15.5.17

High-Functioning Autistic Teens and Oppositional Defiance

“I have a 14-year-old son with high functioning autism who behaves in a way that mystifies me...I cannot do anything right, according to him. I had never heard of Oppositional Defiant Disorder, and after reading the symptoms, I think that he should be seeing a doctor about possibly having this disorder. I have noticed symptoms like the ones mentioned in him since he was very young.  I have tried to talk to him about it and he has told me that he feels out of control at times with his temper, especially when it comes to people of authority. I have learned to not talk about anything he might turn on. I e-mail him across the house and have learned to speak to him in his language. Is it possible for a child to have both disorders? What action should parents take in these cases?”

Many parents have difficulty recognizing the difference between a strong-willed, emotional teen with High-Functioning Autism (HFA) or Aspergers’ (AS) and one with Oppositional Defiant Disorder (ODD). Clearly, there's a range between the usual independence-seeking behavior of teens and out-of-control defiant behavior. It's normal to exhibit oppositional behaviors at certain stages of an adolescent’s development. However, your teen’s issue may be more serious if his behaviors:
  • Have lasted at least six months
  • Are persistent
  • Are clearly disruptive to the family or school environment

The following are behaviors associated with ODD:
  • Tantrums
  • Spiteful or vindictive behavior
  • Refusal to comply with adults’ requests or rules
  • Difficulty maintaining friendships
  • Deliberate annoyance of other people
  • Blaming others for mistakes or misbehavior
  • Argumentativeness with parents, teachers and other authority figures
  • Anger and resentment
  • Aggressiveness toward siblings and peers
  • Acting touchy and easily annoyed
  • Academic problems



Oppositional defiant behavior often occurs along with other behavioral or mental health problems, such as autism spectrum disorders, depression, ADHD, and anxiety. The symptoms of defiant behavior may be difficult to distinguish from those of other behavioral or mental health problems. It's important to diagnose and treat any co-occurring disorders, because they can create or worsen irritability and defiance if left untreated.

Stressful changes that disrupt an HFA or AS teen's sense of consistency increase the risk of disruptive behavior. However, though these changes may help explain disrespectful or oppositional behavior, they don't excuse it.

If your HFA or AS teen has signs and symptoms common to ODD, make an appointment with your physician. After an initial evaluation, the physician may refer you to a mental health professional who can help make a diagnosis and create the right treatment plan for your teen.

==> Discipline for Defiant Aspergers and High-Functioning Autistic Teens

Here's some information to help you prepare for an appointment:
  1. Write down your family's key personal information (e.g., factors that you suspect may have contributed to changes in your teen's behavior).
  2. Make a list of stressors that your teen or close family members have recently experienced.
  3. Write down the signs and symptoms your teen has been experiencing – and for how long.
  4. Take a trusted family member or friend with you to the appointment. Someone who accompanies you may remember something that you missed.
  5. Make a list of your teen's key medical information (e.g., any physical or mental health conditions that he has been diagnosed with).
  6. Write down the names of any medications your teen is taking (include any over-the-counter medications).
  7. Write down questions to ask the physician in advance so that you can make the most of your appointment.

Questions to ask the doctor if your HFA or AS teen is referred to a mental health provider include:
  1. What treatment approach do you recommend?
  2. What factors do you think might be contributing to my teenager’s issues?
  3. What else can I and my family do to help my teenager?
  4. Should he be screened for any other mental health problems?
  5. Should I tell his teachers about this diagnosis?
  6. Is this condition likely temporary or chronic?
  7. Is my teen at increased risk of any long-term complications from this condition?
  8. Do you recommend family therapy?
  9. Do you recommend any changes at home or school to encourage my teen’s recovery?
  10. What do you believe is causing his symptoms?
  11. Are there any other possible causes?

Being ready to answer the physician's questions may reserve time to go over any points you want to talk about in-depth. You should be prepared to answer the following questions from your physician:
  1. What are your teen's symptoms?
  2. When did you first notice these symptoms?
  3. How would you describe your teen's home and family life?
  4. How often over the last six months has your teen been touchy, easily annoyed or deliberately annoying to others?
  5. How often over the last six months has your teen been spiteful or vindictive, or blamed others for his own mistakes?
  6. How often over the last six months has your teen been angry or lost his temper?
  7. How often over the last six months has your teen argued with you or his teachers?
  8. How often has he refused to follow through with your rules or requests?
  9. How have you been handling your teen's disruptive behavior?
  10. How do you typically discipline your teen?
  11. Have your teen's teachers reported similar symptoms?
  12. Has your teen been diagnosed with any other medical conditions?
  13. Do any particular situations seem to trigger defiant behavior in your teen?

Treatment—

Treating oppositional defiant behavior (whether or not your teen has a formal diagnosis of ODD) involves several types of psychotherapy and parent-education training. The cornerstones of treatment for oppositional defiance usually include:

1. Social skills training: Your teen may benefit from therapy that will help him learn how to interact more positively and effectively with peers.

2. Parent training: A mental health provider with experience treating oppositional behavior may help you develop skills that will allow you to parent in a way that's more positive and less frustrating for you and your teen. In some cases, your teen may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems. As part of parent training, you may learn how to:
  • Remain calm and unemotional in the face of opposition.
  • Recognize and praise your teen's good behaviors and positive characteristics.
  • Offer acceptable choices to your teen, giving him a certain amount of control.
  • Limit consequences to those that can be consistently reinforced and last for a limited amount of time.
  • Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the teen.
  • Avoid power struggles.
3. Individual and family therapy: Individual counseling for your teen may help him learn to manage anger and express his feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.

4. Cognitive problem solving training: This type of therapy is aimed at helping your teen identify and change through patterns that are leading to behavior problems. Research shows that an approach called collaborative problem solving — in which you and your teen work together to come up with solutions that work for both of you — is highly effective at improving oppositional-related problems.

Although some parent-management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience. Most important in treatment is for you to show consistent, unconditional love and acceptance of your HFA or AS teen — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient mom or dad.

