Is my son mentally ill?

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Our 11-year-old has taken a turn for the worse. He has been diagnosed with ADHD/AS, and over the past year his medication has more or less controlled his symptoms, until recently. Recently he has taken to chanting incessantly "You're confused," and when asked what we're supposed to be confused about, he says it would take a doctor to understand and that we don't understand him. We do know that he doesn't understand the subtleties of our facial expressions and then he becomes very angry, but there’s probably more to it than that. He is violent at times in speech. Bipolar? We don't know. He's not depressed or sad.

He goes around with hunched shoulders to hide his neck that he has suddenly and recently decided is unsightly. His neck is the latest part of him that he imagines is ugly; before that, it was his tongue. He takes two to three hours to have a bath, so obviously he has OCD as well, along with various other oddities typical of the spectrum. We think he's washing off some of his medication patch. He also refuses to take the anti-anxiety medicine prescribed for him; in fact, he's never taken it. We've taken him to two psychiatrists, a psychologist, and his pediatrician; the latter we'll see tomorrow with the latest report on his worsening behavior.
We seriously wonder whether he's mentally ill along with everything else, that is, just plain psychotic. We're puzzled by these mood swings--very angry at our "confusion" and then all soft and sweet later on. He's very impressionable, by the movies he watches, the video games he plays (we restrict video game playing as it seems to have a bad effect on him), and what seems to calm him down are spiritual things, animals, birds, etc. Spoilt? Selfish? Mentally sick? All of the above?

We're getting to our wits' end. He's becoming impossible to live with. We can't even sit down to watch a movie without him getting paranoid about our expressions (he watches us more than the movie), and then he starts shouting out that we're confused. He has frequent outbursts daily, shouting angrily. He's literally paranoid and delusional about people (including us) taking pictures of him. We will pursue further investigation and treatment, but in the meantime, we would really appreciate commentary from parents and others who have real and practical experience with any and all aspects of this terrible situation and disorder we're experiencing.

Thanks.

In children on medication who are deteriorating, the medication should always be considered as a potential cause. Sometimes they just trade one problem for another, and because children have such dynamic brains, it is not impossible for a medication to work fine, and then not. In fact this happens even in adults.

There are no "symptoms" of AS that medication treats. Medication may be used to blunt negative reactions of the individual to environmental stresses. To that end, the ethics of using it in individuals who actually only have AS is questionable, as it is much akin to putting an NT in an environment they find stressful, and using medication to suppress the actions of very valid emotions.

However, as you said, your son also has ADHD, and might very well have OCD or some type of body dysmorphic disorder.

I would request that your son have a medical workup. I would ask them to check his thyroid, and vitamin levels....vitamin deficiency is not common in westerners but due to the symptoms they can cause and the ease of which they can be treated, it's worth checking.

If he has OCD, he might be chanting "You're confused" as an OCD related ritual, in which event, if he were to try to tell you why he was chanting it, you likely wouldn't understand. People with OCD will frequently engage in rituals that do not make sense to others because they don't actually have a direct relation to their purpose. For example, he might be chanting "You're confused" because in his head, he has to chant thing in certain situations, or a certain number of times, to rid himself of the sense of something bad happening, or block out disturbing, intrusive thoughts.

i agree that you are confused. maybe try listening to him and try and understand what he has to say before calling him insane and pumping him full of medication.

I have worked with a lot of people with disabilities, ranging from dementia to schyzophrenia, and what I've found more often than not the changes in mood/symptoms varies with home situation. Even subtle changes can upset people with all types of disabilities. That and the medication itself. I am very much against medication for children primarily because it's difficult to know what exactly the effect will be especially through their puberty years.

If I may, what medication/s is he on?
I also agree with Chronos. A full medical workup.

What "symptoms" of AS is this medication supposidly assisting?

My brother will often watch me and my husband just as much as the activity we're doing. Whether it's a movie or painting or walking. He will get irritated at seemingly the most harmless things. Me bouncing my leg, a certain facial expression, etc. I am not bothered by this much of the time, but I supose it is nagging at times. What we have learned is to redirect him to the activity or ask if he'd rather do something else if he can't pay attention to the task.

Good luck!

