AuDHD 10 year old depressed - how to help

[unstablefeeling]

My DS is 10 years old and has been diagnosed with ASD since he was 8 and just been diagnosed with ADHD in the last few weeks. He has very high anxiety and was prescribed Fluoxetine by CAMHS about 18 months ago, which does seem to have helped his anxiety but now he is really suffering from depression and I was wondering if anyone else has experienced this and can give some ideas of how to help him. We've spoken to his psychiatrist, who has recommended starting him on Ritilin (or something similar) and we have support from a CAMHS worker on a monthly basis who helps us by talking through the behaviours we are struggling with and giving us tips on how to talk to him and support him, but nothing seems to help. He goes to a specialist independent SEMH/ASD/ADHD school but has recently been refusing to go in and he's now too big and strong for me to be able to get him dressed etc if he doesn't want me to, so I can't get him into school and so he's spent a lot of time lately lying around at home in his pyjamas.
The first thing he says to me in the morning is "Will you kill me?" and it's usually the last thing he says at night, along with hundreds of times during the day. He tells me that life is too stressful and the only solution is for him to die, but he doesn't know how to kill himself so he wants me to do it for him. He gets very angry when I say I won't/can't. Sometimes I think it's just become a bit of a habit saying it, like he's just saying it for something to say, like he used to say "what can i do?" repeatedly. But I do genuinely think he means it a lot of the time. He's sleeping a lot during the day, which isn't like him usually. He's really bored, but he doesn't want to do anything and because of him executive disfunction he finds it really hard to get started on any activity independently. He says he isn't interested in anything and because he is quite demand avoidant it's impossible for me to just tell him to get up and go for a walk or something that I know would help. He says he doesn't care about "the science" that I tell him has proved the things that actually help low mood, such as exercise and a healthy diet.
The Psychiatrist says that the ADHD meds might help him find it easier to get started on activities, and ease some of the chaos in his brain so it might help with his low mood. Has anyone experienced similar?
Really grateful for any experiences that might help us.

ADHD meds can help some people’s mood. This isn’t always a quick process. It can take time to find the right medication and dose.

You could review the Fluoxetine dose with the psychiatrist, or even discuss a change of medication.

Sounds like you need an early review of the EHCP. On their website, IPSEA has a model letter you can use. What support does it currently include? Does it include any therapies?

Can DS communicate what he is struggling with at school?

Has DS had bloods recently? For example, vit D and B12?

How is DS’s eating? What about his sleeping at night?

This sounds awful OP, I have an autistic 10 yo too. It sounds like you definitely need a med review. I would also say he needs CAMHS, or the school, to provide him with direct therapy instead of, or as well as, what they’re providing to you as parents. If he’s into gaming you could also look at MindJam, though they have a bit of a wait list.

Have you looked into autistic burnout? People like Kristy Forbes, who is also PDA with PDA kids has talked a lot about this and has lots of great advice on how to navigate it. I think you have to tread very gently.

I really hope things improve for you all soon

Thank you both for your responses. In answer to your questions: DS isn't able to explain exactly what it is about school that he doesn't like, only that it's "torture". He finds the other children annoying and loud, and hates anything that he perceives as learning. The staff at school are always trying to tell me he's happy when he's there, and they send me photos of him laughing and smiling, but he is adamant that he's just putting on a brave face and that he hates every moment of it.
His EHCP doesn't specifically mention any mental health therapy, just OT and SALT, both of which contribute to helping with this, of course. His school has a therapist who has spent the last 2 years building a relationship with him but he still won't engage in 1:1 therapy and only occasionally in group therapy sessions. CAMHS won't provide him with direct therapy because he won't engage with it.
He had a blood test yesterday, so will see what that says when we get the results back. This was done because he has a lot of tummy trouble though, not because of his low mood, so might not be measuring his vitamin d or b12, I'm not sure. His diet is pretty poor, standard for an autistic kid I'd say! Lots of white carbs, the odd vegetable. His sleep is OK, he finds it hard to settle so usually isn't asleep until 10ish, but stays asleep until about 7:30 usually.

I'm hesitant of asking for an EHCP review because I'm not sure what else they would offer. He's in the only special school near us that could meet need.

I will talk to the psychiatrist about changing his fluoxetine, when we talk about the ADHD meds.
Thanks again for your support, I really appreciate it.

CAMHS won't provide him with direct therapy because he won't engage with it.

It is far more likely to be can’t engage rather than won’t. CAMHS need to amend their approach, not refuse care. The way around that is to get therapies in F of the EHCP. That way it must be provided. It can also mean therapies CAMHS don’t offer can be provided, more frequently, for longer and without the need to sit on the waiting list.

It doesn’t sound like the school is meeting DS’s needs or understanding him. Disappointing but all too common that a special school does not recognise DS is not ‘fine’ in school. More support can be given via the EHCP, including a mental health therapy or something like MindJam as Open suggested. Therapies that rely less on verbal communication that tap into DS’s interests (what does DS enjoy doing?) can be a way in. You could also look at a day or 2 at an AP based on DS’s interests whilst still attending school the other days. If there aren’t other suitable schools, you could look at EOTAS.

