Regressive/Violent Behavior in 6th Grade with HFA

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My son, Nathan, is 11 years old and in 6th grade. He attends a private school for children with autism and is high functioning. On top of the autism, he has ADHD, ODD, and developed severe OCD approximately 14 months ago. The OCD has been debilitating, so we opted to try antidepressants which is the common treatment for OCD. Lexapro caused no problems, but didn't help the OCD. Anafranil was a nightmare and caused Nathan to go into violent, screaming fits EVERY day. Then he was moved to Zoloft and the daily violent fits were replaced with moodiness, crying, and an overall angry attitude, so we stopped the antidepressants since they were doing no good for the OCD and made things worse. He has been off the antidepressants for two months and we are just giving him natural supplements (multivitamin, magnesium for anxiety, B complex, and high DHA/EPA fish oil - I honestly don't know if it helps any, but it doesn't seem to be doing any harm either).

The main problem we are having is that Nathan has regressed over the last 6 months or so. He hits, bites and kicks, pees his pants on purpose, and has a horrible, hateful attitude - he has told me many times he hopes someone hits me with a car and kills me because he hates me (he and I have always had a wonderful relationship up until recently despite the typical autism difficulties). His hands are covered in scars from biting himself and he has bruises covering his arms because he sucks his skin and pinches himself. The anger and hate is focused almost entirely on me. He says he hates my voice and he "has" to hit me, but doesn't know why. Every time he comes near me, he pinches me, kicks me, and yanks my shirts which is ruining my clothes. I just married my boyfriend of 10 years two weeks ago and Nathan refused to come near me. The one picture he took with me shows him screaming/crying because he didn't want to be near me. It broke my heart that my son wouldn't talk to, take pictures with, or hug me on my wedding day.

Also, my son and I have both been seeing a therapist (separately), but that hasn't helped any just yet. I have given my son stress balls, water balls, hand exercisers, stretchy toys, all in an attempt to stop the pinching, hitting, clothes yanking, but it hasn't worked. We have considered putting him in an acute care facility, but then a day or two will go by where he seems to be getting "better", only to have the behaviors start back up. When he is "better" we let go of the acute care idea. We have a prescription for Abilify in the cabinet, but we are reluctant to start it because the horrible side effects of the antidepressants and the fact that the psychiatrist did not seem to have a lot of confidence that the Abilify would do any good in our case. My primary care doctor put me on clonazepam because my therapist says I have situational depression (adjustment disorder) and anxiety caused by the anger and violent behavior from my little guy. Basically, home life is miserable for the whole family at this point.

My question is, has anyone experienced this sort of regressive, violent, angry behavior in a preteen on the spectrum? One person told me it was the Zoloft and he would "go back to normal" a month or so after stopping, which isn't the case. Others have said it's puberty, but my son does not appear to be going through puberty (I don't see the physical signs). I really don't understand why he went from loving his mom and being my best friend to hating me and hitting/pinching me everytime we are in the same room. Any suggestions? Any input?

Just to clarify: Is he off all of his meds or just some of them, currently?

Sometimes meds stop working and need to be retweaked. Sometimes kids need to be taken off everything--see what the situation is devoid of any meds and then if there are still issues, do the med trial and error thing all over starting at square one.

The other thing I would try to investigate is what is going on at school. (Does he go year-round- or has he had off?) are there problems there that he is reacting to, perhaps.

There are a lot of things than can set off a kid and anxiety is certainly one of those things. I don't know a whole lot about ODD, but I am assuming that that also can be worsened by things like anxiety, struggles with self-esteem (social or academic difficulties).

There may be a lot of things to try to parse out, so I guess my first step would investigatory.

As far a puberty goes, I think it depends on the kid. We were actually told that it can help. In our case it seems to be easier to explain and communicate with our son. I don't think it is because of puberty itself, but but the correlation to a maturing mind. But for that to come into play, you have to have some calm, and it maybe you have to sort out the brain chemicals and/or environmental factors first.

@ASDMommyASDKid: Nathan is off all medications at this time. He just takes nutritional (over the counter) supplements. It has been two months since he stopped the antidepressants and has been on no medications since then.

