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Tips for Reducing Stress Related to Parenting Kids on the Autism Spectrum

"My (high functioning autistic) child is one of the most wonderful blessings of my life – yet at times, stress may cause me to wonder if he is at the root of my most intense times of irritability and anxiety. I don't like thinking like this. Any tips on how I can reduce my stress while at the same time, care for my son's special needs.?"

Let’s be honest. Caring for a child on the autism spectrum can be tiring. On bad days, we as parents can feel trapped by the constant responsibility. The additional stress of caring for a child with High-Functioning Autism (HFA) or Asperger's (AS) can, at times, make a parent feel angry, anxious, or just plain "stressed out." These tensions are a normal, inevitable part of the family, and parents need to learn ways to cope so that they don't feel overwhelmed by them.

To see if you are experiencing toxic amounts of parental stress, answer the following questions:
  1. Are you often irritable?
  2. Are you suffering from lack of sleep?
  3. Are you worried about your child’s future?
  4. Are you worried about your family’s finances?
  5. Do you avoid of social interaction outside the home as much as possible?
  6. Do you choose the self-serve lane at the supermarket and the ATM at the bank because doing things by yourself is just easier?
  7. Do you ever find yourself so rushed and distracted that it’s “just annoying” when a cashier or neighbor tries to make chitchat with you about the weather?
  8. Do you ever get so caught up in one subject (e.g., IEP worries or your frustration with your child’s school) that you catch yourself repeating the same complaints to anyone who will listen?
  9. Do you find yourself snapping at your child for interrupting you, then feeling guilty afterwards?
  10. Do you have a disregard for personal appearance and social niceties?
  11. Do you keep meaning to pick up the phone and call a friend, but find yourself too busy or distracted?
  12. Do you scan each room you enter for things that might trigger a meltdown in your youngster, (e.g., unusual smells or loud noises)? …and do you find yourself doing so even when he isn’t with you? …for that matter, after avoiding those things for so long, do you find that they now irritate you, too?
  13. Have the cute hairdos and perky outfits been replaced by ponytails and sweats?
  14. Have you ever had the thought, “I don’t like my child”?
  15. Have you found yourself getting annoyed when your spouse tunes you out or tries to change the subject?

If you answered “yes” to several of these questions, you too may be suffering from parental stress associated with parenting a child with an Autism Spectrum Disorder.
 

Stress becomes a problem when you feel overwhelmed by the things that happen to you. You may feel "stressed out" when it seems there is too much to deal with all at once, and you are not sure how to handle it all. When you feel stressed, you usually have some physical symptoms. You can feel tired, get headaches, stomach upsets or backaches, clench your jaw or grind your teeth, develop skin rashes, have recurring colds or flu, have muscle spasms or nervous twitches, or have problems sleeping. Mental signs of stress include feeling pressured, having difficulty concentrating, being forgetful and having trouble making decisions. Emotional signs include feeling angry, frustrated, tense, anxious, or more aggressive than usual.

The stress of parenting a child with an Autism Spectrum Disorder does not have to damage the bond you have with your child. In fact, if you take the necessary steps to reduce stress in your life, it can actually strengthen the closeness of your relationship with your youngster.

20 Tips for Reducing Stress Related to Parenting Children on the Spectrum

1. As a mother or father, it’s a necessity to take care of yourself so that you have the energy and motivation to be a good parent.

2. Avoid fatigue. Go to bed earlier and take short naps when you can.

3. Coping with the stress of parenting an HFA or AS child starts with understanding what makes you feel stressed, learning to recognize the symptoms of too much stress, and learning some new ways of handling life's problems. You may not always be able to tell exactly what is causing your emotional tension, but it is important to remind yourself that it is not your youngster's fault.

4. Develop good relationships. Family relationships are built over time with loving care and concern for other people's feelings. Talk over family problems in a warm, relaxed atmosphere. Focus on solutions rather than finding blame. If you are too busy or upset to listen well at a certain time, say so. Then agree on a better time, and make sure to do it. Laugh together, be appreciative of each other, and give compliments often. It may be very hard to schedule time to spend with your family, doing things that you all enjoy, but it is the best time you will ever invest. Moms and dads and kids need time to spend one-to-one. Whether yours is a one or two-parent family, each parent should try to find a little time to spend alone with each youngster. You could read a bedtime story, play a game, or go for a walk together.

5. Have a realistic attitude. Most moms and dads have high expectations of how things should be. We all want a perfect family, and we all worry about how our children will turn out. But, wanting “the ideal family” can get in the way of enjoying the one you have. 
 

6. If you don’t already belong to a group for parents of HFA and AS kids, you’re missing out on great social and emotional support. But, also remember that you had interests before you became a harried mom. Whether it’s decorating or reading murder mysteries, we all need some sort of pleasant diversion, and friendly folks to share it with. If you’re able to join a local support group and club, great! But if not, there is a plethora of online discussion groups about just about any interest you can imagine.

7. If you feel guilty about the idea of trying to plan time and activities apart from your youngster– don’t! How can we teach our "special needs" children that socialization is important, healthy, and worthwhile, if we hardly ever take time for it ourselves? So pick up the phone and plan time for some fun with a friend. If you won’t do it for yourself, do it for your youngster.

8. If you're feeling pressured, tense or drawn out at the end of a busy day, say so. Tell your kids calmly that you will be happy to give them some attention soon but first you need a short "quiet time" so that you can relax.

9. Keep in mind that your child experiences stress, too – at any age. So when you work on methods to reduce your own stress, try to incorporate stress relieving techniques that both you and your youngster can use to reduce stress. Of course, the stress relieving activities that you choose for you and your child to share will depend on your child’s age.

