Concerns regarding my son's mental health, information and advice welcome

Thanks for your knowledge and advice.

Follow up appointment with CAMHS today, let's see what is said and if anyhting will be offered.

jo and jack said:

School, we know is not the environment and positive experience it could be for him, but it has improved too what it was. Many discussion/letters on lack of support/disability discrimination have been had and sent too school.

so school isn't as bad as it was but it still isn't good? The influence of the environment is cumulative and will have built up over the years.

Does he need to be at school or would he benefit from taking some time out?

CAMHS, from our visit last week, they don't seem to that concerned with his presentation/mental health. We are seeing them again this Thurs, to see how he is.

Advice was around keeping sharp objects out of his view/reach.

He needs reassurance and positive encouragement. If he is in the wrong frame of mind then he will seek out a weapon, better to reduce the anxiety and distress.

We will be insisting on a ref to psychiatrist to further explore his mental health.

but only a specialist with specific expertese in autistic spectrum patients.

A question that keeps going round my head. If a person is diagnosed with such conditions ASD+ADHD, and one of the areas leave the person with deficits in displaying emotions/communications. Then asking someone on the spectrum days after an event to tell someone how they felt at that particular time, how would that work. In my view (and I could well be wrong) my son is very much here and now, struggles to remember effectively some past events.

He may have deficits in displaying emotion but under the surface he may be in turmoil and obsessing over something. He may not be able to go back to something that you think is relevant because it isn't relevant to his thoughts at the moment.

My recollections of school are too far in the distant past to be relevant to modern schooling, and yet......probably the contexts have no changed that much.

Break times were to some extent in my control, to stay where there were a lot of people around and possibly staff, or to go off somewhere I was reasonably sure I wouldn't be vulnerable. Wandering in corridors and finding remote toilets to hide in was part of that landscape.

The difficulties lie with places you have to be, where there are no teachers watching. Possibly the worst was being in a classroom when the teacher is out of the room. Changing rooms were another tricky environment, and toilets.

My point being that there are too many situations where bullies can get their way. Likewise bad influences. It was somehow safer sometimes hanging out in places that were forbidden or riskier if there were tougher allies not into bullying, if that makes sense.

So for example I'd act as a look out for the secretive smokers. Hanging around with dodgier people is actually one way of avoiding the bullies, who curiously tend not to linger where there are rougher elements.

Consequently it is easy to find the wrong kinds of friends.

OK it is hard to compare my school world of the mid 50s to late 60s with schools nowadays, but I suspect the vulnerabilities are not much different.

Something that sociology and human geography students do for dissertation projects is study the geographies of social groups. It is tricky to set up, because special clearance has to be set up to protect minors, but there have been a lot of useful studies. There is literature on where kids hang out, and what kinds of kids in a given context.

It should be possible to find out where your son gets involved with these bad influences and how, and potentially may be easier to introduce strategies to reduce unsuitable contact. Kids who are bullied are easily drawn into a bad crowd. Its not hard to understand.

School, we know is not the environment and positive experience it could be for him, but it has improved too what it was. Many discussion/letters on lack of support/disability discrimination have been had and sent too school.

CAMHS, from our visit last week, they don't seem to that concerned with his presentation/mental health. We are seeing them again this Thurs, to see how he is.

Advice was around keeping sharp objects out of his view/reach.

We will be insisting on a ref to psychiatrist to further explore his mental health.

A question that keeps going round my head. If a person is diagnosed with such conditions ASD+ADHD, and one of the areas leave the person with deficits in displaying emotions/communications. Then asking someone on the spectrum days after an event to tell someone how they felt at that particular time, how would that work. In my view (and I could well be wrong) my son is very much here and now, struggles to remember effectively some past events.

The school have failed to provide a good environment for him. He is not socially integrated and accepted and his mental health is being damaged as a result. Mental health problems are frequent consequences of poorly managed ASD. How quickly is his referral being progressed? As it stands he is showing things that, in a non autistic person, would be treated in isolation (schizophrenia and bipolar spring to mind from what you have said so far). Given his ASD however, it is imperative that the whole situation is taken into account and a better environment is built around him so that he can recover a more balanced view of the world and how he fits into it.

Thanks for the replies.

There is a lot in what you have said that what I see in him and his experiences up till now.

At school, yes I believe my son has experienced levels of bullying from both pupils/peers and staff and yes this could be impacting on him. He often wonders the corridors or locks himself in a toilet cubicle with his headphones in, shutting the world out.

He disclosed, last year, he and his group of “friends”, had witnessed an incident not involving them. An unknown male had chased them with a knife, pointing it at the group. This was reported to the police, sadly despite us chasing this up, nothing ever came of the report.

We are aware he has been coerced by “friends” into a fight, which was filmed put on to face book. With his supposed friends baying him on to fight (heartbreaking).

Again through “friends” became involved with a group, who we found out were into substance misuse (smoking and selling) and carrying knives.

He started another “friendship group”, again it wasn’t the best choice. The original friend had introduced him to others, in turn it lead to him hanging around a known area for drug dealing/exploitation.

We have managed to enable him to see, these “friendships” are not the best for him. We are constantly monitoring who he is with, where he is going, picking up and dropping off, discussing our concerns in relation to “friends”.

Having said that, we are seeing his moods dip and since the start of what we have seen as the first depressive episode (Nov 14). The pattern seems to be around every 4 weeks. After his low mood comes and uplifted mood (but euphoric) talking of being an inspirational speaker and the best game designer.

There is a definite struggle with his emotions, on what and how to display them in an effective manner. He is talking a lot lately of feeling angrier with what he sees as un fairness.  

Yes it worries us, he is hearing up to 6 voices telling him to harm others. He discussed taking sharp objects, knife, compass etc. When emptying his blazer pockets I found a school compass, it could be that he feels the threat is at school and that is where he feels most vulnerable.     

I suspect they have to give serious consideration to the onset of Schizophrenia which can be co-morbid with autism, and 15 is potentially a point where it might begin to show.

However with autism it is important to look for other ways of interpreting that there are voices of 6 people telling him to harm people with a knife. With schizophrenia there should also be feelings of persecution and vulnerability. Just voices in his head, associated with anger could be due to other triggers.

A traumatic experience - bullying or direct assault - could stick in his mind as memories of voices heard at the time. Because people on the autistic spectrum replay and analyse social interactions they cannot resolve, these can get detached from the original trigger.

Also the meaning could drift from him being threatened with a knife to the voices suggesting he harms others.

Because people on the spectrum can be impressionable the voices could be because real people are putting ideas into his head, taking advantage of his gullibility.

So it might be useful to look into whether bullying is taking place, or there have been significant bullying events in the recent past.

From what has been said about not suspecting depression/mental health hopefully the CAMHS worker is considering other factors related to autism. But it might be worth asking around (other parents with pupils at your school, for example) to see if he has been subjected to bullying or manipulation.

Firstly, hearing voices is much more common than once thought. Have a look at

www.mind.org.uk/.../hearing-voices

Secondly, it sounds as though he is being referred to someone who can distinguish between normal and alarming. If it was just hearing voices then it wouldn't be too alarming but the instructions to use a knife are alarming. Sounds to me as though CAMHS are doing the right thing.

Depression is very common with ASD so you will find quite a lot of discussion about it here in the forum if you "search the community". It is possible that our predisposition to depression together with the social isolation that is common with ASD have taken him to a bad place and he needs to be helped back to a better mental state.