Understanding Mental Health in Autism

InfoThis is a summary of the following YouTube video:

Mental Health Issues Faced by Autistic People Webinar

CAMH Professionals Videos

Mar 16, 2023

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Nonprofits & Activism

Autistic mental health challenges and support strategies

  1. The session focuses on mental health challenges faced by autistic individuals, hosted by Jana Vigor at CAMH's Patient and Family Learning Space in Toronto.
  2. Dr. Meng-Chaun Lai, a psychiatrist and senior scientist at CAMH, is the main speaker, with Riley Goldsmith and Alex Ekovitz as youth engagement specialists and autistic self-advocates.
  3. Riley Goldsmith emphasizes the importance of understanding the intersection of disabilities and mental health, advocating for education and positive change in the neurodiverse community.
  4. Alex Ekovitz highlights their role in ensuring the voices of youth with neurodevelopmental disabilities are heard and integrated into CAMH's work.
  5. Dr. Meng-Chaun Lai discusses neurodevelopmental and physical health conditions that often co-occur with autism, which can exacerbate mental health issues.
  6. The presentation outlines major mental health challenges faced by autistic individuals, including selective clinical topics relevant to autistic individuals and families.
  7. Dr. Lai proposes ideas for understanding the origins of mental health challenges in autism and suggests clinical support strategies.
  8. The content includes evidence-based information and clinical anecdotes, acknowledging that some terminology may not align with current respectful language standards.

Autistic individuals face higher mental health risks

  1. Autism is a neurodevelopmental condition present from early life, often overlapping with other neurodivergent features like ADHD and motor-related issues, impacting individual well-being.
  2. Neurodevelopmental conditions such as communication and intellectual challenges frequently co-occur with autism, sharing origins and affecting life outcomes based on environmental treatment.
  3. Physical health issues, including allergies, immune, cardiovascular, gastrointestinal, and neurological problems, are more prevalent in autistic individuals compared to non-autistic groups.
  4. Psychiatric conditions are notably more common in autistic people, with higher prevalence rates than in typically developing individuals, as shown in a California health registry study.
  5. Common mental health diagnoses in autistic individuals include ADHD, anxiety, depressive, bipolar, schizophrenia spectrum, OCD, impulse control, and sleep disorders, with rates significantly higher than the general population.
  6. Meta-analysis of literature reveals that autistic individuals have a 28% prevalence of ADHD, 20% for anxiety disorders, and other mental health issues, indicating a broad spectrum of challenges.
  7. The literature includes both population-based and clinical studies, showing variability but consistently higher mental health diagnosis rates in autistic populations compared to general rates.

Autistic females face highest mental health diagnosis

  1. A study from the Swedish registry examined the rate of new mental health diagnoses in autistic individuals aged 16 to 25. It found that autistic females assigned at birth had the highest rate of diagnoses, exceeding 70%, followed by autistic males, non-autistic females, and non-autistic males.
  2. The data suggests that autistic individuals, particularly females, are more likely to receive new mental health diagnoses during their youth.
  3. Anxiety is identified as one of the most common mental health challenges, often severe enough to interfere with daily functioning, leading to a disorder diagnosis.
  4. Different types of anxiety include separation anxiety, social phobia, specific phobias, generalized anxiety, and obsessive-compulsive disorder (OCD). Each type has distinct characteristics and impacts on individuals.
  5. Separation anxiety involves difficulty in separating from caregivers, while social phobia is the fear of social interactions due to past negative experiences or fear of judgment.
  6. Specific phobias are intense fears of particular objects or situations, such as needles or animals, that impair daily life.
  7. Generalized anxiety is characterized by excessive worry about various aspects of life, while OCD involves intrusive thoughts and compulsive actions to alleviate anxiety.
  8. Autistic individuals may experience unique anxiety manifestations not typically recognized, such as social fear related to new environments or social overload.
  9. Uncommon phobias in autistic people may include fears of specific sounds, colors, or images that are not usually problematic for neurotypical individuals.
  10. Special interests anxiety involves the fear of losing access to comforting or intensely focused interests, causing distress.
  11. Fear of change is prevalent among autistic individuals, as they require routine and predictability. Disruptions can lead to significant anxiety, sometimes not expressed verbally.

Autistic individuals face unique mental health challenges

  1. Clinicians need to recognize autism-specific anxieties, which are prevalent. A study by Dr. Kern shows that only 17% of autistic individuals have traditional anxieties, 15% have atypical anxieties, and over 30% have a mix of both. This highlights the importance of understanding these unique anxieties.
  2. Depression in autistic individuals may manifest differently than in the general population. While the criteria for depression remain the same, autistic people might experience and express these symptoms uniquely due to differences in processing emotions and internal feelings.
  3. A joint project led by Dr. Stephanie Amos at CAMH provides insights into how depression manifests in autistic individuals. Symptoms like lack of pleasure, feeling down, changes in sleep and appetite, and feelings of guilt may present differently, such as feeling numb or having a high pain threshold.
  4. Autistic individuals may experience changes in energy levels, such as feeling tired, overwhelmed, or restless. They might also experience brain fog or trouble concentrating, which can affect their daily functioning.
  5. Thoughts of self-harm or a fascination with death can be more pronounced in autistic individuals experiencing depression. Physical pain, although not a DSM criterion, is commonly reported and may relate to atypical sensory processing.
  6. Sensory experiences can change during depression, becoming more overwhelming. This can affect an autistic person's ability to handle daily challenges, as their sensory thresholds may be altered.
  7. Sleep issues are common among autistic individuals, ranging from insomnia to changes in circadian rhythms. These sleep disturbances can significantly impact their overall well-being.