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Parenting Strategies—

At home, you can begin chipping away at problem behaviors in your HFA or AS teen by practicing the following:
  • Develop a united front. Work with your partner/spouse to ensure consistent and appropriate discipline procedures.
  • Set up a routine. Develop a consistent daily schedule for your teen. Asking your teen to help develop that routine can be helpful.
  • Set limits and enforce consistent reasonable consequences.
  • Recognize and praise your teen's positive behaviors. Be as specific as possible (e.g., "I really liked the way you helped pick up your room tonight").
  • Pick your battles carefully. Avoid power struggles. Almost everything can turn into a power struggle — if you let it.
  • Model the behavior you want your teen to exhibit.
  • Build in time together. Develop a consistent weekly schedule that involves you and teen being together.
  • Assign your teen a household chore that's essential and that won't get done unless he does it. Initially, it's important to set your teen up for success with tasks that are relatively easy to achieve, then gradually blend in more important and challenging expectations.
  • Take care of yourself. Counseling can provide an outlet for your own mental health concerns that could interfere with the successful management of your teen's defiant behavior. If you're depressed or anxious, that could lead to disengagement from your teen, which can trigger or worsen oppositional behaviors. Let go of things that you or your teen did in the past. Start each day with a fresh outlook and a clean slate. Learn ways to calm yourself, and take time for yourself. Develop outside interests, get some exercise, and spend some time away from your teen to restore your energy.
  • Remind yourself that your teen’s defiance is most likely a temporary inconvenience rather than a permanent catastrophe.

At first, your teen is not likely to be cooperative or appreciate your changed response to his behavior. Setbacks and relapses are normal, so be prepared with a plan to manage those times. In fact, behavior often temporarily worsens when new limits and expectations are set. However, with persistence and consistency, the initial hard work will pay off with improved behavior.





