger that goes on for two weeks or longer
  • Talking about running away from home or attempting to do so
  • Use of alcohol or drugs

When to see a doctor:

If you suspect your adolescent may be depressed, make a doctor's appointment as soon as you can. Depression symptoms may not get better on their own — and may get worse or lead to other problems if untreated. Adolescents who are depressed may be at risk of suicide, even if signs and symptoms don't appear to be severe.

If you're an adolescent and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your doctor or school nurse. Share your concerns with a parent, a close friend, a faith leader, a teacher or someone else you trust.

Suicidal thoughts:

If your adolescent is having suicidal thoughts, get help right away. Here are some steps you can take:
  • Call a suicide hot line number — in the United States, you can reach the toll-free, 24-hour hot line of the National Suicide Prevention Lifeline at 800-273-8255 to talk to a trained counselor or have your adolescent talk to someone.
  • Contact a family member or friend for support.
  • Contact a minister, spiritual leader or someone in your faith community for advice.
  • Seek help from a doctor, a mental health provider or other health care professional.

When to get emergency help:

If you think your adolescent is in immediate danger of self-harm or attempting suicide, call 911 or your local emergency number immediately. Make sure someone stays with him or her until help arrives.

Causes—

It's not known exactly what causes depression. As with many mental illnesses, it appears a variety of factors may be involved. These include:
  • Biological differences. Individuals with depression appear to have physical differences in their brains from individuals who aren't depressed. The significance of these changes is still uncertain but may eventually help pinpoint depression causes.
  • Early childhood trauma. Traumatic events during childhood, such as abuse or loss of a parent, may cause changes in the brain that make a person more susceptible to depression.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
  • Inherited traits. Depression is more common in individuals whose biological family members also have the condition.
  • Learned patterns of negative thinking. Adolescent depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.
  • Life events. Events such as the death or loss of a loved one, financial problems, and high stress can trigger depression in some individuals.
  • Neurotransmitters. These naturally occurring brain chemicals linked to mood are thought to play a direct role in depression.

Risk factors—

Although the precise cause of depression isn't known, factors that seem to increase the risk of developing or triggering adolescent depression include:
  • Abusing alcohol, nicotine or other drugs
  • Being a girl — depression occurs more often in females than in males
  • Being attracted to members of the same sex — which can cause depression linked to negative social pressures and internal emotional conflicts
  • Having a chronic medical illness such as diabetes or asthma
  • Having a family member who committed suicide
  • Having a parent, grandparent or other biological relative with depression
  • Having an anxiety disorder
  • Having been physically or sexually abused
  • Having been the victim or witness of violence
  • Having biological relatives with a history of alcoholism
  • Having certain personality traits, such as low self-esteem or being overly dependent, self-critical or pessimistic
  • Having experienced recent stressful life events, such as the death of a loved one
  • Having few friends or other personal relationships
  • Having strict moms and dads that are quick to blame or punish
  • Obesity, which can lead to judgment by others and to low self-esteem
  • Parental divorce

Complications—

Untreated depression can result in emotional, behavioral and health problems that affect every area of your adolescent's life. Complications associated with adolescent depression can include:

• Suicide
• Social isolation
• Relationship difficulties
• Family conflicts
• Anxiety
• Alcohol and drug abuse
• Academic problems

Preparing for an appointment—

You're likely to start by taking your adolescent to see his primary care doctor or pediatrician. However, when you call to set up an appointment, you may be referred directly to a psychiatrist or psychologist — mental health professionals who specialize in diagnosing and treating mental health conditions. 
 

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea for you and your adolescent to be well prepared for the appointment. Here's some information to help you get ready for your adolescent's appointment, and what to expect from the doctor.

What you can do:
  • Make a list of all medications, vitamins or supplements that your adolescent is taking.
  • Write down any symptoms your adolescent has had, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes your adolescent has experienced.
  • Write down questions to ask your adolescent's doctor.

Your time with the doctor is limited, so preparing a list of questions ahead of time will help you and your adolescent make the most of your time. List your questions from most important to least important in case time runs out. For problems related to depression, some basic questions to ask the doctor include:
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
  • Are there any possible side effects or other issues I should be aware of with the medications you're recommending for my adolescent?
  • Are there any restrictions that my adolescent needs to follow?
  • Is depression the most likely cause of my youngster's symptoms?
  • Is there a generic alternative to the medicine you're prescribing?
  • My adolescent has these other health conditions. How can he or she best manage them together?
  • Other than the most likely cause, what are other possible causes for my youngster's symptoms or condition?
  • Should my adolescent see a psychiatrist or other mental health provider?
  • What are the alternatives to the primary approach that you're suggesting?
  • What kinds of tests will he or she need?
  • What treatment is likely to work best?
  • Will making changes in diet, in exercise or in other areas of my adolescent's life help ease depression?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions at any time during your adolescent's appointment.

What to expect from your adolescent's doctor:

The doctor is likely to ask your adolescent a number of questions. Making sure he or she is ready to answer them may reserve time to go over any points you or your adolescent wants to spend more time on. Your youngster's doctor may ask your adolescent:
  • Do you ever have suicidal thoughts when you're feeling down?
  • Do you have any biological relatives — such as a parent or grandparent — with depression or another mood disorder?
  • Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
  • Have you experimented with alcohol or illegal drugs?
  • How long have you felt depressed? Do you generally always feel down, or does your mood change?
  • How much do you sleep at night? Does it change over time?
  • How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
  • What other mental or physical health conditions do you have?
  • What, if anything, appears to worsen your symptoms?
  • What, if anything, seems to improve your symptoms?
  • When did your family members or your friends first notice your symptoms of depression?

Tests and diagnosis—

When a doctor suspects an adolescent has depression, he or she will generally ask a number of questions and may do medical and psychological tests. These can help rule out other problems that could be causing symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:

• Psychological evaluation. To check for signs of depression, your doctor or mental health provider will talk to your adolescent about his thoughts, feelings and behavior patterns. The doctor may have your adolescent fill out a written questionnaire to help answer these questions.

• A physical exam. This generally involves measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.

Diagnostic criteria for depression:

To be diagnosed with depression, your adolescent must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

For a diagnosis of major depression, your adolescent must have five or more of the following symptoms over a two-week period. At least one of the symptoms must be either a depressed mood or a loss of interest or pleasure. Symptoms can be based on your adolescent's feelings or may be based on the observations of someone else. They include:
  • Depressed mood most of the day, nearly every day, such as feeling sad, empty or tearful (in adolescents, depressed mood can appear as constant irritability)
  • Diminished interest or feeling no pleasure in all — or almost all — activities most of the day, nearly every day
  • Either restlessness or slowed behavior that can be observed by others
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness, or excessive or inappropriate guilt nearly every day
  • Insomnia or increased desire to sleep nearly every day
  • Recurrent thoughts of death or suicide, or a suicide attempt
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite nearly every day (in adolescents, failure to gain weight as expected can be a sign of depression)
  • Trouble making decisions, or trouble thinking or concentrating nearly every day

To be considered major depression:
  • Symptoms are not caused by grieving, such as temporary sadness after the loss of a loved one
  • Symptoms are not due to the direct effects of something else, such as drug abuse, taking a medication or having a medical condition such as hypothyroidism
  • Symptoms aren't due to a mixed episode — mania along with depression that sometimes occurs as a symptom of bipolar disorder
  • Symptoms must be severe enough to cause noticeable problems in day-to-day activities, such as school, social activities or relationships with others

Other conditions that cause depression symptoms:

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so your adolescent can get the appropriate treatment. Your doctor or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:
  • Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.
  • Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder.
  • Psychotic depression. This is severe depression accompanied by psychotic symptoms such as delusions or hallucinations.
  • Postpartum depression. This is a common type of depression that occurs in new mothers. It often begins four to eight weeks after delivery and may last for months.
  • Dysthymia. Dysthymia (dis-THI-me-uh) is a less severe but more chronic form of depression. While it's usually not disabling, dysthymia can prevent your adolescent from functioning normally in his daily routine and from living life to its fullest.
  • Cyclothymia. Cyclothymia (si-klo-THI-me-uh), or cyclothymic disorder, is a milder form of bipolar disorder.
  • Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression.
  • Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect your feelings, thoughts and behavior.