10. Learn some ways of unwinding to manage the tension. Simple daily stretching exercises help relieve muscle tension. Vigorous walking, aerobics or sports are excellent ways for some people to unwind and work off tension; others find deep-breathing exercises are a fast, easy and effective way to control physical and mental tension.

11. Look for community programs for moms and dads and kids. They offer activities that are fun, other moms and dads to talk with, and some even have babysitting.

12. Look for parenting courses in your community. 
 

13. Make a play date. The great thing about play dates for moms is that you don’t have to referee them – you just have to find time for them! Sit down with your calendar, get on the phone, and schedule time to spend with friends, at least every couple of weeks. It doesn’t have to be anything elaborate. Go together for manicures or a trip to Target, followed by lattés, while Dad watches the kids. But make sure you schedule in play dates with Dad occasionally, too. If you can’t find a sitter, trade off watching the kids with another couple who has a youngster on the spectrum – most, I’ve found, are happy to make such a deal.

14. Make quality time for yourself, and reserve time each week for your own activities.

15. Most of us live hectic lives, and working through lunch can easily become habit. Make a commitment to yourself that at least three days a week you’re going to operate as a social human being. Go over to the food court with your coworkers, or brown bag it and catch up on the gossip in the lunchroom. You need interaction with grown-ups who are interested in topics that you are interested in. So after the dishwasher is loaded, put everybody down to nap or stick in a DVD for 20 minutes, and pick up the phone and call your best friend or sister, and give yourself a dose a grown-up time.

16. Practice time management. Set aside time to spend with the kids, time for yourself, and time for your spouse and/or friends. Learn to say "no" to requests that interfere with these important times. Cut down on outside activities that cause the family to feel rushed.

17. Take a break from looking after the kids. Help keep stress from building up. Ask for help from friends or relatives to take care of the kids for a while. Exchange babysitting services with a neighbor, or hire a teenager, even for a short time once a week to get some time for yourself.

18. Take care of your health with a good diet and regular exercise. Moms and dads need a lot of energy to look after kids.

19. Talk to someone. Sharing your worries is a great stress reducer!

20. We all have reactions to life's events which are based on our own personal histories. For the most part, we never completely understand the deep-down causes of all our feelings. What we must realize is that our feelings of stress come from inside ourselves and that we can learn to keep our stress reactions under control.

If you are considering getting some additional support or information to help you cope with the stress of parenting, there are many different resources available, including books and video tapes on stress management, parenting courses and workshops, professional counseling and self-help groups.
 

By

The 3 Interventions to Prevent Meltdowns in Kids on the Autism Spectrum

"Mark, You refer to 'meltdowns' quite frequently in your articles. Is it not similar to a tantrum... if not, what can be done to prevent them?"

A meltdown is not identical to a tantrum (although there is an overlap on occasion). From a biological standpoint, a meltdown is an emotional outburst wherein the higher brain functions are unable to stop the emotional expression of the lower (i.e., emotional and physical) brain functions. 
 
Kids who have neurological disorders are more prone to meltdowns than others (although anyone experiencing brain damage can suffer from meltdowns too).

From a psychological standpoint, there may be several goals to a meltdown, which may or may not be the "rewards" that are consciously desired by the youngster. To many parents and teachers, these goals may seem irrational, inappropriate, and sometimes criminal. 
 
To kids familiar with - or trained to recognize - the psychological causes of such behavior, however, there are clear emotional, cognitive, behavioral, and biochemical correlates to meltdowns.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

The three major interventions that are usually most effective in preventing a meltdown from manifesting in children with High-Functioning Autism (HFA) include (1) managing emotions, (2) a sensory diet to maintain optimal sensory regulation, and (3) visual supports.

1. Managing emotions:

Most often, the youngster's feelings are way too big for the situation. Managing felt emotions does not come automatically, but can be learned over time with systematic instruction. CBT is one example of an effective therapy for managing emotions.

2. Sensory diet:

Children with High-Functioning Autism usually do not have sensory systems that regulate automatically; rather, they must discover how to keep themselves regulated. This is most often accomplished by employing a sensory diet.

Just as a youngster needs food throughout the course of the day, he needs sensory input – and opportunities for getting away from stimulation – spread out over the whole day. A “sensory diet” is a carefully designed, personalized activity plan that provides the sensory input an autistic child needs to stay focused and organized throughout the day. In the same way that you may soak in a hot tub to relax, kids on the autism spectrum need to engage in stabilizing, focusing activities, too.

Each ASD youngster has a unique set of sensory needs. Generally, a youngster whose nervous system is causing him to be hyperactive needs more calming input, while the youngster who is more under-active or sluggish needs more arousing input.

The effects of a sensory diet are usually immediate and cumulative. Activities that perk up your youngster - or calm him down - are not only effective in the moment, but they actually help to restructure your youngster’s nervous system over time so that he is better able to:
 
(a) handle transitions with less stress,
(b) limit sensory seeking and sensory avoiding behaviors,
(c) regulate his alertness,
(d) increase his attention span, and
(e) tolerate sensations and situations he finds challenging.

3. Visual supports:

 “A picture is worth a thousand words” is the absolute truth. Although each child on the autism spectrum has a unique experience, processing written and spoken words is not considered to be her “first language.” Visual supports can be anything that shows rather than tells. Visual schedules are often used successfully with many ASD children. 
 