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… Absolutely possible! My daughter has High Functioning Autism and ODD. We have found that by changing how we approach certain triggers, we can avoid the ODD eruptions. If she does blow up, we've also learned that it is not the time to push her or try to persuade her unless it is a safety issue. she can only have a learning experience once she has calmed down.
•    Anonymous said… Following. Yes please which meds have been given and which worked best in your situations
•    Anonymous said… I am exhausted! What meds have helped? I have a 17 year old with Aspergers and a suspected ODD diagnosis.
•    Anonymous said… I believe it to be under the umbrella... ocd and add/odd are subcharacteristics of HFA and Aspergers. My son was orignianlly diagnosed ODD/OCD/Major Depression (missing the BIGGER picture for a couple of years until finding a doctor who knew what Aspergers looked like). Once medicated (this took time to find right fit), years of counselling and finding something he enjoyed and was good at, much of the ODD symptomology extinguished. It's understandable how one would be oppositional when his/her life is so "out of control"- anger, fear, frustration all leads to a normal brain to want to gain control over his/her environment; couple that with the angst of teenage years for the neurotypical as well and you have a big mess. Most difficult years for me and mine were ages 11 to 16. Again, medication helped tremendously; in addition to, all of the other components to a comprehensive plan (counselling, family support). I point to the medication because if one is crawling out of his/her own skin...behavior modification will not work. My son is 31 today, still medicated and is successful and happy (gainfully employed, lives on his own, is delightful). It's a long hard road, but worth the pain.
•    Anonymous said… I do think it is unfortunate to label a particular behaviour as a disorder. We have had occasions over the years when my son has dug his heels in and refused to do as expected of him. He quite logically explains that he is unable to comply with our expectations at times when he doesn't feel in control of a situation and feels over-anxious. He is 19 now and recently started playing guitar. A family friend helps run a folk club and invited us to go along. I was amazed the first time that Oliver got up when invited and performed in front of everybody. He attended again on the next meeting and again performed. My friend had arranged to pick up us again a couple of weeks later and I was so looking forward to this but Oliver made it clear that he wan't going to go this time. I was disappointed but nothing would persuade him. AFTER the event when I was able to talk to Oliver calmly he explained that he just hadn't felt ready with his new song but would go again in the future when he felt better prepared. We have been a couple of times since. The real problem over the years was always my own frustration with his decisions when they interfered with my own plans but if I stayed objective and calm we could in due course talk things over together. I could help Oliver understand my disappointment when things didn't go as planned and Oliver would help me see how difficult it was for him to do things if he was over-tired, unprepared, stressed or just having a bad day.
•    Anonymous said… I have looked at PDA and although there are similarities with ODD and PDA, our son is definitely ODD and both of these diagnoses can operate in ASD. We have been on our journey for more than five years and with therapy, medication and great support we've made incredible accomplishments with our son. It is as many have said though...very exhausting.
•    Anonymous said… PDA strategies are ery different to strategies for ODD. Reducing demands and providing an anxiety free environment is ideal. Anxiety free isnt possible but a happier calm child has a better chance of learning strategies to deal with demands.
•    Anonymous said… I was that child...tho they did not have a label for it back then. I would recommend to be respectful and ackowledge his feelings but at the same time dont walk on egg shells. Use "i" statements like "i need u to..." and avoid labels like "youre" this and that etc. At the same time clear boundaries and expectations and a consistant reward and consequence system. Another huge thing is the consequence having something to do with the action and not being a punishment. I know this wouldve helped if my parents had known better. but i got a lot of name calling from my parents and was made fun of by kids at school as well as my parents. It cannot have been easy for them and they mustve gotten some relief out of letting off some steam. A psychiatrist even recommended that they slap me (yes a westwood, ma psychiatrist who is still practising). I would say that has been the most detrimental thing to my aspergers and ODD and would not recommend it.
•    Anonymous said… I've never heard of ODD but it sounds like my daughter might have this. Thanks for mentioning it.
•    Anonymous said… My aspie gas O.D.D. & believe, it's a challenge!!!!
•    Anonymous said… My daughter was dx with ODD 10 years ago and it never sat right with me, after researching PDA I believe she has that
•    Anonymous said… My son has Asperger's and O.D.D. We are also questioning P.D.A. but CAMHS aren't keen on giving it as a diagnosis. Worth reading about it though. My son is 15, not hit puberty yet and it's really hard going most of the time x
•    Anonymous said… My son has both its very difficult and trying  😣
•    Anonymous said… My son is 14 and is diagnosed ODD, Aspergers and Mixed Mood/Anxiety. His first diagnosis was ODD aged 9.
•    Anonymous said… My son is on seraquel, Prozac and trazadone ..he's 18 and doing much much better, hang in there!
•    Anonymous said… My son was diagnosed when he was 4 with ASD ADHD and odd its a real challenge to say the least..
•    Anonymous said… My sons defiance seems to come from anxiety. Wanting to gain/regain control because he frequently feels powerless or vulnerable. Not sure if he has ODD but giving him explanations about why things need to be done and helping him find ways to feel more in control and powerful sometimes has really helped. The more I push the more he pushes back. You have to bend and manoeuvre. Tiring and time consuming but works for us.
•    Anonymous said… Not only possible..very likely, Autism always pairs with another disorder from what I have been told through the many hospitals and psychiatrists we have seen, my son who is 18 now was diagnosed with both way back when, it's a long hard struggle and a lot of work, do the testing for diagnosing ..stay strong friend!
•    Anonymous said… ODD and Aspergers combined have been the most challenging diagnoses I have ever encountered! I am worn out as a parent. Meds have helped but it has been a tough journey.
•    Anonymous said… Our 11 year old is on the Spectrum as high functining (aka Aspergers) with multiple diagnoses, one being ODD. We have him in therapy and he's learning how to manage it. It is definitely exhausting, but very treatable. Hang in there...if you can find a support group for yourself...you'll find that helps.
•    Anonymous said… Our son was diagnosed at age12 with high function autism. He is now 15 and I strongly feel he also has ODD.
•    Anonymous said… Please research PDA. People with ASD with Demand avoidance behaviours usually have Pathological Demand Avoidance. If they dont have ASD then they probably have ODD. PDA is part of the Autism spectrum.
•    Anonymous said… Ugh, what do you do when this keeps on into adulthood?
•    Anonymous said… Vincent my 4 yr old seems to have ODD. I'm not sure if it is a symptom of Autism or a standing disorder in him. I was told, I needed to verify if he was indeed not Autistic because ODD can be a symptom of Autism. Not sure how I feel about my developmentally delayed child possibly being diagnosed as Autistic when I am not even sure if I believe he is, and know in my heart that he could be due to how he is AND his delays. I'd hate for him to be misdiagnosed whem he very well may just have ODD. So, If I were you I would research and speak to multiple professionals about weather or not this is a symptom of or an actual disorder for your individual child.
•    Anonymous said… We have tried several meds throughout the years (Clonodine, Intuniv, Prozac etc)! What worked the best for my child was Seroquel.
•    Anonymous said… Yes our son was diagnosed with Aspergers and ODD at 15, although he had these symptoms for years...The medicine Lamictal has really helped!
*   Anonymous said...What do you recommend for my 15yo high-functioning ASD with ODD who absolutely refuses anymore counseling or meds? We’ve done both over the years, with no real success. The meds we’ve tried have all had side effects that make him feel horrible. He also hates how they numbed his appetite, and he said they made him super quiet “like a zombie” (teachers confirm this). They didn’t improve his grades (he also has dyslexia & math LD)The counseling, though good advice from the counselors, had no effect on him outside the counseling room, and now he refuses to go anymore. If we try to force it, with consequences and such, we get the out-of-control, angry, horrible behavior nonstop…it’s unbearable. So we’ve been on no meds & no counseling for 6 months now. Behavior is inconsistent, but grades and motivation at school are still bad. Still rude and illogical when the mood hits, but we avoid power struggles and allow for reasonable compromises when he’s trying to exert control. He has good and bad days. It’s like he’s in that gray gap- not bad enough to force meds or professional treatment, but not on the healthy road to success with his choices and behaviors. Any advice? Again, meds and counseling he refuses at this point. Thanks for any advice.
*   Anonymous said...I have a 10 YO Son ASD, ODD, working with the local health food store on supplements, 5 HTP heavy metal detox etc. To help him to be able to control himself. It has worked for tons of friends, I will keep you posted. Also homeopathic remedies are helping too.
 
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COMMENTS & QUESTIONS [for May, 2017]

Do you need some assistance in parenting your Aspergers or HFA child? Click here to use Mark Hutten, M.A. as your personal parent coach.

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Hi Mark, all the way from little old New Zealand.. We have just recently come across your online support group and so many things ring true to what we are going through at the moment with our Miss 14 ( we've been in a living nightmare for the last year and a half )
And no light at the end if the tunnel. we have almost given up.  I get called a f***ing whore, s**t, b**ch on a daily basis, get food thrown over me, over walls, floors etc telling me how disgusting the food  I make is. That stuff is only the start of it.   She has currently decided that we, her parents, are the worst people in the world and has run away to stay with her also 14 year old boyfriend and his family.  We have told her we love her, but this time it is her choice to make. She either wants to be here, or she doesn't.  That this time, we won't stop her, no police etc, and that she can come home when she is ready.  As long as she's ready to to start making a change and also making an effort. It's been almost 2 weeks.

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Basically, my son is non-violent, very lovely, smiley, very well-behaved [loves to co-operate & collaborate] & we can see how he tries hard to be calm & open to correction. All the adults invariably love him for his behaviour & purity of thought. Even his carer said she absolutely loves him & he won role model of the year because he is caring, kind & self-controlled from intensive 1 on 1 training. Yet, he has no social skills & always tell the truth 100% of the time however tactless.

