Gifted Issues Discussion homepage Forums Twice Exceptional ASD/Anxiety/Depression/School refusal

Hi all, am wondering if what my DS11 is going through rings a bell with anyone. I'm so lost.

For the first 11 years of his life he was certainly quirky and stubborn, but also happy, sparky, enthusiastic, confident and self-directed. He was the child I thought would do brilliantly in any situation. Things started to go downhill about Easter last year in terms of general mood, and then spiraled rapidly into severe anxiety, school refusal, aggression and misery. He ended up missing all but two weeks of the third school term (Australia) and spend three weeks in hospital. They said ASD and anxiety, and put him on Fluvox, which helped to a degree and he went to school for most of the last term.

Starting high school last week was always going to be iffy, but it feels like we're back to where we were in the middle of last year - he's home again today. He won't speak about it, and screams if the subject is raised (he absolutely does look and sound like an autistic child when the anxiety is in full swing). He won't go to see the doctor or psychiatrist. He has been violent and says he wants to die.

I expect that when we see the psych again (probably without DS11) they'll push again for anti-psychotics to be given in addition to the fluvox for anxiety. So far I've resisted but I'm feeling backed into a corner.

I should say that I'm not anti-drugs per se, but my concern is that no-one has been able to explain what has happened, all we've got is categorisation of symptoms with no reason given for the relatively sudden onset. Nothing changed anywhere in his life - that has been thoroughly gone over. My lovely boy, who has always been a sweet, kind, funny, bubbly, sociable, happy-go-lucky, creative child with plenty of really nice friends, is now in a terrible place. To the extent that he has ASD, presumably he's had it his whole life but with no ill effect and to such a mild degree that no-one noticed(!), so what has gone wrong? Is throwing a mix of drugs at him really the only option we have? His solution is home schooling, but I'm a single parent so that's not possible.

I've found so little online. When DS13 finally got the ADHD diagnosis (yes, I drink wine) it was easy to get my head around the problem and the treatment. With this though... there's so little. Perhaps that's just how it is and I have to get used to not understanding.

Thanks if you've read this far, and if you have any insights they would be much appreciated. I know people with ASD kids, but no-one in our situation.

BKD, I'm so sorry you and your children are going through such a difficult period.

My first thought is probably not going to be very comforting, but I feel I should mention that, despite the thorough going over, it is quite possible that something did happen, that he is either unwilling or unable to communicate. (If unwilling, probably for reasons that make a lot of sense to him, even if they might not to another person.) I have had students with various elements of what you describe, and often there has been trauma at the root of it. This does not mean, by the way, that the trauma was necessarily criminal in nature, but the relatively sudden onset suggests to me that it is possible something happened (perhaps at school) that he experienced as traumatic. More than once, the same ASD/anxiety diagnostic categories have been raised with these students, with anxiolytics helping a little bit, but reintegration into school occurring mainly as we were able to build expanding safe spaces and safe experiences in the school (i.e., by acquiring new, controlled experiences of school as a safe, positive environment).

School refusal is a very challenging behavior to treat. From a glance back at your history, I see that you are, shall we say, a reader of primary sources. You might find these publications to be valuable sources of information:

Handout from National Association of School Psychologists on school refusal, with list of recommended reading:
https://www.nasponline.org/Document...ol_Refusal_Information_for_Educators.pdf

One of the top professional reference works on interventions for school refusal, by Mary Wimmer (update of one of the citations in the NASP handout):
http://www.amazon.com/Evidence-based-Practices-School-Refusal-Truancy/dp/B00JNKZ4EK/

BKD, you might take a look at some of my very earliest posts on the forum, from when DD16 was the same age as your child.

She had always been intense and highly autonomous/stubborn-- but that year, things took off and snowballed in a way which was (and still is, in many respects) a complete and total mystery to me.

My DD later sustained a tremendous trauma that led to additional diagnoses (when we could finally get her cooperation to see a series of mental health professionals, that is)--

but we have had to come to terms with the fact that she probably has an anxiety disorder that is fairly severe and will likely be something she has to deal with all of her life.

What has made it better? Honestly-- more autonomy. For her, much of the root cause is about control. It's what is underneath even the socially-prescribed perfectionism. Tackle that, and the rest of it self-resolves.

I would say to you-- keep reading, keep digging, and bear in mind that you know your child better than ANY outsider ever can. When I read about socially prescribed perfectionism and related anxiety disorders, it was as though a neon sign flickered on, saying "Yes! This! This! This!" for the first time in my years of parenting this child, I felt like I'd been handed a key that unlocked insights into what made her tick.

