Advice on medication for depressed Autistic 12 year old

My 12 year old daughter has been in autistic burnout for about a year. She has not been in school for 10 months and probably won't return.

Previously a high academic achiever, loved reading and art but now will only play video games as her special interest. Struggles to leave her room. Won't allow us to bathe her, wash hair, clean teeth. She doesn't see the point in getting up in the mornings.

We have done everything suggested to us, CBT, OT Ed Psych, SALT and there is no change.

We believe she is depressed but we don't know how to get her help as CAHMS won't get involved as they say it is due to her autism and she is not self-harming or suicidal.

We feel like we have nowhere else to turn.

Has anybody had a similar experience? What helped?

We are thinking about medication for depression but we don't know who can help us? Private Psychiatrist maybe?

  • The distinction between autistic burnout and depression is certainly not clear cut. If it is purely autistic burnout then antidepressants are very unlikely to help. The problem is that prolonged burnout can lead to depression which may have happened with your daughter.

    We are not allowed to give medical advice on here. The official NHS position on the most commonly used type of antidepressants is that they aren't usually recommended for children and young people under 18, due to the increased risk of suicide and self harm and the potential impact on brain development.

    https://www.nhs.uk/mental-health/talking-therapies-medicine-treatments/medicines-and-psychiatry/ssri-antidepressants/considerations/#:~:text=SSRIs%20aren't%20usually%20recommended%20for%20children%20and%20young%20people,in%20children%20and%20young%20people.

    My own experience of taking such medication when much older than your daughter was horrific and personally I would not go back on them or recommend them. The warnings about the increased risk of suicide are there for a good reason.

    Autistic people generally need to have interests to motivate them and make life worth living. Some people do have video games as their special interest but that in itself isn't enough and in your case appears to be no longer making your daughter happy. The question is how to re-engage her with the things she used to enjoy or find new interests.

    It is a very difficult situation but sadly not an uncommon one. I've linked below some articles on burnout which contain some tips on recovery. I hope you can find something in there that might help your daughter.

    https://theautisticadvocate.com/an-autistic-burnout/

    https://www.barrierstoeducation.co.uk/burnout

    https://neurodivergentinsights.com/blog/autistic-burnout-recovery

  • Well let me give you some background so you know where I'm coming from. I'm autistic, I was homeschooled most of my childhood and I have been on antidepresentas for depresion (as an adult). The first thing to say is from my personal experence antidepresents are not happy pills. They don't make depresion go away they adjust your energy levels so you are more able to function and hopefully adress the undelying issues causing your depresion. I found that with out anti depresentas I was having brife moments of functionality then crashing for most of the day. Anti depresenats let me function more consistantly, but it was like functioning at 75% capacity. Sences and wits slightly dulled.

    I also tried CBT. We got to the core of the issues really fast. And then hit a brick wall because there was very little we could do about those issues. Most of the improvment came from improved self care and offloading some self imposed duties (strategic giving up). Your daughters game playing probably is a form of self care. Obviously not one she can indulge 24/7.

    They say girls mature faster than boys. Statisticly their hormones hit them a year or two earlyer. When you hit your teens sudenly socialising with other kids becomes much more confusing and their comunication indirect. Getting by socialy for autistic kids sudenly becomes 1000000 times harder. And at the same time you feel driven more than ever to get your peers attention, especially the oposite sex. It's consevable her school rejection is a responce to the compleat colapse of her social life at school. Social life at school is like a game designed to be imposable for her to win. It's easy to see how video games that reward hard work might feel preferable.

    Reading and art are both windows into fantasy worlds in the form of novels and painted scenes / stoires. Video games are just a kind of fantasy that rewards you directly for engaging with them. You need something worth while to tempt her back into the 'real' world. If she's anything like me at 13 (eg horny and hetrosexual) the best thing would probably be a boy she likes showing even the slightest bit of interest in her. As a teen I almost never took a shower unless it was the night I went to the youth group where the cute girls were. The opposite sex can be a powerful motervator.

    Since a boy's probably not something on the cards. One thing you can try is emphersising that education is difrent than school. Try to get her to study at home. I'm sure there are aspects of education she does enjoy. My mother had to drag me out of the house to get me to study english (which I hated), but science. I used to carry university science and engenering textbooks around with me where ever I went. I was almost never out of the house without a textbook. Try forcing her to spend some time every day on her favorite school subjects. With a textbook at a desk. Or better yet out of the house. If you can seperate the social side of school from the learning side in her head she may regain interest in school. And if she doesn't at least she's learning at home. Show her learning can be fun.

  • Chiming in a little here, is she interested in coding her own? Video games aren't always a special interest. They can be a practical and worthwhile solution to de-stressing. The content of a video game might be of interest, such as architecture or gardening, or problem-solving a thing in particular. As mentioned in the thread below, some games can aid healing, some can become addictive, some grow critical thinking skills and when my son was young, I noticed adventure games helped him with reading (dyslexic). It can be difficult for kids to understand why they're captivated and drawn to a thing. The important question is if it's inspiring or therapeutic.

    As a mother, I have reinforced my son take a full day off once a week to do nothing and just be (we are not human doings but human beings). It doesn't always happen, but he will let me know if there's a day he's tapping out. This reinforces self-care and a part of self-care still involves cleanliness and self maintenance. Promoting time out for self-care is not so much self-indulgence (which isn't bad in moderation),but an important role in thriving. Self care also means minding food which is healthy for me (which might be toxic to someone else, not everyone can eat the same things), hydration, exercise, maybe a daily multi vitamin and connecting with nature in some small way. So, if she's tapped out of school, swimming or yoga - or whatever she likes, a few times per week. Allow her to choose, and change her mind until she finds a thing she enjoys (maybe you already do this). 