I find coaching him social skills very difficult as he's only an enthusiastic listener at his own familiar home. Outside of what is thoroughly familiar like being comfortable at home & with adults, he days dreams & fails to listen when youngsters talk about anything that is not within his sphere of obsessive interest - he zones out... another world. This zone-out inability to listen to a turn-taking conversation frustratingly for all but himself happens almost all the time. If you play/talk snooker/music with him, he would take turns, easily, no problem. He would not zone out but how many youths love snooker as obsessively or plays as much music as he does? None. He has not met any. Not even one - his age.

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We are looking for a therapist for our son to also help him as we go through the process. We live in Alpharetta GA in case you know of anyone. We have a very high functioning son and somehow we have forgotten in the process that he has Aspergers. He is now 16 and after two years of fighting with him, we are just now realizing that while he has grown so much,  he still has areas that we need to focus. I feel terribly that we did not realize this before.

He is in a college prep program and really doing extremely well, but here is my question. The environment he in at 16 is stressful, he is making friends and doing well in classes. But home life is full of melt downs and challenges. He hides out in his room and will not talk to us about any issues or conversations so we cannot help him. He truly dislikes being told he is different and hates it when we tell him he has any social or emotional challenges. Do we continue to push him to understand his limitations  - so he understands he still needs to partner with us? He doesn’t want to be considered different and thinks that HFA means he is not smart or able. I have not been able to change this perception for him at all. Thoughts? Advice?

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Hello Mark,

I am a single mom with a 15 years old son.  I had triplets which are 22 all scholar and athletic. I home school them for several years and had never had an issue.  My  younger son on the other hand always been an issue with school, social and activities.  He was diagnose with ADHD at 9 years old.  I have been able to help him with school until this year.  He just started high school and struggle to get a "d" he is failing 9th grade.  I am getting lots of pressure from
My ex and the other children. They are telling me I am too soft not disciplinary enough.  I see my son with so
Much anxiety that I don't want to add to it.  I don't know what else to do with him.  We had several session with a counselor and she mention to have him
Tested for asperger.  I have to wait until August for insurance to pay for it but when I read the symptom, He has at least 75% of it.  So now I do see the light at the end of the tunnel.  I thought I was going crazy for a while. He doesn't do  anything that I tell him. He doesn't want any of my help.  I just need a little direction since this is new to me.  I will buy your audio book tonight.  If you have any other advise, it would be awesome.

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My friend teen daughter is way out of control.  Besides trying blackmail to get what she want now she is cutting and uses the excuse that she is being abused at home.. I know that she is not being abused. Example last week she came home drunk after her curfew.  Her mother scolded her for drinking so she went to her room and cut her wrists if her mother had not heard her fall to the floor she would have bleed to death.  When the police questioned her she told them that she was being abused now the mother faces losing not only one child but her youngest daughter also.  The teen refuses to go to any consoling.   It appears that the police only believe the teen on what is going on.  I have even talked to them and they do not seem to listen to anyone but the teen.

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Dear Mark:
I have been following your website for months now hoping that someone would ask about helping their child through retirement. My wife and I are "late in life" parents to a beautiful 12 year old aspie daughter. My wife is a teacher and I a hospital chaplain. Our daughter has, according to her specialist, abilities with communication, empathy, compassion and the arts that are not often seen. She still struggles socially but is better than most.

My wife within the last week has been told by a neurosurgeon that she must have a complex cervical fusion surgery that will likely impact her voice and so he recommends retirement due to that and the recovery time necessary. She has decided to retire early to give herself the best chance at a good recovery. However, our daughter is transitioning from the private elementary school across town to the middle school where my wife used to teach and she expects that her mother is going to be there next year.

Question - how do you tell a pre-teen aspie that the dream that they have had is now not going to happen and that it is nobody's fault? My daughter has never been the type to be ultra angry or violent but I can see that this is going to be a real difficult situation for all of us with a possibility of huge fall out. what are your suggestions?

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Once again I am reaching out to a discrete group of clinicians with experience in evaluating or treating young men with ASD who were charged criminally for engaging in inappropriate  behavior, typically online viewing of child pornography. I am a criminal defense lawyer.  Over the past decade, I have become increasingly involved, directly or indirectly, in defending these young men.   

 I need to get the benefit of collective experiences on a question, hopefully in a way that only puts a small burden on you, but which may provide enormous help to a present clients.  I am only asking around in the belief that it may be possible to provide what I need without spending a great deal of time. 

I am currently working on a cases initially involving a young men with ASD who was arrested for  viewing child pornography.  However when being interrogated he volunteered that several years earlier he had touched a much younger niece under her underwear.  That is difficult enough to deal with.  But see what happened at the time and how it affected the cop: 

During this interview as he would recall the specific details he would smile uncontrollably and giggle. It was only during the time he was talking about the actual sexual assaults of the child. It was actually disturbing even to me as he went over the two assaults. What was disturbing specifically was the smile and laughter, the apparent satisfaction while in the moment of the assault. It was clear that he was reliving the moment and it was bringing him satisfaction while explaining it to me . . . He said ‘even going over what I’ve done I don’t consider myself what the TV calls sexual predators. I’m not going after kids.’ I then said ‘yeah you’re not ripping kids out of your neighborhood and tying them up in your basement.’ When I said that he got really excited and giggled with a huge smile from ear to ear and said ‘no.’ This actually was so disturbing to me that I had to move my chair away from him and stand up. . .  .  I then asked him what would prevent him from touching any other children in the future, he just again smiled and giggled . . . At this point I confronted him and told him that it was disturbing to me that he giggled and appeared excited when we were talking about assaulting little girls. He agreed that he could ‘see how it would be disturbing.’ I then explained that it was disturbing and scary to me that when I talked about touching other little girls that he was smiling and giggling, clearly excited. He responded ‘yeah that’s bad.’”   

This is a perfect and catastrophic example of misinterpreting someone with ASD because of their inappropriate facial expressions. Of course the clinical and family history confirms that smirking, etc. is the way he reacts under stress or when being criticized, a very common experience. However, if not explained to the satisfaction of the prosecutor and judge, I see no chance of avoiding a criminal conviction and sex offender registration and substantial jail time. 