Make sure that you understand what type of depression your adolescent has so that you can learn more about his specific situation and its treatments. 
 

Treatments and drugs—

Numerous treatments are available. Medications and psychological counseling (psychotherapy) are very effective for most adolescents with depression.

In some cases, a primary care doctor can prescribe medications that relieve depression symptoms. However, many adolescents need to see a doctor who specializes in diagnosing and treating mental health conditions (psychiatrist or psychologist). Some adolescents with depression also benefit from seeing other mental health counselors.

If your adolescent has severe depression or is in danger of hurting himself or herself, he or she may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Medications:

A number of antidepressant medications are available to treat depression. There are several different types, categorized by how they affect the naturally occurring chemicals in the brain linked to mood.

Because studies on the effects of antidepressants in adolescents are limited, doctors rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for adolescent depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with grown-ups, other medications may be prescribed at the doctor's discretion (off label).

Types of antidepressants include:

• Atypical antidepressants. These medications are called atypical because they don't fit neatly into another antidepressant category. They include trazodone and mirtazapine (Remeron). Both of these antidepressants are sedating and are usually taken in the evening. In some cases, one of these medications is added to another antidepressant to help with sleep.

• Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), isocarboxazid (Marplan) and phenelzine (Nardil) — are generally prescribed as a last resort, when other medications haven't worked. That's because MAOIs can have serious harmful side effects. They require a strict diet because they may cause life-threatening high blood pressure if combined with certain common foods such as aged cheeses, pickles and chocolate. They can also interact with some medications, including decongestants. MAOIs can be very dangerous in overdose. Selegiline (Emsam) is a newer MAOI that's applied to the skin as a patch rather than swallowed as a pill. It may cause fewer side effects than do other MAOIs.

• Norepinephrine and dopamine reuptake inhibitors (NDRIs). Bupropion (Wellbutrin) falls into this category. At high doses, bupropion may increase the risk of having seizures.

• Selective serotonin reuptake inhibitors (SSRIs). Many doctors start depression treatment in adolescents by prescribing one of these medications. SSRIs are safer and generally cause fewer bothersome side effects than do other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro). These medications can cause side effects. These may go away as the body adjusts to the medication. Side effects can include digestive problems, jitteriness, restlessness, headache and insomnia. These medications have a low risk of death in overdose.

• Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications include duloxetine (Cymbalta), venlafaxine (Effexor) and desvenlafaxine (Pristiq). Side effects are similar to those caused by SSRIs. In high doses these medications can cause increased sweating and dizziness. Individuals with liver disease shouldn't take duloxetine.

• Tricyclic antidepressants. These antidepressants have been used for years and are generally as effective as newer medications. Examples include amitriptyline, imipramine (Tofranil) and doxepin. Because they can have side effects, they generally aren't used in adolescents. Side effects can include low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. Tricyclic antidepressants are also known to cause weight gain. These medications can be very dangerous when taken in overdose.

• Other medications. If your adolescent's depression isn't getting better with one antidepressant, the doctor may recommend adding another antidepressants or another type of medication for better effect — such as a stimulant, mood-stabilizing medication, anti-anxiety medication or antipsychotic medication. This strategy is known as augmentation.

Managing medications:

Carefully monitor your adolescent's use of his medications. In order to work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for adolescents with depression, your adolescent's doctor may prescribe only small supplies of pills at a time, or recommend that you dole out your youngster's medication so that your adolescent does not have large amounts of pills available at once. Be especially careful if you think your adolescent is at risk of suicidal behavior and is taking a tricyclic antidepressant or an MAOI — these medications are more dangerous than other types of antidepressants when it comes to overdose.

Finding the right medication:

Everyone's different, so finding the right medication or dose of medication for your adolescent may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts. If your adolescent has bothersome side effects, he or she shouldn't stop taking an antidepressant without talking to the doctor first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered down. Quitting suddenly may cause a sudden worsening of depression.

If antidepressant treatment doesn't seem to be working, your adolescent's doctor may recommend a blood test to check for specific genes that affect how his body processes antidepressants. The cytochrome P450 (CYP450) genotyping test is one example of this type of exam. Genetic testing of this kind can help predict how well the body can or can't process (metabolize) a medication. This may help identify which antidepressant might be a good choice for your adolescent. These genetic tests aren't widely available, so they're an option only for individuals who have access to a clinic that offers them.

Antidepressants and pregnancy:

If your adolescent is pregnant or breast-feeding, some antidepressants may pose a health risk to her unborn youngster or nursing youngster. If your adolescent becomes pregnant, make certain she talks to her doctor about antidepressant medications and managing depression during pregnancy.

Antidepressants and increased suicide risk:

Although antidepressants are generally safe when taken as directed, the Food and Drug Administration (FDA) warns that in some cases, kids, adolescents and young people ages 18 to 24 may have an increase in suicidal thoughts or behavior when taking antidepressants. This risk may be highest in the first few weeks after starting an antidepressant or when the dose is changed. Because of this risk, individuals in these age groups must be closely monitored by while taking antidepressants.

While this warning may seem alarming, for most adolescents the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.

If your adolescent has suicidal thoughts when taking an antidepressant, immediately contact his doctor or get emergency help.

Again, make sure you understand the risks of the various antidepressants. Working together, you and your doctor can explore options to get depression symptoms under control.

Psychotherapy:

Psychological counseling (psychotherapy) is another key depression treatment. Psychotherapy is a general term for a way of treating depression by talking about depression and related issues with a mental health provider. Psychotherapy is also known as therapy, talk therapy, counseling or psychosocial therapy. Psychotherapy may be done one-on-one, with family members or in a group format.

Through these regular sessions, your adolescent can learn about the causes of depression so that he or she can better understand it. He or she will also learn how to identify and make changes in unhealthy behaviors or thoughts, explore relationships and experiences, find better ways to cope and solve problems, and set realistic goals. Psychotherapy can help your adolescent regain a sense of happiness and control and help ease depression symptoms such as hopelessness and anger. It may also help your adolescent adjust to a crisis or other current difficulty.

Cognitive behavioral therapy is one of the most commonly used therapies for adolescent depression. It helps a person identify negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts — not other individuals or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way. Interpersonal therapy and psychodynamic psychotherapy are other examples of counseling commonly used to treat depression. There are a number of additional types of psychotherapy that can be effective. Many therapists use a combination of approaches.

Hospitalization and residential treatment programs:

In some adolescents, depression is so severe that a hospital stay is needed. Inpatient hospitalization may be necessary if your adolescent is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your adolescent calm and safe until his mood improves. Partial hospitalization or day treatment programs also are helpful for some adolescents. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control. 
 

Lifestyle and home remedies—

Depression generally isn't an illness that you can treat on your own. But there are some steps you and your adolescent can take that may help:
  • Pay attention to warning signs. Work with your adolescent's doctor or therapist to learn what might trigger depression symptoms. Make a plan so that you and your adolescent know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
  • Make sure your AS or HFA adolescent gets plenty of sleep. Sleeping well is important for adolescents, especially adolescents with depression. If your adolescent is having trouble sleeping, talk to his doctor about what can be done.
  • Make sure your adolescent gets exercise. Even light physical activity can help reduce depression symptoms.
  • Learn about depression. Education about your adolescent's condition can empower your adolescent and motivate him or her to stick a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression. Counseling that focuses on this is known as psycho-education.
  • Help your adolescent avoid alcohol and other drugs. Your adolescent may feel like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat.
  • Encourage your adolescent to stick to his treatment plan. Make sure your adolescent attends psychotherapy sessions or appointments, even if he or she doesn't feel like going. Even if your adolescent is feeling well, make sure he or she continues to take medications as prescribed. If your adolescent stops taking medications, depression symptoms may come back. Quitting suddenly may also cause withdrawal-like symptoms.

