Hi. Concerns have been raised that my son with hfa may be experiencing psychotic episodes. He is currently being assessed as an outpatient (a process that started 4 months ago) and we have no answers yet. I'm feeling confused, lonely and scared, and was hoping that someone might have had helpful experiences / information to share with me? Thanks in advance.
Just another thought to add to Longman's thoughts. People with ASD can take things too literally so his school mates may be winding him up by telling him things (the sex shops and drug dealing) that may not be real but that he can be lead to believe to be true. Also, drug dealing isn't that unusual at secondary schools so I wouldn't automatically assume that part to be made up.
The isolation endured by autistic people can also have cumulative affect on sufferers. He needs help from CAMHS if he isn't already getting that.
Does he still attend school? Is he actually benefiting from that at the moment?
I see what you mean about immediate triggers and longer term build up of stress. I also suspect Matthew has been bullied at his previous school - he is only now starting to talk about what happened there. He has always tended to copy others and found 'dramatic' behaviours exciting so I suspect to some extent some of the things he is doing now may have been learnt in his previous setting.
Re 'trigger peers' now, it is often him that instigates the problem (and I've seen him do it as well as the school) - he says he wants to make them laugh. He says he wants to be bad because it's fun. He finds getting a reaction rewarding. Once he has the impulse to do something (for example crash into the room of a peer who is fearful about others entering his space) he will carry it out irrespective of consequences (for example getting attacked by that peer).
I am trying to remain patient and keep open minded about what my son is going through. I dearly hope that he is not having psychotic episodes (hasn't he got enough to cope with already!) but whatever we find out can only be positive as it will help us to help him as best we can. Thank you so very much for your perspective and insightful comments.
OK I can see what they mean by psychotic episodes. You can understand why they need to explore the possibility of something beyond autism.
Without trying to undermine that in any way, a lot of what you describe is familar to what other parents have reported on here, and indeed some may be able to post similar experiences and their outcomes.
One thing is to try not to link meltdowns to immediate triggers. They can be last straw responses to a long term build up of stress, where the underlying causes are long term and not directly connected to the meltdown, and the immediate triggers are relatively minor.
The other thing is his maturity may be delayed but he is at an age when his peers are are going through puberty, and he will feel more different, and be made to feel more different. Age 13 or 14 is about right for massively worsening issues. Teens are often the worst time for people on the spectrum because the differences and peer pressures are most marked.
I was interested in his reactions to certain peers triggering episodes on sight. I always feel the need to be careful here as I'm probably milder end, even though I think some periods were quite bad. But I'm wary of making easy comparisons of my experiences with someone with more marked symptoms. Nevertheless this makes me think of experiences.
A lot of the bullying I experienced was because I could be pushed towards a meltdown. I've been remarkably lucky since in having few, but my teens were when I had them a lot. And the main cause was complex and sudden sound and movement. My contemporaries realised I could be wound up for entertaining effect, so it happened often. The usual way they achieved this was gathering behind me and making gestures and sudden movements on the edge of my peripheral vision, making sudden noises, crowding round me, jostling and pushing me from behind. They got quite good at stage managing explosive reactions.
When you say peers trigger a reaction by just looking at him, it makes me wonder if they are playing with his sensory vulnerability for entertainment. By doing it often they are keeping him at prolonged high tension so he is anticipating such attacks. That's just a guess however, and maybe someone else on here has other insights on this.
But I venture to suggest it might be worth looking into whether there is bullying of this kind going on, or at least to be able to eliminate it as a factor.
Thank you so much for your considered, informative and authoritative reply.
My son is 14. He's over 6 foot, has been in puberty since he was 9 (we think) and likes CBeebies. Your link to your comment re social referencing really resonates - he was excluded several times from mainstream school and is now in a specialist provision.
It's hard to summarise something that is so complex, but I'll try. At times, he is unresponsive, he assumes a rigid posture, either twiddles his hair or makes rigid gestures with his hands, looks worried/scared and swallows repeatedly and/or talks to himself. This can occur mid-sentence when he is asking you a question or carrying out a task (e.g. eating /brushing teeth).
Alongside this, he is unpredictablly violent - previously we had been able to pre-empt meltdowns - sensory overload, anxiety, unreasonable demands - but now outbursts seem to come from nowhere. For example, he'll throw things at me when I'm driving, opens the car door, throws things out of the window...
He has hit me several times, sometimes when someone else has 'wronged him', repeatedly tries to strangle our dog, has bullied other children (saying he wants to kill them), and threatened to kill his sister.
He appears sometimes to have an 'unusual' grip on reality, which he is convinced of. He has told school 'odd' things that have happened at home and told us 'odd' things that have happened at school (for example sex shops and drug-dealing).
He is hugely impulsive - there are 'trigger' peers that only have to look at him for him to 'do the wrong thing' (e.g. throw things around, hurt animals, smash windows) He says he wants to be bad and is refusing the medication that has been prescribed - respiradone and methylphenidate. Though he is happy to take Sertraline as he feels it helps him with his worries - which have been everpresent and in previous years HUGE.
The context of this is that he hasn't had a social context for 13 of his 14 years (despite our best efforts) - and is just forming the first reciprocated and positive friendships of his life. At last we feel a school 'gets' him (it's a specialsit provision and we've had to fight tooth and nail for it) and staff are trying their best to help him.
What you've shared with me makes a great deal of sense. My gut feel is that he is making sense of a world he has little handle on.
Thanks again for taking the time to respond to my appeal. I really value what you have said and have shared it with my husband.
You don't give his age - it might be useful.
As far as I am aware, the psychiatrists etc still link autism to schizophrenia, even though only a few individuals might develop the latter in association with autism. So they are always looking for signs.
Trouble is I don't think there's enough understanding of autism in the day to day terms of a sufficient variety of individuals to actually know whether strange behaviours arise merely from autism, or from some developing psychosis.
However if you are solitary or excluded, with little or no social referencing - it is likely you live in your own mind a lot, so unorthodox behaviours along the lines of imaginary friends,being influenced by imaginary friends or spending too much time in imaginary worlds can easily he read as hearing voices, having delusions etc. Routines and rituals can be seen as something more serious, and special interests can be perceived as obsessions.
I caused much concern in later primary school because I did not mix with other kids but wandered around alone and talked about imaginary companions a great deal. The fact I was being bullied and excluded a lot didn't figure in the interpretations of advisers, and there wasn't an obvious diagnosis then - so I had a very close shave with being diagnosed and treated for something serious or taken out of education. But it was a passing phase. And if no-one will talk to you or play with you, and it was in those days considered must be the fault of the affected individual, it probably is understandable everyone over-reacted.
I still recall a lot of what I talked about, so I can understand why they got worried.
Therefore it still alarms me that 55 years on I still read about young people on the spectrum being attributed with psychotic episodes. Yes real psychotic episodes may develop as a co-morbid condition with autism, but how often I wonder are such assumptions arising from lack of adequate understanding of how autism affects individuals.
I read somewhere about a boy on the spectrum who, when asked if he heard voices, responded yes. But he probably meant he could hear when other people were speaking.
I guess you have to be prepared for the possibility there is some psychotic problem developing. But at the same time there still seems to be a misunderstanding about what happens to children when they are socially isolated and forced to live too much in their own heads.
Have they explained what sort of psychotic episodes they perceive are happening? Is it something predictable for autism?