I would like to provide as many examples as I can this kind of misunderstanding.  So I am looking for examples in literature, or from clinical practices of individuals who have had similar problems, especially with the police,  that I can use as examples.  And whatever useful information I get I will try to make it available to other defense lawyers seeking to help the same population. 

As you can see from the attached, I am relying on fairly general stuff, in literature and individual reports from individuals on web sites like Wrong Planet.  I need something more.  Any technical additions or references you can think of for me to add, I would appreciate greatly. 

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My 10 year old daughter was abused in fostercare before i adopted her. I have had her most of her life but by age 5 her behavior was more than tipical 5 year old behavior. By age 10 she was diagnosed as having RAD. She is having trouble at home, school and any place that she is not allowed to be totally in control. Is there help for her to ever be able to cope with the rules of living in the real world? Since there is no medicine that will help her the psychiatrist discharged her and in her DC comment she let me know there is alternate housing when and if it becomes more than i can handle.  
I'm not looking for an alternative I'm  looking for perminant help for my child.

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Dear Mark,
              I have sought out help throughout the web and you seem to be the only one that can offer me advice. For that i am thankful. My 15 year old son seems to think that his physical motions upon me is the only manner inwhich he can gain control of me. Recently, he picked up a pair of scissors and began marking up my wife's dresser. I asked him to stop but he refused to do so. I then took his hands and raised them. Upon doing so, he managed to strike me with the scissors in his hand to my right eye. I went to emergency and was taken care of. Afterwards, he muttered death threats against me. I am 57 and i was raised properly. I have always leaned on what was right. I now know that my son smokes pot. Weather or not he has done other drugs i am uncertain. We currently have CAS involved but they do not help me despite me asking. I also have called the police yet again, without assistance. How or where do i proceed?

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Good morning. I am now re-reading your ebook as my marriage has hit a downswing again. My husband and I have tried therapy in the past and it was a complete nightmare, and then for several years he refused to go. When our one son (he is 5 now) became diagnosed with high functioning Autism Spectrum Disorder, ADHD, and Sensory Processing, it became very clear to me that my husband is also likely on the spectrum. Additionally, my husband's ex-wife who is still close to our family (mainly through our children and sharing blended family holidays) sent me an article a few years ago on living with a partner with Aspergers and told me that her marriage to my husband now makes perfect sense to her. After reading that article and literature afterward that I so closely identified with, it was as if I could have written the article myself. Anyway, back in July of 2016 after threatening to separate from my husband and actually meaning it, my husband agreed to go back to a therapist with me to work on our communication issues (is as if we speak completely different languages and live on different planets). I brought up autism spectrum to my husband as possible reasoning for our communication difficulties and my opinion of this was not taken well at all, so I put that to rest as long as we were still progressing toward getting some professional help with or without a diagnosis. I did however chose a marriage and family therapist that was on my son's treatment recommendation list hoping he might be better equipped to bridge communication difficulties of couples both on and off spectrum better than a traditional therapist. The therapist is a Gottman therapist (John Gottman Model). So far we have made quite a bit of progress in how we communicate and relate to one another (going every two weeks or so) and have read the major Gottman text, but even still we get into cycles of arguments where the downswings are almost unbearable. I love my husband and don't want to separate, but we also need to be able to apply the tools we have been given consistently to maintain more peace in our home than not and have an emotionally stable environment for ourselves and our kids. When I am asked to share my feelings by him and do, my feelings are met with much resistance and I'm accused of criticizing him and trying to hurt him. He will act like he cares and shows concern until I tel him my actual feelings and then he gets angry and tells me that he is unaffected by me and what I think of him and tells me he doesn't feel empathy for me. I do not understand my husband. We were high school sweethearts too (didn't understand him then and don't now either). I find myself getting very offended by my husband and how he talks to me (or doesn't speak to me) and I don't want to be offended and anxious so much of the time, but I just am. 

So, my questions to you are- 1.) in your professional opinion as a therapist and expert on couples on and off spectrum- Can couples make substantial progress without a diagnosis because it is not likely my husband will ever be professionally diagnosed, as "I am the one with the problem that needs to change, not him." He seems to think that being labeled with ASD is some sort of character flaw that he couldn't bear and I'm awful and abusive to even mention it as a possibility. I willingly go to my psychiatrist for my ADHD meds and go to my own personal therapist as needed or in times of situational crisis. He is perfectly supportive of my son's diagnosis, but even mentioning a possible diagnosis for him appears to be out of the question. So, I want to know if we are wasting our time in therapy without a diagnosis? Please, please, please advise. Thank you so much.

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Hello Mark
Do you have suggestions for helping parents in the launching process of  a 36 yo individual dx with Asperger’s who has a team around him of professional supports but he refuses to share information with the parents.  The parents see the same behavior in the home and wonders why he is not working and not moving out?  He appears capable but complains of anxiety and says he is getting support for 15 years?  How can the parent differentiate between narcissim, entitlement, or ordinary fears of adulating  -- between the challenges of Asperger’s? They are frustrated acting on their own without being kept in the loop.  They have fears if they ask their son to leave the family home they may find him lying in the streets.  I can’t imagine why they would leave the parents out of the loop of care plan, unless the son is  happily living the life he has chosen without having to take the responsibility of moving forward.
We recently attended a conference with Temple Grandin and other then saying “tell him to go work”, I didn’t find her suggestions very helpful.  This is a more complex question.   The parents often encourage him to go get work work and have found him many jobs but he says the jobs are just too stressful.  They feel unsafe or fearful for him when they consider pushing him.  They don’t know enough about his experiences to make a rational decision towards launching.  Nor do they have support.  Unfortunately, there is no support for parents here for adults dx with Asperger’s.   Just thought you might have some suggestions.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~

My brother, a minister, and his wife adopted a baby 13 years ago
Joshua's mother was on drugs and drank
He was born 3 months premature and no one knew what could happen

He has Asbergers
Is very smart with electronics
Reads well but has no comprehension skills