Alternative medicine—

Alternative medicine strategies for depression include supplements and mind-body techniques. Here are some common alternative treatments for depression.

Herbal remedies and supplements:

A number of herbal remedies and supplements have been used for depression. Examples include:

• Omega-3 fatty acids. Eating a diet rich in omega-3s or taking omega-3 supplements may help ease depression and also appears to have a number of other health benefits. Cold-water fish and fish oil supplements are good sources of omega-3s. Omega-3s are also found in flaxseed, walnuts and some other foods.

• SAMe. Pronounced "sam-EE," this is a synthetic form of a chemical that occurs naturally in the body. The name is short for S-adenosylmethionine. As with St. John's wort, SAMe isn't approved by the FDA to treat depression. However, it's used in Europe as a prescription drug to treat depression.

• St. John's wort. Known scientifically as Hypericum perforatum, this is an herb that's been used for centuries to treat a variety of ills, including depression. It's not approved by the Food and Drug Administration to treat depression in the United States. Rather, it's classified as a dietary supplement. However, it's a popular depression treatment in Europe.

Some supplements — including St. John's wort and SAMe — can interfere with antidepressants.

Mind-body connections:

The connection between mind and body has been studied for centuries. Complementary and alternative medicine practitioners believe the mind and body must be in harmony for you to stay healthy.

Mind-body techniques used to improve depression symptoms include:

• Yoga
• Meditation
• Massage therapy
• Guided imagery
• Acupuncture

Make certain you understand risks as well as possible benefits before pursuing any therapy for your adolescent. To be safe, talk to your adolescent's doctor before he or she takes any herbal or dietary supplements — particularly St. John's wort or SAMe. Keep in mind, alternative treatments aren't a replacement for conventional medical treatment or psychotherapy.

Coping and support—

Showing interest and the desire to understand your adolescent's feelings lets him or her know you care. You may not understand why your adolescent feels that things are hopeless or why he or she has a sense of loss or failure. Listen to your adolescent without judging and try to put yourself in his position. Help build your adolescent's self-esteem by recognizing small successes and offering praise about his competence.

Encourage your AS or HFA adolescent to:

• Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your adolescent to talk to a family member or other trusted adult whenever needed.

• Connect with other adolescents who struggle with depression. Talking with other adolescents facing similar challenges can help your adolescent cope. So can learning skills to manage life's challenges. Local support groups for depression are available in many communities, and support groups for depression are offered online. One good place to start is the National Alliance on Mental Illness.

• Encourage your adolescent to keep a private journal. Journaling can improve mood by allowing your adolescent to express and work through pain, anger, fear or other emotions.

• Have realistic expectations. Many adolescents judge themselves when they aren't able to live up to unrealistic standards — academically, in athletics or in appearance, for example. Let your adolescent know that it's OK not to be perfect.

• Make and keep healthy friendships. Positive relationships can help boost your adolescent's confidence and stay connected with others. Encourage your adolescent to avoid relationships with individuals whose attitudes or behaviors could make depression worse.

• Simplify his life. Encourage your adolescent to carefully choose his obligations and commitments, and set reasonable goals. Let your adolescent know that it's OK to do less when he or she feels down.

• Stay active. Participation in sports, school activities or a job can help keep your adolescent focused on positive things — rather than negative feelings or behaviors.

• Stay healthy. Do your part to make sure your adolescent eats regular, healthy meals, gets regular exercise and gets plenty of sleep. These are priorities — encourage your adolescent not to avoid these things because of social activities, school responsibilities or other demands.

• Structure his time. Help your adolescent plan his activities by making lists or using a planner to stay organized.

Prevention—

There's no sure way to prevent depression. However, making sure your AS or HFA adolescent takes steps to control stress, to increase resilience and to boost low self-esteem can help. Friendship and social support, especially in times of crisis, can help your adolescent cope. In addition, treatment at the earliest sign of a problem can help prevent depression from worsening. Some adolescents with Aspergers need to continue taking medications even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.


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Transitioning to Adulthood: Help for Older Teens with Aspergers and HFA

The greatest challenge you will face as a mother or father of an Aspergers or high functioning autistic (HFA) child is supporting him or her through the transition to adulthood. As protective (or over-protective) as you may be, at some point you will be ready for your teenager to leave home to venture out on his own into the adult world.

Of course your relationship with your adult child will continue long after he or she leaves the nest, and your loving support can help with “grown-up” responsibilities.

Is your 18 or 19-year-old teenager ready for adulthood? Answer yes or no to the following questions:
  1. Can your adolescent drive?
  2. Can your adolescent make meals and snacks for himself?
  3. Do you get frustrated with your adolescent's inability to complete projects?
  4. Do you give your adolescent opportunities to make his own decisions?
  5. Do you give your adolescent positive feedback?
  6. Do you listen to your adolescent's problems, make suggestions and then allow him to choose how to proceed?
  7. Do you still pick up after your adolescent when he leaves things around the house?
  8. Does your adolescent clean her bedroom?
  9. Does your adolescent complain when her friends are busy, therefore “there’s nothing to do”?
  10. Does your adolescent do a weekly chore regularly without more than one reminder?
  11. Does your adolescent do her laundry?
  12. Does your adolescent handle stress well?
  13. Does your adolescent handle your direction without back-talk or sulking?
  14. Does your adolescent have a checking account that he handles on his own?
  15. Does your adolescent have a healthy hygiene routine?
  16. Does your adolescent have a job outside of your home?
  17. Does your adolescent know how to make money-saving goals and then achieve them?
  18. Has your adolescent ever taken a CPR or First Aid class?
  19. Has your adolescent used any of the community's resources?
  20. If your adolescent is facing a problem with a teacher, do you allow her to fix it?
  21. Is your adolescent able to ask other people questions without being too shy?
  22. Is your adolescent able to make her own appointments?
  23. Is your adolescent able to plan a trip successfully?
  24. Is your adolescent able to plan out her week effectively?
  25. Is your adolescent comfortable doing things on his own?

If you answered “no” to three of the questions above – it should be a red flag that “life skills” are lacking. If you answered “no” to five or more – then your child may not be ready for adult responsibilities yet.

If your parenting goes as planned, your young adult will - at some point - leave home and live independently. Life skills will help your older adolescent to be independent and live on his own, which is the goal of a successful young adult and her parents. But it isn't easy. Older teenagers with Aspergers and HFA often feel they can take the big step towards independent living without possessing all of the life skills they will need to succeed “out in the real world.”

You can help your teenager be independent by encouraging good habits and helping him learn the life skills it takes to be independent.

Below are 15 life skills your teenager will need to learn in order to be successful at living independently the first time she is on her own:

1. Ability to Find Housing

2. Finding and Keeping a Job— In order to live independently, your adolescent will need to have a job. The job will need to make enough money to cover their living expenses, at minimum. Today's happy young adult has a job that contributes to a high quality of life and not just monetarily.

3. General Housekeeping Skills

4. Goal Setting— Defining what it is you want is called setting a goal. Figuring out and taking the actions you need to get your goal is how you obtain that goal. Both of these are important life skills. Learning how to set and obtain a goal are necessary life skills your adolescent will need to be a happy and successful adult.