Having a clear way to show beginnings and endings to the activities shown on the visual schedule helps the child to have smooth transitions, thus keeping a meltdown from gathering momentum. For the best results, visual supports need to be in place proactively rather than waiting until the child's behavior unravels to pull them out.
 
 
Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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COMMENTS:

Anonymous said… Meltdowns are not always "temper tantrums." I am a certified Aspie and my meltdowns usually have nothing to do with temper to anger. Meltdowns are the result of overstimulation in some area. It could be related to sensory issues such as a certain noise, or certain colored lights, or it could be a reaction to an emotionally charged situation (we don't understand emotions so when emotions are high it is unnerving and we can't handle it). I recently wrote about a meltdown on my own blog The Christian Aspie. It is a first hand account, through the eyes of an Aspie. It is horrible to experience. There is a lot of anxiety and stress, an out of control feeling. I have had milder meltdowns when people lie to me. I have also had rather serious meltdowns when I have just been overloaded in one way or another (usually sensory related). The thing to remember is that 1. We can't help it. Sometimes I have to stomp or flap my hands to release the pressure. 2. There is nothing you can do about it except to try to get the person into a sensory friendly (low sensory input - low lights, muted sound, isolated, etc) area.

Anonymous said… I think a lot of it is semantics. The closest term to describe a 'Meltdown', is a severe temper tantrum, altho a temper tantrum in a 'normal' child is generally caused by a child that is simply not getting his way and has learned that if he pitches a big enough fit, he will get his way. No Aspie or Aspie parent wants that perception to be used to describe an Aspie meltdown. I think there is also a big difference between a 'meltdown' and a 'shutdown', depending on how the aspie deals with the anxiety and often overwhelming experience of trying to navigate the 'normal' world. Some aspies INternalalize their feelings and emotions, and some EXternalize them. An internal 'meltdown' I would describe more as a 'shutdown'. They may be just as devastating to the child, but don't have the same outward effect on those around them, as a full-blown 'meltdown' can have. Especially if it happens in public. In my opinion, the term 'meltdown' has become way overused by some parents to describe anytime their child, aspie or not, cries or doesn't behave perfectly. I often want to tell these parents, "you apparently have never seen a real meltdown". In our experience, Mark Hutton described a meltdown perfectly, and I think the overuse, and misuse of the term minimizes what Aspies and their caregivers deal with daily. Thank you Mark for clarifying this. 

Anonymous said... A meltdown can be very subtle. Essentially they are overwhelmed with emotion or sensory input. Early on this can be expressed as irritability (early in the meltdown). It can go into a tantrum/screaming fit or just as easily into what I call a shutdown (retreating somewhere "safe" and trying to block the world out).

Anonymous said... A meltdown is NOT the same as a tantrum. A meltdown is involuntary, it is not under the child's control, and it is usually due to sensory overload, something important getting changed unexpectedly, or some kind of "straw that broke the camel's back," when somebody's been under chronic stress and there's a final incident that they just can't take anymore. Good ways to avoid one are to tell a child in advance if something in their plans or schedule is getting changed--not waiting until the last minute. Figure out what kind of environmental/sensory stresses cause them sensory overload, and avoid those, or make sure they have a way to escape if they need to.

Anonymous said... I found my meltdowns used to occur mostly in social situations that were noisy -- too much noise, too many people talking, too much input. I have learned to handle them by staying to the side of a room, so it is not all around me and occasionally having a time out (from the noise) where I would go outside or to the bathroom & just breath and calm down. But them I am over 50 and have had many years to figure out what works. It is not a tantrum which, as I understand it, comes from anger and not having ones own way; it seems to be a sensory overload which explodes.

Anonymous said... Tantrums are typically from not getting their own way. Meltdowns or at least with my son are usually because he got overwhelmed with something and doesn't know how to properly express it to me. Kudos for finding something that works for you!
 
Post your comment below…
 
By

Children on the Autism Spectrum Who Suffer with Encopresis

Question

I have my 12 yr old Grandson living with my husband and I, It isn't easy because his mother had to leave him with us for awhile. We are implementing your assignments in your book, it hasn't been easy but we are making significant headway. One thing that bothers us more than his behavior is him soiling his pants. I don’t know why and I have tried asking him why he does but all he says is he doesn`t know. I know that maybe he doesn`t know why but it is hard for my husband to understand how he can let it sit in his pants without a care. When my husband addresses this with my grandson he is confronted with a complete shutdown, he won`t look at him, answer him. I understand why he does but when I approach him on it, I will ask if he soiled his pants his first reaction is to tell me no he did not do it. Then I ask to check his pants, when I do I can see it and at that point I calmly ask him to get some clean clothes go to the bathroom have a shower and I make him clean out his shorts. He does this almost every day and when we noticed he didn`t do it that one day we praise him to no end. I don`t know what I can do to help him stop or why it happens in the first place. I would appreciate any comments as to how I can help him get over this. My grandson isn`t the easiest to handle when he gets to upset he is 12 at 6` tall and 230lbs so having an easy approach would be greatly appreciated.


Answer

Some High-Functioning Autistic children beyond the age of toilet-training who frequently soil their underwear have a condition known as encopresis. They have a problem with their bowels that dulls the normal urge to go to the bathroom, and they can't control the accidents that typically follow. Problems with encopresis and constipation account for more than 25% of all visits to doctors who specialize in disorders of the stomach and intestines.

Most encopresis cases (90% +) are due to functional constipation (i.e., constipation that has no medical cause). The stool (or bowel movement) is hard, dry, and difficult to pass when the youngster is constipated. Many children "hold" their bowel movements to avoid the pain of constipation, which sets the stage for having an accident. Moms and dads are often frustrated by the fact that their youngster seems unfazed by these accidents, which occur mostly during waking hours.

