Autism and aggression

[Betty193]

My DS was diagnosed with asd about a year ago when he was 13. This coincided with him being extremely aggressive at home. In primary school he was struggling academically but very well behaved at school and home.

We have seen camhs who have just prescribed 1ml of risperedone a day. They are not doing any work with him

He does not think there is s problem with him hitting me and my husband. We are aware that a lot of it is due to stress at school where he struggles and doesn't have friends. There really is no other school for him to go to. Camhs say that he hits us beacuse he bottles it all up at school. They have told us not to trigger him.

We can't carry on as we are. I don't know who can help us. He doesn't see the need for help and has said he will not engage with anyone.

Has anything worked for you? Does the medicien actually help?

Thanks for any advice

Hi, I have no proper advice but didn't want to read and run. I can imagine how difficult this is for you.
My son certainly bottles everything up at school then becomes quite defiant at home, but I've noticed this happens much much more during the beginning and end of academic year..
Hopefully someone will give u some great advice!

Risperidone was a disaster for ds2 as it increased rather than decreased the aggression and in a totally unpredictable way. As I said to the psychiatrist I can alter my behaviour if there is a trigger to prevent incidents but how the heck do I prevent it when there was no apparent cause. In hindsight the warning sign that something was going very wrong was dramatically increased need to go the loo so contact CAMHS if you notice anything like this. Having said that risperidone does help lots of children it just needs careful monitoring.

On our experience the best way to reduce the aggression is via reducing overall anxiety levels. This means reducing demands and trying to get better support at school. We used to find Sunday night (i.e. before school) was a major trigger point so we moved things like washing hair (also major trigger point) to another night and made sure tea was something he was guaranteed to eat. Have you met with the SENCO at school and described the issues at home. There might be extra support they can put in for your son if they know what lessons are causing particular issues.

I would also recommend trying to find a course like the NAS Managing Anger which helps you understand your child's triggers and how to prevent and de-escalate incidents. If you treat the aggressive incidents as panic attacks it really helps you stay calm and de-escalate the situation. dh and I often swop over if we hear the other getting stressed and this also helps.

I think part of the aggression you are currently seeing is part of puberty. ds1's class (fourteen) were a nightmare last year. Both of mine are scared about the future, relationships and employment prospects and I think it is a difficult age for them. ds2 also struggled with his diagnosis at first and medication (aside from the side effects he thought we were telling him by giving him a drug that there was something wrong with him). Perhaps talking to your son that it's OK to have an ASC and show him good role models of people with an ASC who have thrived in life might also help his self-esteem

Thank you for your thoughts. The respiridone did seem to help at first. I don't know whether he can tolerate it now and so its effect is lessening.

We know certain things are triggers and do try and avoid but it doesn't help that things are so contradictory.

Camhs say he doesn't want to engage so they won't do therapy with him but then they suggest some youth offending buddy type support.

I don't know whether people with less asd knowledge will be able to help more than Camhs but I guess it is worth a go

I think at the start we tried to be pragmatic and now I think it has veered too much towards appeasing him which is not good.

It's not good for his younger brothers either as they can see the power he has over us.

Will also look at the autistic society courses

Thanks again

Actually one thing that did help ds2 for a while was a buddy (from social services) so I would take that up if you are given the opportunity. With ds2's usual bad luck it didn't last for him because the buddy could come for a while and all trust was lost but it did help initially, Youth targeting support wouldn't touch my two after an initial session because they were frightened of doing more damage than good - we were not impressed as we had made it clear they would need to build up trust slowly but they went straight into personal questions which whacked up the anxiety levels. Hopefully, you will have a better experience.

I agree that reducing demands does really help and being aware of triggers such as noise.

My child is younger and also on risperidone which has helped I think thoughvin earlier days of taking it there were unexplained outbursts which I found worrying.

CAMHS did FA for him other than meds.

The only other thing I can suggest is a course on Non Violent Resistance which a friend of mine did and said was great. Our CAMHS doesn't offer it but worth looking into

I'd agree with reducing demands. Really scaling back including at school. Go in and say you need to work together to identify what may be triggering.

Keep a detailed diary of even low level stress.

Ideally you'd have a good behavioural psychologist to make a plan with you and school. I'd even consider finding someone privately.

It must be really tough.

Thank you all. A lot of what you are saying rings bells and we are trying to do

He is teased at school and finds it stressful but he holds it together there. And takes it out on us st home.

Ironically the summer has been really difficult beacuse it hasn't been structured. We had put together a calendar showing what was happening each day and what activities could be done.
But he has got very anxious and doesn't want to go out so we haven't forced him.

