Autism, Anxiety, Depression and Perception – A Perfect Storm

My son was diagnosed with Autism Spectrum Disorder when he was three years old. Nonverbal until kindergarten, not fully potty trained until first grade, he was academically a year or two behind his peers until fourth grade. Private tutoring, speech and occupational therapy successfully transitioned him to middle school. He was a polite, considerate, respectful, thriving, straight A student, well liked by his teachers and peers. 

Joining the track team in eighth grade, he was awarded a coveted trophy for sportsmanship and achievement. He applied and was later accepted to an elite merit based high school. He was a model student seemed to have the world by the balls.

However, in late October, I received a phone call from my son’s guidance counselor informing me my son had dropped his books and backpack on the floor and ran out of the back door after one of his classes. Shocked, my husband and I sped to the school, wondering if he may have been bullied and was hiding somewhere near the school grounds. Frantically we searched, but couldn’t find him. The police were notified.

A police officer found him several miles away near a homeless shelter. He confided to that officer he thought the world would be a better place with out him. In that moment, life as we knew it changed. 

Initially my son was admitted to the emergency room, the first stop in navigating through the mental health process. Next were psychiatrist appointments then placement in a specialized autism crisis day program.  We sadly learned our happy go lucky son, always presenting as if nothing bothered him, in reality felt isolated and severely lonely.  He believed no one liked him, he claimed he had no friends and stated he felt ‘invisible’ in school. He thought he was an embarrassment to the school.  He believed it would be better for everyone if he were dead.

In addition to the crushing blow of my husband's affair, my son was now in crisis.

He was diagnosed with severe depression and anxiety.  My husband and I were heartbroken to learn of depth of his despair. It was overwhelming for me to see my son in so much pain. We had been cautioned that the hormones during adolescence could in some cases exacerbate autism symptoms, but we saw no advance warnings or even subtle indications of anything amiss.

He was removed from school and enrolled in the autism day program at a local mental health facility. The program spanned only a few weeks. His doctors felt confident in his steady progress, planning to transition him slowly back to school after two and a half weeks. However, because he didn’t use the insurance 'trigger words’ about wanting to hurt himself, our health insurance company would not approve his final week of treatment, which included the school transitioning. I was informed at noon on the Friday of our transition plan meeting that I had to take him home. Blue Cross refused to approve medical coverage for the final week of treatment. Experiencing this situation nauseated me, realizing first hand the increasing need for competent, accessible and medically covered mental health services.

Returning back to school, a mere two days passed before he planned to run away again. We were petrified that he would try and hurt himself. Desperate for help, I drove him back to the day program and was able to get him re-admitted.

He expressed his frustration about the ‘bad’ classes with the ‘bad’ kids. Was he being bullied? No. Were the kids mean to him? No. It was, in fact, just the opposite.  Everyone liked him. They all spoke with him. So why did he perceive that everyone hated him, the kids were bad, and everyone was conspiring against him causing him such profound loneliness?

Subsequent to the third incident in as many months, the light bulb moment appeared. Though he spent hours of counseling in the day program, more hours with a private counselor, interventions with several social workers and autism support personnel in school, no one particular person seemed to have all the pieces. The fourth meeting at school assembled everyone together including his psychiatrist, guidance counselor, autism support social workers, our school principal, my husband and myself. One of the social workers and I finally put the pieces together.

My son had been inadvertently passed over for an advanced math class last year in 7^th grade.  As a result of this, his ‘good’ (smart) friends obtained different schedules from my son. His own schedule was centered around the ‘bad’ (not academically smart) kids, who were disruptive and loud in class.  They were not serious students. He did not identify with the ‘bad’ kids, therefore he perceived he had no friends, even though everyone liked him. The isolation and loneliness he felt lead to escalating anxiety and depression. He ruminated about how the teachers and administration screwed him by not giving him the advanced class and being separated from the ‘good’ kids. Loud noise and disorder had always been triggers for him and were now amplified due to his class schedule. He was forced to endure a loud environment throughout most of his school day. The ‘good’ kids wanted to learn while the ‘bad’ kids weren’t dedicated to their work. He was only able to keep it all inside for a brief period, hiding his feelings from us at home until it became overwhelming for him.

We were lucky that our school administrators and staff accommodated his needs and adjusted his schedule. We were blessed with a wonderful support system of medical professionals and social workers. We were fortunate to have identified his issues and implement a support system now for him and hopefully assist him in facilitating a successful transition to high school.

Among his peers, my son is normally somewhat socially awkward normally, amplified now by puberty.  His perception of being deliberately overlooked because nobody liked him caused him to ruminate over this perceived insult.  His anxiety and depression intensified until he could no longer deal with these issues. And the polite, considerate, respectful, intelligent young man whom everyone had a good word to say about, melted down.  The consequence of my son’s perception and resulting anxiety caused him to sink down in the throes of severe depression. It was my son’s perfect storm.

As parents, we frequently have a sixth sense as to when something is seriously off with our children, but occasionally they succeed in hiding their true feelings.

Everyone’s experience with autism varies. All issues we experienced to date were relatively minor. Prior to this incident, our situation compared to others was almost too good to be true.

ASD affects everyone differently. Adolescence is challenging enough, but combined with autism, social situations sometimes spiral out of control. ASD has skyrocketed in the past generation. Identifying problems and procuring treatment can be difficult but crucial to our children’s mental health.