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Common Social Deficits of Kids on the Autism Spectrum

“Is it common for a child with high functioning autism to have difficulty interpreting the messages others give in conversations? Our son does not seem to understand the rules of social interactions. If he doesn’t understand what someone is saying or doing, he will always be unable to give the appropriate response.”

Yes, these issues are very common. This is why social-skills training in crucial for young people with High-Functioning Autism and Asperger’s. Skills that “typical” children gain naturally do not become so automatic for kids on the spectrum. Below are some of the socially-related deficits that are part of the disorder.

The child may:
  • “Tell” on peers, breaking the “code of silence” that exists (he will then be unaware why others
    are angry with him).
  • Avert eye contact, or keep it fleeting or limited.
  • Avoid observing personal space (is too close or too far).
  • Avoid turning to face the person he is talking to.
  • Be unable to use gestures or facial expressions to convey meaning when conversing.
  • Be unaware of unspoken or “hidden” rules.
  • Confront another person without changing his face or voice.
  • Engage in self-stimulatory or odd behaviors (e.g., rocking, tics, finger posturing, eye blinking, noises such as humming/clicking/talking to self).
  • Fail to assist someone with an obvious need for help (e.g., not holding a door for someone carrying many items or assisting someone who falls or drops their belongings).
  • Fail to gain another person's attention before conversing with them.
  • Have body posture that appears unusual.
  • Experience difficulty with feelings of empathy for others. 
  • Have interactions with others that remain on one level, with one message.
  • Have tics or facial grimaces.
  • Ignore an individual’s appearance of sadness, anger, boredom, etc.
  • Lack awareness if someone appears bored, upset, angry, scared, and so forth (therefore, he does not comment in a socially appropriate manner or respond by modifying the interaction).
  • Have little awareness of the facial expressions and body language of others, so these conversational cues are missed.
  • Lack facial expressions when communicating.
  • Laugh at something that is sad, or ask questions that are too personal.
  • Look to the left or right of the person he is talking to.
  • Make rude comments (e.g., tells someone they are fat, bald, old, have yellow teeth).
  • Respond with anger when he feels others are not following the rules.
  • Discipline others or reprimand them for their actions (e.g., acts like the teacher or parent with peers).
  • Smile when someone shares sad news.
  • Stare intensely at people or objects.
  • Talk on and on about a special interest while unaware that the other person is no longer paying attention, talk to someone who is obviously engaged in another activity, or talk to someone who isn’t even there.
  • Touch, hug, or kiss others without realizing that it is inappropriate.
  • Use facial expressions that do not match the emotion being expressed.
  • Use gestures, body language, or facial expressions infrequently or atypically when interacting with others.

Also, when questioned regarding what could be learned from another person's facial expression, he may say, “Nothing.” Faces do not provide him with information. Unable to read these “messages,” he is unable to respond to them.

For information on providing social-skills training, click on the link below…

==> Teaching Social Skills and Emotion Management
 
More resources for parents of children and teens on the autism spectrum:
 

==> Videos for Parents of Children and Teens with ASD
 
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Helping Kids on the Autism Spectrum to Develop Their Own “Emotional Toolbox”


Perhaps one of the best techniques we as parents of kids with ASD level 1, or High-Functioning Autism, can employ is the creation of an “emotional toolbox” designed to help the child to “repair” his or her feelings.

Most kids know that a toolbox usually includes a variety of tools to repair a machine, for example. So, parents can begin discussion and activities that are used to identify different types of “tools” for specific problems associated with feelings.

For example:
  • One type of “emotional repair tool” can be a paintbrush, which can be used to represent relaxation tools that lower the heart rate (e.g., drawing, reading, listening to calming music, etc.).
  • A picture of a manual can be used to represent thinking tools that are designed to improve cognitive processes (e.g., phrases that encourage reflection before reaction). James, a young man with ASD, developed his “antidote to toxic thoughts” through the use of this tool. He developed a “stop and think first” technique whenever he was upset and about to lash-out at someone.
  • A two-handle saw can be used to represent social activities or people who can help repair feelings (e.g., communication with someone who is known to be sympathetic and able to alleviate negative feelings). This can be by spoken word or typed communication, enabling the child to gain a new perspective on the problem and providing some practical advice. 
  • Another type of emotional repair tool can be represented by a hammer, which signifies physical “tools” for calming down (e.g., going for a walk, bouncing on a trampoline, crushing empty cans for recycling, etc.). The goal here is to repair emotions constructively by a safe physical act that increases the heart rate. One child with Asperger’s explained how running around the yard “takes the fight out of me.”

