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mental health Flashcards

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1
Q

What are the requirements for diagnosis of mental health disorders?

A

Must be causing distress & significant impact on lifeMeet set criteria in DSM 5Clinical judgment (can be biased or subject to human error)

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2
Q

What is the link between ASD and mental health

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Overlap between symptoms of autism and MHD (e.g., anxiety and depression)Can lead to mis-/under-diagnosis and lack of support

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3
Q

What is mental health difficulties in Autism

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1st described in clinical reports by Kanners (1940); depression and fear/anxiety around objects/events noted Insistence on sameness part of current diagnostic criteria for ASD and co-occurring anxiety commonly seenBeen recently explored among other conditions to improve diagnosis and treatments

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4
Q

What is the prevalence of mental health problems in typical and ASD

A

23% of UK (typical) and depression most common79% of ASD adults meet criteria for psychiatric disorder and depression most common (Lever & Geurts 2016)30-50% of ASD adults and 30% of ASD children have depression (Cassidy et al 2014; Strang et al 2012)

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5
Q

What are the risk/protective factors which can effect likelihood of Autism experiencing mental health difficulties

A

Environmental (e.g., bullying, unemployment)Societal (e.g., stigma, policies)Biological (e.g., brian structure and function)Psychological (e.g., thinking style)Autism effects likelihood of experiencing many of these factors

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6
Q

What are the 2 forms of levels of interventions for risk/protective factors affecting autism-related mhd

A

Government policies (e.g., Improving Access to Psychological Therapy)Psychological therapies (e.g., CBT; may not be accessible/effective for ASD))

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7
Q

How do ASD adults experience difficult life experiences
Griffiths et al 2019

A

ASD adults more likely to report difficult life experiencese.g., exclusion from education, unemployment, poverty and abuse/exploitation

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8
Q

What is the thinking styles of ASD individuals and what can it lead to

A

Black and white, concrete thinking & difficulties in cognitive flexibility Leads to issues in thinking of alternatives, problem solving, switching between trains of thoughtsReduces protective factors (e.g., finding solutions to problems)

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9
Q

What are the social difficulties of ASD and what can it lead to?

A

ASD experience difficulties interacting w non-autistic (Milton, 2012 DEP)lead to risk of loneliness, lack of social support, exclusion from social spacesReduces protective factors & cause feelings of rejection and low self-esteem

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10
Q

What are the social challenges faced by ASD individuals

A

Autistic people have difficulty interacting with the neurotypical majority (Milton, 2012).Autistic people tend to be perceived negatively by non-autistic people (Sasson et al. 2017).Autistic people may be less readable by non-autistic people which may lead to being perceived negatively (Alkhaldi et al, 2019).‘Double Empathy Problem’.

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11
Q

What do ASD individuals do to cope with social challenges

A

Camouflage or mask autistic characteristics to cope/fit in Can contribute to under/misdiagnosis, takes a toll on mental health, loss of identity, is exhausting, lack of acceptanceBUT helps to fit in to NT society (survival mechanism)

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12
Q

Hull et al 2017 qualitative study on 3 main themes for camouflaging in ASD

A

Described camo as “putting on best normal”Identified: Assimilation, compensation and masking

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13
Q

What is the Camouflaging Autistic Traits Questionnaire (Hull et al 2019)

A

Identified 3 main constructs from Hull et al 2017 (compensation, masking and assimilation)Used as measure to capture camouflaging autistic traits in ASD and typical Normally distributed in NT and ASD but higher scores in ASD population

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14
Q

Hull et al 2021 study investigating camouflage as predictor for mental health

A

Higher camo scores predicted increased depression, generalised/social anxiety symptomsAssociation strongest for anxiety & equal across genders305 asd adults

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15
Q

Cassidy et al 2018 study investigating camouflaging predicting suicidal behaviours

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Survey co-designed w autistic adults (described camouflaging as key risk marker for experience of suicide)

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16
Q

What is the Interpersonal Psychological Theory for MHD and ASD

A

Autistic traits predict thwarted belonging and perceived burdensomeness

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17
Q

Cassidy et al 2020 study on how autistic traits are associated with interpersonal psychological theory

A

Self-reported high autistic traits associated with camouflaging, thwarted belonging and suicidalityShows how camouflaging can lead to orher risk markers of MHD

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18
Q

Mitchell et al (2021) conceptual model of double empathy problem, camouflaging and mental health

A

People w low traits of autism find it harder to interpret autistic behaviour, causing lack of readability and social favourability Can increase social motivation to camouflageDepending on insight of other people’s behaviours/reactions, it can lead to feelings of loneliness (thwarted belonging)Can increase risk of MHD and suicidality

