Transcript Autism Spectrum Disorders and Mental Health

Autism Spectrum
Disorders and Mental
Health
BETTINA STOTT
Surrey Branch Conference
October 2007
AB
Workshop Content
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Mood Disorders:
Depression
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Anxiety Disorders:
GAD
OCD
AD & Disruptive
Behaviour Disorders:
ADHD
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Definition
Prevalence
Vulnerability
Signals
Treatment Options
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Depression
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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
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Symptoms
weight-loss/-gain,
in-/ - hypersomnia
marked diminished
interest in almost all
activities
Recurrent thoughts of
death
Feelings of
worthlessness/ guilt
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Depression: Prevalence
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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
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Depression: Vulnerability
Gene-Environment Interaction
 Awareness of ASD
 Loneliness
 High levels of anxiety
 Misunderstanding/
misinterpretation
 Psychological differences (ToM)
 Life experiences
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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
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Depression: Treatment
Options
Professionals:
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Anti-depressants
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(SSRIs)
Psychological
Therapies (CBT)
Social Skills training
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Parent/ Carer
Encourage to talk
Give vocabulary to
express/ other
media
Look for signs
Don’t dismiss
feelings
Encourage positive
experiences
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General Anxiety Disorder
(GAD)
Definition
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Symptoms
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Restlessness/ feeling
on edge
Easily fatigued
Difficulty
concentrating/ mind
going blank
Irritability
Muscle tension
Sleep disturbance
months or more of
persistent and excessive
worry
 Person finds it difficult
to control the worry
 3 or more symptoms
(1 in children):
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GAD: Prevalence
3-5%
in general population
84% in a sample of children with
PDDs*
*Muris
et.al. (1998)
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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
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GAD: Signals
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Physical:
Sweating
Racing heart
Palpitations
Rapid breathing
“Butterflies” in
stomach
Dizziness
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Behavioural
Increase in rituals
And obsessions
Refusal
Avoidance
Challenging
behaviours
Rocking/ flapping
Repetitiveness
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GAD: Treatment Options
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Professional
Behavioural
techniques
(recognising
symptoms)
CBT
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Parents/ Carers
Recognise signals
Social Stories
Teacch
Distraction
Physical activity
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Anxiety Disorders: OCD
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Definition
Recurrent, obsessive
thoughts or compulsive
actions (mind/
behavioural)
Stereotypic obsessive
behaviours NOT OCD
(Baron-Cohen, 1989)
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Symptoms
Repetitive behaviours
performed according to
rigid rules
Behaviours/ mental
acts are aimed at
reducing stress/
preventing a dreaded
situation/ event
Compulsion causes
distress
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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
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OCD: Vulnerability
Psychological differences (ToM,
central executive dysfunction, central
coherence)
 Boredom/ Lack of structure
 Differences in sensory experiences
 Misinterpretation of communication
 Social misunderstandings
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OCD: Signals
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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
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OCD: Treatment Options
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Professional
Medication
CBT
Behavioural
treatments
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Parents/ Carers
Encourage to
communicate
feelings
Adjust environment
Sensory
awareness
Low arousal
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Attention Deficit
Hyperactivity Disorder
(ADHD)
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Definition
Persistent pattern of
inattention/
hyperactivityimpulsivity
Impairment from
symptoms must be
across two settings
Clear interference with
developmentally
appropriate functioning
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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
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ADHD: Prevalence
3-7% in school-aged children
 Variety of studies: 50%-66%
 PDDNOS almost always present as
comorbid condition
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Ghaziuddin et.al. , 1992
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ADHD: Vulnerability
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Psychological differences (sequencing,
anticipating consequences; what is
“finish” and when?)
Sensory Issues
Difficulties filtering
Need to work things out cognitively (not
“naturally”)
Misunderstandings/ misinterpretation
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ADHD: Signals
Many “signals” are part of the
presentation of ASDs
 Where is the “cut-off”?
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ADHD: Treatment Options
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Professionals
Medication
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Parents/ Carers
Consistent
approaches
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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 coordination includes referral to
professionals
 Private – can be costly; expertise
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Questions
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