Autism Spectrum Disorders and Mental Health

1. Autism Spectrum Disorders and Mental Health BETTINA STOTT Surrey Branch Conference October 2007 ABC

2. Mood Disorders: Depression Anxiety Disorders: GAD OCD AD & Disruptive Behaviour Disorders: ADHD Definition Prevalence Vulnerability Signals Treatment Options Workshop Content ABC

3. 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 Depression 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. Professionals: Anti-depressants (SSRIs) Psychological Therapies (CBT) Social Skills training Parent/ Carer Encourage to talk Give vocabulary to express/ other media Look for signs Don’t dismiss feelings Encourage positive experiences Depression: Treatment Options ABC

8. 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 General Anxiety Disorder (GAD) 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. Physical: Sweating Racing heart Palpitations Rapid breathing “Butterflies” in stomach Dizziness Behavioural Increase in rituals And obsessions Refusal Avoidance Challenging behaviours Rocking/ flapping Repetitiveness GAD: Signals ABC

12. Professional Behavioural techniques (recognising symptoms) CBT Parents/ Carers Recognise signals Social Stories Teacch Distraction Physical activity GAD: Treatment Options ABC

13. 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 Anxiety Disorders: OCD 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. Professional Medication CBT Behavioural treatments Parents/ Carers Encourage to communicate feelings Adjust environment Sensory awareness Low arousal OCD: Treatment Options ABC

18. 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 Attention Deficit Hyperactivity Disorder (ADHD) 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. Professionals Medication Parents/ Carers Consistent approaches ADHD: Treatment Options 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