Well, I don't actually have 12 of my own. I run a home for boys 12-21y who have autism spectrum disorders. I am lucky to be young and unmarried: I still have the energy to run around with the boys!
The boys range from Asperger's to severe autism. I am struggling currently with a young man, age 17, who has recently been hosptalized 3 times in psychiatric wards. I need assistance and am turning to you all for some help!
M is 17, completely non-verbal, extremely routined, and has no functional language, signs, etc. His receptive language is incredible, though. He is 6ft, 245lbs, and can knock me over when he wants. He was on a slew of medications (psychotropics) for behaviors, anxiety, obsessive behaviors, etc. He was stable for quite a while, before suddenly regressing into old behaviors.
Namely, M tears papers. This is rather destructive in a home with 12 boys who have autism that have 20 rotating staff. Paper is our way of communicating from shift-to-shift, etc. We currently have all paper locked up in closets. Once there was no longer paper to tear, he began tearing cardboard boxes (game boxes, etc), laminated papers/schedules, and puzzles (he used to love to do puzzles and never destroyed them!). When we restricted this further, he began tearing off his clothing in an "Incredible Hulk" manner. When we was allowed to tear small amounts of paper, he became overwhelmed and would begin hitting himself (slapping/punching his face). When he was prevented from tearing, he'd hit himself in the same manner and then would move to the next most destroyable object. This includes: bedding, paint, mattresses, ceramic tile, curtains, shower curtains, wooden objects, plastic objects. We hospitalized him initally for a medication wash, thinking that perhaps he was on too much medication (Seroquel, Buspar, Luvox). He ended up being in the hospital the first time for 6 1/2 weeks. They did nothing but make him significantly worse. He left the hospital on Anafranil, Adderacks, and Neurontin. He went back into the hospital 3 days later for self injury including head banging on walls, floors, for 4-5 hours at a time. Physical restraint doesn't work. He is too big and too powerful. The hospital maintained him on PRN sedatives. This has been going on since February.
He was recently rehospitalized, and was released on: Seroquel (200mg/ 5X day)for psychotic behaviors; Lamictal (50 mg qHS) for mood stabilization; Tenex (1.5mg BID) for impulsivity; Buspirone (10mg BID) for anxiety; Adderacks (50mg TID) to prevent skin irritation- supposed cause for tearing off clothes... I told the doctor he was nuts... he didn't listen; and Trazadone (200mg qHS) for sleep. He came home from the hospital and had his first ever grand mal seizure: VERY SEVERE! The doctors put him on Depakote (500mg BID). Oh, the neurologist stated that the cause of the seizure was the high dose of Seroquel. Nice, huh?
Sadly, M is still tearing his clothing off, seems more sensitive to lights and sounds, and still hits himself when agitated.
We haven't been able to do a good thing for him, and I have done everything clinically that I can do: changing environment, ABA thearpy, DIR therapy, etc. Martin's mother wants him on no medication; Martin's father just wants his son healthy and happy.
Any suggestions? I am in the chicago area, and am wililng to seek out further assistance from doctors/specialist.
Oh- Martin has not been allowed in school since Feb. because his behaviors are so severe. They offered us 2 hours of home school each week... I laughed at that... I do home schooling for him instead, but I also have 11 other boys to take care of medically, educationally, etc. HELP!!!
the boy is lucky to have you. feel badly for him. seems to me something is bothering him terribly. i would side with mom about no meds. all those medications all have side effects which could be doing this. it is too bad he has no way to communicate. have they tried pecs with him. sorry i can offer you no help just support. i would work on communication aspect. i have a 19 year old non verbal but very easy going. he uses pecs and it has been a godsend.My son, who is PDD (high-functioning) and 17 years old chews things - popsicle sticks, plastic Gatorade lids, and metal soda cans (yes, metal). It is not tearing, but similar. He also chews his fingernails until they bleed. However, he is verbal and has great communication skills but even when we discuss this, he won't stop. I have resorted to some behavior modification techniques, like making him clean up the mess he makes, etc. We are in the process of this. He takes Luvox and Anafranil. My only suggestion is to use standard behavior mod - reward and punishment. Whatever will reward him (differs for each kid) should be used when he doesn't tear...start with a VERY short time period. 2 minutes and work up. Also, when he does tear, punish him with something unpleasant for him. [I am assuming here that you are sufficiently professional to know the appropriate limits here.] I have found that consistently applied behavior modification is the most effective method of dealing with these behaviors. I don't mean to be disrespectful, but it worked for Pavlov's dog. I am sympathetic, however, with the limited amount of time you have to devote to this. Sorry I don't have more to offer.
We have tried ABA, DIR, Lovaas, etc. M cannot seem to get past destruction. PECs is almost impossible with him because of the destruction. Laminate and plexiglass are no match for him! He destroyed a dry erase board and a chalkboard this week... I think I will buy the "chalkboard" paint and make an area of his room that he can write on. Maybe that will help. He likes to write/color but again, can't get past the destruction.
He had a good week- that is compared to the past 4 months or torture he has been going through.
I appreciate the suggestions. I have tried a lot of the reinforcement/punishment, etc. Nothing seems to be effective. I wonder if I were to "paint" the PECs onto the wall, if he could use them... that might work... I'll let you know how it goes.
Stacey