Teenage Anger – A case study

Teenage years are challenging with the coming of self awareness. This has a major impact on students who also have Autism Spectrum Condition (ASC) and results in increased manifestations of mental health issues and social isolation (Mazefsky & White, 2014).

Consider a student who is 15. Maibeth has ASC as well as diagnosed anxiety however she does not always take her medication for anxiety. Maibeth struggles with friends, initiating conversations and also uses very strongly maladaptive strategies for dealing with human interactions and the consequences of these. She has the following ASC characteristics.

Characteristics	Looks Like	Sounds Like
Cognitive Inflexibility	Unable to accept other’s view points Shaking, picking at skin, tense muscles	“No, you’re wrong” “That’s stupid” “It never works” “Nothing helps”
Verbal Rage Melt downs	Shaking, picking at skin, tense muscles Intense pacing Unable to be still Have to get into an open space	Raised voice “That’s F***’d” “I hate life” “I hate you” “I hate everyone”
Impaired perspectives	Calm behavior	“I know what they are thinking” “That’s just wrong” “No – that would never happen” “Of course I get it – I’m not stupid”
Strong Perseverance	Weeks of similar behaviors over one incident	Repetition of incident including echolalia of same phrases

As a function of Maibeth’s ASC and anxiety, Maibeth regularly melts down or has what is known as the “Rage” cycle. During her rage cycle, Maibeth is unable to use adaptive emotion regulation strategies such as re- framing or problem solving and will continue to focus on the incident long after her rage cycle has ended. Maibeth’s maladaptive strategies are listed below.

Maladaptive Strategies		Looks like
Internalizing	Shutdowns Anger Rumination Fixation	Muttering Glaring Picking at skin No eye contact Self imposed isolation
Self Hate	Suicidal statements non persistent self harm	“I want to kill myself” Horizontal scrapping of plastic knives on arm Drinking alcohol Running away
Social Anhedonia (avoidance)	limited friendships limited interests in peers preference to be alone	Only speaks/interacts with one peer at a time. Will not attend any gathering larger than 25 students. Sits by self in class. Does not get invitations to social events.

Maibeth presents has having 2 major current areas of concern being her social interaction and her emotional dysregulation. Whilst both areas need to be addressed – the use of maladaptive strategies in stressful situations will be focused on initially.