    However, the desire for these things, is always triggered by experiencing the reward. And that takes time, patience and practice.

    At 14, my son was just emo. I let him be him. I could sense his struggles, but didn't quite know all of them, so I tried to help find ways to relieve pressures. However, I did expect small things and this was important. He wanted to play piano, so he would have to practice scales for just 10 minutes at least 3 days a week. I set the expectation at something which didn't feel overwhelming, and he would always end up playing for at least an hour. Making ones bed is pointless. But it's this odd simple discipline that can help us actually learn to just do a thing even though it's boring. (My son is much older and quite enjoys the aesthetic of a made bed) One doesn't really need to wash their hair but once a week. So ask what day she would prefer to do this. She might protest, but this is normal for a teenager, just kindly respond by reinforcing self care. You might even agree, but still gently reinforce matters that will someday matter, or ones of great consequence like brushing ones teeth. 

    We create an aesthetic for our world with even the smallest things. And over time, we learn to appreciate this. The taste of my toothpaste is more enjoyable than when I wake up. So perhaps see if you can sit together on the internet and find a clutch of different toothpaste's to try (if anything, you'll be stocked for a year). Rotting teeth cause a great deal of problems and expense. Better to spend a little bit of money turning this ritual into an exploration than the expense of a dental hazard. 

    Self-Care has to be the full process or it won't help her fully recover. It sounds like she went at 110% for a serious period of time and needs help learning to prioritise Health first, then Work. From what I'm reading, Anti-depressants don't sound necessary? And for many autistics they might do more harm than good, as they lower GABA, responsible for gut-brain health, which I've found in recent research to be something Autistics and ADHD'rs can already have too low of levels. 

  • but unless she's coding her own, video games aren't a special interest.

    I don't think that's fair. If a cinemaphile isn't making movies does that mean film isn't a special interest? If a clasical music enthusiast isn't playing or composing clasical music does that make it not their special interest? I've never animated an anime but I love the stuff. Collect it, watch it often. Colecting and apreciating artistic works (which video games certainly are) can be a special interest as much as films or music.

    That said everyone should learn to code (as important as reading these days) and 12 is certainly not too young to start coding your 1st game ... might not be a bad idea if she's interested in that.

  • You have a fair point. I could word that better. I'm on the fence because while they can have a therapeutic aspect, they also have an addictive side. And some far more than others. They can be created a bit like machines in Vegas. Music and the cinema can be therapeutic as well, but what would an addiction look like?  It feels like a grey area - even though, I'll admit, an audiophile can get a job as a Music Supervisor or Music Editor, a classical enthusiast also has good options. And jobs in video games pay really well. I know teens who've been paid to play games.

    These are also things made to touch the human experience, and can be of deep / intense interest to anyone. Perhaps I'm being too particular about the term "special"?

    With kids, it can be important to help them discover what it is in particular they are drawn to and maybe it is the whole of the experience - animation, composition, movement and philosophy.  An intense interest is captivating, but also motivating. Inspiring. And while when young, we might be so engrossed we forget we desperately need the loo, something which inspires, which we connect deeply to, shouldn't override a few minutes of personal hygiene. And mum shouldn't be asking if we need antidepressants. 

    I'll fix the generality of this, though. An escape from a complete shutdown can become an addiction if not tempered correctly. I'm a firm advocate of affording uninterrupted time - sometimes months if needed. But also helping children learn to mind health and well being. 

  • I want to add, things which expand our perspective, widen our understanding of the world around, stretch the imagination and even strengthen neuro-circuitry like classical music, can aid well-being and thriving. I think it really depends a great deal on the content, how it's affecting my every day life, my values and character growth. I'm a big Tarkovsky fan, I'll never tire of his movies. I know a few cinemaphiles, a few non-autistic, one ADHD. These tend to inspire, branch into new discoveries. My grandparents had an Atari, my father plays WoW with 2 characters at the same time. I grew up with gamers, engineers and coders. Video games have come a long way, but there's still an element to many of them which parents should be mindful of. 

  • shouldn't override a few minutes of personal hygiene. And mum shouldn't be asking if we need antidepressants.

    yeah video games don't cause depresion or bad hygeen (which may be partly secondery to depresion). If she didn't have video games it would just be movies or books or something else. It's certainly posable to be a depressed book goblin that just wraps themself in a blacket with messy bed hair and reads novels all day.

    Corilation is not causation.

  • I don’t think video games cause depression and I didn’t say they did. Other factors cause depression, but I’m not sure what’s happening even is depression but exhaustion  

    But anything which becomes an addiction can override our ability to make small healthy decisions. 

  • Ok let me put it another way. I don't think people withdraw from the world into the world of video games and loose interest in other things unless there is something baddly wrong with the world in which they live. Video games are not an adiction in the way say, heroin, is an aduction.

    Addiction implies a strong physical or psycological dependance that is unnatural and persists even when someones enviroment improves. A heroin adict who lives in a warm and suporting enviroment where their physical and social needs are met will continue to be an adict untill he forces him self off the drug (or someone else does). A person playing video games every hour gods send to escape from the world will return to more moderate use of games on their own if their enviroment improves.

  • There’s a load of studies on this. My 27 year old son is actually trying to start a degree in therapy and this is one aspect he sees in his world.  

    Some video games have the same effect on the brain as heroin. They can have great lives and few or just enough problems. 

    Im not sure how old you are, but perhaps for those of us who loved 8-bit and played early games, we might not have the same response. If I leave my phone at home I don’t suffer anxiety, I actually feel a bit liberated. But the younger generation have a different relationship with games and their phone and social media. My brothers youngest has a 2 hour timer and plays games which provide continual reward hits like slot machines. it’s a different world, I’m afraid.