Psychosis in ASD

[clair]

Hi there, I have not posted for a while regarding my 11 year old son. He was diagnosed when he was 7 with ADHD and medicated. A few months back he was diagnosed ASD and still kept the label of ADHD and medication. He managed to access a special school however they do not do "behaviour". He had never been one for going into the classroom in mainstream but we thought that this might change going into smaller classes. He is just the same, only going into the classes when he feels able to. He says that he feels as if someone is stopping him going into the classsrooms, "It is like a wall that everyone else can walk through but I am being told not to" were his words. Yesterday he had a good day and today a bad day. When asked why he managed to go into the classes yesterday he said "someone inside me pushed me in the classroom" . He has been observed talking to the wall by the teacher as if someone is there and my daughter has caught him talking to someone in his room. When asked who he was talking to his reply came after a long pause and a funny look, "You". She had not been in the room.

 

Now it may seem funny being that I am in training to be a mental health nurse and can't work this out. I know about psychosis and took him back to the consultant who thinks it is more anxiety based. He does get a lump in his throat you see. He said that my son should try 5 minutes in the class and then come out so he feels in control. A good idea in theory but it is not happening. The psychiatrist said that after 4 weeks he would put him on Risperidone to take the edge off but has to keep him on his Equasym tablets as he has a report that when he is off them he is uncontrollable which is a fair statement.

 

Does Risperidone work for any of your children?

Are psychotic symptoms very common in ASD children?

Do ASD only schools manage the not going into the classroom thing?

 

 

I live in Warwickshire and the LEA tend to send their ASD kids to schools in Coventry. Does anyone have any experience of any of these. Any help would be appreciated.

[Sally44]

I don't have experience of medication so cannot comment on that.

My own son does talk to himself, the air, the wall etc alot of the time. Sometimes he is repeating TV or DVD dialogue. Sometimes he is running through conversations. Many times he is talking to himself, moving in a strange way or pacing up and down or round in circles and giggling to himself as well. And along time ago ASDs used to get diagnosed as childhood scizophrenia. So I would not panic. Try not to put your own assumptions or interpretations onto his behaviour. He may said he was talking to 'you' when that was true. My own son assumes I know things that have happened to him and I haven't even been there. So I would keep on observing him and ask him what he is saying at these times. It might be something from TV or in a film or he maybe holding a conversations with someone - but that does not necessarily mean he is hallucinating and 'seeing' the other person he is holding the conversation with. My son frequently rehearses conversations or questions.

There is obviously alot of anxiety at the moment. Do ASD schools handle this type of problem better. Well, I think they should have a better grasp of the difficulties the child might be having. Afterall they should have years of expertise, experience and training whereas a mainstream school may only have 'willing staff', which although positive is not the same thing. Many times they are starting from ground zero from an expertise or experience point of view. They will usually have no training in ASDs and may often not understand the problem or try an inappropriate solution to a difficulty. And mainstream schools do not get the support they need from outside agencies such as Ed Psych or autism outreach teacher. In our own LEA the AOT has around 200 on her books. She works alone, so that works out at around 1 days input per child per year. And for many children and schools that simply is not enough. The Ed Psych also has a 'budget' insofar as they usually see only 2 children per term per school. Again that isn't enough if a school has more than 2 children with SEN needing their input.

I presume they have given him a visual timetable so he knows exactly what is going to happen each day. Does he have this problem with going into any or all rooms, or is it only limited to going into a classroom to do a lesson? Would he be able to go into the same room to do a puzzle? If so they could build up on that so that eventually he is going into the room to draw a picture or paint. Then you are one step away from writing or doing some kind of work. And it might work to do play based work to begin with rather than straight into reading/writing/numeracy.

Is he able to choose between options given to him. If so he might find it easier to be given a two choice option ie. next it is choose time. What would you choose - water play or painting. This sometimes works. My own son cannot handle options so it wouldn't work with him.

Some mainstream schools do have autism units as well or 'communication' units which are usually children with ASDs. How is your son doing academically.

[Sally44]

I also wanted to mention the sensory side of ASDs as well. Psychosis also talks about the senses and how these maybe affected, and there again maybe some similarities, but the root cause is different. For example Donna Williams talks about not being able to see whole objects. She saw 'bits' of visual information and also suffered with visual fragmentation. She also sees lights and particles due to hypersensitive vision. Another commonly reported difficulty is with fluorescent lighting because they can see the light flicker. Our (NT) eyes cannot process that information quick enough.

Again with hearing some children with ASDs can hear sounds we cannot hear and can respond as if in pain or distress to other noises that do not bother us. Or they can fluctuate between hyper and hypo sensitive hearing. Or they may seek out noises.

So it is worth finding out about sensory issues incase your son also has these. It can affect any or all of the senses. There is a fact sheet on the NAS website about sensory issues.

 

 

[call me jaded]

They used to call autism "childhood schizophrenia" so I can see where you're coming from. Plus the chances of having mental health problems increases in children with autism and disabled children generally.