The idea is to provide a “repair statement” (i.e., self-talk) for the autistic child that counteracts his or her negative thoughts. For instance, “I can't deal with this (a toxic or negative thought), but I can do this with mom’s help (positive thought or antidote).” 
 

The child can also be taught that becoming overly-emotional often inhibits his or her intellectual abilities in a particular situation that requires good problem-solving skills. The self-talk here might be, “When I’m angry and frustrated, I need to cool down so I can think about how to solve this problem.”

The concept of a toolbox can be extremely helpful in enabling the youngster with ASD not only to repair her own feelings, but also to repair the feelings of others. Kids on the spectrum often benefit from instruction in learning what tools to use to help friends and family - and which tools others use - so that they may borrow tools to add to their own emotional repair kit.

Humor and imagination can be used as “thinking tools.” Contrary to popular myths, young people on the spectrum greatly benefit from laughter, can enjoy jokes typical of their developmental level, and can be very creative with puns and jokes.

Parents should also have a discussion of “inappropriate tools” (e.g., one would not use a hammer to fix a wrist watch) to explain how some actions (e.g., violence) are not appropriate emotional repair mechanisms. For instance, one child with Asperger’s would slap himself to stop negative thoughts and feelings, which only had a very temporary effect and did not solve the problem.

Another tool that could become inappropriate is for the child to repeatedly retreat into his fantasy world (e.g., imagining he is a superhero), or to plan retaliation. The use of escape into fantasy literature and games can be a typical tool for ordinary children. But for kids on the autism spectrum, escape is of concern when it becomes the exclusive coping mechanism (e.g., the fine line between fantasy and reality may be unclear to the child).
 

Another concern is when daydreams of retaliation to teasing/bullying are expressed in drawings, writing, and threats. Although this may be a typical means of emotional expression, there is a concern that the expression is misinterpreted as an intention to carry out the fantasy – or may be a precursor to retaliation using weapons.

Talking to pets as a “social tool” in preference to talking to friends or developing relationships with people is another inappropriate tool in some cases.

“Unusual tools” should also be discussed. For instance, one teenage girl with Asperger’s explained that, “Crying doesn't work for me, so I get mad.” In this case, tears were a rare response to feeling sad, with a more common response to sadness being anger, which caused others to misinterpret her behavior.

Another unusual tool is that of being quick at resolving grief and serious tragedies (e.g., death of a loved one). This trait can be of concern to the child’s parents, who expect the classic signs of prolonged and intense grieving. Parents may view the child as uncaring, yet the rapid recovery is simply a characteristic of the disorder.

Developing an emotional toolbox to “fix” feelings is a way to improve a child’s self-esteem, train her to be able to relate to others effectively, and help her develop a sense of how she learns best in the area of social skills and emotional control.

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

==> Videos for Parents of Children and Teens with ASD
 
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Affective Education: Teaching Children on the Autism Spectrum About Emotions


Does your child have difficulty expressing troubling emotions using his or her words rather than acting-out? Does your child seem to lack an understanding about the emotions of other people? If so, here are some ways to educate your child on the subject:

The main goal of Affective Education is to teach children with ASD level 1, or High-Functioning Autism (HFA), why they have emotions, their use and misuse, and the identification of different levels of expression. A basic principle is to explore one emotion at a time as a theme for a project.

The choice of which emotion to start with is decided by the parent (or teacher), but a useful starting point is happiness or pleasure. A scrapbook can be created that illustrates the emotion. This can include pictures of people expressing the different degrees of happiness, but can be extended to pictures of objects and situations that have a personal association with the feeling (e.g., a photograph of a rare lizard for a child with a special interest in reptiles).

The content of the scrapbook also can include sensations that may elicit the feeling of happiness or pleasure (e.g., aromas and textures), and/or can be used as a diary to include compliments, and records of achievement (e.g., certificates and memorabilia).
 
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

Affective Education includes the parent describing - and the child discovering - the relevant cues that indicate a particular level of emotional expression in facial expression, tone of voice, body language, and context. The face can be described as an “information center” for emotions.

The typical errors that children with HFA make when trying to comprehend emotions include not identifying which cues are relevant or redundant, and misinterpreting cues. The parent can use a range of games to “spot the message” and explain the multiple meanings (e.g., a furrowed brow can mean anger or bewilderment, or may be a sign of aging skin; a loud voice does not automatically mean that an individual is angry).

