Autism Spectrum Disorders and Mental HealthBETTINA STOTT

Surrey Branch ConferenceOctober 2007

Workshop Content

Mood Disorders: Depression

Anxiety Disorders:

GAD

OCD

AD & Disruptive Behaviour Disorders:

ADHD

Definition Prevalence Vulnerability Signals Treatment Options

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

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

Depression: Vulnerability

Gene-Environment Interaction Awareness of ASD Loneliness High levels of anxiety Misunderstanding/

misinterpretation Psychological differences (ToM) Life experiences

Depression: Signals

Increase in social withdrawalIncrease in obsessive behaviours/ ritualsChange in obsessionsIrritabilityLoss/ regression of skillsPsychotic Behaviours, such as: Hearing voices, paranoia, self-neglect, aggression

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 Don’t dismiss

feelings Encourage positive

experiences

General Anxiety Disorder (GAD) Definition6 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

GAD: Prevalence

3-5% in general population84% in a sample of children with PDDs*

*Muris et.al. (1998)

GAD: Vulnerability

Sensory Filtering difficultiesMisunderstanding social situationsMisinterpretation of verbal communicationLiteralnessInflexibility of thoughtPsychological differences (central coherence, central executive dysfunction)Life Experiences

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

GAD: Treatment Options

Professional Behavioural

techniques (recognising symptoms)

CBT

Parents/ Carers Recognise signals Social Stories Teacch Distraction Physical activity

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

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

OCD: Vulnerability

Psychological differences (ToM, central executive dysfunction, central coherence)

Boredom/ Lack of structure Differences in sensory experiences Misinterpretation of communication Social misunderstandings

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

OCD: Treatment Options

Professional Medication CBT Behavioural

treatments

Parents/ Carers Encourage to

communicate feelings

Adjust environment Sensory

awareness Low arousal

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

ADHD: Prevalence

3-7% in school-aged children Variety of studies: 50%-66% PDDNOS almost always present as

comorbid condition

Ghaziuddin et.al. , 1992

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

ADHD: Signals

Many “signals” are part of the presentation of ASDs

Where is the “cut-off”?

ADHD: Treatment Options

Professionals Medication

Parents/ Carers Consistent

approaches

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

Questions