Susan's Blog

Wednesday, May 16, 2012

Autism Mommy Swami #3: Aggression?

Dear Autism Mommy Swami,

Do you think Nat’s aggression/anxiety was worse during puberty? Jeremy just turned 13, and although the aggression has subsided, the anxiety and rigidities seem to have escalated. I’m hoping hormones may be playing a part in this, and that later on (sooner than later I hope) things will level out. I think you are going to be very busy with this new endeavor…bless you, Swami!

Dear Cookie,

Thank you for writing. The way I’m going to answer this one is to tell you all the factors that I believe went into Nat’s behavior when he was aggressive. I do this so that you can think in terms of possible reasons for Jeremy’s aggression, to give you a context to work from. You don’t need to compare your situation to mine; just know that you can use your own observation and empathy skills to try to figure out what’s going on. I say empathy so that it will be easier to remember to stay on his side. My biggest mistake was becoming afraid of Nat and being apart from him. When a child is feeling bad enough to hurt others, it is so important to stay with him. I think of this as “being the adult.” It is very hard, because you’re scared: for him and for others (and you). But try to feel for him, and you will stay connected. Connection is definitely a way out of troubled times.

Nat started to become overly energetic when he was 10, shortly after beginning Paxil. This period also coincided with his starting in a classroom that was not appropriate for him. The teacher was a skittish person and the speech and OT people took Nat’s behavior personally. This was the only experience in Nat’s entire school life where he was disliked by staff. And boy, did he know it. Even now rage simmers angrily inside of me when I remember them. I mention this because we parents always try to pinpoint when difficulties began and why, but what do we really know? My gut tells me that Nat’s synapses were becoming too slippery on the Paxil, making him almost a little manic and definitely uninhibited. But combine that with a tough winter and Blue Meanie teachers… why wouldn’t someone start hitting out at them?

But why did he also hit me? I still don’t know. This period lasted on and off for a year or two, until Nat was settled in a new school program where he stayed until he turned 22. During those years under the care of a wonderful humane doctor we started him on a tiny dose of Resperidone to see if it would calm him a little — not sedate, but calm him, give him a split second of space before responding impulsively. That was the theory. The Resperidone did help somewhat, but also I’m sure we were relieved to have something to try and so we calmed down, too, and that was good for Nat to experience. Can a parent fake calm? I would advise it.

We also started Nat in Special Olympics gymnastics at this time, and this was such a positive experience for him that he really started to feel good again. His coach was lovely and the other kids on the team were his age and some became friends of his to this day.

Winter gave way to spring, and this also helped.

Hormones make anyone crazy, be they adolescent boys or middle-age perimenopausal moms. Indeed, people in general tend to straighten out once their bodies do.

Here is another thing that helped, and you must read this without judging the Swami. Nat’s school had an idea which was to use a time-out room for 1 minute to help him decompress when he became aggressive. This way they could avoid restraining him. It was a small room with a small window. I cried when I signed the consent, but I felt that we should try it and see how he responded.The time-outs were fine for him; he could be alone and away from whatever/whoever had set him off. It served as a cool gust of air in a hot room (I think).

Time-out rooms are not legal these days, but I think that Nat benefited from the quiet separate space for those brief intervals. They were not used as punishments; they were used as a distancing device. I think that’s okay. I think it did him good to experience that he could be calm rather than aggressive.  Would I do it this way, knowing what I do now? Probably not. Now that I know how much he wants to communicate (but on his terms), I would have worked harder trying to teach him words and typing emails.

As Nat grew, so did his language, and I believe that was the element that had the biggest effect on his peace of mind. He could identify what was bothering and he could see that telling us about it had a positive result. This built trust, which is what may also be at the heart of some of the aggression. I think that when Nat would get so worked up that he would hit someone, it was driven by fear of not being validated. I think he felt alone, needing something but not knowing how to tell us. I think this enraged him, at us and at himself.

What I’m trying to tell you, Cookie, is that yes, I think Jeremy will grow out of it the way we all do, and that also there may be some concrete things to try like Special O, maybe meds (under a good doctor’s care), communication skill-building. I think you should trust your gut and your kid, that it definitely will get better and that you both will have learned a lot at the end of this phase.