Depression? Autism? What are we dealing with?

[bethben]

Ds (age 13) is currently in therapy for what we felt like was depression.  He was sleeping a lot, not eating great, and was mumbling all his answers.  He has no friends and no desire (so he says) for friends.  The therapist feels like he is having some sensory/audiology processing disorder along with verbal processing disorder (basically autism spectrum).  We ask ds how he feels about something and we get a lot of "I don't know".  We ask him what he wants and while it's getting better, the answer is usually "I don't know".

 

The therapist also believes he's moderately to severely depressed.  The pediatrician would say mild to moderate based on a different test.  In doctor's offices, he's moody and "dark".  Almost crying but not allowing himself to do so.  The last doctor's appointment for a well child check, he was mumbling, dark, moody, almost crying before and during the time in the office even after I promised him no pokes and needles.  In the elevator ride down after the appointment, he was back to his happier self and chatting away.  At home, he seems pretty happy - he's smiling a lot and gives dh some trash talk when they play video games - he wrestles good naturedly with his older brother, and while he's fixated on Minecraft, he's happy about what he gets to do.  He has no friends and doesn't seem to desire them.  I have to make "play dates" for him because he never asks and never wants to go to the bother.  We have to arrange activities for him to participate in and he'll do them, but not really want to go back to them again.  He does go to a one day a week program and his teacher doesn't notice that he's different from any other kid.  She did notice he was pretty stressed when they had 2nd grade buddies come in to do an activity one on one with the 7th graders.

 

The therapist still believes there is underlying depression.  I'm having trouble reconciling the kid I see every day at home (this happy kid for the most part) and the kid he sees in his office (dark, depressed, and crying).  I have no problem with any type of diagnosis - I just want to get him appropriate help.  Any suggestions or thoughts?  This is a puzzle to me.

Edited October 29, 2017 by bethben

[itsheresomewhere]

To me based on my own experiences, it sounds like an anxiety problem more than depression.  Has the therapist ever mentioned it?   One member of my family has anxiety that could look like depression if you didn't really know them. 

Edited October 29, 2017 by itsheresomewhere

[bethben]

That's what I've mentioned to the therapist - anxiety rather than depression.  He still feels like it's depression.  He's in his 70s and has worked in this field for over 40 years so he's seen a LOT of kids.  Just that his mood could flip so easily like that when the office visit was ended.  Also, when he was working with his 2nd grade buddy, he was methodically pulling at his shirt collar the whole time.  She's never seen him so agitated.

[MercyA]

My first thought was anxiety, including social anxiety. (And those could co-exist with ASD. The mumbling and pulling at his collar could be stimming / self-soothing behaviors.)

 

:grouphug:  :grouphug:  :grouphug:

Edited October 29, 2017 by MercyA

[itsheresomewhere]

That's what I've mentioned to the therapist - anxiety rather than depression.  He still feels like it's depression.  He's in his 70s and has worked in this field for over 40 years so he's seen a LOT of kids.  Just that his mood could flip so easily like that when the office visit was ended.  Also, when he was working with his 2nd grade buddy, he was methodically pulling at his shirt collar the whole time.  She's never seen him so agitated.

 

It might be time for a new therapist.  Sometimes being much older than the patient does not always work for the best.  

[TrixieB]

I don't know if you are able to obtain this information - is your child able to discuss feelings with the therapist?  Or does your child respond "I don't know" and get angry/upset/cry when the therapist tries to discuss your child's feelings? 

 

Has your child ever been able to discuss feelings with you?  More in-depth discussion than stating likes/dislikes?

 

Has your child ever had close friends, especially any whom he has asked to get together with regularly, over an extended period of time?  Or only casual acquaintances, with whom you've set up the playdates?

 

The answers to those questions could point to ASD, anxiety, depression... which can co-exist.

 

Being happy at home and having great relationships with siblings and parents doesn't contraindicate the possible diagnoses above.

 

If your gut feeling is that something other than/in addition to depression is going on, I think it's better to set up evaluations now instead of wait till later. 

 

ETA:  I'm not saying it's ASD, but I will say that not all kids with ASD present the way some therapists expect ASD to "look".

Edited October 29, 2017 by TrixieB

[sbgrace]

Anxiety seems likely in what you wrote. I wouldn't think depression if that affect is just specific to situations outside the home. It sounds very much like you need a second opinion on the depression vs. anxiety. 