Once the key elements that indicate a particular emotion have been identified, it’s important to use an “instrument” to measure the degree of intensity. The parent can construct a model “thermometer,” “gauge,” or volume control, and can use a range of activities to define the level of expression (e.g., the parent can create a selection of pictures of happy faces and place each picture at the appropriate point on the instrument).

Some kids on the spectrum can use extreme statements (e.g., “I am going to kill myself”) to express a level of emotion that would be more moderately expressed by a “non-autistic” child. During a program of Affective Education, the parent often has to increase the child’s vocabulary of emotional expression to ensure precision and accuracy.

Affective Education not only includes activities to detect specific degrees of emotion in others - but also in oneself. The child (and those who know him well) can create a list of his physical, cognitive, and behavioral cues that indicate his increase in emotional arousal. The degree of expression can be measured using one of the special instruments mentioned earlier (e.g., an emotion thermometer). One of the aspects of Affective Education is to help the child perceive his “early warning signals” that indicate emotional arousal that may need cognitive control.
 
==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

When a particular emotion and the levels of expression are understood, the next part of Affective Education can be to use the same procedures for a contrasting emotion. For example, after exploring happiness, the next emotion explored might be sadness. Feeling relaxed would be explored before a project on feeling anxious. In addition, the child should be encouraged to understand that certain thoughts or emotions are “antidotes” to other feelings (e.g., some strategies or activities associated with feeling happy may be used to counteract feeling sad).

Many children with HFA have considerable difficulty translating their feelings into conversational words. The parent can create “comic strip conversations” that use figures with speech and thought bubbles (e.g., a cartoon of an angry boy who is thinking to himself, “I’m really upset right now”).

Other activities to be considered in Affective Education are the creation of a photograph album that includes pictures of the child and family members expressing particular emotions, or video recordings of the child expressing her feelings in real-life situations. This can be particularly valuable to demonstrate the child’s behavior when expressing anger.

Another activity called “Guess the Message” can include the presentation of specific cues to indicate doubt (e.g., a raised eyebrow), surprise (e.g., wide-opened mouth and eyes), disgust (e.g., crinkled nose with tongue sticking out), and so on.

Lastly, it’s important to incorporate the child’s special interest in the program (e.g., a child whose special interest is the weather and has suggested that his emotions are expressed as a weather report). 


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

==> Videos for Parents of Children and Teens with ASD
 
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Why Teens on the Autism Spectrum Can Suffer from Depression

“I’m concerned that my son is depressed (17 y.o.). Is this something that happens along with high functioning autism? If so, why? How can I know for sure if he is really struggling with depression? He has made some off-handed comments about wanting to kill himself. How seriously do I need to be taking these comments?”

Depression seems to be common among teens and young adults with High-Functioning Autism (HFA) and Asperger’s (AS). Many of the same deficits that produce anxiety often unite to produce depression.

The relationship between serotonin functioning and depression has been explored in detail in this population. There is good evidence that serotonin functions may be impaired in kids and teens on the autism spectrum, which suggests that depression is a common comorbid condition.

In addition to impaired serotonin functioning, (a) deficits in social relationships and (b) poor coping-strategies that allow the teenager to compensate for disappointment and frustration may fuel a vulnerability to depression. (As a side note, there is some genetic evidence suggesting that depression and social-anxiety are more common among first-degree relatives of autistic kids, even when accounting for the subsequent effects of anxiety.)

Because some features of depression and autism spectrum disorders overlap, it is important to track that the changes in mood are a departure from baseline functioning. Therefore, the presence of social withdrawal in a teen with the disorder should not be considered a symptom of depression unless there is an acute decline from his or her baseline level of functioning.

Another important point is that the core symptoms of depression should arise together. Therefore, the simultaneous appearance of symptoms would point to depression (e.g., decreased energy, further withdrawal from interactions, irritability, loss of pleasure in activities, sadness, self-deprecating statements, sleep and appetite changes).

An additional point is that teens who display “affective” (i.e., relating to moods and feelings) and “vocal monotony” (i.e., a droning, unchanging tone) are at higher risk for having their remarks minimized by peers, which often gives the HFA or AS teen the impression that he “doesn’t matter” – which in turn can fuel depression.

Some teens on the autism spectrum can make suicidal statements in a manner that suggests an off-hand remark, without emotional impact. When comments are made this way, parents may underestimate them. The content of such comments may be more crucial than the emotional emphasis with which they are delivered. Thus, comments around “wanting to die” should be taken very seriously.