5. Health and Hygiene Skills— In order for your adolescent to be happy while they live independently, they will need to be successful at keeping their bodies healthy and clean. These life skills are taught throughout your adolescent's childhood and adolescence by encouraging good hygiene routines and healthy habits.

6. Interpersonal Skills

7. Money Skills

8. Personal Safety Skills

9. Stress Management Skills

10. The Ability to Cope with Loneliness— Coping with loneliness is a very important skill on my list of needed independent living skills for adolescents because every adolescent I've ever known has needed it. Adolescents who know how to recognize loneliness as the temporary feeling it is, use their support system and work through their loneliness do just fine.

11. The Ability to Deal with Emergencies

12. The Ability to Find What You Need in Your Community

13. The Ability to Procure and Cook Food

14. Time Management Skills

15. Transportation Skills— One life skill that adolescents need to learn to become independent but generally leave to their parents or caregivers, is transportation or getting from Point A to Point B.

Does your "special needs" adolescent need to know all of ins and outs of each skill well? No. Your adolescent may even get by not having to know one particular skill at all. For example, a young man who has no idea how to do laundry may have a girlfriend who does. This young man may be able to get his interpersonal skills to help with his household skills by convincing his girlfriend to help with his laundry. But, do your best at teaching your adolescent each skill as if they will need it. This will give them the greatest chance of being successful at living independently the first time they live on their own.

Other points to consider:

When your teen behaves badly, you may become angry or upset with him, but these feelings are different from not loving your teen. Older teens need grown-ups who are there for them. They need people who connect with them, communicate with them, spend time with them and show a genuine interest in them. This is how they learn to care for and love others as an adult.

Older teens need support as they struggle with problems that may seem unimportant to their parents and families. They need praise when they've done their best. They need encouragement to develop interests and personal characteristics.

Adolescence is a time for exploring many areas and doing new things. Your youngster’s interests will change, in academics and recreation. He may experiment with different forms of art, learn about different cultures and careers and take part in community or religious activities. Within your means, you can open doors for your youngster. You can introduce him to new people and to new worlds. In doing so, you may renew in yourself long-ignored interests and talents, which also can set a good example for your youngster.

Older teens need parents or other adults who consistently provide structure and supervision that is firm and appropriate for age and development. Limits keep all kids, including adolescents, physically and emotionally safe.

It is tempting to label all young teens as difficult and rebellious. But adolescents vary as much as kids in any other age group. Your youngster needs to be treated with respect, which requires you to recognize and appreciate her differences and to treat her as an individual. Respect also requires you to show compassion by trying to see things from your youngster's point of view and to consider her needs and feelings. By treating your young adolescent with respect, you help her to take pleasure in good behavior.

Older teens need strong role models. Follow the values that you hope your youngster will develop. Your actions speak louder than words. If you set high standards for yourself and treat others with kindness and respect, your youngster probably will too. As teens explore possibilities of who they may become, they look to their parents, peers, celebrities and others.

Depression in Teens with Asperger’s & High-Functioning Autism

"How have some of you dealt with a depressed teenager? My son is 16 (high functioning) and a loner. His self-esteem is shot, and we're worried. Any advice is greatly appreciated!!!"

Adolescents suffer from depression more often than any number of grown-ups who live their entire lives with it. Moms and dads are generally dismissive of their child’s low moods, because they think that ALL teenagers are simply moody, hormonal, or tired and cranky. This dismissive attitude generally results in teenagers being even more depressed, because they think their mother or father doesn’t care. Take that in combination with adolescents with High-Functioning Autism (HFA) or Asperger’s (AS) who have very little impulse control as it is, and you have a horrible combination.

Depression is a serious medical problem that causes a persistent feeling of sadness and loss of interest in activities. It affects how your teenage son or daughter thinks, feels and behaves, and it can cause emotional, functional and physical problems. Although mood disorders like depression can occur at any time in life, symptoms are significantly more pronounced in adolescents than grown-ups. To make matters worse, the HFA/AS teen’s depressive symptoms are usually more pronounced than that of a “typical” teen.

Issues such as peer pressure, peer rejection, bullying, academic expectations and changing bodies can bring a lot of ups and downs for HFA and AS adolescents. But for some of these young people, the lows are more than just temporary feelings — they're a symptom of depression. Adolescent depression isn't a weakness or something that can be overcome with willpower — it can have serious consequences and requires long-term treatment. For most HFA and AS adolescents, depression symptoms ease with treatment (e.g., medication and psychological counseling).



Adolescent depression signs and symptoms include changes in your HFA/AS adolescent's emotions and behavior, such as the examples below. Be alert for emotional and behavioral changes, such as:
  • Agitation or restlessness (e.g., pacing, hand-wringing or an inability to sit still)
  • Changes in appetite (e.g., decreased appetite and weight loss, or increased cravings for food and weight gain)
  • Disruptive or risky behavior
  • Extreme sensitivity to rejection or failure, and the need for excessive reassurance
  • Feelings of sadness, which can include crying spells for no apparent reason
  • Feelings of worthlessness, guilt, fixation on past failures or exaggerated self-blame or self-criticism
  • Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
  • Frequent thoughts of death, dying or suicide
  • Insomnia or sleeping too much
  • Irritability, frustration or feelings of anger, even over small matters
  • Loss of interest in, or conflict with, family and friends
  • Loss of interest or pleasure in normal activities
  • Neglected appearance (e.g., mismatched clothes and unkempt hair)
  • Ongoing sense that life and the future are grim and bleak
  • Poor school performance or frequent absences from school
  • Self-harm (e.g., cutting, burning, or excessive piercing or tattooing)
  • Slowed thinking, speaking or body movements
  • Tiredness and loss of energy
  • Trouble thinking, concentrating, making decisions and remembering things
  • Use of alcohol or drugs


It can be difficult to tell the difference between (a) ups and downs that are just part of being a young person and (b) full-blown depression. Talk with your teenage son or daughter. Try to determine whether your youngster seems capable of managing challenging feelings, or if life seems overwhelming. If depression symptoms continue or begin to interfere in your HFA/AS adolescent's life, talk to a physician or a mental health professional trained to work with these teens. Your adolescent's family physician is a good place to start. Your adolescent's school may recommend someone as well.

If you suspect your “special needs” son or daughter is depressed, make a physician's appointment as soon as you can. Depression symptoms likely won't get better on their own — and they may get worse or lead to other problems if untreated. Depressed adolescents may be at risk of suicide, even if signs and symptoms don't appear to be severe.  If you're an adolescent and you think you may be depressed — or you have a friend who may be depressed — don't wait to get help. Talk to a health care professional such as your physician or school nurse. Share your concerns with a mother or father, a close friend, your pastor, a teacher or someone else you trust.

==> Discipline for Defiant Aspergers and HFA Teens

If your teenage son or daughter is having suicidal thoughts, get help right away. Take all talk of suicide seriously. Here are some steps you can take:
  • Seek help from your physician, a mental health provider or other health care professional.
  • Reach out to family members, friends or spiritual leaders for support as you seek treatment for your HFA/AS adolescent.
  • Call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 800-273-TALK (800-273-8255) to reach a trained counselor or encourage your HFA/AS adolescent to do so.

If you think your teenage son or daughter is in immediate danger of self-harm or attempting suicide, make sure someone stays with her or him. Call 911 or your local emergency number immediately. Or if you think you can do so safely, take your HFA/AS adolescent to the nearest hospital emergency department.

It's not known exactly what causes depression. A variety of factors may be involved. These include:
  • Learned patterns of negative thinking. Adolescent depression may be linked to learning to feel helpless — rather than learning to feel capable of finding solutions for life's challenges.
  • Inherited traits. Depression is more common in individuals whose biological (blood) relatives also have the condition.
  • Hormones. Changes in the body's balance of hormones may be involved in causing or triggering depression.
  • Early childhood trauma. Traumatic events during childhood (e.g., physical or emotional abuse, loss of a mother or father, etc.) may cause changes in the brain that make a teenager more susceptible to depression.
  • Biological chemistry. Neurotransmitters are naturally occurring brain chemicals that likely play a role in depression. When these chemicals are out of balance, it may lead to depression symptoms.

