My Teenager Needs Help But Doesn't Want It!"

Nathan looked like a typical 17-year-old–a little bored, a little sullen. Though he desperately tried to cover his insecurities with a cool-guy stance, behind the façade of stringy blond hair and a trace of acne hid a nice-looking young man who felt anything but cool.

Branded as a misfit long before his diagnosis of PDD/NOS (pervasive developmental disorder) when he was in eighth grade, he had developed patterns that kept peers at a distance, and left him feeling alienated and inferior. Now, as a high school junior, adolescence magnified those differences, and he struggled with profound depression.  

Everyone else seemed to have it together, even classmates who spent most of their day in special ed classes like Nathan, but Nathan felt like an outsider looking in. High school was supposed to be fun, but it certainly wasn't for him. Other guys had girlfriends, but not Nathan.   He wanted to have a girlfriend, but his social skills were so inadequate, girls were definitely not open to his clumsy advances. Other guys his age had driver's licenses, but not Nathan.   He was so immature and belligerent, his parents said he wasn't ready for driver's ed.

Nathan is a little bit below average in intelligence, and he had been a special education student for years. He put very little effort into his studies, finishing up most of his homework at school and settling for mediocre grades.

Nathan's relationship with his parents seemed to deteriorate more with every passing day. He was furious with them for withholding permission to drive, and he retreated to his room during most of his waking hours, responding with one-word answers whenever his parents attempted to communicate with him. With increasing frequency, he and his father indulged in angry, noisy rows, leaving both father and son frustrated and bitter.

More recently, his parents had become deeply concerned when, after yet another fight with his father, Nathan said he wished he were dead. It was at this point that someone recommended they make an appointment for Nathan to talk with me.

I met first with Nathan's worried parents, Katie and Rick, then I visited alone with Nathan. He spouted angry clichés, blaming everyone else for his problems. His parents nagged, he said, and he just wanted to be left alone. He had no plans for the future because he couldn't think of what he might like to do.

He reiterated his complaints that everyone else had a driver's license and a girlfriend and plans for college or jobs, but nothing was working out for him. He'd never found a niche. "I'm a failure at everything," he said.

After I'd listened and gained some modicum of trust, my first priority was to get him to promise that he wouldn't harm himself. Because of the severity and duration of Nathan's depression, I referred him to a psychiatrist, for further evaluation of his depression. Since teens on the autism spectrum often struggle with bouts of depression, and have an unusually high suicide rate, especially during adolescence, it was important to have this second opinion. His psychiatrist recommended anti-depressant medication to treat the depression, to which Nathan and his family agreed.

Next, we talked about his relationships with parents and peers. Life should be fun, he said, but right then it wasn't fun for him. He had no friends and couldn't seem to figure out how to bridge the gap with his peers. He was at a loss to think how to solve any of his problems.

As a clear picture of his negative self-perception emerged, I tried to pull out some of the things that Nathan does well–things with which he had had some measure of success. He loved classic rock music, and he'd become sort of an expert on rock groups of the 1970s era. He'd received an electric guitar for his birthday, and was learning to play.

He loved animals, and he took very good care of his cocker spaniel. He'd even drummed up a little business walking dogs in the neighborhood and taking care of animals while their owners are gone. I tried to help him to see that he's a caring and trusted person in the neighborhood, and that he was performing a valuable service.

I tried to help him envision how he would like his life to be in the future. He'd said he'd like to have friends, work in a music store or have a job that involved animals. I talked with him about all the knowledge he had acquired and how valuable this could be in his future choice of a job, and at least a hobby. I repeatedly tried to focus on all the things he'd been doing right.

He clearly was not getting enough exercise, and of the options we discussed, he decided he would try karate.

He talked about wanting to meet other kids, and he was willing to try joining his church's youth group.

We discussed some strategies for smooth ways to talk to girls, and we role played some of those techniques together.

In sessions with his parents I tried to help them better understand the often frustrating dynamics of adolescence. We reviewed some of the ways Nathan's disability further complicated what is generally, under the best of circumstances, a pretty rocky period in the lives of most kids. We talked about techniques for modifying family communication patterns.  

In one of my last individual sessions with Nathan, I noticed that he no longer seemed belligerent. After several weeks on the anti-depressant, he felt better, and he was making a conscious effort to communicate more effectively with his parents. They, in turn, were attempting to include him in more daily living activities that involve interaction. Katie roped Nathan into helping her wash windows, and Rick made it a point to ask for his advice on glitches with the computer and other electronics equipment. Rick often invited Nathan to ride along when he made trips to Home Depot, and the two of them have decided to take golf lessons together.

Though progress was slow, Nathan gradually gained some self-confidence. The physical activity involved in karate has been good for both his physical well-being and his self respect.

He joined a small youth group and his peers in the group are also teens who feel a bit out of place. Thanks to an understanding leader, the group has bonded around their common need for acceptance.  

At my suggestion, he joined one of my Friendship Groups designed for helping teens on the autism spectrum develop social skills. I matched him up with two other teens he was able to connect with. He became eager to work on his social skills with the other two in the group, and the three of them bonded well.

The other two members of the group were not into classic rock music, but Nathan learned to listen to them talk about their own special interests. One of the other guys was intrigued with weather, and Nathan got a whole education about weather systems, world climate changes, and what it's like to chase storms. The third person in the group was interested in geology, and he invited Nathan to come home with him and see his rock collection.  As the three of them learned to listen to each other's interests, they discovered some important strategies that will help them to communicate on a more giving level for a lifetime.

The last I heard, Nathan was trying to work up the courage to ask one of the girls from his youth group to the prom.

Rick and Katie are encouraged by the changes they've seen in Nathan's behavior, and are enrolling him in a pre-driver's education program, where he will be evaluated to determine if he can become a safe driver.

Rick says, "It's been a long time since we've had a major argument, and it's a huge relief to see Nathan broaden his interests and develop some self confidence. He's volunteering at the Humane Society's animal shelter, and he is beginning to take some initiative in making friends. A few months ago, I would not have dreamed this was possible!"