He doesn't listen well to his parents
He explodes and has no control
He has no social skills

My sister-in-law has been taking him to Massachusetts to an organization that works with brain waves ... it is costly and I have not seen much progress

Can he have a normal life
He has been home schooled along with going to christian schools but neither has been too helpful - he doesn't listen to his mother and gets frustrated at school which makes him explode at home

My brother doesn't make a lot of money
my sister-in-law won't send Joshua to a public school in Bethlehem as they live in the inner city ... therefore he has not been getting much interaction with other kids or school

Are there public schools that can be helpful and how do you find them

Do you know anything about organizations that say they can help readjust the brain through various lessons ... if might be something for the future but now I think it is just taking money from parents who are desperate

I worry that Joshua will get worse as he gets older and though he has a loving family, he doesn't respond well ... he knows he is adopted and wishes a rich family had adopted him

I wish there was something that can help these kids ... more so with the anger issues

I don't know if you have any suggestions, but anything you say would be appreciated.


~~~~~~~~~~~~~~~~~~~~~~~~~~~

Hi Mark:
I am actually not a parent!  I am a defense attorney representing a client in federal court with documented diagnoses of Aspergers and PTSD, and I turned to your resource manual for some insight.  My client definitely demonstrates the Weak Central Coherence and Executive Dysfunction you describe.  And the problem for him is that his probation officer and federal judge ascribe a level of malice and criminality to his thinking that I believe is far better explained by aspects of his Aspergers, which were never really addressed at home by his mother, who falls squarely into your “Indulgent” category of parenting.

I can see how my client drives the court and probation department crazy.  But I fear they are simply locked in an unnecessary and punitive power struggle with him, instead of being willing to tailor his conditions of probation to his disorder.

I would really love to chat with you informally about this, just so I can incorporate some of these concepts into the presentation of my client’s case at his probation revocation hearing, which is coming up.  If there is a time when you could schedule a 20 min. call that would be terrific.

Thanks for your work in this area.  You are, no doubt, preventing more youngsters with spectrum disorders from entering into the criminal justice system.
~~~~~~~~~~~~~~~~~~~~~~~~~~

We have a very difficult teen, I have some areas to improve and now understand why some things I do are working.
My husband who works away is going to read this and hopefully be consistent in applying this as well.

This is one of our problems we parent different. Mike disaplines  in anger but hopefully we can work together now and be consistent to bring change.

My big question is.
The three areas my
Son has his down falls in is
1. Speaking disrespectly to other kids and other adults.
2. Lying and being so convincing it hard to find the truth ( some times he is very honest and other times very dishonest)
3. Eats junk food and lying he is only having a bit when it's more ( so lying)

I have trying many things but find it hard when I don't have solid evident he is lying.

What and what do I deal with first 
The disrespect or the lying.

He is on the brink of getting kick out the only school I think he could cope with and being a single parent 7 months of the year ( husband works away)
I don't think I could handle homeschooling him
Again. 

~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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10.5.17

Autistic Kids Who Hate To Be Hugged

“I have two sons. The older son (age 9) is very loving and always has been. Lots of hugs and snuggles. Very verbal and social. Well here comes son #2 (age 4) who has high functioning autism. Not a word. He doesn't like hugs or kisses. Anytime I ask for one, he runs away. Anytime I give him a hug, he struggles to get loose. His main method of communication is an irritating SCREAM. He does have his moments of being affectionate, but they are few and far between (usually when he is not feeling well). Of course I love both of my kids, but it saddens me that son #2 just doesn't seem to reciprocate most of the time. Anyone else have a fiercely independent child that you just have to learn to love.... differently?”

First of all, you’re not alone. This is a common issue. Most youngsters with asD level 1 or High-Functioning Autism have a lot of difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact or make eye contact. They seem indifferent to others, and often prefer being alone. They may even resist parental attention, hugs and cuddling – and seldom seek comfort or respond to a parent’s displays of affection.



Even though a youngster with ASD is attached to his mom and dad, his expression of this attachment is unusual and difficult to “read.” To caretakers, it may seem as if their youngster is not attached at all. A mother or father who has looked forward to the joys of cuddling and playing with their youngster may feel disappointed by this lack of the expected and typical attachment behavior.

Youngsters with autism also are slower in learning to interpret what others are thinking and feeling. Subtle social cues (e.g., a smile, wink, or grimace) may have little meaning. For example, to the youngster who misses these cues, “come here” always means the same thing, whether the parent is smiling and extending her arms for a hug, or frowning and planting her fists on her hips.

Without the ability to interpret gestures and facial expressions, the social world is confusing. To make a bad problem worse, the autistic child has difficulty seeing things from another person's perspective. “Typical” kids understand that other people have different thoughts, feelings, and goals than they have. However, the autistic child lacks such understanding. This inability leaves him unable to predict or understand other people’s actions.

Although not universal, it is common for children on the autism spectrum to have difficulty regulating their feelings. This can take the form of “immature” behavior (e.g., verbal outbursts that seem inappropriate to those around them). These kids may also be disorderly and physically aggressive at times, making social relationships even more problematic. 
 
They have a tendency to “lose control,” particularly when they're in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves (e.g., bang their heads, pull their hair, bite their arms, etc.).

Consistency and repetition are crucial to kids on the autism spectrum, and this applies to the “lack of displayed affection” issue as well. Trying to figure out a puzzling disorder like autism can be a lifelong challenge. For many moms and dads, the affection issue may be the biggest obstacle to overcome. But, with patience and learning to go by your youngster’s cues and not your own, you will be able to connect with your son in a deep and meaningful way.




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

==> Videos for Parents of Children and Teens with ASD
 
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8.5.17

Disciplinary & Intervention Guidelines for Parents of High-Functioning Autistic Kids

“My 8 y.o. son has autism (high-functioning) and is constantly disrespectful, talks back, is stubborn. He thinks that we (parents) are 'being mean' to him. We have tried reward charts, try to be encouraging and positive, have taken away computer and TV, removing the thing he is playing with, setting him in a corner, doing extra chores, and NOTHING works. We are just so discouraged because nothing seems to be getting through. We have read dozens of books and seemingly tried everything. Please help. I am going insane!”

