Asperger’s, Social Anxiety, OCD…?

Reader’s Question

My 15-year-old son, other than being very shy, pretty much glided through life as normal. Even his shyness did not really interfere with his life, as other children always seemed happy to initiate the first contact; once past that he would be at total comfort.

Separation from me was never a problem, he was very involved in sport, had one very close long term friend and many social friends, spent time both at our home and their homes…even the usual boundary pushing, of always wanting to spend more time with them.

Once out of their environment, the next time contact was due to be made, he would “never do it.” He would always wait for that first greeting…then totally engage and enjoy.

School reports were always stating he was a very shy but polite boy. Always a quiet achiever. Teachers often commented that peers have great respect for him. Math, Science, English around the B-C marks; Art, Sport and Music always A.

Age 13: High school starts for him, new incomers to the school, still involved with the same sports and peers. Most of the boys are showing strong signs of adolescent behavior, in terms of both growth and thinking. He shows a “small” amount of interest in girls…I’m not sure though. He shows no signs whatsoever of physical change…and has become the smallest boy, although he never showed any indication that this bothered him. (He still doesn’t.) He is a late bloomer, only reaching puberty now at 15.

Half way through first high school year, my son starts to show signs of sadness, anger, loss of focus, and is confused about what matters to him.

I let it go for a while…then I felt he was withdrawing. He would not open up at all. Barely hanging on to grades, teachers started to say he’s disorganized and away with the fairies. He was losing all his belongings, shoes, phone, books. When asked he said simply said, I don’t know what is wrong.

We seek medical help for the first time from here.

Today/now, age 15: We know when he got to high school (age 13) he did get bullied. We know he felt like an outsider, as the bullying was brought into school/sports from outsiders coming into the high school. We know this must have made him feel that his existing long term peers had lost their respect for him too. He started to avoid socializing with them. In turn, they started asking questions, and he hated all the attention this was creating. He coped by avoiding more and that led them to gang up…and he fast became a joke to them. TODAY HE GOES TO SCHOOL IN GREAT PAIN! He does all he can to avoid having to make any contact with them. Yes this makes them react worse, but the school are right on top of it now!

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He is seeing a therapist having CBT for OCD, and is on a low dose of Zoloft. He does not articulate well, so we are a lot of the time left unsure.

He avoids every possible outing, he does not want anything to do with peers…even his long term close friend. He says he wants it this way…doesn’t need them. He has nothing to do with Sport, Art or Music. There has been a complete turnaround of interests: he is completely dedicated to academics — Math, Science, etc. Grades up to A. Teachers are worried about his ability to cope in the real world, because of his lack of articulation…and shyness.

I see autistic thinking, I see magical thinking OCD, I see a boy that does not want to ever let go of being a child, I see him isolating himself, I see extremely high morals, narrow minded thinking, STRONG SOCIAL ANXIETY. He does not recognize the person he once was, the person we saw as happy…in his mind he never was. He has this bizarre view of sex. (And no he has managed to confirm that it’s not to do with triggering thoughts, or OCD related.) He is repulsed by it in every way…even if it’s about love or marriage. No interest in ever having a relationship. Won’t look people in the eyes, puts his head down, walks in shame mode…he won’t talk unless he has to. He fears the sun, fears taking any risks, does not want to been seen as attractive…stating his belief that attractive people have a hidden agenda, and are not so nice. He can’t see any sense in doing anything that’s fun, as it is not at the end achieving anything…in his eyes it is non-productive.

I love this boy and I want to set him free! I feel like I’m his only trust in life…but truth is, I don’t trust that I’m guiding him right. Docs are not here living with the symptoms; yes I respect their work and believe they are trying their best to figure this out. But after one year of OCD treatment (and this boy has “GREAT UNDERSTANDING OF OCD”), I still see a boy that is fast becoming a recluse…and saying that’s what he wants.

Even if he manages to hold on to his academic grades, he will not be ever able to work, deal with society and the cruel things the working environment sometimes throws at us. Never feel that special love with a partner. Never have freedom.

Things I’ve read about and questioned may be more the problem than OCD are Social Anxiety, Personality Disorder, Asperger’s… I wonder often about this one.

We have tried various medications and he has been receiving therapy for OCD for a fair time now…with very little response in terms of making his life less encumbered. What would your thoughts be? Do you think we need to change tack? Focus less on OCD? And look at the main cause more closely again?

After OCD was diagnosed it was almost as if things spiraled down fast. I often ask myself what happened? And how can someone change so much so fast!

I know this is a hard one, but any advice/views would be greatly appreciated. Sometimes a fresh view can help.

Thanks.

Psychologist’s Reply

Yes…this is a hard one. You’re describing a lot of symptoms in a lot of areas of functioning. Like you, I see indicators we often find in Social Anxiety, Asperger’s, etc. If the current treatment approach is not effective, it may be time for a second professional opinion. I would recommend obtaining a psychiatric opinion, with a child psychiatrist if available in your area. The use of Zoloft in this case sounds like a prescription from a family MD and may not be a good fit for his multiple symptoms. A psychiatrist is best trained to identify those symptoms that are appropriate targets for medication. I would continue the therapy but again, arrange for a second opinion.

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