Many factors increase the risk of developing or triggering adolescent depression, including:
  • Abusing alcohol, nicotine or other drugs
  • Being a female (depression occurs more often in females than in males)
  • Being bullied or rejected by peers
  • Being gay, lesbian, bisexual or transgender (becoming socially isolated or experiencing bullying may increase the risk of depression)
  • Having a chronic medical illness (e.g., cancer, diabetes or asthma)
  • Having been the victim or witness of violence (e.g., physical or sexual abuse)
  • Having certain personality traits (e.g., low self-esteem or being overly dependent, self-critical or pessimistic)
  • Having few friends or other personal relationships
  • Having issues that negatively impact self-esteem (e.g., obesity, peer problems, long-term bullying or academic problems)
  • Having other conditions (e.g., anxiety disorder, anorexia or bulimia, attention-deficit/hyperactivity disorder or learning disabilities)

Family history and issues with family or others may also increase your HFA/AS adolescent's risk of depression:
  • Having a dysfunctional family and conflict
  • Having a family member who committed suicide
  • Having a mother or father, grandparent or other biological (blood) relative with autism, depression, bipolar disorder or alcoholism
  • Having experienced recent stressful life events (e.g., parental divorce, parental military service or the death of a loved one)

Untreated depression can result in emotional, behavioral and health problems that affect every area of your HFA/AS adolescent's life. Complications related to adolescent depression can include:
  • Academic problems
  • Alcohol and drug abuse
  • Family conflicts and relationship difficulties
  • Involvement with the juvenile justice system
  • Low self-esteem
  • Social isolation
  • Suicide

You may choose to start by contacting your HFA/AS adolescent's family physician. In some cases, you may be referred directly to a mental health professional, such as a psychiatrist or psychologist.

To the extent possible, involve your teenage son or daughter in preparing for the appointment. Then make a list of:
  • Questions that you and your HFA/AS adolescent want to ask the physician
  • Key personal information, including any major stresses or recent life changes your HFA/AS adolescent has experienced
  • Any symptoms your adolescent has had, including any that may seem unrelated to the reason you scheduled the appointment
  • All medications, vitamins, herbal remedies or supplements that your HFA/AS adolescent is taking

Basic questions to ask the physician include:
  • Are there any possible side effects with the medications you're recommending?
  • Are there any printed materials that we can take home?
  • Are there any restrictions that my adolescent needs to follow?
  • How will we monitor progress and effectiveness of the treatment?
  • Is depression the most likely cause of my youngster's symptoms?
  • Is there a generic alternative to the medicine you're prescribing?
  • My adolescent has these other health conditions. Could they be linked to depression?
  • Should my adolescent see a psychiatrist or other mental health provider?
  • What are other possible causes for my youngster's symptoms or condition?
  • What are the alternatives to the primary approach that you're suggesting?
  • What kinds of tests will my youngster need?
  • What treatment is likely to work best?
  • What websites do you recommend?
  • Will making changes in diet, exercise or other areas help ease depression?

To make the most of the time allotted, make sure your HFA/AS son or daughter is ready to answer questions from the physician, for example:
  • Are you using any mood-altering substances, such as alcohol, marijuana or street drugs?
  • Do you ever have suicidal thoughts when you're feeling down?
  • Do you generally always feel down, or does your mood change?
  • Do you have a history of significant weight gain or loss?
  • Do you have any biological (blood) relatives — such as a mother or father or grandparent — with depression or another mood disorder?
  • Does your mood ever swing from feeling down to feeling extremely happy and full of energy?
  • How long have you felt depressed?
  • How much do you sleep at night? Does the amount change over time?
  • How severe are your symptoms? Do they interfere with school, relationships or other day-to-day activities?
  • What is your diet like?
  • What other mental or physical health conditions do you have?
  • What, if anything, appears to worsen your symptoms?
  • What, if anything, seems to improve your symptoms?
  • When did family members or friends first notice your symptoms of depression?

When adolescent depression is suspected, the physician will generally do these exams and tests:
  • Lab tests. For example, your HFA/AS adolescent's physician may do a blood test called a complete blood count, or test your teen’s thyroid to make sure it's functioning properly.
  • Physical exam. The physician may do a physical exam and ask in-depth questions about your HFA/AS adolescent's health to determine what may be causing depression. In some cases, depression may be linked to an underlying physical health problem.
  • Psychological evaluation. This evaluation will include a discussion with your son or daughter about thoughts, feelings and behavior, and may include a questionnaire. These will help pinpoint a diagnosis and check for related complications.


To be diagnosed with depression, your teenage son or daughter must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Symptoms can be based on your HFA/AS adolescent's feelings or on the observations of someone else. For a diagnosis of major depression, the following symptoms must occur most of the day, nearly every day, during at least a two-week period, and be a change or worsening in the adolescent's usual attitude and behavior.

Your adolescent must have at least one of the following:
  • Diminished interest or feeling no pleasure in any or most activities
  • Depressed mood, such as feeling sad, empty or tearful (in adolescence, depressed mood can appear as constant irritability)

Your adolescent must also have four or more of the following:
  • Fatigue or loss of energy
  • Feelings of worthlessness, or excessive or inappropriate guilt
  • Insomnia or increased desire to sleep
  • Recurrent thoughts of death or suicide, making a suicide plan or a suicide attempt
  • Restlessness or slowed behavior that can be observed by others
  • Significant weight loss when not dieting, weight gain, or decrease or increase in appetite (in adolescence, failure to gain weight as expected can be a sign of depression)
  • Trouble making decisions, thinking or concentrating

To be considered major depression:
  • Symptoms are not caused by grieving (e.g., temporary sadness after the loss of a loved one)
  • Symptoms are not due to the direct effects of something else (e.g., drug abuse, taking a medication or having a medical condition such as hypothyroidism)
  • Symptoms aren't due to a mixed episode, which is mania along with depression that sometimes occurs as a symptom of bipolar disorder
  • Symptoms must be severe enough to cause noticeable problems in day-to-day activities (e.g., school, social activities or relationships with others)

Other types of major depression include:
  • Psychotic depression. This is severe depression accompanied by psychotic symptoms, such as delusions or hallucinations.
  • Dysthymia. Dysthymia is a less severe, but more long-term form of depression. While it's usually not disabling, dysthymia can prevent your teenage son or daughter from functioning normally in a daily routine and from living life to the fullest.
  • Atypical depression. In this type of depression, key signs and symptoms include increased hunger, weight gain, sleeping a lot, feeling that your arms and legs are heavy, and difficulty maintaining relationships.

 ==> Discipline for Defiant Aspergers and HFA Teens

There are several other conditions with symptoms that can include depression. It's important to get an accurate diagnosis so that your HFA/AS adolescent gets appropriate treatment. Your physician or mental health provider's evaluation will help determine if the symptoms of depression are caused by one of the following conditions:
  • Adjustment disorder. An adjustment disorder is a severe emotional reaction to a difficult event in your life. It's a type of stress-related mental illness that may affect feelings, thoughts and behavior.
  • Bipolar disorder. Bipolar disorder is characterized by mood swings that range from the highs of mania to the lows of depression. It's sometimes difficult to distinguish between bipolar disorder and depression, but it's important to get an accurate diagnosis because treatment for bipolar disorder is different from that for other types of depression.
  • Cyclothymia. Cyclothymia, or cyclothymic disorder, is a milder form of bipolar disorder.
  • Schizoaffective disorder. Schizoaffective disorder is a condition in which a person meets the criteria for both schizophrenia and a mood disorder such as depression.
  • Seasonal affective disorder. This type of depression is related to changes in seasons and diminished exposure to sunlight.

