My daughter, can't even do cyber school

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Hi Everyone,

My daughter, 16, is in a crisis mode. She has developed such anxiety about her cyber school that she was on a medical leave of absence for 3/4 of last year. We enrolled her in a new cyber school that is even more flexible but she is having such anxiety about it that she is really struggling to get started. She does have some OCD, particularly around touch and contamination. The OCD seems to have extended to school and she feels she has to do everything perfectly. She is also very gifted and often the school work is repetitive and that also makes her very anxious. She was sitting here last night, trying to read her "Emerging Genetics" lesson which sounds really interesting but she said she already knows what was in the lesson and had already had it in Biology. She says when she is on her own computer, reading or playing games she has no problem thinking but as soon as she sits down at the school computer a "veil" comes over her mind and she can't think.

We had a behavioral analyst come to the house to do an evaluation for her school IEP. She thinks she needs behavioral therapy. Jaime reacted very badly to her, of course, as she was pushing her to modify her behavior. There is more and more pressure from therapists, etc. to put her in a residential treament center setting to address her anxiety and sleep problems. We have avoided using medication because when we tried it, she reacted very badly to it.

What concerns me is that Jaime cannot see that she does need to modify her behavior in some way if she wants to be able to live in the world. We have really modified her environment to accommodate her sensory sensitivities and such by letting her do cyber school but the result has been that her world keeps shrinking and now she feels she has "no life". I think the OCD is the main problem (and probably some adoption trauma from birth) but the behavioral analyst thinks it is her defiance and aspergers that are the main problem.

Sorry - I am not making much sense - we have mostly avoided the behavioral approach with her but now she is in such a crisis that I wonder if we made a mistake. I am sure that a residential treatment program for anxiety would include medication and a lot of behavioral therapy. If this is what she needs, that's good but if this would be bad for her, I don't want to do it. If anyone knows of a treatment program that would understand aspergers, I would appreciate hearing about it.

We were all set on taking her for some intensive OCD treatment but the center does not have much experience with aspergers so not sure if that is a good fit.

Sandy

Wow, I wish I had answers. I will say that I hestitate on the residential approach and I hestitate on medication; I've heard of situations where these sorts of things escalated all the difficulties further.

What does you instinct tell you on her behavior, ie is it reflecting real needs, or is some defiant teen thinking kicking in? AS kids aren't immune from the later, and it has to get addressed with someone who is AS just as it does with any teen: you call them on it, and stick to the ground rules.

We do have other parents here with teens who have dealt with some serious issues like yours, and hopefully one of them will post soon.

Hello there,

I should begin this post by requesting that no matter what choices you make, you do your best to try and remain calm, level headed, and open minded. As you have said yourself, your daughter is in crisis mode. Becoming panicked yourself would be the normal human reaction when in this situation, but I must point out that if you’re panicking also, things probably won’t work out well. What your daughter needs more than anything else at this time is for you to think things through carefully and rationally.

That being said, here is the best advice I have for you:

In order to accomplish anything with your daughter, she needs to buy into it. In other words, she needs to agree that the course of action you decide upon is the correct one, and willingly go along with it. If you try sending her to therapy when she doesn’t want to go to therapy then the only thing therapy will accomplish is making her resent you for sending her to therapy. Likewise, sending her off to a residential treatment center isn’t going to work if she doesn’t want to go and refuses to participate. The people there may be willing and able to help her cope with her anxiety, but if she refuses to let them help, she will never improve. So, whatever you decide to do, make sure that you get her agreement in the matter. As I have said many times on this forum, your best chance of success is when you work WITH (bolded for emphasis) your child rather than AT them.

Your daughter shouldn't agree to attend therapy because she doesn't want you nagging her. She should agree to attend therapy because she understands that there is a problem, and wants to fix it. Any good therapist will tell you that overcoming your anxiety and fears is not something anybody else can do for you. If you want to overcome your fears, you must do the majority of the work yourself. The only thing a therapist can do is help by providing guidance and feedback, but it will be up to your daughter to put forth a major effort if she is to see any real change. And in order for her to put forth the effort, she must be a willing participant who is self-motivated to see things change. If she is not self-motivated to see things change, but is being coerced into it by nagging, threats, etc. then it is unlikely she will be able to overcome much of anything. Keep in mind that if you try turning this into a battle of the wills, you are going to lose, and since your daughter won’t get the help she needs, she will lose also.