 

If autism is being mentioned and seems possible to you, you would want him assessed by someone who specializes in autism evaluation. Of course sometimes autism might look like a kid who just doesn't want to interact with peers (along with other things). But so can social anxiety and introversion/some personalities. A professional can sort that out. 

 

 

 

[Ausmumof3]

I have anxiety with Drs and it sounds like this might be what you are dealing with? Not that nothing else is going on but that would be the first thing.

[Pawz4me]

It sounds to me as if you need to step things up from the therapist. I’d look around for someone who can do full psycho-educational testing (psychologist or neuropsychologist). I’m not sure that an elderly therapist (or any therapist) is the best choice for a young teen with possibly complex diagnoses to tease apart. And as others have said, the three issues you’re looking at often co-exist. Most people who have autism certainly usually have some level of anxiety.

[maize]

I'm also seeing anxiety in what you described.

[bethben]

I don't know if you are able to obtain this information - is your child able to discuss feelings with the therapist?  Or does your child respond "I don't know" and get angry/upset/cry when the therapist tries to discuss your child's feelings? 

 

Has your child ever been able to discuss feelings with you?  More in-depth discussion than stating likes/dislikes?

 

Has your child ever had close friends, especially any whom he has asked to get together with regularly, over an extended period of time?  Or only casual acquaintances, with whom you've set up the playdates?

 

The answers to those questions could point to ASD, anxiety, depression... which can co-exist.

 

Being happy at home and having great relationships with siblings and parents doesn't contraindicate the possible diagnoses above.

 

If your gut feeling is that something other than/in addition to depression is going on, I think it's better to set up evaluations now instead of wait till later. 

 

ETA:  I'm not saying it's ASD, but I will say that not all kids with ASD present the way some therapists expect ASD to "look".

 

No, my ds is not able to discuss feelings with us or the therapist.  He will say a lot of "I don't know" and with the therapist gets fairly upset.  A lot of how we figure out what is going on is seeing his reaction or the emotion on his face and saying something like, "I see that you're trying not to cry.  When people start to cry, they are upset or sad.  Are you upset or sad?"  We have been making some progress, but most of figuring out his emotion comes from very drawn out conversations like the above.  It's exhausting.

 

My ds had a neighbor friend who was 3 years younger even though he had a brother his age.  He never went to his house to ask him to play outside.  The friend always came to our house.  Same with other children.  Ds never asked to have them play.  He is awkward at best with peer relationships and really has no friends that are over at our home regularly.  We are going to start forcing this issue a bit since he does have an acquaintance who is much like him.  It's the quietest interaction I have ever seen.  They don't talk to each other almost the whole time but both of them feel like it was a good time.  

 

He is scheduled to see a neuropsychologist in early March for diagnosing autism spectrum.  It was the soonest we could get in with any neuropsych in our area.  

Edited October 29, 2017 by bethben

[itsheresomewhere]

No, my ds is not able to discuss feelings with us or the therapist. He will say a lot of "I don't know" and with the therapist gets fairly upset. A lot of how we figure out what is going on is seeing his reaction or the emotion on his face and saying something like, "I see that you're trying not to cry. When people start to cry, they are upset or sad. Are you upset or sad?" We have been making some progress, but most of figuring out his emotion comes from very drawn out conversations like the above. It's exhausting.

 

My ds had a neighbor friend who was 3 years younger even though he had a brother his age. He never went to his house to ask him to play outside. The friend always came to our house. Same with other children. Ds never asked to have them play. He is awkward at best with peer relationships and really has no friends that are over at our home regularly. We are going to start forcing this issue a bit since he does have an acquaintance who is much like him. It's the quietest interaction I have ever seen. They don't talk to each other almost the whole time but both of them feel like it was a good time.

 

He is scheduled to see a neuropsychologist in early March for diagnosing autism spectrum. It was the soonest we could get in with any neuropsych in our area.

Just a suggestion- you might want to look into a social skills group for teens. We have one that meets about once a month and they also go on trips together (movies, bowling, dinner,etc). Those easy trips help ease the kids into social activities. Edited October 29, 2017 by itsheresomewhere

[lmrich]

In the meantime, get him exercising.