Many types of treatment are available. In some cases, a primary care physician can prescribe medications that relieve depression symptoms. However, many adolescents need to see a psychiatrist or psychologist or other mental health counselor. A combination of medications and psychotherapy is very effective for most HFA/AS adolescents with depression.

If your teenage son or daughter has severe depression or is in danger of self-harm, she or he may need a hospital stay or may need to participate in an outpatient treatment program until symptoms improve.

Antidepressants and increased suicide risk— Although antidepressants are generally safe when taken as directed, the FDA requires that all antidepressants carry "black box" warnings, the strictest warnings for prescriptions. In some cases, kids, teens and young people under the age of 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. So, individuals in these age groups must be closely monitored by parents and health care providers.  If your son or daughter has suicidal thoughts while taking an antidepressant, immediately contact your physician or get emergency help.  For most HFA/AS adolescents, the benefits of taking an antidepressant generally outweigh any possible risks. In the long run, antidepressants are likely to reduce suicidal thinking or behavior.

Antidepressants and pregnancy— If your teenage daughter is pregnant or breast-feeding, some antidepressants may pose an increased health risk to her unborn or nursing youngster. If your daughter becomes pregnant, make certain she talks to her physician about antidepressant medications and managing depression during pregnancy.

Finding the right medication— Everyone's different, so finding the right medication or dose for your HFA/AS son or daughter may take some trial and error. This requires patience, as some medications need eight weeks or longer to take full effect and for side effects to ease as the body adjusts.  If your adolescent has bothersome side effects, she or he shouldn't stop taking an antidepressant without talking to the physician first. Some antidepressants can cause withdrawal symptoms unless the dose is slowly tapered off — quitting suddenly may cause a sudden worsening of depression. Encourage your adolescent not to give up. If antidepressant treatment doesn't seem to be working, your adolescent's physician may recommend a blood test called cytochrome P450 (CYP450) to check for specific genes that affect how the body processes antidepressants. This may help identify which antidepressant might be a good choice. However, these genetic tests have limitations and may not be widely available.

Hospitalization and other treatment programs— In some HFA and AS adolescents, depression is so severe that a hospital stay is needed, especially if your son or daughter is in danger of self-harm or hurting someone else. Getting psychiatric treatment at a hospital can help keep your adolescent calm and safe until symptoms are better managed. Day treatment programs also may help. These programs provide the support and counseling needed while your adolescent gets depression symptoms under control.

Managing medications— Carefully monitor your HFA/AS adolescent's use of medications. To work properly, antidepressants need to be taken consistently at the prescribed dose. Because overdose can be a risk for adolescents with depression, your adolescent's physician may prescribe only small supplies of pills at a time, or recommend that you dole out medication so that your son or daughter does not have a large amount of pills available at once.

Medications— Because studies on the effects of antidepressants in HFA and AS adolescents are limited, physicians rely mainly on adult research when prescribing medications. The Food and Drug Administration (FDA) has approved two medications for adolescent depression — fluoxetine (Prozac) and escitalopram (Lexapro). However, as with grown-ups, other medications may be prescribed at the physician's discretion (off label), depending on your HFA/AS adolescent's needs. Talk with your adolescent's physician and pharmacist about possible side effects, weighing the benefits and risks. In some cases, side effects may go away as the body adjusts to the medication.

Psychotherapy— Psychotherapy is a general term for treating depression by talking about depression and related issues with a mental health provider. Psychotherapy may be done one-on-one, with family members, or in a group.  Through these regular sessions, your teenage son or daughter can:
  • explore relationships and experiences
  • find better ways to cope and solve problems
  • learn how to identify and make changes in unhealthy behaviors or thoughts
  • learn about the causes of depression
  • set realistic goals

Psychotherapy can help your son or daughter regain a sense of happiness and control, and help ease depression symptoms like hopelessness and anger. It may also help your HFA/AS adolescent adjust to a crisis or other current difficulty.




You are your adolescent's best advocate to help her or him succeed. Here are some steps you and your “special needs” child can take that may help:
  • Encourage communication with your HFA/AS adolescent. Talk to your son or daughter about the changes you're observing and emphasize your unconditional support. Create an environment where your youngster can share concerns while you listen.
  • Help the HFA/AS adolescent avoid alcohol and other drugs. Your son or daughter may feel like alcohol or drugs lessen depression symptoms, but in the long run they worsen symptoms and make depression harder to treat.
  • Learn about depression. Education can empower your teenage son or daughter and motivate her or him to stick to a treatment plan. It can also benefit you and other loved ones to learn about your adolescent's depression and understand that it's a treatable condition.
  • Make sure your HFA/AS adolescent adopts healthy habits. Even light physical activity can help reduce depression symptoms. Sleeping well is important for all adolescents, especially those with depression. If your teenage son or daughter is having trouble sleeping, ask the physician for advice.
  • Pay attention to warning signs. Work with your HFA/AS adolescent's physician or therapist to learn what might trigger depression symptoms. Make a plan so that you and your child know what to do if symptoms get worse. Ask family members or friends to help watch for warning signs.
  • Stick to the treatment plan. Make sure your HFA/AS son or daughter attends appointments, even if he or she doesn't feel like going. Even if your adolescent is feeling well, make sure he or she continues to take medications as prescribed. If your child stops taking medications, depression symptoms may come back. Quitting suddenly may cause withdrawal-like symptoms.

Avoid replacing conventional medical treatment or psychotherapy with alternative medicine. When it comes to depression, alternative treatments aren't a substitute for professional care. But some mind-body therapies may help.

Complementary and alternative medicine practitioners believe the mind and body must be in harmony to stay healthy. Examples of mind-body techniques that may be helpful for depression include:
  • Acupuncture
  • Guided imagery
  • Massage therapy
  • Meditation
  • Music or art therapy
  • Relaxation techniques
  • Spirituality
  • Yoga or tai chi

Relying solely on these therapies is generally not enough to treat depression. But they may be helpful when used in addition to medication and psychotherapy.

Showing interest and the desire to understand your HFA/AS adolescent's feelings lets her or him know you care. You may not understand why your adolescent feels hopeless or why she or he has a sense of loss or failure. Listen to your “special needs” child without judging and try to put yourself in his or her position. Help build your child’s self-esteem by recognizing small successes and offering praise about his or her competence.

Encourage your HFA/AS adolescent to:
  • Ask for help. Adolescents may be reluctant to seek support when life seems overwhelming. Encourage your son or daughter to talk to a family member or other trusted adult whenever needed.
  • Connect with other adolescents who struggle with depression. Talking with other adolescents facing similar challenges can help your son or daughter cope. So can learning skills to manage life's challenges. Local support groups for depression are available in many communities. And support groups for depression are offered online (but check them out to make sure they're credible and trustworthy sites).
  • Encourage your HFA/AS adolescent to keep a private journal. Journaling may help improve mood by allowing your child to express and work through pain, anger, fear or other emotions.
  • Have realistic expectations. Many adolescents judge themselves when they aren't able to live up to unrealistic standards (e.g., academically, in athletics, in appearance, etc.). Let your teenage son or daughter know that it's OK not to be perfect.
  • Make and keep healthy friendships. Positive relationships can help boost your HFA/AS adolescent's confidence and stay connected with others. Encourage her or him to avoid relationships with peers whose attitudes or behaviors could make depression worse.
  • Simplify life. Encourage your son or daughter to carefully choose obligations and commitments, and set reasonable goals. Let your child know that it's OK to do less when she or he feels down.
  • Stay active. Participation in sports, school activities or a job can help keep your teenage son or daughter focused on positive things, rather than negative feelings or behaviors.
  • Stay healthy. Do your part to make sure your child eats regular, healthy meals, gets regular exercise and gets plenty of sleep.
  • Structure time. Help your child plan activities by making lists or using a planner to stay organized.