 

I think of autism as a primary diagnosis with all kinds of 'optional extras' IYSWIM, including anxieties.

 

My son has perfected the art of not going into the classroom - he spent his last two years of primary school wandering around the school. He is now at a NAS school and they have worked very hard with a system of reward that means he does stay in the class and actually enjoys being there. They also have a policy of phoning you if they have to withdraw him and that is great because you know what to expect later in the day, and the entire school is 'low arousal' which is the complete opposite of most special schools.

 

Can't really speak about meds.

[Karen A]

Hi.I don't know much about side effects of medications.However psychosis as a diagnosis as used in mental health for example in scizophrenia or bi-polar disorder would be very unusual in a child as young as 11 so it is unlikely.Although mental health problems are more common in ASD the common co-morbid disorders are anxiety and depression.I have not come across any recognised association between ASD and psychosis.

 

I was a nurse [RGN] and district nurse although my registration has lapsed.When I was in training it was a frequent occurence that students would come across a medical condition and wonder if they had it.I wonder if this might be an issue for you.I hope I do not sound patronizing but am attempting to offer some reasurance.

 

I have had intensive psychotherapy in the last three years through CAMHS.I have had a history of very brief episodes of psychotic thinking when extremely anxious.The CAMHS psychotherapist who is extremely well qualified is certain that these episodes are not abnormal but are a response to anxiety.He said that it is not unusual at all and is experienced to some degree by perfectly mentally healthy people.Perhaps your son is not unusual for his age in talking to himself but is just less socially aware and so whereas an individual without ASD might have a conversation in their head he does not worry about saying it out loud.

 

 

I should say that although the label childhood-scizohrenia was used at one time most professionals are now clear that ASD has a neurological and developmental basis.Professionals in the field of ASD are keen to say that it is certainly not a mental illnees.

 

In the past there were cases where people were given a diagnosis of mental ilness such a scizophrenia when they did in fact have ASD.The issue was often that Mental Health Professionals did not understand the description given by a person with ASD or the person with ASD gave a literal answer to a question which was not understood.

For example a psychiatrist might well ask ''Do you hear voices ?''.Ben who is 11 and has AS would answer ''Yes'' .In Ben's thinking he hears peoples voices very well because he is not deaf.

 

Regarding school I was wondering if the school has any experience in ASD ?

Even if it is a special school if it is not specialist in ASD then staff may not understand that some behaviours in ASD are the result of anxiety or difficulties with Social Communication.So behaviour programmes that would work well for children with BESD or ADHD may need to be adapted.Sometimes it is more helpful for staff to understand what is causing difficult behaviour in ASD and to modify the environment.If the school is a school for children with BESD or learning difficulties staff may not be aware regarding ASD.

Do you have any support from Autism outreach or SALT ?

Karen.

Edited October 21, 2009 by Karen A

[Enid]

Hi, mine definately has mental health issues, it started at about age 11 to 12, with the onset of puberty. although at the time they, Cahms, would not have it, they are now of the opinion it is early onset childhood bi polar. resperidone saved us, literally, as my sons bizarre behaviour put him and us at risk, He still takes meds for his ADHD, straterra, and there dosnt seem to be any side effects. the biggest side effect with the resperidone is the weight gain, but for us it was a no brainer. Now his behaviour is "under control" I am able to address his diet. feel free to pm as there is a lot I cant say on an open forum. <'> Enid

[clair]

Hi everyone and thanks for responding. First of all I have to say that the school my son is at is a school for kids that are quite academic which is right for him. When I looked at the school it was recognised as being a school for the following.

 

Blind and sight impaired, Autistic Spectrum of Difficulties, and physical disability. They try and get the kids to aim really high and encourage A-levels too.

 

I can see why it is a risk for him to be behaving unpredictably around children with these difficulties. Today I went in as I was told that he could not come home on the taxi as he had been goading a boy that is on his minibus. He would not stop and when asked why he said that he wanted to help pick up the leaves at dinnertime. He apparantly wound the 17 year old up so much that he was close to socking my 11 year old son but did not. My son was saying come on come on and clenching his fists squaring up to him. Once my son was wound up he came out with all sorts of horrible things like he hated people in wheelchairs as they were all thickos and he wanted to be the only lad in the school with ADHD. This is after all what he was used to in mainstream primary.

 

The deputy head teacher spoke to me and said that she has been teaching kids with Autism for twenty plus years and she is trying all sorts to get him included in the lessons, however, she admitted today that he is definatly presenting as very odd and is really struggling to help him with the strategies that she has always succeeded in using. It made me doubt the diagnosis then (as I had to fight for it in the first place) and now I just don't know whether it is me that has been trying to find answers for his bizarre behaviour. When my son is at home and left alone or outside in the garden he is as happy as he ever could be. He even started reverting back to his truck driving behaviour today that he used to do at primary where he makes all the noises of the airbrakes and the reversing beep.

