L5 - Mental Health in Typical and Atypical Development

Question 1

What is mental health in autism?

Answer 1

First described in 1940 by Kanner
- fear and anxiety
- depression
- insistence on sameness
- intolerance to uncertainty
Recently been explored among other conditions to improve diagnosis

Question 2

What is the prevalence of mental health?

Answer 2

23% of the UK population experience a mental health problem - depression is the most common
79% autistic adults meet criteria for a psychiatric condition - depression being the most common
Depression/anxiety presents 30-50% of autistic adults and 30% of children

Question 3

What are the risks/protective factors?

Answer 3

Environment - stress, bereavement, finance, bullying, unemployment
Societal - attitude, stigma, poverty
Biological - genetic, brain structure and function
Psychological - thinking style, coping strategies

Question 4

How does difficult life experiences link to autism?

Answer 4

Autistic adults are significantly more likely to report difficult life experiences than non-autistic adults
- exclusion from education
- unemployment
- poverty
- abuse and exploitation

Question 5

What difficulties can autistic people have with their thinking styles?

Answer 5

Difficulty thinking of alternatives
Difficulty to problem solve
Difficulty to switch from one train of thought to another
- protective factors - finding solutions/way out of difficult mood/circumstances

Question 6

What social difficulties do autistic people face?

Answer 6

Difficulty interacting with non-autistic people
Increasing risk of: loneliness, lack of social support, exclusion from social spaces, lack of acceptance, feeling rejected, low self esteem

Question 7

What are social challenges for autistic people?

Answer 7

Have difficulty interacting with neurotypical majority (Milton, 2012)
Perceived negatively by non-autistic people (Sasson, 2017)
Less readable by non-autistic people which may lead to being perceived negatively (Alkhaldi, 2019)
Double empathy problem

Question 8

What is camouflaging?

Answer 8

What autistic people do to cape/fit in to social situations
- contribute to misdiagnosis
- takes toll on mental health
- loss of identity
- exhausting
- lack of acceptance
Compensation - compensate for social difficulties
Masking - present a less autistic persona
Assimilation - fit into uncomfortable situations

Question 9

How does camouflaging link to mental health?

Answer 9

305 autistic adults (18-75 years):
Increased camouflaging scores predicted increased depression and anxiety
Association strongest for anxiety
Associations equally strong across genders
High autistic traits associated with camouflaging, thwarted belonging and suicidality

Question 10

Is there a link between camouflaging and suicidality?

Answer 10

164 autistic and 169 non-autistic adults:
Predictors of lifetime suicidality - autism diagnosis (4.5%) - autistic traits (3.2%)
Autistic adults - camouflaging (3.5%), unmet support needs (3.1%), non-suicidal self-injury (4%)

Question 11

What are the findings of camouflaging and mental health?

Answer 11

Inconsistent:
Camouflaging doesn’t equal depression (Cage 2019)
Camouflaging does equal depress in men (Lai 2017)
Camouflaging doesn’t equal anxiety
Possibly due to small sample size

Question 12

What is the critical appraisal of research?

Answer 12

Autistic adults without co-occurring intellectual disability
Large portion of females
Most diagnosed autistic were male
Large proportion late diagnosis
Self-report measures
Opportunity samples, self-selecting
Camouflaging is not well defined
Gender differences?

Question 13

What are social and non-social difficulties?

Answer 13

Non-social - difficulties thinking of alternatives, problem solving difficulties, increase risk of mental health problems
Social - difficulties in imagination and repetitive behaviours –> suicidality, suggest feeling sad, stuck and difficulty in imagining alternative strategies increases risk of suicidal thoughts

Question 14

How does social problem solving link to depression?

Answer 14

Self-reported autistic traits associated with current self reported depression, significantly mediated by difficulties in social problem solving skills

Young adulthood + ASD social struggles –> social consequences –> emotional consequences

Question 15

How does autism include description of mental health?

Answer 15

Early description of autism include mental health difficulties - depression and anxiety
- is mental health part of autism
- are they expressed differently in autism
This can lead to difficulties in assessing mental health in autistic people

Question 16

What are the challenges for measuring depression in autistic people?

Answer 16

Behavioural challenges - similarity in signs and symptoms
Cognitive - interpretation of questions

Question 17

What makes a good assessment tool?

Answer 17

Structural validity and internal consistency
Hypothesis testing
Criterion validity - does it correlate with gold standard assessment
Content validity - are questions understandable and relevant
Reliability - can you replicate the results

Question 18

What are the similar characteristics of autism and depression?

Answer 18

DSM-V Depression:
- Depressed mood
- Insomnia or hypersomnia
- Loss of energy
- Impaired concentration
Autism Characteristics
- Social withdrawal
- Difficulties with sleep
- Flat effect
- Reduced eye contact

Overlap leads to over or under diagnosis

Question 19

What are the cognitive aspects of autism?

Answer 19

Alexithymia - difficulty verbalising internal thoughts and feelings prevalent in autism
Theory of mind - difficulty putting yourself in another’s shoes
Literal interpretation - of language, taking things at face value, difficulty reading between the lines
Reduced flexibility in thinking - sticking on one train of thought, difficult to consider other alternatives

Question 20

How can the content be misunderstood by autistic people?

Answer 20

Feeling down - Alexithymia (don’t know how they feel so can’t answer)
Feeling down - Literal interpretation (down is an interpretation)
Misinterpreted

Question 21

How can depression tools be adapted for autistic people?

Answer 21

Include autism specific items to capture unique presentation of depression in autism
Difficulties autistic people have got worse when depressed
Loss of interest in a previously intense interest
- Change in: eating, sleeping, movement
- Include Qs on: sensory sensitivity, camouflaging?

Question 22

What is anxiety?

Answer 22

Associated with three or more of the following six symptoms (with some present for most days over 6 months)
- restlessness or feeling on edge
- easily fatigued
- irritability
- muscle tension
- sleep disturbances

Question 23

What is anxiety in autsm?

Answer 23

Part of initial clinical reports - insistence on sameness, rituals
Associated with intolerance of uncertainty, RBRs and sensory processing
These could affect the presentation of anxiety in autism and must be taken into account for assessment
Social anxiety - in general population, fear of negative evaluation - in autism fear of violation or unpredictable

Question 24

What is anxiety autism assessment?

Answer 24

Revised child anxiety and depression scale adapted for children with autism
Literature search identified additional autism specific areas to include in the measure
Focus groups with parents to refine content validity
Survey established factor structure

Question 25

What are the gaps in support/treatment?

Answer 25

Participatory research project showed autistic young people have difficulty obtaining a mental health diagnosis and appropriate treatment (Crane 2019)
- difficulties evaluating their mental health
- report high levels of stigma
- often face severe obstacles when trying to access mental health support
Participatory research project showed autistic adults have difficulty obtaining treatment and support for mental health problems

Question 26

What are the implications for treatment?

Answer 26

Presentation of autism can affect ability to engage with traditional treatments
Cognitive behavioural therapy required high degree of emotional literacy - an area autistic people find difficulty
High sensory sensitivity, and rigidity associated with anxiety in autism (challenging to treat depression, suicidal thinking)
CBT is hard to autistic people due to introspection
Autistic adults can benefit from psychological therapy to treat mental health difficulties such as anxiety, but it takes much longer

Question 27

What is virtual reality to treat anxiety on autism?

Answer 27

VR environment gradually exposed 9 autistic children to specific phobias, they could chose their exposure
After the study 8 children were able to tackle their phobia situation