Asperger’s Syndrome Symptoms

In reviewing a checklist of symptoms for Asperger’s Syndrome:

Asperger’s Symptoms that match The Captain

  • failure to develop peer relationships appropriate to developmental level
  • lack of social or emotional reciprocity
  • apparently inflexible adherence to specific, nonfunctional routines or rituals
  • stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

Asperger’s Symptoms that do NOT match The Captain

  • marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
  • a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
  • encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  • persistent preoccupation with parts of objects

On The Spectrum

During the in-patient program at the hospital, one of The Captain’s new acronyms was PDD, or pervasive development disorder.  The definition of this is sufficiently vague, and includes Autism and Asperger’s.   The psychiatrist did not go into any specifics at the time, so I can only assume his lack of specifics means that he meant PDD-NOS, pervasive development disorder, not otherwise specified.

Pervasive Developmental Disorder – Not Otherwise Specified, or PDD-NOS, for short, is a condition on the spectrum that has those with it exhibiting some, but not all, of the symptoms associated with classic autism. That can include difficulty socializing with others, repetitive behaviors, and heightened sensitivities to certain stimuli.

There seems to be some disagreement as to whether PDD-NOS is the same thing as HFA, high-functioning autism.  And, I’m not sure which label I prefer, as PDD-NOS sounds too vague and sounds like a developmental problem, where HFA, while having the stigma of autism, includes the phrase high-functioning, which sounds nicer to me.

The current psychiatrist has said he is on the autism spectrum and has referred to him as high functioning autism.   Perhaps it would be best to say that he has Autism Spectrum Disorder.

The Doctor had us go through a checklist and he scored high on it.  If I recall, you had to match 12 of the traits listed to be considered, and he matched like 15 or more.  Below are some examples, but the actual checklist we went through was much longer and more detailed.

Interestingly enough, his dad, The Admiral, matched several of the checklist criteria as well.

Austistic Symptoms / Traits That Match The Captain

  • Have trouble understanding other people’s feelings or talking about their own feelings
  • Repeat words or phrases over and over (echolalia)
  • Give unrelated answers to questions
  • Get upset by minor changes
  • Have obsessive interests
  • Flap their hands, rock their body, or spin in circles
  • Have unusual reactions to the way things sound, smell, taste, look, or feel
  • Does not understand personal space boundaries
  • Avoids or resists physical contact
  • Is not comforted by others during distress
  • Hyperactivity  (very active)
  • Impulsivity (acting without thinking)
  • Short attention span
  • Aggression
  • Causing self injury
  • Temper tantrums
  • Unusual eating and sleeping habits
  • Unusual mood or emotional reactions
  • Lack of fear or more fear than expected

Austistic Symptom / Traits That Do NOT Match The Captain

  • Not respond to their name by 12 months of age
  • Not point at objects to show interest (point at an airplane flying over) by 14 months
  • Not play “pretend” games (pretend to “feed” a doll) by 18 months
  • Avoid eye contact and want to be alone
  • Have delayed speech and language skills
  • Avoids eye-contact
  • Prefers to play alone
  • Does not share interests with others
  • Only interacts to achieve a desired goal
  • Has flat or inappropriate facial expressions

New Tools Discovered

I’ve been doing more research on early onset bipolar disorder, via internet searches and books.  I’ve read quite a bit even previous to The Captain’s diagnosis, having suspected for years that there was more going on in his head than ADHD.

One interest resource I came across was, where I first learned about how bipolar relates to the Circadian rhythm and about light and dark therapy.   I ran out and purchased some yellow bug lights from Ace Hardware and installed F.lux on all of the computers.  I’m not sure if the yellow lights in The Captain’s room have had any effect, or if the software is working, but it’s certainly worth a try.

Yesterday, I started reading The Bipolar Child by Demetri & Janice Papolos.  Much of it was information I had already run across, but it too discussed light therapy and Circadian rhythms.

It also suggested the use of Melatonin to aid in restorative sleep and the use of Omega 3’s or fish oil which may be able to act as a mood stabilizer themselves.   I didn’t have time to absorb all of the Omega 3 section, but I got the part about the melatonin, so while we were out yesterday, I got some melatonin supplements from Walgreen’s, at about $8 for a bottle of 5mg.

Last night, I gave The Captain a pill just before quiet time, and he calmly, quietly went to his room, and very soon after was sound asleep.   I’ll have to wait to hear how his day went, but the rest of my evening was wonderful.

The Emergency Room Visit

A few weeks later, we still did not see improvements, and The Captain had a Very Bad Day.  He got into an argument with his brother and hit him in the back with a large piece of wood from the deck.  Afterward, he was uncontrollable as he banged his head into the floor and the wall and destroyed anything he could reach.  Our stress level was as high as it had ever been.

