Mental Health Services and Autism Spectrum Disorders Ann M. Neumeyer, MD Medical Director, Lurie Center / LADDERS Associate Pediatrician and Neurologist Massachusetts General Hospital Assistant Professor in Neurology Harvard Medical School March 28, 2011

Autism Spectrum Disorders Communication Atypical Behaviors Social Interaction

Causes of Autism Genetic Neurochemical Neurobiology Functional changes Prenatal factors

Genetic –Many genetic abnormalities can cause autism –Diseases associated with autism Rett Syndrome Tuberous sclerosis Fragile X syndrome Angelman Syndrome –Males > Females (4.5:1) –There is no one “autism” gene

Neurochemical Monoamines Glutamate Alpha amino hydroxybutyrate Neuropeptides Oxytocin

Neurobiology Neuroanatomic Changes- Bauman and Kemper, 1984 Cortical, callosal and limbic abnormalities, amygdala, fusiform gyrus MRI/ PET studies: Cortical White Matter

Functional Changes –Functional MRI –Autonomic Nervous System

People with Autism have different brains Increased likelihood of mental health issues

Mental health disease and Autism Depression Anxiety Obsessive Compulsive Disorder and features Attention Deficit Hyperactivity Disorder Aggression Intellectual Disability is not a part of 38%!!!!

Approach to treatment of Autism Spectrum Disorders Improved Function Medical Neurological Treatment Social Skills Therapy Vocational Skills Training Behavior Therapy Education Psychopharm. Treatment Speech and Occupational Therapy

Results of Treatments? Less mental illness Improved adaptive functioning –Communication –Social Skills –Vocational skills Improved Learning More independent living skills Higher functioning in our society Lower cost to state

The Solution? Work together Wrap around services

Collaborative Integrated Care Medical Care Education Mental/ Behavioral Health Care

Dedication To the many children and their families who have taught me about autism. Special thanks to Dr Margaret Bauman