 This is so hard, and you are not alone.  :grouphug:  :grouphug:

[bethben]

The therapist suggested that I wasn’t ready to accept the diagnosis of possible autism and depression. Nope—I told him I have dealt with a much worse diagnosis. I am just trying to figure out what is really going on because the happy kid at home doesn’t seem to be the same kid a doctor sees in his office. My mommy gut which has often helped me figure out my nonverbal child is telling me we are most likely dealing with mild autism spectrum with social anxiety. For example, in the doctor’s office, he looked and acted depressed but his heart rate was greatly elevated. To me, that screams anxiety.

 

My biggest challenge is that I don’t know how hard to push him. Do I force social relationships on him? Do I send him to a full time university model school or do we go just part time? Do we force a sport on him? These are questions I don’t know how to answer.

 

 

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[maize]

Is he getting regular exercise?

 

If not I would do anything in my power to make that happen.

 

I've got a similar sounding kid by the way. They are tough to figure out and work with.

[Katy]

If you're concerned about anything as serious as autism, depression, or anxiety I'd call the area AEA and ask who evaluates things like that in your area.  It's too important to get an accurate diagnosis to just rely on a bunch of strangers on a message board who haven't met him.

[bethben]

I'm just asking for more opinions since I don't have this kind of support around me right now.  He is under care of a therapist and we are seeking a diagnosis with a professional.  In the meantime we're just trying to navigate this a little better and are wondering what is out there for help.    What is AEA?  

[eternalsummer]

If you're concerned about anything as serious as autism, depression, or anxiety I'd call the area AEA and ask who evaluates things like that in your area.  It's too important to get an accurate diagnosis to just rely on a bunch of strangers on a message board who haven't met him.

 

She says she has an appt in March, the soonest she could get, for an autism evaluation.

[Tanaqui]

I don't know what it is and am not going to offer an opinion. I will say that depression, anxiety, and autism are all commonly found together in the same individual.

[Terabith]

The more anxious my 12 year old is, the more autistic she looks.  When the anxiety is under control, there really are no autistic symptoms.  Everyone who looks at her (frequently us included) thinks autism, but she's passed the ADOS three times now. 

[bethben]

The more anxious my 12 year old is, the more autistic she looks. When the anxiety is under control, there really are no autistic symptoms. Everyone who looks at her (frequently us included) thinks autism, but she's passed the ADOS three times now.

Obviously, since he’s 13 and we’re just now looking into a diagnosis, his has been mild if anything until now. It makes me wonder if we address the anxiety/depression better if the social piece and emotional piece would get better? I have no idea...the neuropsychology eval can’t come soon enough.

 

 

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[Storygirl]

:grouphug:

 

DS13 has a diagnosis of NVLD and is very close to the autism spectrum, though we do not have an ASD diagnosis at this point. I agree that what you describe could have multiple things at its root; hopefully the NP will help sort it out.

 

I just wanted to comment on your observations about how different your son is at home versus in a doctor's office. My son is also extremely different at home than he is at appointments and at school. At home he is very talkative (though he only talks about his own interests), whereas at therapy appointments and at school, he clams up. He offers one word answers to questions they pose, and he often answers, "I don't know."  He can't describe how he feels or thinks about things, usually.

 

For DS, I think he clams up because of anxiety and because of the social demands of the situation. He has low pragmatics (which measures social skills). When the social demands are higher, he closes down. Having to answer questions from a doctor or therapist -- he hates this! So his anxiety goes up, and his communication skills go down.

 

 

[Storygirl]

The more anxious my 12 year old is, the more autistic she looks.  When the anxiety is under control, there really are no autistic symptoms.  Everyone who looks at her (frequently us included) thinks autism, but she's passed the ADOS three times now. 

 

Terabith, the ADOS is considered by many to be a "gold standard," but it also extremely subjective and relies upon the evaluator's observations during the test. If you decide to have her evaluated sometime in the future, you may want to look for a psychologist who will run some different testing.

 

[Rosie_0801]

No, my ds is not able to discuss feelings with us or the therapist.  He will say a lot of "I don't know" and with the therapist gets fairly upset.  A lot of how we figure out what is going on is seeing his reaction or the emotion on his face and saying something like, "I see that you're trying not to cry.  When people start to cry, they are upset or sad.  Are you upset or sad?"  We have been making some progress, but most of figuring out his emotion comes from very drawn out conversations like the above.  It's exhausting.