NOTHING else had ever quite fit. If I hadn't seen that, hadn't had that moment, she would certainly have been misdiagnosed and probably medicated (inappropriately), which would NOT have helped her in the least-- actually, stimulant meds are bad, bad, BAD news for her, even caffeine at levels found in coffee is a definite no-no for her.

I also recommend Misdiagnoses,... (the book) because that, too, led to a lot of self-reflection on our part about why DD could appear to be depressed, have an ASD, have ADD, etc. etc. but just-- not-- quite.

Some people would say that we coddled DD through those years. I disagree. She could avoid school and still do very well. So we let her. I realize that not everyone has that option-- but letting her complete high school in an online setting, while far from ideal in many, many ways-- let her have the breathing room that she needed in order to build a framework of good habits, self-care that is meaningful, and time to explore within herself. She's PG. She has that time, obviously.

I won't say that I truly know what caused all of this. I don't. I don't even think that there was any one trigger for the latent potential which was probably always there in her. I do believe that it was a perfect storm of factors which occurred when she was 8-10yo.

VERY best wishes to you as you wrestle with this. There is very little out there in the way of good information about mental health struggles in high ability children and adolescents, I'm afraid.

Thanks both for your thoughtful responses, I really appreciate it.

AEH - there certainly were some less than ideal experiences for DS11 at primary school though I don't think a particular traumatic event as such. The school deteriorated significantly with a new principal and DS11 lost all respect for the administration in a short period of time - not a good outcome for someone with his personality. I've possibly underestimated the impact on him. He has come to see 'school' as run by incompetent, dishonest people who don't care about him, and while DS13 would shrug this off and carry on (more or less), DS11 is *rather* judgmental and unforgiving. Based on our experiences last year with DS13, the new school is infinitely better, but it may take some time to bring DS11 around. I'll see if the city library has the Wimmer book - thank you for the reference.

HowlerKarma - I read through those early posts, you really had a tough time of it. I recognised my son in some of those posts, including the devious use of devices in the night-time! Drives me bananas and I know it's dreadful for his health, but when he's at his dad's place I think it happens more often than either will admit. Which is a large part of why he goes there and I'd stop him if I could. He tends towards perfectionism, not to the extent your daughter does, but enough that it's likely to be a factor in his anxiety. I'm in your 'just--not--quite' position with most of the contenders for diagnosis.

I spent much of yesterday obsessively googling, to see what I could come up with. In the last few years there's been some interesting research around stress oxidisation/immune problems/mitochondrial dysfunction which may have some leads. When my boy isn't stressed you'd think he was a regular kid (for the most part), it's when the stress escalates that most of the autistic behaviours kick in, which in turn further limits his ability to deal with stress. It's a horrible feedback loop that can degenerate to extreme situations very quickly. The limited diet (ugh - beige food) may well be a contributing factor here too.

He's refused school again today, so I've booked an appointment at the GP to ask for a blood test referral (I'm very popular - for some reason he loves having this done). I'd like to check vitamin/mineral levels, and see if it's possible to easily test for biomarkers re immunity/stress.

There are a few university research programs in the city too, so they might be worth a call re genetic testing. I've never had psoriasis, but my mother did and my brother suffers badly, so that could be an autoimmune risk. DS11's father is the confirmed Aspie so I'd always assumed it was HIS fault :), but there are probably things to look at on both sides.

His new teacher rang yesterday to see how he is and if there's anything she can do. She's lovely! She was DS13's teacher last year and we were so impressed. She said to tell him that she'll be uploading all teaching material to the website where he can access them, so he doesn't need to worry about falling behind if there are days he misses. The contrast with last year's primary school - I emailed the principal, deputy and guidance officer to let them know my boy was in hospital and that he'd like some schoolwork, even just a few homework sheets, and NONE of them even bothered to respond.

I'll try to have a serious talk with DS11 later today about the realities of the situation: at some point he has to get back to school or he'll end up in hospital again. Hopefully he'll find the headspace to think this over calmly and meet the world halfway. I'll need to go in and talk to the school too - I'm sure they've dealt with this kind of thing before so will have some ideas.

Thanks goodness DS13 currently LOVES school! I'd be certifiable if I had both of them going to pieces at once.

Greetings BKD-
I PMd you. I'm not on here enough to know if it shows up when you PM someone!