 

My son also when asked to try and explain his behaviour today in front of me, was trying really hard not to smile as he was telling me. No matter how hard he tried a smile kept creeping up on one side of his face. He knew that it was serious but it is as though he can't control it. I would just like to add that he has always been sensiitive to noises and labels in clothes and that the school is supposed to be low arousal although when talking about his issues today he said that the wheelchairs squeak. It is usually my son that makes all of the noise anyway.

 

I know that training in mental health could be making me assume all sorts of things but I just need to know if what I am describing at times can be normal for ASD as all of the other ASD children in the school seem to behave perfectly.

[smiley1590]

yes you are describing perfect common traits/signs of ASD as many children get misdiagnosed as ADHD when in fact they are ASD! hopes this helps you XKLX

[smiley1590]

i smile when something serious is said to me or something i done etc , sensitive to noises are another and clothes label irratating his skin i have all same and i'm AS!!!

[Boy]

I can't speak for anyone else but traits I share with your son:

 

* talking to myself/imaginary people (I have read that this is quite common in ASDs as the ASD person has complete control over the interaction - you can repeat the same conversations over again and again, if you mess up).

* making noises.

* smiling/laughing at inappropriate moments, whether I find the situation funny or not (despite the fact I don't really smile or laugh as much as most other people, apparently, as I'm not very expressive).

* when I explain things, due to my difficulties communicating, sometimes this can cause concern in other people as they assume I mean something else, or I haven't edited the information accordingly.

* when I am angry, I can be very aggressive and hurtful towards people.

 

I obviously cannot say for sure if this actually matches what is happening with your son, though, of course, but thought I'd add it, just incase it is of any help.

[Sally44]

I have also been reading an interesting book over the last couple of weeks about language and communication difficulties with ASDs. One suggestion made, which is backed up by autistic adults that are quoted in the book, is that because many things are not 'obvious' to them, they make up their own rules which might or might not be totally inappropriate.

For example my son recently has become very keen, to the point of obsession, on being 'Star of the Day'. I never thought he would do that because previously he was not interested at all in impressing anyone. So now he always puts his hand up in class all the time. And he always wants to be picked to give the answers. If he isn't he can get upset or angry. If he tries really hard all day and isn't 'Star of the Day' then it is like th end of the world for him because according to the 'rules' as he knows them, if he puts in XXX amount of effort (as he did the last time), he should be star of the day. He doesn't understand about 'others having a turn at being star of the day'. He then finds the system unfair. Which I suppose from a 'literal' interpretation it is.

So the example with the leaves. Your son may have 'thought' for whatever reason that he should be allowed to pick them up. When he wasn't he wanted to fight. Has he seen a similar scenario on TV ie. if you get upset/angry or don't get what you want then you have a fight. That could be literal interpretation of what he seen and how he now believes you resolve these types of issues. My son saw something on TV where someone got angry/upset about something, packed a rucksack and left for ever. I cannot count the number of times I have found him packing his rucksack and ready to leave. I have to keep all doors and windows locked. In his mind that is how the situation is resolved. So he has to be taught explicitly other ways of resolving these types of issues.

My son also makes noises, infact he could do most noises required for films/TV if allowed to. Now his speech is much better, but when he was younger the noises were about 50% of his speech.

My son also does not understand tone of voice and therefore can laugh if I am trying to tell him off because he doesn't get the clues from the tone of voice/gestures/words I am saying. I have to tell him right at the beginning that he is in trouble and that it is serious and not something to laugh about. Afterwards he is usually mortified at his behaviour, especially if he has got upset/angry and has said all kinds of things to me such as wishing I was dead, that I am a rubbish mum, that our family stinks etc etc. Apparently they say there is less control in the frontal lobe areas that control emotion etc. But again you can't just 'accept' this behaviour and professionals should work with the child on emotional recognition in themselves and others and 'teach' them more appropriate ways to respond.

Although this school is very good, it maybe that your child is just different to others she has experienced. There is such a vast difference from child to child.

Although you say he makes most of the noise, that is not the point. The noise he makes he controls and therefore is predictable. The squeaking of a wheelchair (or many of them) is sudden and unpredictable. The anxiety and anticipation around waiting for that noise could have him on a knife edge all day. I read a book about a teenager who was expelled from class because the teacher had touched them on the shoulder to gain their attention and the child hit back. On discussing the incident with the child they talked about a ruler hanging over the edge of the teachers desk and having to watch it until it fell to the floor. The fear of the sudden noise of the rules falling to the floor if he wasn't watching it was too much for him to bear. When the teacher came up to him the child said he saw 'an arm' coming towards him and hit back in defence. It was later found that this child also had visual fragmentation when over aroused and therefore did not see 'the teacher' just 'an arm'. When you hear of experiences like that, it helps you understand why the child behaved as they did. If the rules had been safely on the desk in the first place then his anxiety would have been low and he might have seen the teacher coming towards him and not had visual fragmentation, and he may not have hit the teacher because he would have been in a low arousal state. Does that make sense.

These are just things to bear in mind about your son. As others have posted, it is possible to have mental health issues as well. But I think all you can do is as you are already doing, and ask questions.