Tantrums/Anxiety and HFA

[Anonymous]

Hi all-

I have a 5 year old son who we are close to concluding has Asperger Syndrome. (two practitioners think AS, one thinks NVLD..but I digress). Anyway, right now, our biggest challenge is how a tantrum will spiral into him remembering every thing that ever upset him. Once he is in this cycle, it is tricky to break it, most often, we have to distract him from it. Tonight it was about how he "wanted pizza". Actually, the family was going out to pizza tonight, one would think he would have been thrilled, but he did not want to eat at the restaurant. It is the same way when we have to stop an activity to go somewhere, etc. Come to think of it, most often, it is related to leaving home. He is home for the summer with me. We are doing a weekly social skills group, and have a few camps scattered through the summer. The lack of a regular schedule has had a negative affect to be sure. Having 2 other children too, we just cannot afford all summer to have daily camps. ( I think this would be good for DS, at least 1/2 days)

Example: I will use this one from a while ago, as I think it really expresses how the cycle goes.

DS got upset because he had not had enough breakfast before church (we were going out after, and he had a cereal bar and juice, which normally would have held him over). We got in the car anyway, as we were running late. Tantrum continued. DH and 2 other children went to sit down. I kept ds in the front hallway sitting with me until he settled down (took a good 15 minutes). When we went to join the family, he began to talk about the following things, that upset him
-"Why do people throw trash in the landfill, it is bad for the environment?"
-"Why do people kill animals, I do not like when people hurt stuff?"

etc.

The issues are most often unrelated, but it happens quite often.

Our play therapist (LCSW) said it is actually a very emotionally intelligent response. Her explanation was that he remembered that those thoughts made him feel the same way he did when he did not feel he had enough breakfast.

I never thought he was an anxious child, but come to think of it, I guess this could be a type of anxiety. Has anyone found a good way to break the cycle?

[Anonymous]

My oldest (8) isn't ASD but he does have ADHD and what you're describing sounds very familiar. I suspect that it's one of those emotional regulation issues that our disorders have in common. I can also see how these 'feedback loops' can later lead to anxiety and depression. We have a strong family history of ADHD/depression/anxiety and so I'm really working to address it while DS is young. I don't want him to go down the path of my brothers. I've spoken to his OT (who's great), our pediatrician and our developmental pediatrician (and teachers of course but they didn't have anything to offer on the therapeutic side). We pursuing cognitive behavioral therapy. Your DS might be a little young at 5 (but he seems to be doing really well at making connections and articulating why he's upset) but you might think about it. The first psychologist we used wasn't a good fit (recommended by our advocate) so we quit him and are now enrolled in an NIH study on anxiety http://clinicalstudies.info.nih.gov/cgi/wais/bold032001.pl?A_01-M-0192.html@fluoxetine . I have a friend who's son participated and she was very positive about it. We also participate in ADHD/dev delay studies there and our experiences were overwhelmingly positive.

I know every kid is different but I can tell you that at 5, my DS was far more unregulated than he is at 8. He's gotten better in the tantrum sense but he's far more anxious and when it kicks in (you should see him the weeks before school starts), it's having a negative effect on our family relationships and is starting to limit the choices he makes. CBT seems like a good place to start since we've done all we can do at home. Sorry I'm not much more help.

[Anonymous]

PP here. I don't know why the smiley face is there. That should be an eight, not a smiley face.

[Anonymous]

My DD, 9, is similar to the PP, only she does not have an ADHD diagnosis, rather anxiety with executive function and emotional regulation issues.

I agree that CBT can really help with the anxiety piece of things and stopping that "feedback loop". We call it the anxiety spiral, but it's the same thing. 5 may be a little young, but even if some part of it helps, it may be worthwhile. We started her in CBT at 8. While that helped a great deal, I have to say that we started her on an SSRI at 9.5 and OMG the difference that has made. We had to experiment a little to find the right one and the right dose, but she is like a different kid now. So much more relaxed and calm and pleasant. She says "I don't have those thoughts and worries overwhelming me all the time now". But it helps that she is older and can articulate these things to us.

Her absolute most out of control time for tantrums was ages 5/6. In retrospect, I think she would just get emotionally overwhelmed and had no idea how to calm herself down or get out of the spiral. So any techniques you can learn or even better teach HIM to use will be great. The problem is that when they get into "that place" it can be really hard to get them out of it or for them to even recognize it.

[Anonymous]

PP's thanks so much. I will have to look into CBT. It is tough, because we are just coming around to figuring out what is "going on" so I am just learning whether these issues are all part of the big picture, or if they are separate issues that need to be addressed.

