Autism%20Spectrum%20Disorders%20and%20Mental%20Health

1
Autism Spectrum Disorders and Mental Health

• BETTINA STOTT
• Surrey Branch Conference
• October 2007

ABC
2
Workshop Content

• Mood Disorders Depression
• Anxiety Disorders
• GAD
• OCD
• AD Disruptive Behaviour Disorders
• ADHD

• Definition
• Prevalence
• Vulnerability
• Signals
• Treatment Options

ABC
3
Depression

• Definition
• A depressed mood, qualitatively different from
  normal sadness
• One or more episodes lasting at least two weeks
• Accompanied by at least four additional symptoms

• Symptoms
• weight-loss/-gain,
• in-/ - hypersomnia
• marked diminished interest in almost all
  activities
• Recurrent thoughts of death
• Feelings of worthlessness/ guilt

ABC
4
Depression Prevalence

• 10 of the general population
• Studies suggest up to 30 in individuals with AS/
  HFA
• Numbers in individuals with autism not known
• Possibly due to easier diagnosis due to
  communication
• Ghaziuddin et. al. 1998

ABC
5
Depression Vulnerability

• Gene-Environment Interaction
• Awareness of ASD
• Loneliness
• High levels of anxiety
• Misunderstanding/ misinterpretation
• Psychological differences (ToM)
• Life experiences

ABC
6
Depression Signals

• Increase in social withdrawal
• Increase in obsessive behaviours/ rituals
• Change in obsessions
• Irritability
• Loss/ regression of skills
• Psychotic Behaviours, such as
• Hearing voices, paranoia, self-neglect,
  aggression

ABC
7
Depression Treatment Options

• Professionals
• Anti-depressants (SSRIs)
• Psychological Therapies (CBT)
• Social Skills training

• Parent/ Carer
• Encourage to talk
• Give vocabulary to express/ other media
• Look for signs
• Dont dismiss feelings
• Encourage positive experiences

ABC
8
General Anxiety Disorder (GAD)

• Definition
• 6 months or more of persistent and excessive
  worry
• Person finds it difficult to control the worry
• 3 or more symptoms (1 in children)

• Symptoms
• Restlessness/ feeling on edge
• Easily fatigued
• Difficulty concentrating/ mind going blank
• Irritability
• Muscle tension
• Sleep disturbance

ABC
9
GAD Prevalence

• 3-5 in general population
• 84 in a sample of children with PDDs
• Muris et.al. (1998)

ABC
10
GAD Vulnerability

• Sensory Filtering difficulties
• Misunderstanding social situations
• Misinterpretation of verbal communication
• Literalness
• Inflexibility of thought
• Psychological differences (central coherence,
  central executive dysfunction)
• Life Experiences

ABC
11
GAD Signals

• Physical
• Sweating
• Racing heart
• Palpitations
• Rapid breathing
• Butterflies in stomach
• Dizziness

• Behavioural
• Increase in rituals
• And obsessions
• Refusal
• Avoidance
• Challenging behaviours
• Rocking/ flapping
• Repetitiveness

ABC
12
GAD Treatment Options

• Professional
• Behavioural techniques (recognising symptoms)
• CBT

• Parents/ Carers
• Recognise signals
• Social Stories
• Teacch
• Distraction
• Physical activity

ABC
13
Anxiety Disorders OCD

• Definition
• Recurrent, obsessive thoughts or compulsive
  actions (mind/ behavioural)
• Stereotypic obsessive behaviours NOT OCD
  (Baron-Cohen, 1989)

• Symptoms
• Repetitive behaviours performed according to
  rigid rules
• Behaviours/ mental acts are aimed at reducing
  stress/ preventing a dreaded situation/ event
• Compulsion causes distress

ABC
14
OCD Prevalence

• General population 2.5
• Szatmari et.al. (1989) 8-10 of AS/ HFA, 5 in
  control group
• Other studies show that OCD can continue into
  adulthood

ABC
15
OCD Vulnerability

• Psychological differences (ToM, central executive
  dysfunction, central coherence)
• Boredom/ Lack of structure
• Differences in sensory experiences
• Misinterpretation of communication
• Social misunderstandings

ABC
16
OCD Signals

• Repetitive behaviours lead to distress
• Repetitive behaviours are not stereotypic,
  increase in stereotypic behaviours
• Distressing thoughts are verbalised
• Person is missing out due to repetitive
  behaviours
• Person is constantly (if not excessively) worrying

ABC
17
OCD Treatment Options

• Professional
• Medication
• CBT
• Behavioural treatments

• Parents/ Carers
• Encourage to communicate feelings
• Adjust environment
• Sensory awareness
• Low arousal

ABC
18
Attention Deficit Hyperactivity Disorder (ADHD)

• Definition
• Persistent pattern of inattention/
  hyperactivity-impulsivity
• Impairment from symptoms must be across two
  settings
• Clear interference with developmentally
  appropriate functioning

• Symptoms
• Disruptive/ aggressive behaviour
• Constantly on the go/ fidgeting
• Disregard for consequences?!
• Inability to finish tasks
• Silly mistakes
• Dislike for activities requiring mental effort/
  organizational demands

ABC
19
ADHD Prevalence

• 3-7 in school-aged children
• Variety of studies 50-66
• PDDNOS almost always present as comorbid
  condition
• Ghaziuddin et.al. , 1992

ABC
20
ADHD Vulnerability

• Psychological differences (sequencing,
  anticipating consequences what is finish and
  when?)
• Sensory Issues
• Difficulties filtering
• Need to work things out cognitively (not
  naturally)
• Misunderstandings/ misinterpretation

ABC
21
ADHD Signals

• Many signals are part of the presentation of
  ASDs
• Where is the cut-off?

ABC
22
ADHD Treatment Options

• Professionals
• Medication

• Parents/ Carers
• Consistent approaches

ABC
23
Seeking Professional Help

• GP first point of contact, referral
• CMHT have an obligation to treat individuals
  affected by enduring mental health problems,
  regardless of ASD diagnosis
• Care Manager/ LD Teams Care co-ordination
  includes referral to professionals
• Private can be costly expertise

ABC
24
Questions
ABC