Traditional disciplinary techniques often fail to produce the desired results for kids with High-Functioning Autism (HFA) and Asperger’s (AS), mainly because these “special needs” children are unable to appreciate the consequences of their actions. Consequently, punitive measures are apt to exacerbate the type of behavior the punishment is intended to reduce.

Disciplining young people displaying autism-related behaviors will require an approach that is somewhat unique to that of “typical” children. Finding the balance between understanding the needs of the HFA or AS youngster, and the disciplinary strategy that is age-appropriate and situationally-necessary will be achievable when applying some of the strategies listed below. These strategies can be implemented at home, school, and in other public settings.

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


Crucial disciplinary guidelines for parents [and teachers]:

1. A short list of rules – along with a visual depiction of each rule – should become your youngster's property, and depending upon the situation, should be kept in his pocket for ready reference.

2. Active ignoring is a good consequence for misbehavior meant to get your attention. This means not rewarding “bad behavior” with your attention – even if it's negative attention (e.g., scolding or yelling).



3. After disciplining your youngster for doing something wrong, always offer a “substitute behavior” (e.g., if she is hitting you to get your attention, work on replacing that with getting your attention by tapping your shoulder).

4. Before you transition from one activity to another, or approach a situation where behavior may deteriorate, discuss with your youngster what will happen, review the family rules, and remind him of the consequences (both good and bad) of any misbehavior. This information may need to be broken down into a few simple instructions and repeated often.

5. Change (not “lower”) your standards. With an HFA or AS youngster, parents need to learn to live in the present moment. The milestones of your youngster’s life are less defined, and the future less predictable (though your youngster may surprise you). In the meantime, set the standards for your youngster at an appropriate level.

6. Children with HFA and AS tend to enjoy being isolated, because it is less stressful for them and they do not have to socialize with others. Therefore, time-outs can actually be a positive experience unless modified slightly. Removing kids from something fun is a better alternative. For example, if the youngster loves to play games on his iPad, the iPad can go in a time-out area – for a period of 15 minutes at most, otherwise the child will feel as though he has lost the privilege for an eternity and will act-out accordingly.

7. Create a list of behaviors your youngster CAN’T control due to his disorder. The list may include items such as repetitive behaviors, poor peer relations or lack of social skills, being easily distracted, sensory sensitivities, obsessive/compulsive tendencies, meltdowns, etc. These are the behaviors that your child should NEVER be punished for. Your youngster will require help and guidance to overcome these issues.

8. Don’t assume your youngster will automatically transfer and apply information previously learned in one environment to a new situation that, in your mind, is remarkably similar. For kids on the autism spectrum, a new situation is a new situation.

9. Enlist the help of your child in creating a “consequence plan.” For each negative behavior you have identified as inappropriate, the two of you decide on a consequence. Discipline needs to be clear, concise, consistent and calm. When your youngster misbehaves, tell her in a few words what she did wrong, and tell her the consequence (which she agreed to in the planning stage).

10. For kids on the spectrum, it is important that the consequence or reward immediately follow the behavior in order to have the greatest effect and opportunity to teach.

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


11. Kids with HFA and AS require more exposure to discipline before they begin to understand expectations. Parents must follow through and apply discipline EVERY time there is an incident in order to effectively send a message. Kids who have trouble learning respond very well to consistent structure and limits. But for this to work, moms and dads must be consistent.

12. Kids on the spectrum thrive on clear rules. Thus, post a list of unacceptable behaviors and their consequences in a prominent location. For younger kids who can’t read yet, the rules can be reviewed periodically, and the list should have visual illustrations to demonstrate the unacceptable behaviors and consequences associated with them.

13. Look for small opportunities to deliberately allow your youngster to make mistakes for which you can set aside “discipline-teaching” time. It will be a learning process for you and your youngster.

14. Never assume that your HFA or AS child will understand appropriate social behavior under a wide variety of specific circumstances, and when that doesn't occur, discipline in the moment.

15. Prioritize problematic behaviors rather than trying to fight multiple battles at one time. List the top 3 behaviors that you feel are most deserving of attention. This is an important step, because (a) many of the smaller problems will take care of themselves once the bigger issues have been resolved, and (b) some behaviors need an intervention or therapy in order to be eliminated rather than simple disciplinary techniques.

16. Reset your anger buttons. Your autistic youngster will inevitably do some things that will frustrate the hell out of you, but getting angry with him will only worsen things. So, when you catch yourself starting to get angry – YOU take a time-out. If you’re still angry after the time-out – don’t show it! Put on a “poker face.”

17. Social stories, developed to help HFA and AS kids understand difficult situations, are particularly helpful for teaching appropriate behaviors.

18. Through role play, you can provide your youngster with alternatives to problematic behaviors (e.g., hitting, yelling, throwing, etc.).

19. View all problematic behaviors as “signals of needs.” Everything an autistic youngster does tells you something about what she needs.

20. While it is true you have to change your expectations of your HFA or AS youngster, you don’t have to lower your standards of discipline. It’s tempting to get lax and let a “special needs” child get by with behaviors you wouldn’t tolerate in your other kids. Your youngster needs to know, early on, what behaviors you expect. Many moms and dads wait too long to start “behavior training.” It’s much harder to redirect a 170 pound teenager than a 45 pound 3rd grader.

21. Your HFA or AS youngster likely has triggers that can cause her to become distressed, which may result in a meltdown. Watch carefully for these triggers and distract her when you sense an outburst coming on. For instance, if she thrives on a schedule and you need to change it for some reason, let her know carefully and watch for signs of a meltdown during the change.




