14yo seeing bugs - Do I take him to A&E?

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Bit worried and looking for advice really. DS14 has ADHD and anxiety, but I’ve suspected autism for a while too. He’s been really low recently, doesn’t seem himself at all, and I think he might be depressed on top of everything else.

He’s been struggling since last year with school refusal, barely managing to go in at all, and things have just got worse. We’re still waiting on CAMHS — been on the list for months and feels like we’re getting nowhere.

Today he’s just been completely flat. Barely said a word all day, wouldn’t eat anything til mid afternoon, just pacing or lying on the sofa staring at the ceiling. Snapped at DP earlier for turning the telly on too loud which isn’t like him. Said he feels weird and can’t explain why. Looks totally worn out but still can’t settle or sleep.

Sleep’s been a nightmare – he’s only had 4hrs the last two nights. He napped for an hour or so yesterday but hasn’t really rested properly. He’s started saying he can see bugs in his room, swore something flew at him last night but there was nothing there when DP checked. He was really freaked out.

He’s exhausted, anxious, not himself at all. I’m not sure if this is sensory stuff or something else but it’s starting to scare me a bit. Would you take him to A&E? I don’t want to overreact but also don’t want to ignore it if something’s properly wrong.

I would take him to a&e, I really doubt it is this because he’s so young but a much older relative of mine (90s) said this and it was something pressing on his brain causing it. It doesn’t sound the same with your son because he can acknowledge they aren’t actually there and thus relative was convinced they were. You’ve nothing to lose by going! Plus, if they then give the ok then give him a drowsy antihistamine so that he sleeps well tonight. It’s probably exhausted and that’s why he is seeing them.

This is how my cousins schizophrenia first manifested. Interestingly he also has autism and adhd.

Don't leave it; if that is what it is, he needs medicating for it ASAP. My cousin ignored it ages and eventually had a complete break from reality.

My autistic DD has seen things when sleep deprived previously on several occasions, but this was also tied in with increased levels of stress and declining mental health.

I would definitely find out the best way via 111 to get him seen locally by a mental health professional, because he also is pacing and has a flat demeanor, he is clearly struggling and needs help.

If it's not too late I'd start with a visit to the opticians, the symptoms you've mentioned. Could be mental health or hallucinations but could also be the start of retinal detachment, a retinal haemorrhage, or a brain tumor.

Check if he has a fever, if not I'd get him assessed ASAP by optician or eye casualty as a starting point

I’ve just phoned 111 now so waiting on a call back. He says the bugs are moths – he saw one crawling on the floor then it flew up at him, said it was fast and really freaked him out. He wouldn’t go back in the room after that. DP checked properly and couldn’t see anything.

He does actually have a fear of moths anyway, always has, so if he thought he saw one it would’ve really set him off. Just not sure if he actually saw something or if it’s something else going on, like his brain playing tricks on him cos he’s so overtired.

He does go out sometimes, mostly with us, but I’m 99% sure there’s no drugs involved. He’s always with us or at home and we haven’t noticed anything that would make us think that. He’s just not right, and it’s getting worse.

Does he have a fear of spiders or insects? My kid is neurodivergent and has a fear of spiders, if he sees 1 spider he can spiral and have vivid images of spiders in the room or crawling on him. He will also have difficulty sleeping as he’s convinced spiders are in the room. It takes some talking and reasoning with him that they are not really there.

I’m so sorry, OP. Another vote for looking into PANS/PANDAS. Your description of not speaking or eating, the anxiety and exhaustion and insomnia, ‘feeling weird but can’t explain it’, all remind me of my child who has Long Covid and has periods with PANS symptoms as part of that. OTC antihistamines (my kiddo also likely now has MCAS), absolute rest and ibuprofen are very useful for managing acute episodes. Doctors tried hard to argue it was all anxiety and school refusal, until we got to appropriate specialists. I hope things improve soon xx

Are you absolutely sure there isn’t genuinely just a moth in his room? They’re everywhere at the moment.

So sorry OP. Our oldest only got her autism diagnosed after she started showing psychotic symptoms. The effort to make sense of information overload can lead to that.

She got a low dose of risperdal and a lot of therapy and is much better. Yes get the ball rolling. Seeing bugs that aren't there is hopefully acute enough to get you a reaction from the sluggish mh services.

….there were three in my DS room when I went to say goodnight last night as he had the window open 🤦🏻‍♀️

This happened to me at a particularly exhausting and stressful time in life when I was struggling with severe fatigue and my mental health was pretty dire - I kept seeing black shapes like mice or rats running under the furniture and random insects flapping across the room and disappearing as soon as tried to look directly at them. It lasted about a week. I didn't end up seeing anyone about it and it hasn't happened since then, but since your son is a young person who still requires you to advocate for him, I'd want him fully checked out if it were me.

I'm glad you've phoned 111. Just sending you lots of support x

Agree with others - please get medical help/out of hours appt asap.

wo0uldnt sit in a and e all night that wont help hope they can advise something else

I’m a mental health nurse. Hmmm it’s impossible to tell exactly what is wrong through a screen. It could be anxiety or sleep deprivation, but conversely it could be the start of a psychotic episode or serious physical illness, so you do need to get him checked out.
What I do want to say is that if it is psychosis-and, hopefully, it’s not- that doesn’t mean he’s now “schizophrenic” and his life is ruined forever. Psychosis is like every other illness in that plenty of people have a single episode which is medicated and never have another one. Sometimes that does develop into schizophrenia, but single episode psychosis is very very common, especially in young men with low mood. I would take any help that is offered, and, if there is any indication of psychosis at all (including psychotic like thoughts caused by anxiety), reach out to your local Early Intervention in Psychosis Team. This is a link to the one in my trust but most areas have one https://hiowhealthcare.nhs.uk/our-services/a-z-list-of-services/early-intervention-psychosis-service . They work with young people/young adults experiencing psychotic like symptoms.
Plus keep posting here if you can and take care of yourself. Mental distress can be very frightening even if it’s someone you love.

Can you find a current wait time for your local A&E? While a sudden apparent decline in mental wellbeing or you could say function, is serious and does require urgent treatment, I would try and avoid A&E if you can. 111 should be able to point you in the direction of a mental health crisis team, who will be able to advise and connect you with services. I don't think you would be a "time waster" at A&E at all, but I don't think your son's condition would warrant by passing others in A&E and he'd probably find a 2-3 hour or more wait distressing.

I second it - I feel like A&E would be a really bad environment for someone feeling like this

If he’s not eaten today, has he been having adequate fluids? Often this can be a sign of dehydration.

can you afford £200 to see a psychiatrist? I would book an online one and ask for melatonin to help with sleep. If your gp does shared care they should then pick up the prescription on the nhs.

Voice collective is a really good resource for both you and your child when they are seeing or hearing things. It’s really not uncommon-I think there is some info and links to other resources on the Childline website too. It does sound scary, but it also sounds like this could be an existing anxiety which is being made worse by exhaustion and stress. Whilst it’s clear you all need support, I’m not convinced that A &E on a Saturday night is the best place for any of you. That said I know some areas are trialling sending paramedics out with mental health professionals and that sort of support might be just what you all need. I have no idea how you find out if your area is involved/you can access this.

Sleep deprivation can cause hallucinations such as seeing bugs. Take him to the doctor

Call 111 and make sure you tick mental health

OP do make sure he’s not dehydrated whatever happens. Get some water in him.

good luck

I have BPD and this is something I experience. Feeling them on my skin, seeing them. Definitely get seen, ring 111 as it's a really frightening thing to experience. Hope he's okay & you too x

Borderline?