He does not go to school during the summer, so he was home with me and his sister for two and a half months and just started back at school two weeks ago. The school sends daily reports to parents and his behavior has fluctuated between uncontrollable to mild over the last two weeks. He has had violent bouts with teachers, but never with other kids. His aggression is almost entirely directed at adults.

The doctor who said Nathan has ODD said it is "mild", but it seems extreme to me and his step dad. His step dad even tried a little experiment with Nathan recently when Nathan was in a good mood. He would say something like "Nathan, can you say 'blue'" and Nathan would respond with "No, I'll say red". It was a bunch of simple requests like repeating after his step dad or his step dad asking him to do a simple task. Nathan, not even once, followed a request. He seems to be incapable of listening to authority figures. Same thing with riding in a car. I always tell him to put on his seat belt as soon as we get in the car and he will typically respond with "Just shut up. I'll put it on in a minute". Or he will say "No" while putting on the seat belt.

At this point, I just want the violence and hatred he has toward me to go away. I don't know where it came from and I just keep hoping it will stop. I wish the bad attitude, cussing, and defiance would stop, too, but mostly I just want him to stop attacking me everytime I look his direction or clear my throat or ask what he wants for breakfast...

I think you need to consider the fact that the wedding (and engagement before that) may have been a trigger. Does he seem to be comfortable with his therapist, do you think he trusts the process? It can sometimes take some shuffling to get it right.

Puberty is a big one, of course, as are medication changes and the start of a new school year. Perhaps any of the above on their own he could have handled, but it sounds like he is probably dealing with all four. Even if you and your boyfriend were living together before this, it is a huge life change for your son, and he is going to have feelings he will need to deal with. They may not be feelings he understands or wants to admit, especially if he has always liked your husband, and that probably makes it all worse.

Until you've got it all sorted out, I suggest going into "pick your battles" mode. Choose one or two behaviors that most need to stop (aka the violence) and put all your techniques into that one area for the next six months. Let him know what the program is and why you are doing it, and then live it. JHMO

Congratulations on your marriage! I hope you can get through this rocky patch with your son and be blessed as a family.

Ok. I would try to go back to what started happening 6 months ago (or earlier) in case it is something he was stewing on for awhile. What changes were going on at that time (or before) that you think might have triggered something.

Does it correspond to be taken off the meds?
Does it correspond to being aware of your engagement?
Did something happen at his school?

Something else?

I know it is hard to think that far back and you are likely only going to recall big changes as opposed to combinations of smaller things, but if you can, it may give you clues as to what kind of scaffolding might help him.

When he is calm, can he talk about his emotions? Is he ever not angry? Is there anyone (a grandparent, maybe) who he is not angry with who he might confide in?

Have you read any of the collaborative problem solving material by Dr. Ross? http://www.livesinthebalance.org/ There are tons of free material there and his book the Explosive Child, may be worth a read. There are some strategies that you can use to give him input to make your son feel less controlled which may help him.

@DW_a_mom: Nathan seemed to be happy about the wedding. He considers my husband his dad because his biological dad has never been in his life. We were engaged 7 months before getting married and we have all lived together for 6 years. It never seemed like the engagement or pending wedding bothered him, but he did tell me yesterday that he didn’t like the music at the wedding because it was too loud (he had a meltdown at the end of the evening and the music may have contributed to how upset he was). I keep hoping this shift in attitude is puberty related because I know it will even out at some point. I'm scared that if it isn't puberty, some switch in his brain got flipped and this is just how he is now. We are focused almost entirely on the violent behavior because I am sick of flinching or backing myself into a wall every time Nathan is near me for fear that he is going to hit me. It's no way to live - being afraid of your kid. For now, his Internet access has been completely removed and he is only allowed to watch TV or listen to music if my husband and I are around because all he likes to watch or listen to is nasty, profanity filled nonsense (South Park, vulgar songs). We hope that by removing the negative stuff he is filing his head with all the time, maybe there will be a positive impact on his behavior. Thank you for the congratulations! Despite the difficulties with Nathan, Scott and I are happy to be married