Denial may be one reason for the youngster's indifference. He/she just can't face the shame and guilt associated with the condition (some even try to hide their soiled underpants from their moms and dads). Another reason may be more scientific: Because the brain eventually gets used to the smell of feces and the youngster may no longer notice the odor.

Well-intentioned advice from moms and dads isn't always helpful because many parents mistakenly believe that encopresis is a behavioral issue. Frustrated moms and dads and caregivers may advocate various punishments and consequences for the soiling, which only leaves the youngster feeling even more humiliated. Up to 20% of children with encopresis experience feelings of low self-esteem that require the intervention of a psychologist or counselor. Punishing or humiliating a youngster with encopresis will only make matters worse. Instead, talk to your doctor. He/she can help you and your youngster through this treatable problem.

As the colon is stretched by the buildup of stool, the nerves' ability to signal to the brain that it's time for a bowel movement is diminished. If untreated, not only will the soiling get worse, but children with encopresis may lose their appetites or complain of stomach pain. Most cases of encopresis can be managed by your doctor, but if initial efforts fail, you may be referred to a gastroenterologist.

Treatment is done in three phases:
  1. The first phase involves emptying the colon of hard, retained stool. Different doctors might have different ways of helping children with encopresis. Depending on the youngster's age and other factors, the doctor may recommend medicines, including a stool softener (such as mineral oil), laxatives, and/or enemas. As unpleasant as this first step sounds, it's necessary to clean out the bowels to successfully treat the constipation and end your youngster's soiling.
  2. After the large intestine has been emptied, the doctor will help the youngster begin having regular bowel movements with the aid of stool-softening agents, most of which aren't habit-forming. At this point, it's important to continue using the stool softener to give the bowels a chance to shrink back to normal size (the muscles of the intestines have been stretched out, so they need time to be toned without the stool piling up again).
  3. As regular bowel movements become established, your doctor will reduce the youngster's use of stool softeners.

Keep in mind that relapses are normal, so don't get discouraged if your youngster occasionally becomes constipated again or soils his/her pants during treatment, especially when trying to wean the youngster off of the medications. A good way to keep track of your youngster's progress is by keeping a daily stool calendar. Make sure to note the frequency, consistency (i.e., hard, soft, dry), and size (i.e., large, small) of the bowel movements. Patience is the key to treating encopresis. It may take anywhere from several months to a year for the stretched-out colon to return to its normal size and for the nerves in the colon to become effective again.

In the meantime, diet and exercise are extremely important in keeping stools soft and bowel movements regular. Also, make sure your youngster gets plenty of fiber-rich foods (e.g., fresh fruits, dried fruits like prunes and raisins, dried beans, vegetables, high-fiber cereal, etc.). Because children often cringe at the thought of fiber, try these creative ways to incorporate it into your youngster's diet:
  • Add bran to baking items such as cookies and muffins, or to meatloaf or burgers, or sprinkled on cereal. (The trick is not to add too much bran or the food will taste like sawdust.)
  • Add lentils to soup.
  • Add shredded carrots or pureed zucchini to spaghetti sauce or macaroni and cheese.
  • Bake cookies or muffins using whole-wheat flour instead of regular flour. Add raisins, chopped or pureed apples, or prunes to the mix.
  • Create tasty treats with peanut butter and whole-wheat crackers.
  • Make bean burritos with whole-grain soft-taco shells.
  • Make pancakes with whole-grain pancake mix and top with peaches, apricots, or grapes.
  • Serve apples topped with peanut butter.
  • Serve bran waffles topped with fruit.
  • Sneak some raisins or pureed prunes or zucchini into whole-wheat pancakes.
  • Top high-fiber cereal with fruit.
  • Top ice cream, frozen yogurt, or regular yogurt with high-fiber cereal for some added crunch.

Have your youngster drink plenty of fluids each day, including water and 100% fruit juices like pear, peach, and prune to help draw water into the colon. Try mixing prune juice with another drink to make it a little tastier. Also be sure to limit your youngster's total daily dairy intake (including cheese, yogurt, and ice cream) to 24 ounces or less.

Successful treatment of encopresis depends on the support the youngster receives. Some moms and dads find that positive reinforcement helps to encourage the youngster throughout treatment. Provide a small incentive (e.g., extra video-game time) for having a bowel movement or even just for trying, sitting on the toilet, or taking medications.

Whatever you do, don't blame or yell — it will only make your youngster feel bad and it won't help manage the condition. Show lots of love and support and, assure your youngster that he or she isn't the only one in the world with this problem. With time and understanding, your youngster can overcome encopresis.

 
More resources for parents of children and teens on the autism spectrum:
 
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COMMENTS:

•    Anonymous said… Aspergers kids often have issued recognizing when they need to go. The nervous system effectively shuts down due to over stimulation so they don't feel it. Get him on a schedule. 30-45 minutes after eating every time. If he's constipated, put him on myralax to get him regulated. Above all, talk to him. Explain to him why he may not recognize what's happening and how you would like to help him get control over it. Make sure you stress that you want to help "him" have control. Discuss it in detail with him. Aspergers kids love detail and logic and rules.
•    Anonymous said… Buy the squatty pottty, they sell them at bed bath and beyond, it is a special stool that you put your feet up on and it helps positioning too. Also kids with asd often have constipation and this may also be a reason they don't use the toilet, they associate it with pain.
•    Anonymous said… Growing up my younger brother did this also. We discovered he had epilepsy. He would have mild seizures we didn't even notice. They were so mild. The Doctor figured that when he had a seizure was when my brother would soil his pants. He was around 16 when he stopped.
•    Anonymous said… Have him tested for coeliac and gut problems, my son had trouble toilet training because he couldn't tell the difference between gas and solids due to wheat and dairy intolerances, which is apparently quite common on the spectrum.
•    Anonymous said… he may not be able to feel it happening because of sensory issues, maybe a regular toilet time about 4 times a day to help him to try to make his movements regular? do you have a very bright or very dark toilet/bathroom? this might be an issue. Another not quite as wonderful solution might be to get him incontinence pants
•    Anonymous said… I am grateful for the question/answer, thanks to the OP for putting it out there. My 7 yr old has only been PT for about 2 years, and while we rarely leave him with a sitter, it seems that he commonly will soil his pants in the care of others. Other than this issue, he is VERY well behaved for other caregivers, but once he does this, they are not eager for him to return. We have tried showing him where the potty is, and making sure he knows it's ok to ask to use the potty and all of that stuff. Separately, the comments on the article about kids even as old as teenagers have this problem are kind of breaking my heart for them, and for our future as well.
•    Anonymous said… If this is it (very common with kids on the spectrum) please take him to see a gastroenterologist (preferably one who is familiar with spectrum issues)
•    Anonymous said… I'm so glad someone asked this I've been having nothing but obstacles with my son and training. I've got him finally in underwear through out the day and using the potty, he stands over it straddling but hey he's doing it. However he refuses to sit and go number 2. When he has to go he runs and gets a pull up. I've tried praise, tokens and even not buying pull ups but it didn't work. He's 7, non verbal and yes stubborn. Any advice??
•    Anonymous said… I'm so glad someone finally asked this. I have been largely ignored when I asked for help in other groups.
•    Anonymous said… Its soo good to hear Im not alone. My son is 9, and I really felt like I was the only person dealing with this. It makes me sad that it could last a long time. Ive tried everything the doctors/counsellars suggested. The more I push him to correct it the more he pushes back. Hes gotten to a point where he cleans himself up, and I feel like thats all I can ask for at this point..
•    Anonymous said… keep schedule of time it's happening. Help him to recognize some signs (gassy, tummy pain, timing of when to sit). The thing is, if he sits on the toilet at said times, his muscles actually help him go so a routine may work. A possible different position on the potty / one leg up or stretched out for stability and muscle help. Sensory is definitely part of the problem if he can sit in it, I would think. An OT or ABA Autism specialist may be able to help. I would make a few calls and get some suggestions. When he has a good day, don't just praise, bring out the big guns, new video game (but take it back after 30 minutes and say he gets it again when he does a good day). His favorite cake, etc. Also explain the sanitary part of good hygiene and maybe have him watch a few videos (they process this faster and better usually, because of the visuals). Some kids grab onto the "we don't like germs" part and understanding it's toxic and needs to go away. This may/may not motivate them but it's worth a try. He needs a good motivator. See if there is something that breaks it down into small steps. 1. I feel pain 2. I get gas 3. I need to go to the bathroom all the way to lastly I wash my hands for 2 minutes with soap. Breaking things down (you can type it up) helps them and the visual of it broken down into small steps. At the end write something like "I am proud of myself that I can smell fresh and clean and minimize germs by going to the bathroom myself. I am growing up and helping at beating diseases and germs." Something like that. Good luck.
•    Anonymous said… Maybe a different position over the toilet? They tend to do different body positions. Good luck!
•    Anonymous said… My 14 year old son is the same way. He says it hurts to go when he sits on the toilet but not when he stands and crosses his legs. We've tried everything. We're on a waiting list for ABA therapy and this will be the first item they tackle.
•    Anonymous said… My child has demand avoidance- so any structured plans always made him more anxious and failed. We had to stop worrying about it and make him clean up when we noticed it. (It was really a problem for a while). Then it just stopped.
•    Anonymous said… my daughter also has epilepsy and while she doesn't soil her pants, she does pee in the bed every night, she is going to be 9 and still has to wear a pull up to bed. When i ask her why she doesn't get up to use the bathroom she says she doesn't feel it when it is happening. This could be the case with your grandson, if he is having a seizure he may have no memory of it. Best of luck. I still have no solution for my daughters nighttime accidents, she doesn't have accidents in the day any longer, but sometimes she waits so long to pee, i tell her to go she says she doesn't have to, then a few minutes later she is racing to the bathroom. Best of luck to you, its never easy but we love them.
•    Anonymous said… my son does this and u know what I make no big deal it is a sensory issue and u can't treat him any different because of it. I help him clean up u know why because it's embarrassing for him and he really has no idea till I show him that it happe s
•    Anonymous said… Not sure if this is relevant due to the age difference but I had that same problem with my 4 year old. We started giving him a fiber gummy every day. If he has the gummy he goes in the potty. If he doesn't have the gummy he will have an accident. Only thing I can come up with is he must not know and the extra fiber causes more force.
•    Anonymous said… Some children have gut problems and get leakage around a hard stool which soils their pants but they can be unaware of it. a regular gentle laxative can help, it can also be used as part of a soiling programme even if there is no constipation.
•    Anonymous said… To begin with, it does no good to ask him why he does it. He doesn't know, he's communicated that to you. Would you ask a baby why he soiled his diaper? No. They do it because they don't know any better. Neither does he. My initial thought is that he is regressing due to the emotional trauma in his life. It doesn't matter how he can willingly sit in it all day. It's possible that it's a sensory issue and he likes how it feels. The point is, it doesn't matter. Regarding the shutdown when his grandfather approaches him about it. My thoughts are that he is embarrassed & he doesn't know how to communicate it. He might not even know what it is that he's feeling. He just knows it's an uncomfortable feeling and he tries to hide it. Next, you ask him if he soiled his pants. I'm thinking that he's probably associated something negative (ie, being yelled at, scolded, spanked, etc.) with soiling his pants, which is why he deflects. If I were in your shoes, & I suspected (or knew) he'd done it, I'd tell him to come with you to the bathroom, say, "Lets look in your pants, is there poop? Yup. There's poop. Ok, what do we need to do?" And then guide him through the steps of changing, showering, etc. Don't ask. Make statements, instruct him, guide him. It does no good to ask at this point. To eliminate this behavior, I'd start with a token system. Start with very short periods of time. For every 5 minutes he's clean, give him a token. When he earns 3, he gets a reward. Let him choose what he's working for. When he can go longer than 5 minutes, up it to 10, increase the number of tokens he has to have, etc., until he gets up to a day. When he goes a day, clean & dry, throw that kid a party. If he has an accident, that's ok, don't scold, it's a bump in the road. He needs encouragement, not discouragement.
•    Anonymous said… Very comman in kids with ASD. My son is the same. Has been for yrs. He is 13.
•    Anonymous said… We did not get any help with the pediatrician. Only a referral to a behavioral clinic that was a year wait to get into and then were not the least bit helpful. You know it's a wasteland out here for that kind of assistance. Hopefully those who live in better areas have better services.
•    Anonymous said… When I worked for a Famiy Practice physician this issue would periodically come up. I would say to work with the child's doctor to come up with a plan to manage the encopresis. Eventully, I think it can be managed.
•    Anonymous said… You are doing it. Stay calm. Have him continue to change it himself. If he says no but you suspect he has, just remind him kindly that "when we have an accident we need to do our best to fix it" then maybe ask him if he remembers what to do to fix a accident in his pants. Letting him figure it out really has helped my son. He still has accidents, or walks around with poop on his hands. This a a difficult thing. You are not alone.