There's no sure way to prevent depression. However, these strategies may help. Encourage your HFA/AS adolescent to:
  • Boost low self-esteem by recognizing small steps toward getting better.
  • Get treatment at the earliest sign of a problem to help prevent depression from worsening.
  • Maintain ongoing treatment, if recommended, even after symptoms let up, or have regular therapy sessions to help prevent a relapse of depression symptoms.
  • Reach out for friendship and social support, especially in times of crisis.
  • Take steps to control stress, for example, not committing to too many obligations at once.

==> Discipline for Defiant Aspergers and HFA Teens

Parenting Teenagers with Aspergers and HFA

Here Are Some Quick Tips for Parents of Teenagers with Aspergers and High-Functioning Autism

Keep Doing The Things That Work—

• Be patient. Remember that kids and adolescents with an autism spectrum disorder (ASD) are relatively immature, socially and emotionally, compared to neurotypical kids of the same chronological age. Imagine sending a 10 year old off to high school (even if she has a chronological age of 14), or putting a 14 year old boy behind the wheel of car (even if he has a chronological age of 18)—or sending that 14 year old off to college or the army. We need to adjust our expectations for adolescents with ASD—and make sure they still have appropriate supports. Don’t pull the “ramp” out from under the “wheelchair”!

• Go with the flow of your child’s nature. Simplify schedules and routines, streamline possessions and furnishings. If your adolescent only likes plain T shirts without collars or buttons, buy plain T shirts. If your kid likes familiar foods, or has a favorite restaurant, indulge her.

• Have realistic, modest goals for what the adolescent or the family can accomplish in a give time period. You may need to postpone some plans for career goals, trips, culture or recreation.

• Kids still need structure, down time, soothing activities, and preparation for transitions.

• Communication: Establish verbal codes or gestures to convey that one or both parties need a time out: a chance to cool down before continuing a difficult discussion at a later time. Impersonal, written communication is easier for the adolescent to absorb: lists of routines and rules, notes, charts, or calendars. E-mail may become a new option. In so far as you can, keep your cool—they can’t handle our upset feelings. Walk away if you need to. Side by side conversations (walking, in the car) may be more comfortable for the adolescent than talking face to face. Tell your adolescent just what s/he needs to know, one message at a time, concisely.

• A regular bed time at a reasonable hour is more important than ever, if you can put/keep it in place. Regular routines of all kinds—familiar foods, rituals, vacations—are reassuring when the adolescent’s body, biochemistry, and social scene are changing so fast.

• Discipline & responsibility: A simple, low key, consistent approach is more important than ever, as adolescents become taller and stronger—not that physical restraint was ever very useful with our kids. Pick your battles. Set and enforce only your bottom line rules and expectations—matters of safety and respect. Write them down. Make sure both moms and dads/all involved adults agree on the rules. Give choices when possible, but not too many. Engage your adolescent in problem-solving; what does s/he think would work?

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

• Make sure thorough neuropsych re-evaluations are performed every three years. This information and documentation may be critical in securing appropriate services, alternative school placements, a good transition plan; choosing an appropriate college or other post secondary program; proving eligibility for services and benefits as an adult.

• Special interests may change, but whatever the current one is, it remains an important font of motivation, pleasure, relaxation, and reassurance for the adolescent.

Possible Shifts and Changes—

• Yes, adolescents do continue to grow and develop. You may get some nice surprises along the way, as you see the adolescent take an unexpected giant step toward maturity. I think of it as their neurons maturing on the vine! Maybe it’s just that they figure some things out, and get used to the feel of their new body chemistry.

• With or without ASD, most adolescents become less willing to take a parent’s word or advice; so we need to hook them up with other trustworthy adults. If you want your adolescent to learn or try or do something, arrange for the suggestion or information to come from a trusted adult other than a parent. E.g.: Handpick your adolescent’s guidance counselor. Look for other good mentors: Uncle? Scout or youth group leader? Psychologist, social worker, peer mentor, “Big Brother,” social skills group leader? Weight room coach or martial arts teacher?

• Boys may need to spend increased amounts of time with their fathers, and/or other male role models, as they undertake to become men. If Dad has taken a back seat, let him know his son really needs his attention now. If you are a single mother, look especially hard for male mentors at your son’s school or in the wider community.

• ASD can intensify parent/adolescent dynamics—which are challenging enough! The “job description” of a teenager is to pull away from moms and dads toward more independence; for our kids, the process can be extra messy—not least because they may be even less ready for independence than other adolescents. Although some adolescents with ASD are more docile and child-like, be prepared to tolerate/ignore considerable distancing, surliness, or acting out, knowing that it won’t last forever. At the same time, set some firm limits, and keep a close eye on the child/adolescent’s welfare.

Hygiene—

Instill the essential habit of a daily shower and clean clothes: peers, teachers, and future potential employers are very put off by poor hygiene. If possible, put your adolescent’s clothes on a well-organized shelf in the bathroom, near the clothes hamper.

Adolescents’ Mental Health—

• Adolescents with ASD are less prepared than neurotypical adolescents for the new challenges of sexuality and romance. Some are oblivious; others want a girl or boy friend, but are clueless about how to form and maintain a relationship. Boys especially may be at risk for accusations of harassment, and girls especially at risk for becoming victims. Teach appropriate rules, or see that another adult does. Look for supervised activities in which boys and girls can socialize safely together, supervised by a staff person who know ASD and can coach appropriate social skills.

• Seek out activity-based, practical social skills groups designed especially for adolescents. Participating in such a group, being accepted by group leaders and peers, is probably the most powerful way to allay an adolescent’s potential despair at not fitting in socially and not having any friends. The positive social experiences and new skills they learn will be assets for the rest of their lives.

• Even for a previously well-adjusted youngster, multiple stressors during the adolescent years may bring on anxiety and even depression. Stressors seem to include increased academic/abstract thinking and social demands at school, peer pressure, increased social awareness, and fears of the future. Highly anxious adolescents who do not get help may be at risk for hospitalizations, school failure, acting out (including alcohol and substance abuse), or even suicide attempts.

• Don’t panic, however—there are interventions you can provide. Appropriate school placement and staff training, exercise (martial arts, yoga), and/or appropriate therapy with a carefully chosen professional, may help control the level of anxiety. Meds may need to be introduced or adjusted.

Moms and Dads’ Mental Health—

• Kids with ASD can be difficult to parent and to love even when they are young. Often, our kids neither accept nor express love or other positive feelings in ways a neurotypical parent expects or finds most comfortable. Kids’ behavior can be trying or embarrassing for us. Adding adolescence to the mix can make this dilemma even more painful.

• If both moms and dads can largely agree about an adolescent’s diagnosis, treatment, and rules, it will save a lot of family wear and tear. To get your partner on the same page, attend ASD  conferences or classes together. When you hear the same information, you can discuss it and decide what will work best for your adolescent and in your family. As you learn more about the disorder, you may also come to better appreciate each other’s contributions to your youngster’s welfare. Attend team meetings at the school together, or alternate which parent attends. Seeing your youngster’s therapist together (possibly without the child), or seeing a couples or family therapist, may help you weather a tough time together.

• Build and use any support networks you can: extended family, close friends, church/synagogue groups, and understanding school staff. At MYASPERGERSCHILD.COM parent support groups, you will find other wonderful moms and dads who will appreciate how hard you are working for your adolescent, and share their strategies, resources, and spirit. If you don’t have a good network, consider individual or family therapy for a little support during a stormy, demanding life passage. When you have a demanding adolescent, it’s good to be reminded once a week that your needs and feelings are valid and important, too!

