A Can of Worms

The title of this blogpost is due to the fact that by posting it I know I will be opening one. I was going to call it Pandora's Box, but that term always reminds me of the line in Notting Hill, " I knew a girl at school called Pandora. Never got to see her box, though."  Inappropriate but cracks me up every time. This being a serious subject I decided to go with the Worms.


My last post was about my session with Professor Tony Attwood and I said I would dedicate a post to my experience with medication. So this is it...


I think you all know by now I have two boys with Aspergers Syndrome. Before I had children I had some very idealistic visions of how parenthood would be and was also very sure of what type of parent I would be. Of course once I actually gave birth to my first child, those ideals were well and truly blown out of the water! I have also had to re-evaluate my opinion on many things. One of those things has been  the much debated topic of medication. Or as one Mother so nicely put it " Drugging my child".


As I said I have two boys with Aspergers. The younger of the two was actually the first to be diagnosed. Because he had a lot of the classic ASD traits ( repetitive and restrictive behaviours, impairment of social skills and social communication and social imagination and many  obvious sensory issues) it became obvious very early ( age 2) . I of course was not the one to notice these issues but as soon as Pierce began attending Daycare it was very apparent to his teachers that he was extremely different to his peers.


My older Aspie,Ryan was not so obvious. I knew from very early on that something was not quiet right but every time I mentioned it to my GP I was told he was " just a boy" . He also managed to go under the radar at Daycare. I worried constantly about his lack of friends and every time I saw him in the playground he was either alone or engaging in parallel play. Ryan actually managed to fake his way through the early childhood years at daycare much like a girl with Aspergers would. At home was another story. Ryan was mayhem with a capital M ! 


The day Pierce was diagnosed with an ASD ( it started with PDD-NOS and changed to Aspergers after his first review) was also the day of Ryans first parent/ teacher meeting at school. As you can imagine I was reeling from Pierces diagnosis and was a little fragile. I had two boys at school at this stage and had my eldest sons interview first. I walked away from it feeling pretty positive. My eldest boy. Shaun. is Neurotypical and every teachers, and parents,dream.. So I walked into Ryans interview feeling ok considering the days news. 10 minutes later I was in tears and total disbelief..After our initial hellos Ryan's teacher,, who is one of my favourite people,she has taught all my boys and is amazing,, said to me "We have some serious concerns about Ryans behaviour. At present he is not progressing at all and it is almost impossible for him to function in the classroom. Ha has been observed by the school psychologist and she feels he needs to be assessed." I handled this information  really well and promptly burst into tears. 


So now I fast track. And I should add, when I was at Pierces diagnostic appointment and our Paediatrician was giving me a run-down of ASD traits and behaviours I had these little alarm bells sounding in my head, They weren't ringing, they were saying : Ryan, Ryan, Ryan!" 


So,off I went again on my many,, many appointments to Occupational Therapists, Speech Therapists and Psychologists and finally, with reports in hand, our Paediatrician,


By now you are probably wondering why this post is about medication? Well, Ryan has always had some very obvious ASD traits BUT we now know when Ryan is anxious and unregulated he likes to soothe himself with sensory input. He throws himself around.cannot sit still and is unable to  concentrate. Of course all of these things   say one thing..ADHD! So,throughout our diagnostic journey it was noted that Ryan displayed extreme hyperactivity which made it hard to further diagnose although all Therapists involved added he needed further observation for ASD.


Hence came the second hardest decision I have ever made in my life. Our Paediatrician diagnosed Ryan with ADHD/ODD with a note that he had many behaviours consistent with ASD but because his Hyperactivity was so prominent it was impossible to diagnose. We then had a long discussion (1.5 hours) about how to best help Ryan.
I am extremely lucky I have a Paediatrician who is very cautious with medication . We did how ever come to the conclusion that Ryan was unhappy, school was unhappy and I was unhappy. Something needed to change. He recommended Ritalin.I was heartbroken and devastated but also had to admit defeat. I consider myself a good Mum.  I love my children and always put them first. I had run out of options with Ryan, no matter the effort I put in I was achieving nothing. I agreed to a trial of a very low dose. 


We started the trial on a weekend. I was so paranoid about what this drug would do to my child I wanted him close. I explained to Ryan the tablet was to help him have a better day at school and not be so " jiggly" as he has always called his hyperactivity. He was more then willing to take the medication which told me he too was looking for help.Although he was willing he immediately gagged on his tablet.We then tried crushing it into icecream. again he gagged. By this time I was feeling like the worst mother ever and told Ryan to not worry he didn'tneed to take the tablet. He said it's ok Mum I can just swallow it with juice, and he did. 


The next 4 hours were, for me.a revelation.The son I always knew I had and loved so dearly had finally made an appearence to the rest of the world. Unfortunately with this newfound calmness came the unveiling of Ryans ASD.Once his hyperactivity subsided the little issues I was always concerned with were painfully apparent. We then revisited all the above Therapists and back to our Paediatrician who immeciately diagnosed PDD_NOS which again has progressed to Aspergers Syndrome. 


