Transcript Autism MH 2016 x

Exploring the
Intersection of Autism
and Mental Health
JANE THIERFELD BROWN, YALE UNIVERSITY,
COLLEGE AUTISM SPECTRUM
MICHELLE RIGLER, UNIVERSITY OF TENNESSEE
CHATTANOOGA
AMY RUTHERFORD, UNIVERSITY OF TENNESSEE
CHATTANOOGA
LISA MEEKS, UCSF SCHOOL OF MEDICINE
ASD and Mental Health Issues
ASD is Complex
neurobiological disorder
characterized by:
◦ Deficits in
communication and
social relationships
◦ Restricted, repetitive
behaviors.
Not a mental illness or
psychological disability
However:
◦ Impact is = if not
more debilitating
◦ High comorbidity
◦ Anxiety
◦ OCD
◦ Depression
◦ Anxiety
Bi-Directional Relationship
White 2013
Increased Social Complexities
“I
don’t know what to do
at a party. I have no idea
how to keep a
conversation going. I
might ramble, and then
people will judge me
and think I’m odd or
stupid.’’
Dangerous Cycles
What symptoms are…
◦AUTISM
◦MENTAL HEALTH ISSUES
Some “Big” Clinical Problems
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Poor integration & synthesis
Misses the big picture
Rigid
Planning, shifting, prioritizing
Perspective taking
Poor social agent
Initiation & self direction
Motivation
Do we treat the symptoms
differently?
YES
◦ People with autism respond to therapy differently.
◦ HOW?
Differential Dx – Anxiety D/O
Autism
Atypical history
Anxiety
Typical History?
Stereotypies, restricted interests
feel good
Compulsions which protect
against anxiety are
Difficulties with social functioning, uncomfortable
reciprocal communication,
Relationships can be distorted
understanding emotions
but basic communication is
“Aloof, detached”
working
Medication can work with both
groups
Avoidant
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Differential Dx - ADHD
ASDs
ASD history
Attentional difficulties reflect
autistic functioning
ADHD
History of high anxiety,
energy, poor sleep etc
Attentional difficulties reflect
primarily attentional
difficulties
Co-morbidity is not uncommon
(Medication can work with both
groups)
Social difficulties tend to be
less severe in nature
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Linking Symptoms to
Treatment
Social Difficulties
Lack of quality/fulfilling relationships
Trouble with peers / coworkers, bosses
Isolation (patterns of interest take over)
Mood disorders, anxiety, substance abuse
More isolation
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Clinical Work
Teaching vs. Talking
Facilitating
development/skills/
Independence vs.
“Curing”
Learning a new
language/Culture
DO NOT REPRODUCE COLLEGE AUTISM SPECTRUM 2012
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Common
Challenges on
college campuses
Stress Management
Students with ASD may misinterpret symptoms of stress for illness
Need to be taught what stress feels like
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Cognitive domain
Emotional domain
Behavioral domain
Physical domain
Identify triggers and develop a stress management plan
Social Skill Difficulties
Many students with ASD need direct instruction around social and
relationship rules
Social situations will need to be dissected and analyzed to identified
Social first aid kits/plans should be developed and practiced with a
support person
Potential tools
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Social scripts
Social skills mapping
Social scenario flash cards
Social emergency response plan
Digging your way out
Student Conduct
Behaviors of a student with ASD could result in counseling center or
student of concern referral
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Stimming
Pacing
Talking about inappropriate subject matter (no-go topics of conversation)
Perceived stalking (Not picking up on social cues)
Poor hygiene
It is important to differentiate between ASD related behaviors and potential
onset of mental health concerns
Conduct decisions should always be based on actual behaviors not the
predictions about harm to self or others
Campus points of
connection
Disability Services
Accommodations are beyond the typical
Detailed intake will help predict potential supports needed
◦ Previous hospitalizations
◦ Times away from school
◦ Medication management
Develop an understanding of each students special interest to assist in
“joining” them during times of distress
Listen to the students’ story as told by them
Counseling Centers
Decreased eye contact
May not appear motivated and engaged in the conversation
May only be able to focus in a session for 30 minutes instead of an hour
May not be able to verbally communicate accurately what he or she is
“feeling”
Should be short term-goal focused
Must be purposeful (why is it important)
Should be repetitive, concrete and visual
Spend time initially listening to the individual talk about or demonstrate
special interests
Career Services
High rate of unemployment and underemployment among people with
ASD (Approximately 46% unemployed and of those employed, 75% are
underemployed-Asperger Training and Employment Program, 2012)
Internships, job shadowing, mock interviews are vital but can be added
stressors
Job coach/mentor could be a good tool for success
Many student with ASD have a tremendous skill set if they find their
professional niche
◦ Combining talents, interests and skills
Residence Life
Students with ASD tend to struggle significantly in residence halls due to
the intensely social environment
Accommodate with a private room
◦ Allows individual control of sensory environment
◦ Place to decompress and recharge
◦ Control in routine
Residence life staff should have an understanding of the difference
between ASD behaviors and more significant mental health concerns
Low sensory areas in buildings
Furniture
Q&A
What concerns you on your campus?
What great things are happening on your campus?
Books
Jane Thierfeld-Brown
Books
Lisa Meeks
Books
Michelle Rigler, Amy Rutherford,
Emily Quinn