So then, your problem (or your daughter's problem) as I understand it is mostly due to anxiety caused by change of routine. This is commonly associated with both OCD and AS, but to be honest labels are just labels. I really don’t care how it gets defined, merely that the problem is clearly understood. In addition, she has problems with switching between tasks (most likely made worse by the anxiety), and perhaps fear of failure. I am not sure if she has a fear of failure, but it sounds like she might from what you post, so it might be something to look into. This situation is being made more complicated because your daughter feels (and rightly so) that you are trying to change who she is, and how she does things. She sees this as a threat to her individuality, which is especially common amongst teenagers who are developing their own independence.

So then, the solution to your current dilemma is probably going to start with you sitting down and talking with your daughter. What you need to do is pretty much have an intervention. Keep in mind that this talk shouldn’t start with listing off everything your daughter is doing wrong. That’s not an intervention, that is just nagging. Your conversation should go something more like this:

“(Child’s name), before we start, I want to make sure that I am clear. I want to have this conversation not because I think there is anything wrong with you, but because I love you, and just want you to have an enjoyable life. I know that you are becoming a mature and independent adult, and as such I cannot make your decisions for you. I don’t want to come across as nagging, or talking down to you, I just want to express my concerns, and then have a mature adult conversation. If you have something to say, I will listen and consider it. And in the same way I would like you to listen to what I have to say, and consider it. I am not trying to assign blame, or complain. I just want for us to talk about something that I think is causing you to have problems, and hopefully come to a solution that we can both agree on which will help to alleviate this.”

Of course the exact words that you use are up to you, but they should be something with roughly the same meaning. What you need to convey to her is that you feel that her current course is unsustainable long term, and also detrimental to her happiness. Give her examples of why her current actions will be harmful to herself. Explain that the world is full of changes and that if she doesn’t manage to find ways to deal with these changes, she will always have a great deal of stress in her life. Let her know that she will find it difficult to hold down a job if she cannot tolerate working with other people. Most jobs require you to interact with some other people on a professional basis. You don’t have to be buddies with all your co-workers, but you need to at least be able to make suggestions, answer questions, and attend meetings about your work. If you have too much social anxiety, to do this, then you won’t be able to work.

Make it clear to your daughter that you are not trying to insult her, or blame her for her difficulties. Just let her know that you think that she will not be happy if she doesn’t change the way she does things, and you don’t want to her to wind up living an unhappy life. Take some time to talk with her and explain your concerns. Keep in mind that as part of this discussion, you will need to listen to her, and consider what she says. If she disagrees with you about something, don’t just dismiss it as an immature reaction. It may indeed be an immature reaction, but your daughter doesn’t see it as such. She sees it as being a good point which needs to be considered. So, do take the time and actually listen to what she says and discuss it.

After that, you can start proposing some solutions. Keep in mind that, you may need to change your expectations, or pick your battles. For example, you say that she has a ‘shrinking world’. There is nothing wrong with perhaps going out more often, or finding some new friends, but trying to sign her up for the local high school sports events in an effort to improve her social skills is probably going to be a bad idea. That’s like jumping into the deep end of the pool with weights attached in an effort to improve your swimming skills. Make sure you get feedback from her on your ideas. Does she think they are good ideas, or bad ideas? Does she foresee any problems with the execution of these ideas? Is she willing to put forth the work in order to make these things happen? If you just sit down, make a nice speech about maturity and mutual respect, and then tell her what to do, you aren’t going to accomplish anything. You need to get some feedback from her and make sure that she is on the same page as you.