I wish this is where our journey with medication ended but it has not.. Ryan has progressed to a slow release Ritalin and he is on the highest dosage for his weight. We have never had any bad side effects,only positive outcomes. Unfortunately due to his late diagnosis and lack of support at age 7 Ryans behaviour reached crisis point. I had just accessed the Helping Children with Autism funding and had finally enlisted the help of specialists. Because my boys had excellent speech I decided to use our funding on a behavioural program run by a local Autism service. This program allowed an Autism specialised teacher to visit our home once a week and she addressed any issues we   needed help with. She observed Ryan on many occasions and was extremely concerned with how unregulated he was. Ryan suffers from extreme anxiety. This anxiety causes him to overreact to situations and the way  he dealt with this became very frightening. I was relieved to have someone available to explain my boys disorder and how it affects them.It was also fantastic to have someone help me set our home up with visual schedules and other behavioural aides, all of which made an enormous difference to our lives. 
During the first school holiday break after Ryans diagnosis he had his first major breakdown. Luckily our behavioural worker was here on the day. As she said her presence was probably the catalyst for Ryans breakdown. School holidays are tough for our ASD kids, with the change in routine and then having a visitor on top of this was more then he could handle.


I had been having escalating issues with Ryans self harming and dangerous behaviour but on this day it reached crisis point and I could no longer ignore it. Ryan had been self harming for most of his life. starting at age one with head banging, usually on concrete or tiled floors. He then progressed to hitting himself in the head and biting his fingers and toes so severely he would end up with an infection. On this particular  holiday break he progressed to lashing out at his siblings and me in particular. I had no idea how to calm him.So, the day of his Paed review we also had our behavioural therapist visit, Ryan was extremely anxious and  behaving very aggressively. I informed our worker of his mood and she tried to calm him. He immediately decided to abscond and it took me almost an hour to get him back to our house. Less then 15 minutes later Ryan became upset because his brother touched one of his favourite toys. He became uncontrolable and repeatedly threw himself at our sliding glass door. I tried so hard to restrain him but he kept managing to break my hold and hurt me each time. I was so terrified of him breaking the glass and cutting himself It was honestly one of the worst days of my life.Once my beautiful boy calmed down he cried and kept saying I'm sorry mummy ,I'm sorry Mummy. So off we went to our Paediatricians appointment with Ryan rocking and chewing his fingers and not able to talk and me totally at a loss and a written description of what had just occurred. Again, I had an in depth and emotional discussion with our Paediatrician.He  was very concerned with Ryans self harming behaviours and aggression and also  his obsessive behaviours. We both agreed that these behaviours were anxiety driven. I was horrified when our Dr recommended Ryan start taking Risperdal. I had been to a Tony Attwood workshop where he voiced his concerns about Risperdal. He did not elaborate just said it's usage concerned him. After discussing my concerns and our Dr informing me of the pros and cons I agreed to a trial of Risperdal combined with Ritalin LA. I had gone from a person totally against medicating children to my son being on two very contoversial drugs. I felt like a total failure but I was also desperate to help my son.


Now for another  flash forward. Ryan is still on Risperdal and Ritalin LA. We have been lucky enough to suffer no side effects. When discussing the use of Risperdal my Paediatrician told me he had found it helped with socialisation. I told him I thought he was crazy.. He wasn't.My sons self harming behaviours are almost non existent. He has many friends at school and his teachers have remarked how amazing the improvement in his socialisation is. Life with Ryan and for Ryan is still tough but I never question my decision to medicate. Anyone who knows him remarks on the positive changes. We are able to go out as a family. We recently went on a family holiday. None of this would have been possible before. Ryan is not a zombie. He is functioning and able to participate in many things he was never able to. We still have tough moments. He becomes agressive and reverts to his obsessive behaviours but never at the dangerous level he was at before. The thing I feared most (medication) has given back my son and given him a life and opportunities
he never would have had.


I understand the concerns with medication, I had them all, but please don't judge those of us who have made this tough decision. I have had people comment that I have medicated my son to make my life easier. NEVER. Even on meds Ryan is probably harder to care for then most children. I did it for him. He was unhappy and lost and misunderstood  and noone,including Ryan could see the amazing boy I knew was in there.


I asked professor Attwood about his concerns with risperdal and he answered this,
Risperdal masks the problem it doesn't fix it. The child needs Cognitive Behaviour Therapy to learn to address their anxiety and aggression. His concern was parents giving their child this drug and not working on  the underlying cause of their problems. He also said a child under 8 is not able to understand CBT. He said as long as we were working with a therapist and addressing his anxiety and aggression through CBT  with the end result being Ryan not having to take Risperdal it was something he would agree with. I asked how long he would expect Ryan to be on Risperdal ( he is in CBT therapy) and he said it would probably take him two years to learn all he needs to. I honestly was hoping for 6months or less but was also glad to hear his concerns were not due to side effects.


So. My name is Teriann and my son is on medication. Please do not judge me for this or anyone else who has had to make the hard call. I do not do it to get a better nights sleep ( my son who does not sleep is unmedicated). I do it to make Ryans life better and the minute it stops achieving that he will not take it anymore.Please do not phone me and tell me when there is a current affairs show with an episode on the side effects of these drugs. I know them, my Dr knows them.


I did not make this desicion lightly,it is the best thing for my boy.I respect everyones right to their own opinion,please respect mine.


Above all,  close that Can of Worms AND Pandora's Box.


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