We don't ask anything very much of him but he has tried to be controlling. Gets cross that his siblings are going out - but doesn't want to go out himself. It is all very irrational
He is super strong and violent and it is hard for us

He refused to engage with any agencies.

have you checked his vitamin D levels? If he is going out less and less you might find this is another factor in his anxiety levels. His vitamin d levels should be at least 70. Elder Son now takes 1000mcg per day to combat this,he was diagnosed with severe vitamin D deficiency partly because he never went out. It took me at least three years to realise there was some connection (in his childhood he had been quite tanned and outdoorsy, so I probably didn't realise his vitamin d levels were sinking as he became teenage recluse)

We found lack of friends to do things with in the holidays were a major source of anxiety and tension with the ASD son, that ironically combined with fear of going back to to school, so it was a lose lose situation. Camhs could not help me at all with this. What helped was home schooling him, holidays became much more fun, as his anxiety decreased and he started to have friends through the home school community. Now he is back at school with an EHCP, and just a joy to be with, no aggression, goes out all the time, has a fixation with football matches (but that gets him out) still controlling in many ways but just Great, and a wise bird with it, often gives us all advice on anger management, and how to calm down -tells the other teenagers off for bad behaviour

13 can be a particular truculent age. School can be a massive trigger for anxieties, social issues AND all the demands of academic curriculum. They are going to have to do more to help him. Could you reduce school hours perhaps, so he gets used to the idea of going out in a more limited way and perhaps doesn't get overloaded? This was a big issue for my son, once he got home he wanted to just hide. when his day was less busy (home schooling was our way of reducing the business) he began to relax and be more adventurous/less controlling.

I can remember holidays between Year 6/7 and Year 5/6 particularily awful - ds hit puberty quite early so it was possibly the pre-pubescent behaviour I was seeing then, and ironically now he is a tall 15 year old with sideburns he seems much less aggresssive and difficult.

We went a few times to CAMHS organised family therapy with ds2, it was absolutely useless for ds2 (although possibly interesting for us) he really couldn't understand what they were trying to get at, kept interrupting, and hated being someone "with a problem". so what worked better was engaging through drama sports or arts activities in a "soft touch" intervention. It was difficult to get him to agree to most activities, we had to find a hook, possibly a person he liked to be with, or an obsession, or a reward. Ds has refused in the past to continue with judo, drama, fencing, singing. It is not as easy to get them involved as people would assume, but a little bit of involvement is better than nothing, just one activity a week even.

Ds2 liked photographing aeroplanes and going on train journeys at one point - that got him out. Next he enjoyed theatre trips. Then long walks became something he enjoyed notching up. It was a slow process to get him engaged in something he liked that was holistic and not screen based. Oh and Red Dwarf - we loved watching that together and laughing at the jokes, moving onto other drama series. Ds liked watching the same series where he knew what the rhythm of the content was ifysim and chatting about it.

Thanks. This is all useful stuff. He hates school but has an absolute fear of missing it. I don't think any of us could do home schooling.
He has no hobbies apart from Lego

He has two activities out of school. One he enjoys and one he endures.
I found it so difficult that he doesn't understand that we hate the violence. He thinks it is funny.

I will definitely check for Vit D. Is there a supplement you recommend. He won't take tablets. And as he doesn't think he has a problem it's so hard to get him to engage

the doctor could prescribe a vitamin d supplement that goes in food, but I presume they only do that if he has been tested with an insufficiency/ deficiency.

has he told you what exactly he hates about school? That might be the key to getting him some help FROM school, the areas where he is struggling. He is probably aware that there is a problem with his behaviour but just thinking about it makes him anxious so he is blocking it from his mind. Laughing can be a sign of embarassment/incomprehension not just malice.

reading your posts back the school most definitely has a problem. they seem to have passed the buck to CAMHS but as school is the place where his anxieties are building up, surely they need to be the ones to put something in place. Smaller classes, less homework, safe place to have lunch, social skills group, homework club, dropping a subject (Ds doesn't do MFL for example but does do academic subject that some children with SNs might have been asked to drop for GSCE, it is tailored) nurture group. School may say they do not have funds for these interventions in which case they at least need to say what interventions they could offer IF they had the funds, and ask the LA for the top up funding. You are suffering because of what he is experiencing in school, and he is suffering too.

It all seemed to get worse when a couple of boys got moved to his class. I'm not entirely clear whether they tease him or it is more straightforward bullying. He is very sensitive and will easily get the wrong end of the stick. So a minor comment to him will really upset him but if he tells a teacher they often can't see the issue. School have doled out punishments though to the boys for some incidents but I think the staff feel he cries wolf.

He doesn't do MFL. He has extra English. He can go to the Sen room at lunch and break. He does get small group lessons and he has an ECHp. He has 1-2-1 Ta in English maths and science and floating support in other lessons.

He's not an academic child but he wouldn't qualify for special school and I don't think ther are any suitable places.

He is jealous of his younger siblings who are highly academic

It is such s mess and I am worried for him but we are also all scared of him. Which is not s good mix. Nothing incentivises him.

Anyway first day back st school today so feeling rather nervous for him

Thanks for all your comments. I do spppreciate people taking the time to post. It's very lonely and I can't tell my friends as I don't want them to judge