Medications that are useful for treatment of depression in kids and teens on the spectrum are serotonin reuptake inhibitors, although no medications have been shown to be particularly more beneficial for depressive symptoms in people with the disorder. Therefore, the decision as to which medications to use is determined by side-effect profiles, previous experience, and responses to these medications in other family members.

 ==> Discipline for Defiant Aspergers & High-Functioning Autistic Teens
By

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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What the Future Holds for Your Teenager on the Autism Spectrum

"I would like to know what to expect from a high functioning autistic child in the teenage years. My son was diagnosed 2 years ago. I know they say that they can suffer from this and that, but what is the long-term goal, what can we expect, what not to expect?"

Young people with ASD level 1 or High-Functioning Autism (HFA) often have a difficult time between the ages of 13 and 19. They may be socially excluded and face rejection by their peers if they act differently from others. They want to be accepted and liked, but often don’t know how to behave and communicate appropriately. School is demanding and they long for friends. The goal for your HFA son is to make it through the teen years with the following:
  • his self-esteem intact
  • at least a friend or two
  • knowledge that his family loves him
  • a high school diploma
 
There are some teens that manage to navigate these years successfully because they don’t care about peer pressure and focus on a special interest of their own (e.g., chess or computers). So, encouraging your son to develop a special interest may help him at this time of life. A special interest may encourage friendships with other teens that have the same interest as well, making it easier to talk to and make friends with others.
 
==> Parenting System that Significantly Reduces Defiant Behavior in Teens with High-Functioning Autism

A big problem for HFA teens is that often they don’t care about fads, clothing, celebrities, and teen communication devices (e.g., cell phones or Facebook). Your son’s interests may be more appropriate for younger children. Boys may be rejected if they are not interested in sports. Some of these issues can be resolved, though.

Help your son become aware of teen fads and how to talk about sports, celebrities, rituals, and school events. Encourage him to leave text messages for and arrange social engagements with peers. Perhaps he could join school clubs, especially those that focus on his special interest. Explain to your teen that he does not have to tell everyone that he has the disorder. He may enjoy talking with other HFA teens in internet chat rooms.

Your son may ignore personal hygiene and wear clothes and a haircut that are not in style. Find a same sex friend who will help him choose appropriate clothes to wear. Monitor your teen’s hygiene and create reminder notes or charts for him about daily bathing, tooth brushing, etc. Reward him for good hygiene, if that’s what it takes!

“Special needs” teens are sometimes not very well-informed about sex and dating. Boys may be very naïve or too forward with girls. Hormones cause rampant emotions, which HFA teens can’t handle. If they get angry, they may physically attack others or have a “melt down.”

You must teach your teen about sex. Provide books for him to read. Choose books that aren’t overly “clinical.” Be specific and detailed about safe sex. Never be judgmental or punish him when he confides in you; instead, counsel him. Boys need to be told that masturbating should take place only at home, in private. Teens on the autism spectrum often respond to “rules” by obeying them. Establish some rules for your son (e.g., “We have a rule in our house that teenagers should not have sex because they are too young to handle the emotions and problems that may occur”).

Some HFA teens develop problems with drugs and alcohol because they are eager to do what other teens do. They are not able to determine a “good” crowd from a “bad” crowd. Other teens may take advantage of your son’s eagerness to be liked and convince him to buy and/or take alcohol or drugs. You must always know where your son is, who he is with, what he is supposed to be doing, and the characters of the other teens he hangs around. Emphasize that drugs and alcohol are illegal. Teens on the spectrum are “rule-oriented,” so this may help your son avoid problems.

HFA teens may have school problems because of the difficulty in dealing with more than one teacher. Each classroom is a different environment, which may be confusing. Some teachers may be hostile. Some assignments may be overwhelming. Keep in close touch with your son’s teachers. A placement into Special Education may be necessary when a teen on the spectrum enters middle school. Some tens on the spectrum need special classes even though they didn’t before.

Make sure your son has a “safe place” at school where he can share emotions with a teacher, nurse, guidance counselor, or psychologist. If your son experiences harassment and/or rejection at school and the staff does not help, a special education placement or a therapeutic boarding school can give professionals a chance to assist your teen academically and socially.

Suicide may become a possibility for a few teens with autism. If you have any worries about this, get help immediately from a psychologist or psychiatrist.
 