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19
Q

What are the inconsistent findings of camouflaging affecting mental health

A

Cage et al 2019: camo NOT associated w depressionLai et al 2017: camo associated w depression ONLY IN MENLai et al 2017: camo NOT associated w anxietyResults may be due to small sample sizes

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20
Q

Critical Appraisals of studies on camouflaging and MHD

A

Autistic adults without co-occurring intellectual disability, which doesn’t show effects in young pplLarge proportion of females in samples, where most autistic people diagnosed are male.Large proportion late diagnosed in adulthood (approx. 34 years in Cassidy et al. 2018).Self-report measures need confirmation using other methods (like diagnostic interviews).Opportunity samples, self-selecting.Camouflaging criticised for not being well defined & items similar to social anxiety q’sMay not be unique to autismNeed to include non-binary participants in sufficient numbers to allow analyses.

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21
Q

What are the non social difficulties of autism

A

Black and white thinking -> diff thinking of alternatives & problem solving difficulties -> increase risk of MHD

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22
Q

South et al (2020) study investigating social and non-social difficulties in ASD

A

High autistic traits and social difficulties reported difficulties in imagination and repetitive behaviours increase risk of suicidalitySuggests feeling sad/stuck and having difficulties in imaging alternative strategies increase risk of suicidal thoughtsResonaltes w many models of suicide (O’connor & Kirtley 2018)Women in sample

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23
Q

Jackson & Dritschel (2016) study on impact of social problem solving and depression

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A

Self-reported autistic traits associated with self-reported depression was significantly mediated by difficulties in social problem-solving skills suggests social problem solving is an important protective factor for mental health

24
Q

What causes difficulties in assessing mental health in ASD

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A

Early descriptions of autism included MHD (espc depression and anxiety); led to unhelpful assumptions