He is young, just 5. The developmental pediatrician mentioned that there may come a time when we may consider treatment (whether medical or behavioral) for attention, anxiety, or both. She felt it was early for both. Right now we are doing social skills work, and might go back to our private sessions with the play therapist too. Come fall, we are going to guage our extra therapy, on how the school special ed. services are meeting his needs.

As of now, I think we might just muddle through, really, he is a sweet boy, but the daily tantrums have been tough. Summer has not helped. I am hoping that he will do better once he is back in school, though then we will be dealing with a new school. So far, he is really excited about starting Kindergarten next Fall.

Any specific techniques you have found held break the spiral/cycle? Reasoning with ds does NOT work. Typically we have to somehow change the subject/distract by reading a book, or engaging in a different activity.

[Anonymous]

7:38 here. As the PP said, when DS gets in that loop/spiral, there's not much to be done but endure it. If it's a tantrum, I warn him that he is "out of control" and his behavior is disruptive and he either needs to stop or go somewhere he won't disturb us. When he's 'in control' he can come back and join us. "Control" is one of our key words and we use it to describe a lot of things. We identify behavior in other people as 'in/out of control', things we do to help us 'get control' (movement breaks, asking for help, deep breaths, etc.) and things that cause us to 'lose control'. We don't use it in a negative or judgmental way, just matter of fact. DH and I also use it to describe our behavior - like right now, I'm having problems with control. It's been a very, very challenging day and rather than yelling at the kids, I told them (and DH) that I need some quiet time to help be get back in control. I told them I had to stop listening to them and remove myself from the room because I was about to 'lose control'. Everyone understands where I'm at.

If DS continued to tantrum after the warning, he got a choice - he could go to his room until he was back in control and could be with us without disruptive behavior or he could go outside to the porch. One or the other. If he didn't make a choice, I did and I always choose the porch. I don't care if it's freezing or melting. It's not going to harm them physically and since we have good doors, I really don't hear him much. I don't open the door again until things are quiet. Sometimes that's quite a while. When he's quiet and I open the door, if he starts in again, I say he's clearly not in control and he can't join us until he is. I close the door and the cycle begins again. I do this with all the kids and it's not just the SN kids that sometimes carry on. It's also my NT kid.

Outright anxiety (as opposed to tantrums) I treat differently. The transition to bed is the hardest time for DS. It's as if he's able to keep the fears down until he starts winding down. We usually take 5 minutes, lay on my bed and talk quietly about what's bothering him. I take his fear seriously and reassure him but don't overly do it. I provide logical answers to his fear - zombies are a big one right now (yeah, I know all kids are afraid of zombies but this level is not normal). He's afraid they're real (as well as other monsters). My response is that if they were real, we would have taught him how to deal with them in the same way we taught him to be careful crossing the street. Also, if they were real, wouldn't the firefighters and policemen be teaching him what to do if they were around. We teach him to 'stop, drop, roll', why wouldn't we teach him about how to deal with zombies? We keep it short, I give him some ideas of things to think about as he's drifting to sleep and his job is to think about the good thoughts and ignore the bad. We can't help him ignore the bad, he has to practice that himself. For social anxiety, we revisit past successes where he was fearful but things turned out okay, we talk about how sometimes his imagination sometimes gets 'out of control' and tricks him into thinking something is bad when it's not. We acknowlege this is hard but that we all have to do things that are hard.

But, a lot of times this isn't enough and so that's why we're pursing more professional interventions. HTH.

[Anonymous]

PP, thank you so much. Now that you describe it that way, I would say what we have is ds having a tantrum, that sprials into anxiety (hence the changing what he is upset about to everything under the sun). He is very, very sensitive to change. We got a new roof, he cried for a half hour that he wanted the old roof back. We wanted to try a new pool last night, he wanted nothing to do with it (dh stayed with him at the car until he settled down) and then he LOVED it. We talked afterwards how it seemed "Rock Brain" had come to visit, and how we were glad that Superflex got him out so he could have a great time. We are finding a good amount of success with the Superflex from Garcia-Winner http://www.socialthinking.com/books-products/superflex-curriculum , which was introduced by our play therapist, and which they are using in the social skills group. It is really hard to feel we are a LONG way from being able to reason with him, but I guess over time, it will get easier....I hope.

Thanks again.

[Anonymous]

OP, I could have written your post except DS is 6. He will go into these episodes when he becomes fixated on something and then a list of everything that has recently upset him comes pouring fourth. Nothing we say seems to help because he doesn't even seem like he is capable of hearing us during those times. Please keep us posted as to what you think is helping. I would consider the CBT route, but he still seems young for that.