Has anyone solved the escalating meltdown problem (teen AudHD)? Need hope/advice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If you’re texting her back intermittently then you are NOT ignoring her. Did you do an FA? If not, why the F not?

What is that?

A functional analysis. If your provider tells you to ignore the behavior without first determining the function of the behavior then I’d fire them immediately and find someone that knows what they’re doing.

Oh ok. If that is some kind of formal assessment or process, then we have not had it. We have talked extensively about the function of the behavior, and the parent coach and DBT individual work together and consult. I’m fairly certain they know what they’re doing.

I think what the PP doesn’t get is that other evidence based modalities do not center on finding a “function” for the behavior. DBT and SPACE see the behavior as an outgrowth of emotional dysregulation and avoiding anxious sensations, respectively. The ABA notion of determine a “function” is really more for kids more severely on the spectrum where it may be harder to determine what is going on - eg they want attention, they are in pain, they don’t like transitions. Or for a very young child maybe a learning disability that is causing behavioral issues because they don’t understand the school assignment.

For a normal IQ teen acting like this, you don’t need to look far to understand the function. She has strong emotions and reacts to them accordingly.

This is OP and I have to disagree with you about DBT, at least the DBT we have. It is not focused on emotional dysregulation or avoiding anxious feelings, but primarily on what behavior we are inadvertently reinforcing. My parent coach feels strongly that this is a learned behavior and how DD has gotten her needs met and gotten relief in the past. And individually DD needs to work on healthier ways to get her needs met. She’s also always reacted disproportionately to any inkling that her feeling that she’s somehow defective is valid. Her meltdowns are always triggered by an insult, perceived slight, or ignoring by a valued peer, her sister, or me. Or, her phone getting cut off. But that’s a whole other story and we nipped that in the bud a while ago thank goodness.

not to split hairs but it might be useful to do some more reading on borderline personality and DBT. The core of it is in fact learning to tolerate difficult feelings ie emotional regulation. DD’s “needs” as she sees them in the moment (not to be abandoned) are never actually going to be met. She needs to learn to tolerate the feeling.

On the parenting side I actually do not know that much about how DBT coaches parents but what you describe sound in line with the PCIT we did. But my point is that the therapist never urged us to find the “function” of the behavior because it was quite obvious the behavior (violence) needed to be extinguished.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, would she understand if you explain the risks to her--that as she gets older, if she hits and throws it's not just a tantrum but a crime? She could get arrested, go to jail, get tased or shot by police. It's deadly serious that she learn to control this. And start planning with her for how she is going to work on building this skill--both for your own safety so you aren't injured by her, and for her own.

Yes, she does understand this and I’ve said it to her more than once. Her answer is that 1) she doesn’t do it in public and 2) it’s not her fault. Then she goes on a rant about how the police don’t understand Autism and need better training.

It does not sound like she fully understands that
a) she is committing a crime when she injures you or your property
b) things don't stop being crimes if they are done in private
c) regardless of what training she things cops need, it will hurt her if one tases or shoots her, and that is a real risk with her behavior

I agree with the PPs who say DBT could address these thinking errors and that you can tell her that you will be with her as she works on these issues. It is not ableist to think that people with disabilities can improve their function with various forms of therapy. No, you can't grow back an amputated limb but you can strengthen the muscles around it. Same for her--she can learn ways to manage her disability and be more functional while still being autistic.

[Anonymous]

OP why are you not responding to anyone mentioning trying medication again. I can't imagine how much help an anxious ADHD teen with severe emotional regulation issues is going to have with any therapy if they are refusing any medication.

[Anonymous]

I can’t take SSRIs or SNRIs because of the side effects, so I get it, but you really need to try again on meds. I agree with your daughter that she can’t help it (and that the police aren’t well trained — heck, parents aren’t well trained — to deal with autism). Her brain needs support in the form of meds. She’s in a losing battle right now and you can’t punish her or therapize her out of her brain chemistry.

[Anonymous]

I am shocked her psychiatrist is letting her do DBT without any medication to calm her so she digests all the material.

[Anonymous]

Can someone share which provider is offering DBT with opportunity to have phone coaching anytime? DC started DBT this year but I don't know that we can call someone when DC has an intense episode to help deescalate.

[Anonymous]

Anonymous wrote:I am shocked her psychiatrist is letting her do DBT without any medication to calm her so she digests all the material.