I don't think I can very well be the judge of that even though I myself am mentally ill....anyways though I would look into the medication being prescribed as chances in behavior if that is what it is could possibly indicate undesired reactions to the medication. If he is on stimulant type ADHD medication those drugs can make one more irritable and impulsive which could be part of it.......otherwise this happens to some people just from too much so maybe the dose is too high.

Also though if he is mentally ill he needs support, compassion and help most likely.

I can tell that your family is really struggling and my heart goes out to you. From the few things included in your post, it is hard to say what is going on but I am troubled by this

I don't want to sound harsh but I think a real change of expectations may be in order if these are the options you come up with as possible causes of his behavior. I would urge you to be very careful about laying blame on him (or yourself for that matter). Behavior is communication and for folks with ASD it is often not very effective communication because it can be very difficult for the recipient (you) to interpret and they haven't learned more effective ways to communicate. For example, I seriously doubt that his chanting "Your're confused" simply means that he thinks you are confused about what is happening in that particular moment. The words themselves may not even have any specific relevance. You need to establish better communication with him in order to figure out how you can help him. Have you ever tried the How Does Your Engine Run program? This is designed for younger kids but if you don't have a means to communicate with him about how he feels, a modified version of this may be a good place to start. Does he do any therapy, OT, ST, psychotherapy? I also would have to question the effectiveness of the medication and the potential that the medication could be causing some of what you perceive as back-sliding. There are naturopathic remedies for anxiety that may prove useful, something to think about anyway.

I think there are very few truly psychotic people in this world so I think you can probably put that word out of your vocabulary. From what I've read here and elsewhere, ASD does often come with other co-morbid conditions and your son may indeed be suffering from a condition or conditions other than ASD and ADHD. IMHO you need a good therapist that will work with your whole family to help you learn how to understand and communicate with each other.

Now I'm more confused than ever. Thanks for the positive reinforcement. This is exactly what I was looking for: a skewed attack rather than a helpful contribution. I thought this thread was supposed to be a forum for discussion with people who would at least have some kind of understanding of the challenges special needs children present and who might be able to offer insights and commentary to help others in need, in contrast to people who have no idea of these disorders and who might offer judgmental and uninformed crticism.

I don't know that its meant as an attack...but honestly your post does kind of come off as very, very harsh and a lot of us here have autism and some have mental illnesses and it kinda seems like you blame mental illness on the individual who has it maybe that is not your intention but it's how it comes off. I mean if your son is mentally ill....its not because he's 'spoiled' or 'selfish' its usually a case of genetic factors, environmental factors and social factors. You know genetic per-disposition, if he has autism then what is a comfortable environment for most neurotypicals might still be too stressful of an environment to him which can lead to anxiety type issues and meltdowns...then maybe he's getting bullied at school, feels misunderstood or is frustrated and unable to verbalize exactly what's bothering him.

Blaming his symptoms on him.....is not the way to go, I mean when I was growing up I had mental illness issues and a lot of people blamed it on me.....so I ended up blaming it on myself and eventually attempted suicide because I felt I was just defective and only cause problems for people and honestly I still feel like that a lot. The thing with mental illness is its not something someone chooses....or does to get a reaction its a sign of being in psychological pain and/or needing help with it or some sort of support. Also it just makes mentally ill people feel more alienated when you accuse them of simply being selfish or spoiled and then try to punish the symptoms out of them.

As for medications it is certainly something to check into, I mean sometimes they can make things worse for some individuals or they might be getting too high of an amount. Medications are drugs and drugs should be used with caution especially when it comes to children.

joiedevivre, I hope that you will come back and see that there are many here who are interested in offering constructive feedback. I too took thedaywalker's comment as a rather pointed jab and that does happen here. We have a lot of folks with AS (and other conditions as Sweetleaf has explained) who post here who are not parents. Sometimes the comments offered sound harsh but many of the adults AS folks who come here give us great insight into our kiddos that you just can't get very many places.

This.

After years of interacting online with adults on the spectrum the other thing that I'd like to point out is that I have met way too many who did not have good parents. They did not have good childhoods. Bad things happened to them. Therefore, I cut them some slack because they may be coming from a place that I--thankfully--will never be able to fully understand. And to be truthful, thanks to their guidance, my kids will never be able to fully understand it, either.