The Doctor had said in the event of him attempting to harm himself or others, we should go directly to the emergency room or call 911.   So, we did.

We managed to get him to the car with no issue.  He screamed and cried along the way but did not actually resist.  His crying fell to a whisper by the time we reached the hospital.

While in the waiting room, The Captain chewed his hospital wristband off.   After a short wait, we were brought in and he had his vitals checked.  We were escorted to a far away hallway in the emergency section with several rooms that had nothing in them but the hospital bed.  No sharp corners.

They handed us a gown and said he needed to change into it.  He did not like this at all and screamed and cried over it for quite a while before we were able to convince him that it was better if he undressed himself than if someone had to do it for him.

He lay on the hospital bed while The Admiral and I stood beside him, waiting.   The Explorer was left at home and we checked in about once an hour.

Overall, we were there for about 4 hours, with intermittent visits from nurses or doctors doing routine things like registration and blood/urine tests.   In the end, The Captain fell asleep in the bed, and we decided to leave.

The day after, we met with the therapist and psychiatrist.   He doubled his dosage of the guanfacine from 1mg to 2mg, actually giving him a meltaway 2mg in the office.  He had us wait there for 20-30 minutes to see how it would affect him.

He was remarkably more playful and less impatient in the waiting area, and this impressed the doctor.   He said we could dose him additionally as needed in .5 mg increments, 40 minutes apart.  We’ve done this once or twice since then and it may or may not have been effective.

Since then, he has seemed better during the day, though still very irritable, but bedtime is still a recurring problem.

The New Doctor

After leaving the in-patient program, we had an introductory session with his new local therapist, followed by an appointment with the new psychiatrist the next day.  The new diagnosis left off the anxiety disorder bit and focused more on the moods and the pervasive development disorder, thus his current diagnosis is ADHD, bipolar, and high-functioning autism.

The Doctor reviewed what the hospital had prescribed (prozac, focaline, guanfacine, and desmopressin) and could not believe it.  Apparently some of these medications could interact with each other in dangerous ways, and some would not show improvement for a month.   He took him off everything, and switched him to just use Abilify.

Within days, he was back to “normal” and the chaos had returned.   At one point, he actually asked for his old medicine back.  The Doctor had said we should start low and move up, though, and that the mood and autism needed to be treated before the ADHD.

The In-Patient Program

The Captain’s hormones finally kicked in full force this spring, when his days and nights became a constant struggle, and his rages became completely uncontrollable.   Up until then, we had been able to “handle” him.  He has been homeschooled/unschooled and unmedicated since second grade.

The current state of the home is unbelievable.    We could no longer let his older brother, The Explorer, share a room with him, because all of The Explorer’s possessions would become destroyed just like The Captain’s.   We moved The Explorer and his stuff into our bedroom, and The Admiral and I out into the living room.   That’s right, we now sleep in the living room.   We are working on renovations to the rest of the house to allow us to be in another space, but until then, we are at the mercy of the living room and its lack of privacy.

Still, his behavior persisted and his rages over any little thing escalated, and his violence towards his brother exploded.   He punched, hit, and slammed The Explorer’s head into a desk.   We were at our wit’s end.

Finally, we made an appointment and took him to a local (but not close by) hospital’s adolescent behavior wing.  Security guards nearly had to drag him in.  After some hours of waiting and little feedback, we had to wait a few days until they decided to accept him into the in-patient program.

For three weeks, he spent his days at the in-patient day program and his nights at home.     He never displayed his rages or aggressive behavior while at the hospital, but based on our reports, the psychiatrist still diagnosed him as having a mood disorder, though he would not specify.   In the end, he was diagnosed as having ADHD, a mood disorder, an anxiety disorder, and pervasive development disorder.

Immediately, they started him on Prozac (for the anxiety) along with Desmopressin (for his enuresis).   His hyperactivity was still in high gear, and perhaps worsened, so they added Focaline to the mix.  Doses were changed, timings of medications were changed, but nothing seemed to help.   Nights at home were better some nights but chaotic on others.

In the last week, they added Tenex (guanfacine) to the mix, and at last, this seemed to normalize him.   He was able to attend homeschool group without throwing tantrums or attacking other kids.  He was able to focus and seemed genuinely happy.  He also learned a few “coping techniques” that he talked about (mostly things to do with his hands when fidgety).  He even stopped wetting the bed some nights (but not every night).

He was good enough to come home, they decided, and we were to meet with a new, local psychiatrist and therapist duo in a few weeks.