 

My dd has been a lot that way do to a lack of adequate emotional vocabulary, and appreciates when I give her words. Sometimes I use literature, sometimes non-fiction.

[maize]

The more anxious my 12 year old is, the more autistic she looks. When the anxiety is under control, there really are no autistic symptoms. Everyone who looks at her (frequently us included) thinks autism, but she's passed the ADOS three times now.

Yes! This happens with my child as well. Doctors offices are particularly high anxiety places for him, and his behaviors there look like textbook autism.

 

The Neuropsych doesn't think it is autism though.

[Katy]

I'm just asking for more opinions since I don't have this kind of support around me right now.  He is under care of a therapist and we are seeking a diagnosis with a professional.  In the meantime we're just trying to navigate this a little better and are wondering what is out there for help.    What is AEA?  

In most areas we've lived there's an agency called something like "Area Education Agency" or AEA that provides evaluations for the school board as well (as well as early intervention for younger kids with developmental delays).  They may be able to send someone to your home to evaluate him for free.

 

She says she has an appt in March, the soonest she could get, for an autism evaluation.

 

Sorry, I missed that.  We have a couple sick kids here this weekend.

[Tanaqui]

Obviously, since he’s 13 and we’re just now looking into a diagnosis, his has been mild if anything until now. It makes me wonder if we address the anxiety/depression better if the social piece and emotional piece would get better? I have no idea...the neuropsychology eval can’t come soon enough.

 

Not necessarily, especially if he's primarily homeschooled. Autism runs in families, and many parents of autistic kids not only have autistic traits themselves, but are used to seeing those traits in their parents and siblings. (Or even their friends! I'm convinced that my mother, for example, only befriends other people who are probably part of the broader autistic phenotype. Consequently, though she recognizes the more obviously autistic traits I have, and has for a long time, she tends to ignore all the less obvious ones because "that's just normal". Having conversations with her on the subject can be frustrating, to say the least.)

 

Edit: Which is not me saying "Wow, your kid is so autistic!", just pointing out that "we haven't considered a diagnosis before" is not a dealbreaker for a diagnosis now.

 

Edited October 29, 2017 by Tanaqui

[ktgrok]

 For example, in the doctor’s office, he looked and acted depressed but his heart rate was greatly elevated. To me, that screams anxiety.

 

 

 

Yes, some people will shut down when anxious, which looks like depression. Fight/Flight/Freeze, and they choose Freeze. 

[ktgrok]

I would NOT force interactions or throw him into a school setting until you know what is going on,and can adress it. I'm not a fan of "sink or swim" approaches. 

[bethben]

Not necessarily, especially if he's primarily homeschooled. Autism runs in families, and many parents of autistic kids not only have autistic traits themselves, but are used to seeing those traits in their parents and siblings. .

My dad most likely was autistic and ds is reminding me of him. They have similar mannerisms even though my dad died before ds was born. I have a nephew also who drives my sister nuts because of his lack of caring about or even understand social interactions (he’s in 8th grade). I also have a niece who is most definitely autistic but she probably has an undiagnosed syndrome.

 

 

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[kbutton]

My dd has been a lot that way do to a lack of adequate emotional vocabulary, and appreciates when I give her words. Sometimes I use literature, sometimes non-fiction.

 

My ASD kiddo also needs this. He has some interesting language issues that intertwine with pragmatics--very high and very low areas overlap in a unique way. I think of the verbal help as being very similar to the picture menus that some kids with autism use for communication. It's just that some kids need a verbal version of that even when they seem quite able to communicate.

 

Anyway, you said he has a language processing issue, and most people with ASD have some kind of language issue, but that language issue can be a bit hard to see or categorize for some kids.

 

I think you might be seeing a problem with answering open-ended questions whether or not autism is present.

 

If your evaluation includes strong language testing, that will probably help sort things out. If not, while you are waiting, you might want to consider working with an SLP who can run some language tests appropriate for a young teen with autism. TOPS (adolescent) and the TONL (also an adolescent version) as well as a pragmatics test could be very eye-opening. 

 

You might have already done this since you know there is a language processing issue. Are you getting good help from an SLP or someone who can work directly with the language issues?