As for what to suggest to your daughter:
She may want to try playing an MMORPG. It is a computer game where you play as a character in an online world with thousands of other people. The point of these games is to team up with other players from around the world and do quests, missions, and other things cooperatively. The most common game of this series is World of Warcraft, but there are many others. I personally play a game called Final Fantasy 11, which I enjoy very much. I also tried Eve-online for about a year, but got tired of the slow pace of the game. This requires that she have enough self discipline to stop playing her game, and do her work when needed, so it may not be the ideal solution if she has difficulty with self control. However I must say, that I have been playing MMORPGs for 5 years now, and I am very glad that I do. They are a great way to socialize with other people, and get the benefits of human companionship in a very safe and comfortable environment. It is like T-ball for socializing (poor metaphor, but I think you get the point). It also is a great way to relax, unwind, and de-stress, which is probably a good thing for your daughter. And yes, these games are indeed a large time sink with no real world rewards, but then again so is sleeping. The point is that you can’t expect your daughter to be on and working hard all the time. She needs to be able to relax and unwind, and what better way to do that then a game which promotes social interaction, teamwork, critical thinking skills, and other such benefits.

Your daughter may want to try out a physical activity. Many people on this forum have said that things like martial arts, long distance running, or hiking are a great way for them to de-stress and unwind. I personally know that I feel much better, and think more clearly when I pace back and forth (which I did for a few hours while composing this post in my head), so this idea makes sense to me. I don’t know if your daughter is athletic or not, but it may be worth discussing.

Your daughter may also want to try something called cognitive restructuring. I personally am a big fan of this method as I used it on myself to great benefits. It is a form of Cognitive behavioral therapy:
http://en.wikipedia.org/wiki/Cognitive_restructuring
There are already many many threads about this topic on this forum, such as this one:
http://www.wrongplanet.net/postt104232.html
If done effectively, it can be very useful in overcoming anxiety, which seems to be your daughter’s main problem. The entire point of this therapy is to calmly, and logically address your fears, and work through them.

You may also want to consider incremental approaches to overcoming situations that give your daughter anxiety. Say for example, she doesn’t like to be around crowds of other people. You could start small by going shopping with her in a small store during a low traffic time, so there are only a few other people around. Do this until she feels comfortable with the situation, then try something a bit more challenging. Perhaps go to a more crowded store, or stay for longer, etc. The idea is to find a situation where you are a bit uncomfortable, but not panicking. You then slowly get used to the situation over multiple times, and make sure that you spend time relaxing and unwinding between each attempt. You shouldn’t push too hard or too fast. Just go at a pace where you slowly expand your comfort zone.

The solutions you come up with will be between you and your daughter. I don’t know your situation well enough to tell you what you should do, but just make sure that it isn’t going to be overwhelming for your daughter, and that she agrees to whatever you decide.

Now as for drugs:
I am somewhat cautious about drugs. Keep in mind that an autistic brain is wired differently, and has a different chemical balance then a normal brain. A chemical analysis will show that neurotransmitters (the chemicals in the brain which are affected by drugs) are different in autistic people. Serotonin levels are higher, Oxytocin levels are lower, Testosterone is higher, etc. This means that when you give drugs designed to work in normal people, they may not have the desired results in autistic people, and may even be counterproductive. Think of it like comparing a gasoline engine to a diesel engine. Both are internal combustion engines that powers cars and trucks, but they work differently. If your gas engine is running poorly, putting in a high octane gasoline fuel may help. If your diesel engine is running poorly, putting in a high octane gasoline fuel will only make things worse.

Now I am not saying all drugs are horrible. Many people on this forum say that they take low levels of anti-anxiety meds, and that they are indeed helpful in controlling anxiety. Just be aware that if you do go the medication route, that you thoroughly and carefully read up on the drug, and explore all possible side effects. Start with the smallest possible dose until you achieve the desired results. And make sure you look out for any abnormal behavior or other problems which may be caused by the drug.

I would also stay away from the anti-psychotic drugs like Abilify, or Risperdal if at all possible. These drugs are only approved for people who have violent tempers and a history of self harm or attacking others. They also have a much higher incidence of causing severe problems (including psychosis). Some on these forums say that they take anti-psychotic drugs, and it helps them to remain calm and control their thoughts. But in generally these should be your last resort only if other less risky alternatives have failed, and you still have serious problems that could land your daughter in jail.

Sandree, tradtionally, Tracker is right on with understanding AS teens and young adults so, definitely, take seriously everything he says. Just wanted to let you know the track record there

I think she needs CBT. Behaviour therapy on its own is not as good. OCD is a large part cognitive.

I would shop around for a CBT practitioner with experience with OCD and ASD. It will be a challenge but that doesn't mean you change everything in one go. That would be an example of poor CBT.