25
What is DSM described by in DSM 5
26
What are the 2 main challenges for accurate depression assessment in autism
Behavioural: similarity in signs/symptoms (diagnostic overshadowing; measures arent precise enough to distinguish btw ASD n dep)Lack of autism specific items (Stewart et al 2006)Cogntive: interpretation of questions (ASD have more literal processing of language)
27
What are the 5 things which make a good assessment tool?
Structural validity and internal consistencyHypothesis testing (accuracy)Criterion validity (correlating w gold standard assessment - expert clinical diagnosis)Content validity Reliability
28
Arnold et al 2019 assessing structural validity of PHQ-9 questionnaire
In factor analysis, items of question formed 2 factors (rather than 1 seen in NT), showing differences in how each population answersCognitive affective & somatic factors in ASD & depression in NTHowever still can be used as items in the 2 factors are correlated in a normal way
29
Uljareciv et al 2018 assessing structural validity of hospital anxiety and depression scale
Factor analysis for depression items is the same in general public and autistic young adults/older adolescentsSame for anxietySuggests it is a good measure
30
Gotham et al (2015) hypothesis testing of depression measurmements
Mild-to-moderate correlations with other measures & clinical diagnosis of depression (what you would expect)
31
What are the 4 cognitive aspects of autism
Alexythymia: difficulty verbalising internal thoughts/feelings (Bird et al 2010)Theory of mind (Baron-Cohen et al 1985)Literal interpretation of language (Happe 1995)Reduced flexibility in thinking (Ozonoff 1997)
32
Issues with Autistic thinking style and content validity of assessments Nicolaidis et al 2020
Due to alexythymia & literal interpretation, some items can be misinterpretedNeed to ensure questions are relevant and understandable to target population
33
Cassidy et al 2018 suggestions to adapt depression tools for ASD
Include autism specific items to capture unique presentation of depression in ASD e.g., loss of interest in previously intense interest, changes in eating/sleep/movement and include questions on sensory sensitivity and camouflaging BUT sensory hypo-sensitivity and depression looks similarCamouflaging has been associated with depression in ASD (Hull et al 2017)
34
What is anxiety defined as in DSAM
35
South & Rodgers (2017) anxiety in autism
Anxiety part of initial clinical reportsAnxiety associated w intolerance to uncertainty, restricted repetitive behaviours and sensory processingCan affect presentation of anxiety in autism and must be taken into account in assessment
36
Wingham et al (2015) model of relationship between sensory processing abnormalities in ASD and anxiety
37
How does social anxiety differ in ASD and typical population Kerns et al 2014
SAD = fear of negative evaluation in general population SAD in ASD = fear of violation of logical rules or unpredictability of social sitchSuggests reconceptualising anxiety for grp
38
Rodgers et al 2016 Anxiety autism assessment
Revised Child Anxiety and Depression Scale to be adapted for children with autismPerformed literature search identifying additional autism-specific areas to include (sensory anxiety, intolerance of uncertainty and phobias) & focus groups w parents to refine content validitySurvey established factor structure; captured 4 aspects of anxiety (uncertainty, separation, arousal and performance)
39
Issues of lack of training amongst psychiatric staff in autism
MHD = common area of first concern prior to adults obtaining an autism diagnosis (Crane et al 2015)Many psychiatrists/mental health professionals NOT TRAINED IN autism or developmental conditions (Raja, 2014).Leads to many autistic adults slipping through the net (Lai and Baron-Cohen, 2015).
40
What are the three reasons that ASD young ppl provide for issues with accessing treatment Crane et al 2019
ASD young ppl have issues obtaining MHD diagnosis and appropriate cateAlexythymia, high levels of stigma, facing severe obstacles when accessing support (lack of tailored/staff trained support)
41
Camm-Crosbie et al 2018 online survey report for autistic adult's reports on difficulties obtaining treatment
Reported tailored support as beneficial and desirableUntailored can have opposite effect
42
Implications of ASD on existing MHD treatments
ASD presentation can affect their ability to engage with traditional treatmentsCBT requires high degree of emotional literacy which is lacking in autism (arythymia) (Camm-Crosbie et al 2018); may need training in emotional literacy prior to CBT
43
Anderberg et al 2017 study on psychotherapy outcomes for people with autism
High sensory sensitivity & rigidity associated with anxiety in autismChallenging to treat depression, suicidal thinking.DEP suggests it could take time to establish rapport & therapeutic relationship between autistic and non-autistic people.Autistic adults can benefit from psychological therapy to treat MHD BUT it takes much longer.
44
Maskey et al 2014 study investigating how VR can be used to treat anxiety in autism
Individualised VR environ; 9 ASD children gradually exposed to specific phobiasAfter study, 8 or 9 children were able to tackle their phobia sitch Innovative technique
45
6 Possible approaches to prevent/treat MHD in ASD
Autism specific mental health pathwayIncreased flexibility in existing services / reasonable adjustments.Increase training/knowledge of professionals.Increase research needed to inform above.Asking autistic people and those who support them for inputGovernment policy to prioritise mental health of autistic people and identify/address known gaps in the UK (but need evidence)Flexibility is stressed by autistic individuals & ppl supporting them (Cassidy et al 2020)
46
What are 2 reasons why people camouflage? Hull et al 2017 (CORE READING)
Assimilation: blend in (avoid stigma and rejection)Connection: make/keep social rlsoften a survival strategy
47
What are 2 techniques people use to camouflage? Hull et al 2017 (CORE READING)
Masking - suppressing stims, changing voice/posture and using "costumes"Compensation - practicing social scripts, forcing facial expressions/eye contact and asking "safe" questions Described as acting/lying/performing
48
What are the 3 negative consequences of camouflaging Hull et al 2017 (CORE READING)
Burnout/anxiety/exhaustion after social interactionsDelayed/missed diagnosisIdentity confusion/shame and low self-esteem
49
What are the gender differences in camouflaging? Hull et al 2017 (CORE READING)
Woman and non-binary report more frequent/intense camouflaging Can explain why females are diagnosed later or misdiagnosedSome may fear being left out if camouflaging was recog
50
What are the 3 main reasons why new ASD diagnostic tools were needed? Rodgers et al 2016 (CORE READING)
Based on typical development; may miss sensory or uncertainty based anxietyOverlaps between ASD traits and anxiety symptomsMisinterpretation of behaviour in specific contexts
51
What are the 3 new anxiety domains added to measure ASD-specific anxiety in RCADS? Rodgers et al 2016 (CORE READING)
Sensory anxietyIntolerance of uncertainty Phobias
52
How many items/subscales are on final ASC-ASD assessment Rodgers et al 2016 (CORE READING)
24 items4 subscales: performance anxiety, uncertainty, anxious arousal, separation anxiety
53
How was ASC-ASD scale developed? Rodgers et al 2016 (CORE READING)
Based on RCADSModified using parent interviews, focus groups and pilot testing Incl new items from validated tools
54
What were the main psychometric findings of ASC-ASD assessment? Rodgers et al 2016 (CORE READING)
High internal consistency (a = .94)High test-retest reliability (.82-84)Moderate to strong parent-child agreement (r = .68)Convergent reliability (correlated w other measures)Discriminant reliability (stronger correlation w SCARED than depression measure CDI)
55
What was not found on factor analysis of ASC-ASD? Rodgers et al 2016 (CORE READING)
No OCD factorNot GAD factorNo phobia factor
56
What are the limitations of ASC-ASD? Rodgers et al 2016 (CORE READING)
Piloted with only children w avg-high cog abilityNot tested in adults or children w intellectual disabilityNo clinical cut off (dimensional tool rather than diagnostic)
57
What is the ASC-ASD tool? Rodgers et al 2016 (CORE READING)
It is a valid ASD-specific anxiety tool Captures uncertainty and sensory-related anxietyAllows for better targeted interventions

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