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Ask the Mental Health Expert Archives 2001-2004

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Working with Autism

Q. I am a mental health professional working with a 6-year-old autistic boy. While working with him in the home last week I witnessed what I believe to be disturbing behavior. There was a moth in the house and the mom and I wanted to catch it and release it outside. The boy had a bottle of windex in his hand and wanted to kill the moth. When I attempted to catch the moth, he began squirting it with the Windex and shouting, "I want to destroy it."

I caught the moth and released him outside. This enraged him. He started screaming, "I want the moth dead", "I wanted to destroy it." He ran into the bathroom and began throwing things etc. He was able to calm down on his own.

His mom also told me that when his little brother brings home caterpillars he would brush them out of his brother's hand and stomp on them. Is this type of behavior something we should be concerned with? Does it signify that something else might be going on?

From what I understand, he does not or has not hurt animals but, I am concerned after last week's incident. I just wanted to run this by someone else and make sure that I am not making something out of nothing. Can you give me any advice?

A. The term autistic covers a very broad territory, and does not exclude co-morbid problems or disorders. I think the answers to your questions depend on a number of factors:

  1. How isolated an incident this was; i.e., does this sort of behavior (impulsive/aggressive) occur frequently, and in more contexts than just that of his little brother bringing home caterpillars?
  2. Is the impulsive/aggressive behavior occuring in the context of conduct disorder behaviors, such as aggression toward people; destruction of property; deceitfulness or theft; and serious violations of rules?
  3. Is the impulsive/aggressive behavior related to (1) an underlying mood disorder, such as early bipolar disorder, in which the aggression appears in the context of an irritable manic phase (perhaps followed by a more withdrawn, depressive phase); (2) a phobic disorder limited to specific stimuli, such as bugs, worms, caterpillars, etc; or (3) a psychotic disturbance, in which the behaviors are related to some delusional belief; e.g., "the caterpillars are going to eat me! I have to kill them first!"

In short, yes: I do think the behavior is something to be concerned with, but I can't say, from what little I know, what that concern should involve. If the impulsive/aggressive behavior is either frequent or pervasive, it may be useful, if it hasn't already been done, to obtain a full neuropsychiatric assessment, preferably by a pediatric neuropsychologist or neuropsychiatrist.

It would be important to rule-out co-morbid diagnoses, such as bipolar disorder, childhood schizophrenia, and conduct disorder. It may be that this child would respond either to a mood-stabilizing medication (e.g, valproate); an SSRI, such as fluoxetine; a behavioral modification plan; or some combination of these interventions. But much will depend on the precise diagnosis. I hope your work goes well.

August 2002

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