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Junk Food Diet in Teens on the Autism Spectrum

"Any suggestions on what to do for a 13 year old teenager with ASD (high functioning) who is perfectly content to eat pizza rolls morning, noon and night - to the exclusion of most other foods? Very frustrating!"

When it comes to adolescents with ASD or High-Functioning Autism (HFA), appropriate diet and nutrition is a critical issue. Even slight worsening of moods, or additional absent-mindedness due to low blood sugar from skipping a meal, may cause these adolescents to fall into difficulties in important social situations. 
 
Once they have created a "social storm" (e.g., a rift with a classmate, an argument with an educator), these adolescents often have more trouble than “typical” adolescents navigating the troubled waters and reaching a safe shore.

In the United States, we often have too much food, and paradoxically, much of it is not healthy or nutritious. Many HFA adolescents complain about the food provided for them and may refuse to eat. Many don't eat well at prepared meals with their families, because they have a confusing array of other choices. 
 
 
They often do not view making daily decisions about what is - and is not - nutritious as their job. That’s where wise parents come in. Parents should guide their HFA adolescents to eat wisely by providing nutritious food, and by limiting the supply of non-nutritious foods available.

At the same time, eating together is one of the most affirming and basic family-building activities possible. It also links us to other human beings in our own community and other communities. It’s one activity that we all have in common, no matter what culture we are from. Our first job as parents, therefore, is to return a sense of pleasure to family mealtimes, and to eating in general, if it isn't already there. 
 
Our second job is to plan for food that is appropriately nutritious, even planning some meals with our adolescents. Our third job is to prepare the food with a calm attitude and with thoughtful attention to the needs of our adolescents, whether it be for portable meals, late-night snacks, or a constant supply of pocket-sized nutritious energy-boosters.

Here are several ways to keep positive attitudes about food in your home:
  1. Try music and candlelight for a change. Ask your adolescent to choose some quiet music that he or she especially likes.
  2. Start each meal together, at the table, and wait for everyone to be there. It helps to share a moment of silent appreciation, a chosen quote, or a prayer if you are so inclined. Let all family members take turns choosing the opening.
  3. Offer only nutritious foods at mealtimes. Try to buy as many fresh foods as possible, and use color contrasts to make the meal appeal to the artist in your HFA teen.
  4. Get family members to take turns helping to set the table creatively with attractive – even unusual – centerpieces or decorations. Some of these may even help generate conversation with ordinarily quiet, self-absorbed adolescents.
  5. Don’t make meal times a time to criticize or moralize. Try to open the conversation to everyone, and avoid topics that exclude some family members, or are boring for kids or teens. 
  6. Ask family members what their favorite dinners are, and either prepare those meals yourself, or allow them to prepare those meals once a week.
 