+1

[Anonymous]

Anonymous wrote:Can someone share which provider is offering DBT with opportunity to have phone coaching anytime? DC started DBT this year but I don't know that we can call someone when DC has an intense episode to help deescalate.

An “adherent” DBT program has 4 components- group skills (24 weeks usually), individual therapy, phone coaching, and a consultation group for the therapist. Many programs are “DBT informed” and teach the skills without the whole program. I’m not sure if this is OP asking, but if your DD has severe dysregulation, I would be sure to do a DBT adherent program. Montgomery County Counseling Center, DBT Maryland, DBT Center of Greater Washington all have adherent programs.

[Anonymous]

Anonymous wrote:OP why are you not responding to anyone mentioning trying medication again. I can't imagine how much help an anxious ADHD teen with severe emotional regulation issues is going to have with any therapy if they are refusing any medication.

OP here and I am reading the med suggestions with an open mind. What may not have been clear is that she was on meds from age 7 until about a year ago. We tried 9 different stimulants and all of them made this kind of behavior more frequent. I am very clear (as is her doctor) that they aren't an option and are not effective for her. We also tried non-stimulants that didn't do a thing, and several SSRIs, SNRIs, etc. And Guanfacine. So it's not like I'm referring to meds that didn't work for her as a young child. She just went off of meds a little less than a year ago and has actually been much better off of them (more motivation, less lethargic, no emotional blunting, etc.). And this kind of meltdown has happened twice during that time until recently. And, she doesn't "refuse" meds, if I tell her that's what we are doing, she'll do it. But she said to me "mom, I'm just tired of tinkering with meds," and I want to listen to that - she's 17. It's really awful to keep experiencing side effects that make things worse, not better. But I have an appointment next week to discuss all of this, including the meds that people suggested that we have not tried yet. thanks everyone for your help.

[Anonymous]

Sounds like borderline personality disorder

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP why are you not responding to anyone mentioning trying medication again. I can't imagine how much help an anxious ADHD teen with severe emotional regulation issues is going to have with any therapy if they are refusing any medication.

OP here and I am reading the med suggestions with an open mind. What may not have been clear is that she was on meds from age 7 until about a year ago. We tried 9 different stimulants and all of them made this kind of behavior more frequent. I am very clear (as is her doctor) that they aren't an option and are not effective for her. We also tried non-stimulants that didn't do a thing, and several SSRIs, SNRIs, etc. And Guanfacine. So it's not like I'm referring to meds that didn't work for her as a young child. She just went off of meds a little less than a year ago and has actually been much better off of them (more motivation, less lethargic, no emotional blunting, etc.). And this kind of meltdown has happened twice during that time until recently. And, she doesn't "refuse" meds, if I tell her that's what we are doing, she'll do it. But she said to me "mom, I'm just tired of tinkering with meds," and I want to listen to that - she's 17. It's really awful to keep experiencing side effects that make things worse, not better. But I have an appointment next week to discuss all of this, including the meds that people suggested that we have not tried yet. thanks everyone for your help.

Something in your house is wrong
17 years of escalating behavior on meds is not normal

[Anonymous]

Anonymous wrote:Sounds like borderline personality disorder

I agree, kindly.

[Anonymous]

Anonymous wrote:Sounds like borderline personality disorder

Many autistic young adult women are misdiagnosed with BPD.

[Anonymous]

Anonymous wrote:They have had a similar pattern since then: something triggers her (usually a reaction to her behavior), she escalates which begins with yelling and evolves into throwing/destroying things, hitting people, etc. They last about 20 minutes but are incredibly disruptive/destructive, then she feels remorse and starts to cry, and then it's over. The frequency has varied over the years from once a week to once every few months. The hitting is infrequent but the throwing/destroying things is more frequent. She very rarely does it at school and has never hit anyone there. Although she has thrown things in a mild way (flipping her lunch off her desk once, and throwing a water bottle once but not at anyone). She does cry and get upset at school fairly regularly but it doesn't escalate like it does at home.

OP tell us more about the frequency and the trend over the past two years (since I think you said that's how long she's been off meds).

[Anonymous]

Anonymous wrote:

Anonymous wrote:Sounds like borderline personality disorder

Many autistic young adult women are misdiagnosed with BPD.

What makes you say that? I do know a lot of the self-diagnosed autism is actually BPD.