meltdown and asthma attack

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We decided to go camping this weekend. Me, my mom, the Eldest (HFA), the Middle Child, and the Sprout (almost 5 and ? on diagnosis).

The Sprout has asthma. He doesn't have attacks that often, but they tend to go from green to red with very little stoppage at yellow. He also has non-food allergies and eczema, kind of the whole environmental allergic trifecta. We were worried that the allergy season would cause more asthma problems, but so far it hadn't. He's only been diagnosed with asthma since last fall, and we are still figuring out his triggers. We hadn't been there long. The kids were playing at the park. I went to check on the Sprout and he is in the red zone with breathing retractions at the base of his throat.

I got the first set of albuterol puffs into him with no argument. He is usually pretty good about it. I got something out for him to do quietly, and he didn't like my interrupting him to give him the second set of puffs, and in the ensuing flailing, his stuff was knocked to the ground. This set off a meltdown that took 30 minutes to get him back to a semi-reasonable state of mind so I could get the second set into him.

I know there was a lot going on in the situation. Obviously, knowing that there was a lot going on, I should have let him finish before trying to get the medicine in him, because trying to follow the rule for it resulted in a 30 minute delay while letting him finish would have been maybe 5 minutes. But he didn't have his normal pre-meltdown warning signs, so I didn't think the interruption would be taken so strongly. Has anyone else dealt with meltdowns and asthma attacks? Do you think that the asthma attack made the meltdown more likely? I know this part is something to talk to his doctor about tomorrow, but was waiting for some cooperation better or would have forcing it when he was out of control been better, from the asthma side of things? Although it would have been near impossible to get it during, because to keep the mask on him, his head needs to be pretty still, and he thrashes if anyone tries to interact at that point.

No asthma in my family...however, I would say yes, the asthma attack may have made a meltdown more likely. DS (Asperger diagnosis) was/remains far more prone to them when there are physical issues. (When he is hungry, when he is tired, when he is ill). I think twice about requests/activities that are challenging to him when any of these factors is present. (Or conversely, if I want him to do something I know is challenging for him, I make sure he is rested/has snacked got the best outcome).

What did the Doctor end up saying? I'm interested because a few things are going through my head with your story; firstly, when a kid comes into our emergency department screaming, their airway isn't compromised and everyone can relax. Secondly however, all the flailing etc could make the asthma worse. Thirdly, spectrum kids can be pretty bad at understanding feedback from their body (like pain, shortness of breath etc) so he might be less likely to 'want' your interfering treatment regardless of how much he actually needs it.

So yeah...interesting conundrum...

Well, I called the asthma clinic this morning, and they said that I need to take him to be checked out by his PCP. I couldn't today, because we had an all day job. I am with you that if he is talking and screaming that he's breathing. He carried on with it for a good twenty minutes after the main angry phase of his fit, but it wasn't so much screaming as he was sort of keening, which is an odd sound for him.

He was retracting at the throat and when I was holding him it felt on his chest like sort of poppy inside. Which is supposed to be very serious, but at the same time, he is talking and crying. So it confuses me. They keep insisting that he should be coughing a lot before he gets to the stage of retractions and crackles, and I have been watching him very closely since we finally got in for the asthma clinic and they told me that. He hardly ever coughs. He wasn't coughing Saturday before this. When I take him to the PCP tomorrow, they will probably say he is fine. I thought that things would make more sense after we got in to the clinic, but now it seems I am still having trouble judging the situation. I will be very glad when they decide that we can use the peak flow meter with him. I would love to be able to put concrete numbers to this.

I don't want to be uselessly clogging up the ER or doctor's office, but I don't want to be under treating something with the potential to be so serious.

I'm kind of annoyed with myself (hence the ranting at myself here), because I have no way of knowing whether it was the massive increase of pollen from being in the house all the time versus being outside at the park, the heat (he's never done well with high temperatures. He's always just sort of wilted at anything over 85), the exercise of being on the playground, or the emotional aspect of having his schedule so disrupted. Or if it was some combo of all the above. Letting everything get thrown in together like that sabotages getting any really useful information from the situation.

My 7yo has not been diagnosed with Aspergers yet but I am sure he is somewhere on the Autism Spectrum - he is definitely not Neuro-Typical! He has also had asthma since 18 months old and his bad allergies and eczema started when he was a baby. I have to say his meltdowns and his control freak, inflexible behaviour get much worse during an asthma flare-up. I had a terrible week with him last week when he had asthma. He's normally so good about his medication but when he's ill he refuses to take it, point blank, and he's so stubborn I sometimes have to just back right off and say: "OK!" or it will trigger a meltdown. He's recently started snatching his spacer and facemask off me: "I can do it myself!" although he is letting me puff the puffer (this is when he's not having a flare-up). After he's had salbutamol (ventolin) he is a total mess, it's awful, he often has trouble modulating his volume of his voice but after ventolin he shouts constantly and is ultra-ultra demanding, even more than usual. He had so many meltdowns and was getting so violent with me, he scratched all down my arm, headbutted me in the stomach, screamed at me for hours on end. I can normally deal with him but I was outright traumatised by his behaviour and had to send him to his grandparents for a couple of days - then he had a meltdown there and attacked my mum! The root of all this was the asthma. My feelings on this is that as well as the asthma and the ventolin "agitating" him, when he's ill I tend to a) let him use my computer to watch TV and play games and screen time totally over-stimulates him and makes him more liable to have meltdowns, b) I'm not as strict with my own rules and he thinks we can now follow "his rules" which he gets hellbent upon. I'm not saying this is what happened with your son, just something I've recognised in my own experience with my son. After the nightmare of last week I'm now redoubling my efforts to get him a diagnosis. I hope your litle boy is feeling better, it's no fun being an asthma/allergy kid!

His asthma is doing much better this week, and we've had a lot of lower intensity level behaviors, but nothing at full meltdown level. Thank you for your response.

Finally had the meeting with the school. They had done the Vineland and the Batelle. He scored well in everything except the Social. On one he scored in the 6th percentile and the other 5th percentile.

Both days that the behavior person had observed him in the classroom, he had really good days. So sort of a bad thing, in that she didn't see any of the behaviors that had prompted the school to call her in the first place, and that are causing problems at home, but good in that she had very good views of how he played around the other kids.

She had some specific incidents she related to ground these things, but here are the terms she used. She found his play to be repetitive with restricted interests. That he only engaged in parallel play never involving other kids with what he was doing or engaging in their games. And that he showed very little empathy (not just lack of feeling for someone getting hurt, but also lack of sharing excitement over their accomplishments). She didn't use the phrase theory of mind, but she did say that he didn't seem to realize that the other kids could have feelings that weren't in line with his.

They were a little hopeful that maybe these are just delays that he might outgrow, because the last few weeks he has shown some signs of more interest in the other kids. His last day I picked him up and when I asked him what he had done that day he said he'd been playing with his friends. He still hadn't bothered to learn any of their names, but he actually said he'd been playing with the other kids. Up until now, the only mention we've gotten of other kids is when they had annoyed him--you know like by stealing the toy he had rightfully (in his view) taken away from them.