• “Spray yourself with Guilt-Away!” Forgive yourself for being an imperfect parent, and for not loving your youngster “enough.” Forgive yourself for sometimes losing your temper, yelling, or handling a tense situation awkwardly. Forgive yourself for getting your adolescent diagnosed “late”—there are still plenty of years in which to help your youngster. Forgive yourself for not arranging play dates, or sports, or tutoring, the way other moms and dads may be doing. We each offer our youngster our own unique talents, interests, and qualities, as people and as moms and dads. We each do the best we can to gather the information, insights, resources, and services that will help our kids live and grow through adolescence. And—willingly or of necessity—we each end up making significant sacrifices for our kids. In the hardest years my mantra was: “The best I can do has got to be good enough—because it’s the best I can do!” It is a hard job; we are all heroic moms and dads (as a kind friend of mine once said to me).

• A regular bed time for the adolescent gives you time you can count on each evening for yourself and/or your partner. If you can build in regular respite—such as a night your adolescent spends with a grandparent once a month—go for it, and plan ahead for some relaxation, fun, or culture. (Divorced moms and dads may be able to count on a little time alone or with friends as long as they set up and adhere faithfully to a regular visitation schedule.)

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

Disclosure and Self-Advocacy—

• Encourage your adolescent to carry a wallet disclosure card to show if stopped by a police officer or other first responder. A lot of adolescents with ASD like to walk at night to unwind, and police may view their behavior as suspicious. You may want to introduce your adolescent to your local police community relations officer, and explain a little about ASD. Refer the police to MYASPERGERSCHILD.COM if they have questions.

• If you have not talked to your adolescent about ASD, you or someone else should do so—to the extent that the adolescent is ready to hear it. It’s tricky for adolescents—they so much want to be “normal” and strong and successful. A diagnosis can seem threatening or even totally unacceptable. In truth, however, the adults with ASD who do best are those who know themselves well—both their own strengths, which point them toward finding their niche in the world, and their own blind spots: where they need to learn new skills or seek out specific kinds of help.

• Adolescents need to learn when to ask for help, from whom, and how. It’s very helpful to have someone such as a trusted guidance counselor whose door is always open, and who can coach the adolescent in problem solving.

School—

• If you can afford it, you may prefer to pay private school tuition rather than paying a lawyer to negotiate with a financially strapped or resistant school system. However, a private school may not be the best choice. Some families move to a community with a better high school.

• Residential schools may be worth considering for some. The right fit can build tremendous confidence for the adolescent, give the moms and dads a break, and prepare everyone for the independence of the post high school years.

• Schedule regular monthly educational team meetings to monitor your adolescent’s progress, to ensure that the IEP is being faithfully carried out, and to modify it if necessary. Because adolescents can be so volatile or fragile, and because so many important things must be accomplished in four short years of high school, these meetings are critical. If an adolescent is doing very well, the team can agree to skip a month—but be sure to reconvene to plan the transition to the following year.

• See the MYASPERGERSCHILD.COM school list in the adolescent information packet. There are no easy answers to finding the mix of conditions where our kids can survive or even thrive; pick the best possible realistic choice, and help your adolescent adjust. Call MYASPERGERSCHILD.COM if you would like to discuss options. Some families hire educational placement services.

• Some adolescents adjust o.k. to middle/high school with appropriate supports and accommodations. Others, however, just cannot handle a large, impersonal high school. You may need to hire an advocate or lawyer to negotiate with your school system to pay for an alternative school placement, tuition, and transportation.

Transition Planning—

• Chapter 688 in Massachusetts mandates a transition from services delivered under the aegis of the Department of Education (DOE), through graduation or age 22, to services delivered by another state agency, such as the Massachusetts Rehabilitation Commission. Involve your state Rehabilitation Commission in the planning process, since they may be the sole or key provider of post-h.s. services for most adults with ASD.

• Consider delaying graduation in order to ensure that transition services are actually provided under DOE. It may be hard to convince an academically gifted, college bound student to accept this route. However, it may be very helpful for students who will need a lot of help with independent living skills and employment issues. Services need not be delivered within high school walls. Community college courses, adaptive driving lessons, and employment internships are just a few alternatives to consider.

• If you have not yet made a will and set up a special needs trust, do it now. Ask the lawyer about powers of attorney or other documents you may need once your adolescent is no longer a minor. Few moms and dads assume guardianship of a young adult 18 or older, but it may be necessary and appropriate in some situations.

• Social skills are more essential to employment success than high IQ or a record of academic achievement. Make sure the IEP provides for social skill learning/social pragmatic language. For example, a good overarching goal is: “Bobby will learn the social skills appropriate to a 9th grader.”

• The transition plan (part of the IEP) should address the skills a teenager needs while in high school, in order to be prepared for the kind of independent life s/he wants to lead after graduation. Many high schools are unfamiliar with transition planning, however—especially for college bound students. The more you know as a parent, the more you may be able to ensure that a solid transition plan is written and carried out.

• What kind of living situation, employment, and transportation fit your adolescent’s picture of his/her future at age 18 or 25? Once the goals are set, where can the adolescent learn the necessary skills? Consider academic courses, electives, extracurricular activities, and additional services within and outside the high school (e.g. community college, adaptive driving school).

• You want input and ownership from the adolescent as far as is possible, but moms and dads can and should have input. You may need to have team meetings when the adolescent is absent, so you can speak frankly about your concerns, without fear that the adolescent may feel you lack respect for or faith in her/him.

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

Steps Toward Independence—

• An activity the adolescent can walk to is great. Learning to use public transportation is also great. Consider buying a T pass, or rolls of quarters.

• Look for opportunities—e.g. in the summer—for a sheltered, successful overnight stay away from home with no parent. Examples: long weekend visits to relatives, a week or two of a carefully chosen sleep-away camp, taking a course on a college campus. MYASPERGERSCHILD.COM has a summer and recreation resource list.

• Look for volunteer activities or part time jobs at the high school or in the community. Be persistent in asking the school to provide help in the areas of career assessment, job readiness skills, and internships or volunteer opportunities. They probably have such services for intellectually challenged adolescents—but may not realize our kids need that help, too. They may also not know how to adapt existing programs to meet our kids’ needs.

• Teach laundry and other self-care/home care skills by small steps over time. Try to get the adolescent to take an elective such as cooking or personal finance at the high school.

College—

• Because your college student is no longer a minor, many colleges generally will not communicate openly with moms and dads, nor disclose the student’s disability without the student’s permission. Some colleges will allow the student to sign a blanket waiver to release information to moms and dads, but many will only allow limited waivers or none. The burden is on the student to disclose, to ask for help, and to let moms and dads know about problems—things that are hard for our kids.

• If your adolescent seems like a good candidate for college, take him or her to visit colleges during the spring vacation weeks of the junior year of high school, or during the summers before junior and senior year. Visits reveal a lot about what environment the adolescent will prefer. Purchase a large college guide to browse (e.g. Fiske). Also look at Colleges that Change Lives by Loren Pope: Clark University, Hampshire College, and Marlboro are New England colleges in this book.

• Not all adolescents are ready for a residential college experience right after high school. To decide, use the evidence of how the adolescent did at sleep-away camp or similar samplings of independence, and look carefully at executive function skills (organizational skills). As an alternative, community colleges offer a lot of flexibility: easy admission, low cost, remedial courses if necessary, the option of a light course load, and the security of living at home. Some college disability offices are more successful than others at providing effective, individualized support. However, if the adolescent is living at home, you may be able more easily to sense trouble, step in with help, or secure supports your young adult needs to succeed.




==> More parenting strategies for helping your teenager with Asperger's or HFA can be found here...


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

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Parenting Children and Teens with High-Functioning Autism

Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

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Highly Effective Research-Based Parenting Strategies for Children with Asperger's and HFA

Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

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My Aspergers Child - Syndicated Content