This really pisses me off, they should be taking the time to build a relationship and gain trust, not just dismissing him as ‘not engaging’. So frustrating.

My heart goes out to you and your boy. A couple of years ago my now almost 11yo boy with ADHD (and recently Autism diagnosed) was very low, not quite as low as your boy, but talking about not wanting to be alive, hating school.

I'm trying to think if anything helped. Life is still very challenging so I'm far from offering solutions, just solidarity really.

Several years ago I looked into getting a specially trained support dog, not possible at the time but I did eventually investigate cat breeds (needing to be guaranteed a good temperament) possible good fits were Ragamuffin, Ragdoll, British Longhair or Shorthair and we now have an emotional support cat.

My son likes the sprays and roll on scents from Tisserand which have helpful names like de-stress and we've tried the Happy Journal and Kurzgesagt Gratitude journal. All these just put a few grains of sand on the positive side of the scales.

I'm so sorry you're going through this.

https://www.autism.org.uk/advice-and-guidance/professional-practice/what-is-an-autism-assistance-dog

@Doable thanks for your message. We do have a cat who DS loves, but he's not keen on dogs. I hadn't heard of Kurzgesagt but those things look great, although probably not for my DS as he refuses to read or write at all. My DD would love them though! Have you tried any medication for your son? I'm interested in whether the ADHD meds will actually help his mental health or not!
We've got an emergency annual review lined up now, arranged by the school at the prompting of CAMHs, so hopefully he can get some more support.

My DS has been on methylphenidate for a while. It helps him have a little more control of his reactions so gives other strategies a sporting chance of having some impact. It definitely doesn't 'solve everything' though. I would encourage you to give it a try.

Kurzgesagt youtube channel is good https://m.youtube.com/@kurzgesagt
DS likes Classic FM and recently discovered Classic FM Calm so I sometimes put it on in the background if he's particularly anxious at night.

Does your DS have any special interests he can absorb himself in at the moment?
If he's spending a lot of the day in pyjamas could you get him a really cosy new pair? Is he willing to take a bath or shower? If so some nice smelling stuff might give him a tiny lift. Would he be willing to do even a minimal bit of mixing to make up eg a chocolate brownie ready mix?
I might say 'I don't know how to make you feel completely better but I want to try and help you suffer less'.

Good luck🌻

@Doable thanks so much for this. I think part of the problem for him is that he doesn't have a special interest at the moment, he feels like he doesn't find anything interesting and has lost interest in all the things he used to enjoy, even computer games. However in a little ray of hope, last night he got out his collection of beer bottle tops that he used to love collecting and organising, and started sorting through them again. It was lovely to see him absorbed in something for a short while. But on the whole I think the lack of ability to focus on anything is contributing to his low mood, he keeps telling me he wants a hobby but doesn't find anything interesting. He was very interested in frogs for a while but this seems to have waned now. I feel like it's the ADHD side of his brain fighting with the ASD side and causing him to be 'stuck'.

Once the right medication/dose has been found, many do find ADHD meds help improve mental health.

Hi
j know this is an old thread , but I read it recently and wanted to reach out to you to see how things are 😘
Audhd is so very hard; so much conflict and anxiety. Couldn’t stop thinking about your lovely ds and all that you are going through.
I sincerely hope that things are better . Sending empathy as a mum of an 18yo ds with the same diagnosis.. it’s just so difficult and heartbreaking xxxx

That's so kind of you to reach out. Things are a lot better now, which I hope can give hope to anyone else in a similar situation! We've made a lot of changes since I wrote this post which have had a positive effect. I took a lot of the advice from posters, so a belated thank you to everyone who commented.

We called an emergency annual review and DS was placed on EOTAS. It then took 6 months to get any provision at all but we now have MindJam and a tutor who comes to the house who is specially trained in working with "hard to engage" children, and she is brilliant, they have a great relationship and he enjoys his sessions, which are mostly crafting and playing with a small amount of maths thrown in.
Taking the pressure of school away has made all the difference and DS is no longer talking about dying. He still has a lot of struggles with anxiety but he's much better able to tell me what he's anxious about rather than flying into a violent rage.
We also took him off the fluoxetine and now he is on Aripirazole, which has really helped with the anxiety and lessening the aggression which came with the anxiety.
We also got another cat! She is much more cuddly than our other cat and he spends a lot of time cuddling her.
He is still struggling with boredom and not finding anything interesting, but he's slowly starting to feel like he can do things and try new things. Things are definitely getting easier for him, slowly, and I feel like he has a bit of hope for his future now. Thanks so much for caring, it can be a lonely road!

It’s heartwarming to read your post this morning and the difference that some positive changes have made to help this lovely young man function better and regulate his emotions more.
Cats definitely help 🐾 We also have felines which bring a lot of joy! My ds18 has masked a lot of his inner struggles and the traits that the polar opposite of the AuDHD means but now we talk a lot about his feelings and I have let go of my expectations for him and allowing him the courage to be himself - still good days and worrying days but we keep the lines of communication open 24/7 xx Sending love and strength 🥰

So happy to hear your update OP. I hope ds continues to make progress.