Planning and preparation:

Turning your kitchen into a generator of good nutrition and better eating habits may feel like a monumental task, but it is entirely manageable if broken down into tasks that only take an hour or less.
  1. Based on your family's list of favorite meals, and the cook's preferences, create a new grocery list featuring fresh foods and non-sugar foods for the main meals.
  2. Go through the refrigerator and the pantry shelves and gradually reduce and eliminate unhealthy foods. These include those foods whose primary ingredient is sugar (i.e., the first ingredient on the label), and foods with artificial ingredients, including preservatives and artificial coloring. Get rid of all soft drinks. Extra salty or fatty foods should also be limited (although these are more problematic for adults; adolescents can handle some salty, fatty foods because of their higher activity levels). Then don't buy unhealthy foods anymore. If anyone asks, you can tell them you can't afford them. Having to buy these foods themselves will immediately reduce your adolescents' (and other family members') need for them.
  3. Rotate cooking duties. Cooking is a practical skill and art form that all adolescents should master early in life. An adolescent with HFA may especially appreciate feeling self-confident serving tasty food he or she has prepared to friends and family.
  4. Continue to provide some snack foods, portable foods, and quick meals. These in-between food sources are often the culprits in poor nutrition and diet. Thus, it is crucial to look closely at ingredients, and change the foods that are available whenever you determine that the current offerings are unhealthy. Make sure that you provide a continual supply of a variety of these meal alternatives, or your adolescent will resort to relying on vending machines and friends.
  5. See how many canned or already prepared foods you can replace with fresh foods. These foods are often a hidden source of unwanted sugars, preservatives, and other chemical additives that can actually damage your family's health. Try the local health food store for spaghetti sauce and other sauces and dressings free of chemistry experiments; farmer's markets often have homemade jams, hot sauces, pesto, flavored honey, herb vinegars and other specialties. Check the local bakeries for bread; often bakeries sell their day-old bread at a significant discount - and it is still a lot fresher than what you will find at the grocery store!
  6. Pay special attention to breakfast foods. You may have to woo your adolescent to the breakfast table, but it is worth the effort. Breakfast is still the most important meal of the day for regulating energy levels, brain power, and moods.
  7. Preparing food should be a happy, not a harried, activity. Have a rule in your house that the cook gets to choose the music or radio program while preparing meals, and others are in the kitchen at the same time only if they are contributing to a positive atmosphere.
  8. Whoever does the majority of the cooking in the family should consider what foods he or she enjoys the most, and should check out a few cookbooks featuring their favorite foods from the library. A happy and inspired cook makes good food. Inspiring food makes better mealtimes and better nutrition possible.

Examples of healthy snack foods:
  • apples and peanut butter
  • carrots, celery, cherry tomatoes
  • cheese and wholegrain crackers
  • granola or homemade granola bars
  • peanuts and raisins, or other fruit/nut mixes
  • quick breads and muffins made from scratch
  • whole yogurt with fresh fruit and honey
  • yogurt and fruit "smoothies" made in the blender

 
Easy recipes:

Portable foods need to be hard, or in a hard container, so that they are not squashed and unappetizing by the time your AS or HFA adolescent gets around to remembering to eat them. Apples and granola bars are a good start. Consider getting some beef, elk, venison or bison jerky from a place that makes their own jerky (more farmers and ranchers are starting to offer these products for sale). 
 
Also, find a favorite cookie recipe. Using whatever basic chocolate chip cookie recipe your family prefers, cut the sugar by one-quarter cup, and substitute one-half cup quick oats for one-half cup of the flour required. Add chopped nuts, and even coconut flakes, if you prefer. Use real butter rather than margarine. Making a variation of these cookies each week, and filling the cookie jar will provide a more nutritious treat than store-bought cookies.

Quick meals should be meals that adolescents can cook for themselves in the afternoon after school, or late at night when returning from an evening out, or if they are up late studying. Provide instruction in how to prepare basic pasta, and then make sure that a variety of interesting pasta shapes and sauces are readily available and that your adolescent knows how to find the necessary ingredients and pots and pans by him or herself. Egg-based meals are another example. 
 
Make sure that your adolescent knows how to prepare basic scrambled eggs, omelets, fried or poached eggs, hard-boiled eggs, and French toast. With just these two basic food sources in his or her cooking repertoire, your HFA adolescent can create a dozen different healthy meals.

Rather than using direct praise for positive changes in your adolescent's eating habits (which may feel too intrusive or excessive for what he or she will rightly regard as a very basic part of life), ask your adolescent to cook for the family. Saying something like, “You prepare such good food these days; could I get you to cook for everyone once this week or next week?” will make your adolescent feel both self-confident, and needed. For an HFA adolescent, these are the marks of growing into adulthood and family membership as the contributing adult that he or she wants to be, deep down.

 
Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Great COMMENTS from Parents:

•    Anonymous said... 9 year old only eats bean burritos, and top ramin.
•    Anonymous said... Can you and her cook some. Wholemeal bases. Goats cheese, different vegetables, etc etc. i do with my boy and he eats them cuz we made them do they must be better.
•    Anonymous said... cheese pizza, grilled cheese, chips-and cutting back on his amounts. Also pop tarts, waffles, beef sticks.
•    Anonymous said... Corny dogs and ketchup, peanut butter and jelly, and spagetti. I can't get my 7yr old aspie boy to eat anything else.
•    Anonymous said... Food allergy testing might reveal some surprises. Dairy and wheat are very common allergens and worsen some ADD/ Aspergers symptoms. Take it or leave it... if you test, only do the IGG blood test which picks up all the sensitivities.
•    Anonymous said... I have same issues with my 13 yr old son, left to his own devices, he forgets to even eat. Only time I get vegetables in him is at dinner, and that can sometimes be a struggle. He would live on sausage rolls and chicken savory bites if we let him. He will not try new foods, and only eats plain foods. I also find it frustrateing, but feel lucky that I can get veg into his main evening meal, but even that he will not eat with sauce or gravy, it all has to be plain.
•    Anonymous said... I really don't have that issue with my daughter.We just started out as a baby you eat what you get.And if I think issues will arise,I give a choice of two items.But she has a tendency to love the good stuff like steamed cabbage,Brussels sprouts and does not like alot of junk food.Would not eat Cheerios,cookies,and stuff like that as a baby.
•    Anonymous said... It's pretty standard now to remove gluten and dairy from anyone's diet who has autism. We took my son of it (now 11) 2 years ago and almost immediately his meltdowns reduced by 70%, his functioning increased shockingly and now he tries all sorts of foods. Gluten and dairy are addictive to those with autism and effects every area of their development.
•    Anonymous said... My daughter eats the same thing everyday for breakfast and lunch...I ask her doesn't she get tired of the same old thing and she says no..As long as she is eating and happy it's fine with me She is 11 and her lunch everyday is a peanut butter and banana sandwich,her favorite snack an apple.
•    Anonymous said... My guy seems to have a different 'preferred food' every week or 10 days or so. They rotate, but generally it's pizza or pasta or indian food or ethiopian food or salad with feta cheese and olives. Period. Nothing else. Which ever preferred food it is that day is all he'll eat all day, for days. And I never know when it's going to switch, or to what, so I often find I'm not prepared for the switch and melt down ensues. I don't have any answers. Luckily my guy isn't a huge processed food kind of guy. But I have learned that once I introduce a food it may, or may not, end up on his preferred foods list. So if I don't want him eating pizza pops all day for days on end, I need to never introduce pizza pops. Not once. That happened with us with frozen pizza. Always made my own until one day broke down and bought a frozen one because too tired to make one and now he 'prefers' frozen and expects frozen every day all day when it's his preferred food. I've had to try all sorts of tricks to try to get him to revert back to homemade pizza and we've had many meltdowns. Lesson learned. Never never never introduce a food I don't want him living off of.
•    Anonymous said... My son is 10 and also eats micro pizza or pasta with pesto for virtually every meal. I just try to make sure he is eating fruit etc for snacks so that he is getting some nutrition.
•    Anonymous said... my son is 21 with aspergers and thats all he eats
•    Anonymous said... My son is the same way, he has a limited amount of foods he eats and when he is stuck on one thing right now pizza bagels he wants them morning noon and night! Then he will get tired after a while and move to something else like Mac and cheese etc etc
•    Anonymous said... my son only eats a few items of food worries me but he wont try anything else
•    Anonymous said... Oh I can so relate! My son is 10 and between cereal and frozen chicken patties and the occasional ravioli he will not try anything new. No fruit no veggies. He will throw up if he doesn't want it. Only kid I know who won't even eat French fries.
•    Anonymous said... Oh my, I just wrote a blog post about this very thing! LOL - not the pizza rolls, but a preteen with ASD & eating issues
•    Anonymous said... sorry to laugh , but my son just got home and asked me for pizza rolls..
•    Anonymous said... We have rules with food in our home. You eat what we're all having for our meals. I let the kids vote on the menu every week and that makes things easier. I have two aspies and an aspie husband. It works very well for our family. My oldest is 12 and she's a proud aspie. She's usually the one begging for cabbage, brussel sprouts, steamed carrots, etc.
•    Anonymous said... It's simple, you stop buying them and explain why. Eventually they will accept something else, going hungry for a few days won't kill most kids.
•    Anonymous said... My 10yo dd strongly refuses new foods but we have a house rule "everyone must, a least, try one bite of everything served each meal." Usually she says she likes it but most of the time will not voluntarily eat it again.
•    Anonymous said... My kid can go hungry for a LOOOOONG time. Its never "simple" like denying them what they will eat (as opposed to what they should).
•    Anonymous said... My son is 19 and he eats the same foods over and over. He does however try new things as long as they do not contain the foods he despises like "cheese and creamy substances". I find it odd that he will eat pizza with cheese....
•    Anonymous said... Sometimes it can be a sensory thing. Once we got meds for one of the kids, his appetite changed.
•    Anonymous said... Vitiams help to supplement nutrition that the child is not getting. It is not the answer but will help. Goodluck.
•    Anonymous said... What if you don't buy pizza rolls?
*   Anonymous said... Don't give up, but do give in and adapt when you need to. It's best to make it a secret give in! When you realize it's a losing battle, fight the same cause for the rest of the day and change strategy the next day so they don't see that they directly effected your decisions. Keep encouraging better eating, try to have very short little grocery shopping trips with just that child where they pick the food, get the pizza rolls "if" they can pick something healthy to try too. Make it fun and buy the milk and bread alone later. That's all the power you have. Withholding food is a terrible idea, my son will not eat until he gets the opportunity to eat what he likes. In my experience these kids don't "get hungry" like most people. If you are blessed with a oppositional child you can use that to your advantage. I have recently had great success with telling my oppositional 12 year old the truth about the fact that these companies make these foods to taste good to trick us into paying high prices for cheap junk. Then get a few similar recipes to try at home, and at least you know what's in them. Finger foods are the only thing my guy eats, using utensils and saucey stuff is a sensory no-no and only endured when absolutely necessary = for poutine! And, if it's anything like my experience, it's a phase and soon pizza rolls will be the last thing your kid wants. It's hard to not feel like a bad mom when our kids don't eat a well balanced diet. You will see there are these high achieving parents out there that want us to think they have it all together but they don't or they were just lucky that their kid's a good eater. I know I am really making a difference for my son and he will be my greatest accomplishment. My neuro typical daughter could be raised by dogs and adapt well, I will get very little credit for the awesome woman she will be.

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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 ASD level 1, or 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 HFA teens is a serious condition – it affects emotions, thought and behaviors. Although adolescent depression isn't medically different from depression in grown-ups, 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.

Warning signs that your 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 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.

Resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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