@Chichikov: Yes, he knows. We took him twice for screening. The first time the facility was going to admit him to their acute care program, but Nathan cried his way out of staying - he just made me feel so guilty that I couldn't follow through. Several weeks later, we went back and the front desk actually had to remove Nathan from the waiting room and lock him in a secured room because he wouldn't stop hitting and kicking me in the waiting area. That time, they opted not to admit him because he was titrating off the antidepressants and they weren't sure if the behaviors were related to coming off the medication (they weren’t). We were going to take him to a different facility this last weekend after my friends and family who were visiting for the wedding went home, but his behavior seemed to be improving out of the blue and we decided against taking him (we regret it now). Nathan either says he isn't going to stay anywhere or says he doesn't care if he goes. So, we don't really know how he feels about it. There is another option we have that takes kids for 7 days to remove them from whatever situation might be causing them problems and hopefully "reboot" them by giving them a break. They are not an acute care facility and they don't do anything with medication. It is called the Calm Center and it seems to be a good starting place, but they only take kids who want to be there since their goal is to maintain a calm, peaceful environment, and Nathan says he won't stay if we take him there...

@ASDMommyASDKid: I honestly can't think of anything that seemed to impact his emotions or behavior other than starting the antidepressants. We started the antidepressants because his OCD became so severe that he had to be carried from room to room and could no longer dress himself. After months and 3 different antidepressants, he became out of control, but now he is off the meds completely and his violent behaviors are still there. There are times when he is not angry and we try to discuss his feelings. He keeps telling people (his therapist, his stepdad) that he loves me, but that he has to hit me. When asked why he "has" to hit me, he can't or won't explain. I have not read any of those materials you mentioned, but I will definitely look into it. Thank you for the suggestion.

BEHAVIOR UPDATE from this morning: Nathan was ok this morning. Aside from the usual trying to yank my clothes or pinch me constantly, his behavior was tolerable and he wasn't having a nasty attitude, which is rare. However, when I dropped him off at school, he got out of my car and kept reaching through the window to try to yank my shirt or squeeze my hands (normal for him). He would walk away from the car and come back to do it again. When he came back a third time I rolled up my window and told him to go to class, so he opened my door before I could lock it so he could yank/squeeze again. He then shut the door and tried to open it again a 4th time, so I locked the door, cracked the window, and told him to go to class. At this point, Nathan started stomp-kicking my car door. I could hear he was denting my car so I screamed for him to stop at which point he yelled "Shut up, you f****** b****". He used to be so sweet and now he is just rotten most of the time. It's really sad...

Despite the long length of time you've been together and despite the fact your son likes your husband, what you write sounds an awful lot like a jealous abuser trying desperately to hold onto the person he thinks he loves. I think this is a road you have to investigate, no matter how unlikely it feels. Something is going on inside your son's head that he cannot put a name to, and he is acting like someone who feels intense emotional pain but does not know how to deal with it appropriately.

I hope you can figure something out. I've heard no positive stories about institutionalization; no one who felt it helped. Once you go down that road, it will be very hard for him to make it back to you.

I can't imagine having to make such difficult choices. You are trapped between your need for safety and trying to figure out how to give your son a positive outcome.

You need to bring him to a Christian church (not catholic). You need to get the pastor and elders of the church to pray for him and anoint him with oil so he is delivered. I know this all sounds scary or mad or whatever but it works. Jesus is your answer.


Kind Regards, Nay.

Is there anything which your son particularly enjoys? What puts him in a "happy" state?

I wonder if indulging in that could be a "start-off point" leading to more ease in alleviating his more extreme behaviors.

Hormones still change during puberty so even though a kid isn't showing any changes with their body, their hormones could be changing.

Have you asked him why he hates you? I would still stick with sticking in into care idea no matter how better he seems to be getting because he keeps slipping back.

I experience some aggressive behavior as a preteen. I also had depression and anxiety and I had grudges about my mother about her past mistakes. I remember feeling so angry in my teens and I would just act out sometimes. Then when my anxiety got worse, my parents would get mad at me about it so it made it even worse for me. I did actually try to have ODD because I thought it would make me get control over the situation but instead it backfired. I had lot of emotional overloads because of anger and anxiety and my family being unsupportive. I call it tough love they were doing. I only got better when our puppy died and when my brothers were older so they started to compromise so they can still have their parties and their friends over without me going crazy. I totally learned that year what intense anxiety does for me.