Should teen DD have therapy alongside medication?

[gospa]

DD is 14. She has ASD, anxiety and selective mutism. Age 9 she stopped managing to attend primary school (mainstream) because of anxiety. That was shortly after her ASD diagnosis. She was assessed for psychotherapy but she wasn’t ‘compliant’. She was then referred for a psychiatric assessment and was prescribed Fluoxetine.

That’s the background and that has been the position for 4 years during which period DD’s medication has been monitored. DD had a successful Y7 and 8 at secondary and then everything fell apart just over a year ago when her school didn’t give her the support she needed. Tipping point was a teacher shouting at her and after that her attendance fell dramatically- this year she only attended 8 lessons in 2 terms. In September she said she could no longer manage to try to reintegrate to that school. Unfortunately she has been too anxious to get into a lesson at a new school - twice she has got as far as the classroom doorway. Now she doesn’t feel able to try any more- and we are not pushing it as it seems counterproductive if her anxiety is too high.

Since the current crisis began in November 18 DD has had 2 increases of Fluoxetine, then changed to Sertraline to see if that helped. However, DD manage to reintegrate and is now anxious about speaking, interacting, learning, school, teachers, being with peers all reinforcing each other.

Should DD be getting some form of psychological help on top of CAMHS monitoring her medication? That consists of an appointment about every 3-4 months and DD doesn’t usually go as she can’t speak to the doctor as there is no way she can build any relationship on that infrequent contact. I haven’t been able to find guidelines that specifically say talking therapies should be given alongside medication.

We did ask the doctor at the last appointment for DD to have additional CAMHS support but the doctor seemed to think DD had adequate input already and dismissed it as there would be a 12-18 month waiting list.

Sorry that was longer than I intended!

I think DD should receive psychological therapy as well. We were told medication alone isn't best practice. DS was given medication so he could access support, not instead of.

These are the NICE guidelines for Depression in children and young people. They state medication alone should not be used, but should be alongside therapy.

These NICE guidelines include managing co existing anxiety alongside ASD. Unfortunately, judging by how you have been treated to date I think your LA/CAMHS would use "verbal and cognitive ability to engage" against you.

These are the guidelines on Social Anxiety Disorder in children. I can't find NICE guidelines for severe anxiety in children.

That is really helpful thanks 10broken. The social anxiety disorder guidelines are interesting - I think that is the type of input DD
needs:

1.5.4 Individual CBT should consist of the following, taking into account the child or young person's cognitive and emotional maturity:

8−12 sessions of 45 minutes' duration

psychoeducation, exposure to feared or avoided social situations, training in social skills and opportunities to rehearse skills in social situations

psychoeducation and skills training for parents, particularly of young children, to promote and reinforce the child's exposure to feared or avoided social situations and development of skills.

The guidelines also state that consideration should be given to involving the parent in the therapy sessions and that would help DD’s engagement.

DD is going to start animal therapy next week - found, arranged and to be paid for by me of course... She is more than happy to meet animals but isn’t so keen on the therapist/therapy angle!

I hope the animal therapy goes well, though you shouldn't have to pay for support.

Your DD is just like DS1. He likes Lego therapy - for the Lego, not the therapy. He will engage with the Lego, except there are sessions the therapist is completely ignored and any attempt to direct DS' building is met with contempt.

It is possible for CAMHS to actively involve you. At times I have played an active role in DS' therapy. We have been given techniques that can help in real life. DS1 is younger than your DD, but at one point we did Theraplay because he couldn't engage with the play therapist alone.