Extreme reactions to insinuating weakness

[Anonymous]

2 part question. I have a 12yo who likely has adhd, or mild autism.

1) Does anyone else's child have an extreme reaction to any insinuation of weakness? Simple things like noticing when they are coming down with a cold. Or acknowledging that they might be fearful or nervous about something. These normal parental gestures, for some reason, trigger extreme angry reactions, and wildly inappropriate behavior. I don't understand it. What's behind it? Even as a young toddler, she would absolutely hate it if I paid any attention to an injury or tried to comfort her. It's like she's in denial and must believe she is invincible.

2) How do you then handle the atypical problematic behavior? For example, DH mentioned that she is congested and sneezing this morning. She then responded with death threats, started making stabbing motions with a fork, throat slitting gestures, and started growling like a feral animal. She's 12.

It's kind of crazy. And at other times can be so sweet and such a cool kid, but then there's stuff like this. We've talked about how inappropriate this behavior is, but at times it's like she reverts to being a toddler and has zero control over how she acts towards us.

Any insights, advice?

[Anonymous]

It sounds like a panic attack.

[Anonymous]

Anonymous wrote:It sounds like a panic attack.

Not quite. It's really intense anger, and in the example I gave, verbal denials. "I'M NOT SICK! And if you think I am, I'm going to slit your throat"

I say it seems uncontrollable, but apparently she has some control, because she knows better than to say these things to a teacher, nurse or friend. At most, it might be a angry "I'M FINE!" And then intense seething with anger all day, until she comes home and tells the story about how she wanted to boil the stupid nurse in hot oil or something similar.

It's also been problematic with doctors visits and with nurses. It's gotten slightly better with age, but only slightly. There was one time she threatened to bite the nurse's hand off, and the nurse, responded appropriately with a severe warning and shut that behavior down.

[Anonymous]

My kiddo had aggressive and threatening behavior from extreme anxiety, so it's possible. There also sounds like an element of shame and anxiety over having attention. Have you had an evaluation? Therapy might be difficult if she can't tolerate a challenging discussion, so it's possible that if this behavior is related to anxiety, medication may lower the anxiety level enough to benefit from therapy. (But you need an eval first.)

As far as how to respond to the behavior, we really needed parent coaching for this type of thing. And I would say you need a next-level type of parent coaching - a therapist who is used to disruptive behaviors. Some therapy practices offer Parent Management Training which is a specific curriculum for managing challenging, disruptive behaviors based on the work of Alan Kazdin. We found it extremely helpful. If you can't find that, we have also found that a therapy practice that offers DBT programs (not just DBT-informed) will also have therapists who are trained in helping parents with more extreme behaviors.

I will also add that although this behavior started only at home, it did eventually start to creep into other parts of life at age 14 so now is the perfect time to get the ball rolling. There were some big social impacts for my DD when things happened in front of friends.

[Anonymous]

Anonymous wrote:My kiddo had aggressive and threatening behavior from extreme anxiety, so it's possible. There also sounds like an element of shame and anxiety over having attention. Have you had an evaluation? Therapy might be difficult if she can't tolerate a challenging discussion, so it's possible that if this behavior is related to anxiety, medication may lower the anxiety level enough to benefit from therapy. (But you need an eval first.)

As far as how to respond to the behavior, we really needed parent coaching for this type of thing. And I would say you need a next-level type of parent coaching - a therapist who is used to disruptive behaviors. Some therapy practices offer Parent Management Training which is a specific curriculum for managing challenging, disruptive behaviors based on the work of Alan Kazdin. We found it extremely helpful. If you can't find that, we have also found that a therapy practice that offers DBT programs (not just DBT-informed) will also have therapists who are trained in helping parents with more extreme behaviors.

I will also add that although this behavior started only at home, it did eventually start to creep into other parts of life at age 14 so now is the perfect time to get the ball rolling. There were some big social impacts for my DD when things happened in front of friends.

We've talked about therapy, but with her extreme emotional reaction to any insinuation that something might be wrong or off with her, yes, it would be very challenging, to even get her to the first visit. Even an eval would be very challenging - not insurmountable, as I think I can successfully frame it in a way that is more of a solution to her unique way of thinking/working and figuring out ways to work with her differences.

I appreciate the warning about how the behavior started to creep into other parts of life at a later age.

I also noticed the behavior comes out more in times of stress, when she's coming down with something, or hasn't been getting enough sleep, or hasn't been eating enough.

As for anxiety....I have a lot of trouble understanding her type of anxiety. I do think she experiences anxiety, but very differently. You might describe her as almost completely lacking any anxiety over most things. She does not care what her friends, peers, or teachers think, what she looks like, whether she sticks out, or looks odd. In fact, she thrives on being different and "unique" and doing her own thing, her own way. She has almost zero fear and doesn't get grossed out by anything- she loves scary, thrilling things, gross things.

But then I do think she has this anxiety around the finality of death, about illness, about weakness, and vulnerability. And she has some sort of social anxiety, but it is very different. She doesn't care what people think, but at the same time, she avoids social situations because she doesn't know how to act, or as she says, she simply doesn't like being around people. She's very quiet, and nervous about talking in front of an audience, but then when the time comes, she's like a pro and she presents with confidence and no sign of nervousness.

I experience anxiety myself, but the way we experience it is so vastly different, I don't really understand the way she experiences it.

