Mental health issues for children with ASD

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Mental health issues for children with ASD

• Dr Sarah Lister Brook
• NHS Consultant Clinical Psychologist
• Social Communication Consultancy
• www.socialcommunication.co.uk

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What are the types of MH problems with onset in
childhood/adolescence?

• Hyperkinetic disorders
• Attention deficit disorder without hyperactivity
• Conduct disorders
• Oppositional defiant disorder
• Mixed disorders of conduct and emotions
• Emotional disorders (separation anxiety phobic
  anxiety social anxiety)
• Disorders of social functioning (elective mutism
  attachment disorders)

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MH problems in children cont.

• Tic disorders
• Enuresis/ encopresis non-organic cause
• Feeding disorder
• Pica
• Stereotyped movements
• Stuttering/cluttering
• Excessive masturbation/nail biting/nose-picking/th
  umb sucking

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Mental Health problems with later onset

• Schizophrenia, schizotypal and delusional
  disorders
• Mood affective disorders (mania bipolar
  depression)
• Neurotic, stress-related and somatoform disorders
  (OCD phobias anxiety)
• Behavioural syndromes associated with
  physiological disturbances and physical factors
  (eating disorders)
• Disorders of adult personality and behaviour
• Mental and behavioural disorders due to
  psychoactive substance use

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Co-Morbidity or symptom sharing
ADHD
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Factors that affect our mental well-being

• Social support /relationships
• Quality of attachment to primary caregiver
• Acute/chronic stress
• Neurological/ neuro- chemical factors
• Psychosocial context

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What promotes mental well-being in children ?
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Why are children with ASD more at risk for MH
difficulties ?

• Primary impairments in ASD are in the development
  of social communication and imagination, which in
  turn affects
• Quality of infant attachment subsequent ability
  to develop social relationships
• Opportunities for peer support
• Problems with recognising, expressing and
  processing emotions
• Problem solving skills and cognitive style
• Increased levels of stress

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1.Disruption of early attachment

• Compromised learning of foundation skills in
  social communication, e.g. turn-taking, shared
  attention, use of eye-contact.
• Compromised learning of affect regulation, e.g.
  receiving comfort and later requesting comfort

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2.Limited opportunities for peer support

• Few friends to talk things through with
• Less likely to feel popular and liked by others
• Less likely to feel the support from and identity
  with a peer group

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3.Difficulties with emotional processing

• Problems recognising and decoding emotions in
  others
• Problems recognising and decoding emotions in
  self
• Difficulties with regulating affect

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4.Reduced capacity for problem solving

• Rigid thinking style, difficulty generating
  alternative options
• Linear in approach
• Prone to thinking errors, e.g. black- white
  thinking
• Less likely to use contextual factors, e.g. more
  concrete and literal in perceptions and
  understanding.

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5. Stress factors

• Constantly challenged task demands for lots of
  things are high across different aspects of their
  lives.
• Being in a social world is stressful, even if
  they are socially proactive.
• Sensory integration difficulties means that
  ordinary stimuli can become acutely irritating.
• The need to maintain sameness is very demanding
  of self energy for other things can easily
  become depleted.

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What are the effects of stress ?

• Acute stress often induces high levels of anxiety
  around a specific event/ trigger and these can
  become very quickly generalised.
• Chronic stress can have a negative affect on mood
  states, i.e. lead to depression

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How might children with ASD present with a mental
health problem ?

• In some cases the presentation of the
  mental/behavioural disorder may be very like a
  typically developing child, alternatively, it may
  be less obvious and need more expert assessment
  to provide clarification.
• Within the systems of classification, a lot of
  the diagnostic categories for
  mental/behavioural problems with onset in
  childhood can not be applied if the child has
  ASD. This means that in many generic CAMHS teams
  the mental health needs of children with ASD go
  unrecognised their difficulties are often all
  put down to their ASD.

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Common emotional/behavioural issues in children
with ASD

• high levels of anxiety (e.g. increased rituals,
  frequent temper tantrums, enuresis, separation
  anxiety)
• difficulties with conduct (e.g. aggression)
• oppositional (e.g. because of need to maintain
  sameness)
• disorganised activity (e.g. difficulties
  regulating activity levels)
• attention deficits (e.g. primary problem with
  developing integrated attention)
• feeding problems (e.g. persistent neophobia)

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Thinking about cases
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Recognising when a child is in need of more
expert help

• Frontline detectives noticing persistent and
  significant changes.
• Usual strategies not effective.
• Difficulty in unpicking the tangle.

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What help is out there ?

• Support
• Networks, parent groups
• Open communication
• Counselling
• Respite
• Benefits
• Therapies for family
• Couples therapy
• Family therapy
• Individual therapy

• Therapies for child
• Speech and Language (communication)
• Occupational (sensory integration)
• Cognitive Behaviour Approaches
• Psychotherapy
• Medication

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PROBLEM SOLVING APPROACH
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What can parents do ?

• Take care of your own MH
• Observe your child, keep a log
• Think about activity levels
• Try to keep POSITIVE keep CALM
• Get help

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What treatments work ?

• Educational approach is key to success in terms
  of minimising impact of ASD on individual
  well-being and decreasing the likelihood of
  secondary emotional/behavioural problems (TEACCH
  principles)
• Cognitive behaviour approaches to managing
  emotional/behavioural issues are expanding. There
  is an emerging evidence base for these
  approaches.
• Medication also has its place in dampening the
  symptoms of emotional/behavioural disorders.

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Cognitive behaviour model the hot cross bun
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Cognitive behaviour approaches

• Desensitisation to stimuli
• Progressive relaxation
• Anger management
• Psycho education
• Scaling emotional responses
• Social Stories
• Cognitive restructuring

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Social stories www.thegraycenter.org
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• Cognitive behaviour approaches are aimed at
  making changes in cognition (thoughts) and
  behaviour but most importantly they are helping
  the child to learn to regulate his/her affect.
  This in turn will reduce the likelihood of them
  developing a emotional/behavioural disorder.