22. If parenting strategies fall short and do not yield the desired outcomes, then seeking outside assistance from a therapist who specializes in autism spectrum disorders is highly recommended. There are various standard courses of treatment, with each treatment modality addressing a different set of issues. Some of the most common treatment options include:
  • Applied Behavioral Analysis is a form of therapy used to teach basic skills in many different areas.
  • Cognitive-behavioral therapy is used to treat the emotional side of HFA and AS (e.g., anxiety, depression, obsessions, etc.). 
  • Occupational therapy is basically used to teach independence. Grasp, handwriting, social skills, and play skills are often included. 
  • Sensory integration therapy may be included by the occupational therapist. This therapy helps get your youngster’s sensory systems in synch.
  • Physical therapy addresses the physical awkwardness that sometimes comes with HFA and AS. 
  • Social skills training is a therapy that teaches kids on the spectrum how to relate to others, making and keeping friends, how to recognize social cues and gestures, and other details such as personal space and understanding slang.
  • Speech/language therapy covers speech articulation as well as pragmatics, or fluency. Language therapy covers social communication, and in some cases, social skills. Speech/language therapy will help your youngster learn to communicate verbally or nonverbally, if necessary, with the use of picture exchange and/or sign language. When a child can use words to express his anger and frustration, problematic behaviors are greatly reduced.

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


23. In worst case scenarios, behavior problems may need to be addressed (in part) through the use of medication. Some medications that may be prescribed include antidepressants, antipsychotics, and stimulants.

24. There are many alternative approaches to treating symptoms associated with HFA and AS. One such approach is Complementary and Alternative Medicine (CAM), which is defined as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” CAM therapies used to treat HFA and AS have been categorized as biological and nonbiological:
  • Examples of biological therapies include: (a) immunoregulatory interventions (e.g., dietary restriction of food allergens or administration of immunoglobulin or antiviral agents), (b) gastrointestinal treatments (e.g., digestive enzymes, antifungal agents, probiotics, yeast-free diet, gluten/casein-free diet, vancomycin), (c) dietary supplement regimens that are supposed to act by modulating neurotransmission or through immune factors (e.g., vitamin A, vitamin C, vitamin B6 and magnesium, folic acid, folinic acid, vitamin B12, dimethylglycine and trimethylglycine, carnosine, omega-3 fatty acids, inositol, various minerals, etc.), and (d) detoxification therapies (e.g., chelation).
  • Examples of nonbiological interventions include treatments such as auditory integration training, behavioral optometry, craniosacral manipulation, dolphin-assisted therapy, equine-assisted therapy, facilitated communication, and music therapy.

HFA and AS children need limits and structure much more than “typical” kids do. When they can predict what will happen next in their day, they feel confident and safe. Of course, they will test the boundaries. But, it's up to parents to affirm that these standards are important – and to let their youngster know that they believe he or she can meet them.


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

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

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

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

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

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

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


COMMENTS:

•    Anonymous said… A couple of things to try. We did this with my son, who had an awful time getting up in the morning. It became a battle every day, just to get him out of bed. 1. Video him and show him what his behavior looks like. He won't like it, and prepare yourself for a meltdown over that in itself. 2. Talk about the video once he's calmed down and talk about the 'other' ways he could have handled the situations. For example, better responses instead of backtalk, a reaction that is different that a tantrum. 3. Take those situations and turn them into role-playing - a way to actually practice what should happen, rather than what is happening. 4. Once you've role-played it, video it again and play it back for him. He will see a positive way that he's changed his behavior. The theory behind this is that you are replacing the negative images and reactions that he 'sees' in his head with the positive ones. It may take a few times to replace the action when the time comes, but if he re-views the positive video, it can help him literally see his behavior in a new way.
•    Anonymous said… Give choices focus on positive ignore negative.
•    Anonymous said… I say, I will. Or speak with you as long as you're talking to me like that. (After over explaining why it's not okay.)
•    Anonymous said… My 5 year old  😞 I'm going to try some of these techniques
•    Anonymous said… My 9 year old is the same way. He needs to become a professional negotiator for a big business someday. He is so good at it, no matter how small they requests from me or his dad. Always an argument, refusal, avoidance or negotiation behaviors happening at our house. It drains my energy.
•    Anonymous said… My son is still young and about to turn six so thank God I have not run into this – yet – I'm coming into this with my eyes wide open now based on all of the other parents experience with their teenagers . However I have been reading and reading for at least a year on every possible autism site I can get my hands on. Although I do not know your son and I do not know what you have tried – I would default to diet and get cannabis with THC. Although there are some kids that the parents have trouble finding the right Balance or strain of cannabis with – I have heard many times more successes been failures with diet, supplements and also cannabis with THC
•    Anonymous said… Positive reinforcement, confidence building, talk therapy (not always in the moment if he's angry). Talk and give some one on one time half an hour a day. Do something they like with them for 30 minutes a day, relationship building / trust building. Let them know what they are doing right. Role play / role model / script conversations that are polite. Make your goal for the month Kindness and reward everytime he is kind. Make a goal (item) he wants to work towards and everytime he's kind, genuinely, give him a reward. I used to also give $10 (big money) whenever I got an unsolicited compliment on my son. I would always share with him what the other person said so he took pride and made sure to "shine that part on" and know "this is where I shine". Good luck, give positive feedback and know that you are supposed to ignore a lot of bad behavior (it's weird to do at first). Pick and chose your battles always and it sounds more like an ADHD problem. My child with Autism also has this Dx. You have to encourage, especially if it "hormonal" time because think of our Hormonal stages and then times that by 10. They feel things more intensely. Physical outlets/sports always. Also, "Downtime" 15 minutes break. 15 minutes work on this. 15 minutes break. 15 minutes get this organized. They frrustrate themselves. Mood boosters help.
•    Anonymous said… Video. Try video. It lets him see another perspective and sometimes is an excellent teaching tool.
•    Anonymous said… We had exactly the same problem with my now 15 year old son, tried literally everything we could think of. Its only now that he is on anxiety meds (Resperidone) that he is almost a different child. I'm not condoning drug use for behaviour but for us it was the best decision we could have made. Perhaps look at the symptoms of ODD as well.

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