For those playing along at home, Kiddo#1 is ten, and he’s the one who figured out how many licks it takes to get to the center of a Tootsie Pop.
Kiddo#1 has always been atypical, and after five therapists, two psychopharmicologists, a psychiatrist, a neurologist, and a neuropsychologist (only the last two really took things seriously) we finally have an answer.
Co-diagnosis: anxiety disorder
Biggest problem: executive function regulation (prioritizing, regulating thoughts and emotions, etc)
Other problem: recognizing feelings and thoughts of others, excessive rigidity, relying on rote memory to compensate for lack of executive function
Recommendation: tons and tons of special interventions on the social level
Also recommended: Prozac
For the last few days, Kiddo#1 has been having tragic meltdowns that begin when he gets home from school, escalate rapidly to violence against his younger siblings and threats (and yes, threats against me too. He told me he’d wait until I fell asleep and then stab me five times) and paranoid delusions that we’re trying to kill him. These episodes were set off by Kiddo#2 asking if she could play in the snow on Monday, and Kiddo#3 saying “Hello!” when he came home on Tuesday.
Yesterday I prevented a meltdown after school by going to the school at 3pm and *making* the kid eat in the office. Since he won’t eat at home, and he needs to, I figured we’d head that off, and he won’t make a scene there (although he was snooty to me). He ate the stupid bag of potato chips and then went back to class, but you know, it *worked.* He came home sweet as punch and was great for the sitter. I’ve put a note in with the school that it is mandatory that the child eat something before going home. Period.
The neuropsych said that absolutely I am to call the police if he gets out of control again.
We have a meeting with a GI doc next week to talk about gluten intolerance. It may also be that because he’s unable to prioritize issues, he reacts to “I’m a little hungry” with the same force as “I’m dying” or “I’ve been shot!” and can’t cope. I’m told some individuals with Asperger’s don’t have a sense of their own physical needs until they hit a crisis point, and that may be an issue with him. He may *need* to eat on a schedule simply to prevent hunger.
The neuropsych described him exactly, btw. She was really sharp at the stuff she picked up about him and how she explained it all, and she said she knew the moment he walked into the office that 15 medical professionals and tons more educators had dropped the ball with him. He is very smart (I now have numbers for his IQ) and he’s been able to compensate by relying on rote memory so far, but that can’t keep you going forever, and the maladaptive strategies he’s learned in order to compensate are at a breaking point of their own.
Because he reacts by rote, rather than by responding to cues, traditional insight-oriented therapy isn’t going to work for him. Quite simply, he has no insight. He doesn’t recognize his own feelings, and he expresses no positive feelings. His affect is flat except for when he’s angry or upset. We need to find a specialist who works with a lot of kids who have Asperger’s and will train him to do things like recognize facial expressions and give him a script for how to respond to certain facial expressions. (ie, “This is a sad face. When you see a face that looks like this, you should know the person is not happy and say, Why are you sad? Can I help you?“)
He can’t turn a question inside out in his head even when he knows the information. For example, if you say that in 1960 a girl won a silver medal, and in 1961 she won a gold medal, and because of the gold medal she went to a competition in Switzerland, he can tell you what happened in each year, but he can’t tell you what happened the year before she went to Switzerland.
Or if you ask a typical kid to write an essay about a cat, the child will organize the information naturally into certain structures: “A cat is an animal. It has fur and walks on four legs. Some cats are owned and some are wild…” Kiddo#1 gives all information the same priority and can’t organize it, so his essay might look like, “Some cats are tabbies. Lions are related to cats. Our three cats are Eenie, Meenie and Mienie. Cats do not like to swim.” And so on.
You never want something to be wrong with your kid, but I knew something *was* and it’s good to at least have a name and a starting point. This is hardly the worst thing she could have diagnosed (I scared myself by looking up the symptoms of childhood schizophrenia). Today’s assignment is to start getting in contact with the support organizations and get some books so I can get some better coping strategies and start equipping him with them too.
[Edited two days later to add: I’ve written an updated reflection on what this means for him.]