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

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

3. 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 AB C

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 AB C

5. Depression: Vulnerability Gene-Environment Interaction Awareness of ASD Loneliness High levels of anxiety Misunderstanding/ misinterpretation Psychological differences (ToM) Life experiences AB C

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 AB C

7. 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 AB C

8. General Anxiety Disorder (GAD) 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 AB C

9. GAD: Prevalence 3-5% in general population 84% in a sample of children with PDDs* *Muris et.al. (1998) AB C

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 AB C

11. 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 AB C

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

13. 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 AB C

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 AB C

15. OCD: Vulnerability Psychological differences (ToM, central executive dysfunction, central coherence) Boredom/ Lack of structure Differences in sensory experiences Misinterpretation of communication Social misunderstandings AB C

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 AB C

17. OCD: Treatment Options Professional Medication CBT Behavioural treatments Parents/ Carers Encourage to communicate feelings Adjust environment Sensory awareness Low arousal AB C

18. 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 AB C

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 AB C

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 AB C

21. ADHD: Signals Many “signals” are part of the presentation of ASDs Where is the “cut-off”? AB C

22. ADHD: Treatment Options Professionals Medication Parents/ Carers Consistent approaches AB C

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 AB C

24. Questions AB C