May I suggest the book Kids in the Syndrome Mix http://www.amazon.com/Kids-Syndrome-Asp ... 1843108100

I'm sorry but please notice that i'm not depressed nor insane and i truely believe you should listen to your kids. Maybe it comes out a little rotten and i understand that a kid is a lot but i have been misunderstood for most of my life so it's realy important to me when something like this comes up, for when i read your story, it reads like it's about me. To me it seems like you'r mind is not open to the possibility that this kid realy knows something or has the idea he does and realy feels like he can't tell it to his parrents because they wouldn't understand.

We didn't know anything about pragmatic speech, or that my son had a speech deficit - and we were experiencing many of the symptoms you describe, plus violent and suicidal behavior that was, to put it mildly, terrifying. I thought my son was bipolar at the time, but what I didn't know was that the world was so incredibly incomprehensible to him that he was constantly on guard for an attack - all because of the speech deficit. He could speak perfectly normally, but we found out that he was really understanding only about 70% of every interaction, in both directions.

Imagine being in a foreign country where you don't speak the language but have access to a phrasebook you barely understand, and you are interacting in a language you don't understand. Now imagine that everybody you meet believes you are a native, and assumes not only that you can understand both what you're saying and the responses to you - but also all the local customs, values, etc. Wouldn't you feel crazy? Wouldn't people treat you like you were crazy? If you had a tendency towards other mental illnesses, wouldn't that exacerbate them? This was what it was like for my son; once we got a decent diagnosis, speech therapy, and he decided to disclose his difference to his classmates, things improved considerably.

Maybe something like this is going on with your son. I wish you the best. Keep in mind that when you come here, you may be talking to people just like your son: they aren't going to candy-coat their feelings for you, but they may be your best chance of seeing things from his perspective.

There are some resources stickied at the top of the board; if you don't want to post for a while you might want to browse there.

I want you to know that your input here is appreciated and I can understand that your response was because you relate to the OP's child. The concern I have is for people new to this board, the OP being one. If a new person sees a rather blunt comment in response to one of their first posts it can chase them off of this board, sometimes for good. If that happens then they aren't going to get any of the input from people here that could really help them AND their kids. So I apologize to you if my comment seemed to be derogatory, I get a bit defensive of parents who are new here because I'd like them to stick around. On the other hand, as I mentioned, we really value the input from adults with AS. I know I have learned A LOT about what it might feel like for my son through the posts that you and many others take the time to write.

I don't know if this is even plausible but could "you're confused" really mean he is confused and he reverses the pronouns? He might be too old for that maybe, but I know every now and then my son will accidentally revert back to reversing pronouns, like he once routinely did.

1. kids these days are hitting puberty way earlier (the horemone changes happen before the obvious ones) and this may be interacting with the kid's medications.

2. Watch when he says "you're confused" - is it after you talk to him? is it after you accuse him of being mad or angry or overstimulated? And yes I use the word accuse - because if he's anything like me, that's how HE sees it. I have only recently been able to realize that my vocal inflections and stances and everything else have a tendancy to make people think I'm angry when I am absolutely not. Once I was telling someone something important and meaningful, and they interupted me and said "do you realize you're yelling at me?". Neither the situation nor the person were stressful or in any way negative, and I was amazed and confused by the suggestion that my tone/expression had been anything but neutral. I would normally have said (in my head) "confused!" and 'labelled' the person in my head as "another idiot"...

But considering who this person was, I, for the first time in my life, opened my mind and admitted that they had no reason to, no inclination to, mess with me on this subject. And I took the situation to heart and learned from it. I'm 36. Yeah. So what he might mean by "you're confused" is that he doesn't feel like you understand him / are reading his posture/inflection rather than his WORDS ONLY. I am a WORDS person; most of humanity is looking behind the words for extras informations that, in my case, are not valid/correctly presented.

My suggestion when he tells you you're confused?
1. Pretend you're listening to someone with real bad english - not that his english is bad (i doubt it is) but that he has learned slightly different ways of defining his words than you have.
2. Ignore the tone (I know it's hard for you NTs) and body language. Just listen to the words as if they were not emotional.
3. Try and suggest he uses different words, or different structure to get the idea across to ytou again. OR write it out. Writing it out always made it better for me. And then compare what he wrote to what you HEARD earlier. Prolly be a hell of a wake up.