Unpredictable teen that loses control in public

[blueboocat]

My 15 year old ds behaviour is getting worse the older he gets. He does have high functioning autism.
He has a lot of worries, anxieties and insecurities but they are always to the very extreme and he seems to find everything a threat. I feel he seems to be paranoid a lot of the time. He is very quiet and shy and has over the years slowly overcome his selective mutism.

He agreed to go out with us for dinner over the weekend and all seemed fine and he was relaxed. Then out of the blue he starts getting angry that a table near us are quite loud. They were harmless and not excessively loud, but he saw them as a threat and it was so out of character as he is painfully shy, but he aggressively went up to the table swearing at them asking them why they are saying things…..it really didn’t make much sense. We managed to diffuse the situation, apologised to the people and left. Once home he was very remorseful and mentioned suicide as he feels he is not in control of himself. This isn’t a one off, he usually struggles to cope but this is the first time he has lashed out at people.

I need help in what can I do for him? He sees a NHS psychiatrist about twice a year as he is in anti depressants, he also sees a psychologist weekly for talking and CBT therapies.
Anyone been through similar that can offer advice please? Is this teenage hormones and autism ….I mean is this a phase at this age with hormones involved or more?

Does DS use noise cancelling headphones or ear defenders?

Even though the next table didn’t appear excessively loud to you, they might have done to DS. Not saying his response is right just that could be the reason behind his response. Has DS had an OT assessment, including a sensory assessment?

Other than the CBT, is DS receiving any support with emotional regulation?

Based on our experience I might revisit the medication and check it is not having unintended side effects. (ds2 become unpredictably aggressive & paranoid on risperidone albeit at a younger age). I would also want to discuss the paranoia with his CAMHS team to make sure there is not something else going on.

Other than that I would talk with him about what else he could have done in that situation e,g. might have been better to take himself out of the restaurant for a few minutes if too noisy. Or in future take noise cancelling headphones, be more aware of acoustics in choosing which table / restaurant to go to (some are really bad we find).

Presumably he is back to school / college imminently so this can ramp out the stress level. We learnt to avoid doing anything out of there comfort zones in this period,

Having said that around fifteen was a turning point for my 2 and we certainly had very few incidents after that. I think mainly because with age they gained / were allowed to take control in the stressful situations. Knowing that they had a get-out option just really helped for them.