[Anonymous]

I’m the PP with the somewhat similar DD whose main diagnosis is OCD. Some of what you say makes me think of that - the rigidity, seemingly illogical, swift anger/aggresssion, not afraid of things that are anxiety producing in most people. There are a lot of OCD themes and some are tricky to tease out. Not sure if any of that resonates, but here are some good articles:

https://www.madeofmillions.com/articles/recognizing-undercover-ocd-in-adolescents/amp

https://www.actbeyondocd.com/types-of-ocd/

[Anonymous]

Honestly it sounds a bit like ASD. Have you read “Is This Autism?” By Donna Henderson? It presents really differently in girls. https://www.isthisautism.com/

I say this with compassion as I have an 11 year old DD who was just diagnosed with autism. As you read up on it you’ll learn more about the unique kind of anxiety she may have and why she can be filled with dread but then turn on the charm (masking.)

She may know inside that she’s different and be totally panicked about it. This may make diagnosis very tricky.

I’m just an internet stranger at the beginning of my journey with this stuff so take my opinions with a huge grain of salt.

[Anonymous]

Is the anxiety around needing to be cared for, like an attachment disorder? I think threats of violence are pretty outlandish for a 12 year old and if she does them in school it's going to have some serious social and disciplinary consequences soon if it hasn't already. Is she able to grasp that and apply it? If not, I wonder if she is autistic. It does sound like an evaluation would be helpful...and if a psychologist or developmental pediatrician saw her decompensating, it might actually help them understand. You might need to video it or find someone who can start with telemed.

[Anonymous]

In the moment, can you just co-regulate with her to get her through it?

Long term, you will need parent training for sure. And an eval and more help for her- it’s time to call in the professionals.

[Anonymous]

What happens if you tell her it's unacceptable? Like if you say "larla, you cannot wave sharp items. You cannot threaten to hurt people. And if you need to make animal noises, do them in your room and you can finish your breakfast when you get done." Did you ever tell her how inappropriate these things are? She might need to be explicitly taught. If they make the meltdown worse, that's a different issue.

[Anonymous]

I would think she's working extremely hard to mask her anxiety/rigidity/OCD at school but she can't keep it up all the time, and comments about health are more likely to happen at home than at school.

I think this sounds like more than just ADHD and you need to see a specialist.

[Anonymous]

Anonymous wrote:What happens if you tell her it's unacceptable? Like if you say "larla, you cannot wave sharp items. You cannot threaten to hurt people. And if you need to make animal noises, do them in your room and you can finish your breakfast when you get done." Did you ever tell her how inappropriate these things are? She might need to be explicitly taught. If they make the meltdown worse, that's a different issue.

Do you have a kid with a complex learning/social emotional disorder? If only it were this simple. Re-read the OPs original post. This has been tried.

[Anonymous]

OK First of all.

You have to look at the WHOLE picture. What other symptoms besides aggressive reactions? How's school going? Can they focus well?

As a mom of a kid with anxiety and another with dyslexia and ADHD I will tell you, people like to jump to autism, OCD, ASD, anxiety straight aways - it's just not like that.

Many times, someone with anxiety has something else - whether OCD or oppositional disorder and sometimes it's JUST anxiety!

Sometimes, the kids at age 12 (I have a 14 and a 12 yr old) have raginggggggg hormones. Based on their personality, they may be a bit nuts. I have friends with kids like this. Hot and cold, crazy one moment to another.

You can also look at magnesium and other nutritional factors. When I put my DD on magnesium, it smoothed her out quite a bit.

And sometimes...you can't really manage a diagnosis. You may not ever be clear as to what it is. People, kids change. It could be a phase. You cannot nitpick one thing your kid does that seems weird and jump to the conclusion they have mild autism - are you serious??!

It could be something for sure. But I'm just suggesting you note more than her aggressive reaction to your suggestions. My kid who has anxiety does not have ADHD or mild autism or OCD. Her anxiety is very much based in social anxiety however. There's always going to be different considerations when someone truly has something going on - you'll see other habits which may be concerning.

Unless there's anything else that really is weird, from what you've described it actually sounds like hormones

[Anonymous]

OP here. I don't think it's OCD. I think it could either be some kind of anxiety, ADHD, or mild ASD. But it really doesn't matter.

So far, there are no issues, other than what I described. No issues at school. No friend issues. I don't think the friend or school situations are ideal, but they are fine. She excels in school. But absolutely despises it. She likes her 3 friends and they like her, but they hardly spend any time together, and she has zero interest in developing any new friendships or meeting new people.

For the most part, she is very pleasant to be around and we have a good relationship. But this is a weird trigger and I guess I just want to understand it better.

Maybe some of it is just moodiness?

I will talk about it after, and she admits she doesn't mean any of it. She says she just exaggerates her feelings. I also found she seems incapable of interpreting her body's signals. When she had Covid recently, she was unable to describe her symptoms. I told her that it's going to be important for her to learn how to describe her symptoms so that if something was going on with her, we would know how to help. She's unable to give us any information about whether she has a headache, or has an upset stomach, or anything.

She also does not experience hunger or fatigue. And an unusual reaction to pain. If someone inflicts pain on her, it's just pure anger. But other than that, it's mostly just a kind of curious confusion, or non-reaction when she gets injured. She has never once cried from getting injured, even as a baby.

[Anonymous]

OP, what you're talking about is "interoception" and it can absolutely go along with autism. Maybe she's getting mad because she can't understand what you're saying because she doesn't perceive it.