==> Parenting System that Significantly Reduces Defiant Behavior in Teens with High-Functioning Autism

Use reasoning and negotiation with your son, instead of orders. If possible, give him two choices rather than telling him what he must do in a situation. He will have more control over his life and feel less resentment. He will be less likely to listen to you (like all teens!) at this age and may exhibit anger and impatience. He may hate school and resist everything you want him to do. Depression is common. If these problems occur, your son may need counseling.

Most autistic teens learn to drive successfully because they obey the rules! Have your son carry a cell phone and a card that explains the disorder. Teach him to call you in a crisis and to give the card to any police officer who stops him. Role play with him so he knows what to do and say if stopped by an officer.

Some teenagers on the autism spectrum do well in summer jobs in an area of special interest or with little contact with the public. Occupational therapy will help your son get ready for adulthood. Special programs are available that teach job and living skills. This will reduce his dependency on you. And above all, ask for help from professionals when you or your son need it.



==> Has your child on the autism spectrum been experiencing a lot of sadness lately? If so, here are a bunch of suggestions to assist in the matter...

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

==> Videos for Parents of Children and Teens with ASD
 
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Here’s what other parents have had to say:

• Anonymous said… All of this is happening with my 15-year-old HFA. It can be heartbreaking for the parent. I just take it day by day.
• Anonymous said… Great article
• Anonymous said… Great article! My HFA is 39 & married now but that article was spot on with ways to help them through it.
• Anonymous said… I have a 16-year-old son that has not been diagnosed yet, but it is very obvious to us he is an HFA. Personally, I am very happy he is not interested in the 'teen fads", makes life much easier in my opinion. He could use a few friends though.
• Anonymous said… I will be homeschooling my son next year. I knew this would start happening. Just glad I have the option to homeschool:)
• Anonymous said… Nice article. My son who is now 17 has faced some of those issues and through counseling has been able to overcome many difficulties. He had a much rougher time in the early teens. Now he is more comfortable in his own skin. He doesn't necessarily follow trends in clothes, has let his hair grow. Still needs reminders with hygiene every now and then, but I believe he is on the road to independence. I want my son to have as beat normal life as possible, I don't want his condition to limit his potentials and who he will be. He can achieve greatness because he is a good kid. He gives me a hard time, but what teenager doesn't. I take it as a phase and guide him in all I can. His school has been very supportive and his peers accept him for who he is. Even when people snicker about him, he pays them no mind. I do like the advice about the HFA card in the wallet. He is learning how to drive and this is a good idea for when he will be driving by hi self and gets stopped by the police. Thanks for sharing this article.
• Anonymous said… Thank you for the article. My son turns 13 this year, I am sure I will be putting this info to good use.
•    Anonymous said... My son Liam is now 14. The best thing I did was have a behavior specialist come to the house once a week, which insurance covers, to help with things throughout the years like facial recognition, conversation with others, even just sitting in his chair and not crawling under the table when he got upset. He grew, matured, and learned, slower than the other kids yes, but still slow and steady learned to manage his behaviors. Now that he is a teenager he decided to do virtual school at home because the business of school, hallways, and other kids faired to distracting for him. He is doing great. Good grades, on a bowling team, has a few friends. Best thing you can do is join you child in something if they are not noise sensitive. It gives them a sense of belonging to a team. Liam started when he was 7 and is still on the team. He does his own laundry, vaccums his room, manages his schedule, takes care of his cat. Can't wait till he can get a job. So proud of him. So to answer your question an hour later lol you have lots of great stuff to look forward to if you get the right help. Also the behavior specialist made me feel like I had someone on my side and I wasn't alone. Relieved some of the stress.
•    Anonymous said... My daughter uses a note book to communicate with teachers, when she feels she can't talk or ask something. She has a brilliant sen support net work at school too and I have one main person who communicates everything to me. Her mood swings can change so quickly that each day is different, just make sure you keep talking to each other x
•    Anonymous said... I found Social Thinking books for teens excellent resource for your teen and you to read (very appealing to teens for how to on social stuff while insightful for parents) An advocate for you and student at school is huge. I truly enjoy communicating with my son and his perspective. Reason, logic, and showing you respect his viewpoint, but he must do the same. Clear, consistent logic. Plus if you want to hear about your teen's day tell them about yours, a chance to walk him through social situations at school.
•    Anonymous said... expect nothing, take each day as it comes and keep clear communication with him as much as possible, try to get him to tell you his feelings and opinions on things so you'll have an idea of how he's perceiving the world, make sure school are on board and check with him which teachers he trusts the most, these are the ones you need the most contact with so you can be part of the same team in helping him, as for hormones, expect the same as you'd expect from any teen. 

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