Autistic individuals face diverse mental health challenges

  1. Autistic individuals often experience sleep disturbances, including irregular sleep patterns, difficulty falling asleep, reduced total sleep time, and poor sleep efficiency. They may also suffer from parasomnia, which involves behaviors or talking during sleep without awareness, and sleep-related breathing disorders like sleep apnea.
  2. Trauma is a significant issue for autistic people, with a meta-analysis indicating that 44% have experienced substantial trauma. This trauma can range from abuse, bullying, maltreatment, and neglect to more severe crimes directed at them.
  3. Emerging phenomena in autistic individuals include autistic burnout, characterized by exhaustion, withdrawal from social interactions, reduced functioning, and increased autistic traits. Autistic inertia involves difficulty starting or stopping activities, with a tendency to maintain the current state and challenges in initiating actions.
  4. Meltdowns and shutdowns are critical experiences for autistic people. Meltdowns involve feeling overwhelmed by sensory, social, or emotional stress, leading to a lack of control. Shutdowns are more internal, with withdrawal from surroundings and significant emotional pain.
  5. Catatonia can occur in autistic individuals, marked by psychomotor disturbances such as decreased speech and motor abilities, or increased activity like agitation. It may involve repeating others' words or actions automatically, known as echolalia, and can occur without psychosis.
  6. The phenomena of catatonia in autism may overlap with inertia, involving slowness in motor and speech, hesitation in movements, reliance on prompts, reduced speech, mutism, and feeling mentally stuck. These experiences highlight the complex mental health challenges faced by autistic individuals.

Understanding and empathy improve autistic mental health

  1. Autistic individuals may exhibit behaviors such as obsessive-compulsive symptoms, shutdowns, agitation, or self-injurious actions, often due to sensory or social overload. These behaviors require clinical attention and intervention.
  2. A large-scale survey revealed that autistic people often use substances to manage behavioral difficulties, sensory overload, and mental health symptoms like depression and anxiety. This usage is often a coping mechanism to improve daily functioning and quality of life.
  3. The 'double empathy problem' challenges the myth that autistic people lack empathy. Instead, it highlights difficulties in mutual understanding between autistic and non-autistic individuals, emphasizing that both groups may struggle to understand each other's perspectives.
  4. Damian Milton's theory suggests that communication breakdowns are not solely due to autistic individuals but also involve non-autistic people's challenges in understanding autism, leading to stigmatization and negative impressions.
  5. Effective communication and mutual understanding between neurotypes are crucial, similar to cross-cultural understanding. Building strong relationships with healthcare providers is essential for autistic individuals to receive better mental health care.
  6. Clinicians must recognize these communication barriers and work towards better understanding and empathy to improve healthcare outcomes for autistic individuals.

Genetic and social factors impact autistic mental health

  1. Autism is linked to genetic factors known as common variants, which are also associated with traits like educational attainment, IQ, and mental health challenges such as major depression, ADHD, bipolar disorder, and schizophrenia. These common variants are widespread in the general population and have a cumulative effect rather than being attributable to a single factor.
  2. Rare genetic variants, which are new changes in a person's genome, are also associated with autism. These variants can lead to intellectual and developmental disabilities and may affect other physical aspects of the body, such as increasing the likelihood of obesity or schizophrenia. Identifying these rare mutations is crucial for monitoring potential health issues.
  3. Autism is often associated with various conditions, including physical health issues, neurodevelopmental disorders, feeding and eating problems, sleep disturbances, anxiety, OCD, trauma, depression, substance use, suicidality, and psychotic disorders. These associations are depicted in a complex diagram highlighting the interconnectedness of these conditions.
  4. Stigmatization and misunderstanding of autistic individuals contribute significantly to mental health challenges such as anxiety, trauma, depression, and behaviors perceived as disruptive. These social factors are critical in understanding the mental health landscape for autistic people.
  5. Adverse experiences, including childhood adversity, bullying, and acute stress, can precipitate severe mental health challenges like depression and psychotic disorders in autistic individuals. Inappropriate healthcare can exacerbate these issues, leading to increased anxiety, trauma, and suicidality.
  6. Cognitive features of autistic individuals, such as sensory perceptual changes, certainty seeking, executive function difficulties, and emotion regulation challenges, can interact with environmental demands to increase mental health challenges. These cognitive traits can be both strengths and challenges, affecting how autistic individuals cope with social and environmental pressures.

Resilience and tailored care for autistic individuals

  1. The text discusses the challenges faced by autistic individuals, including genetic and environmental factors that contribute to mental health issues. It emphasizes the importance of identifying resilience factors that can protect against these challenges.
  2. Resilience factors, such as addressing the double empathy problem, can help shield autistic individuals from stigmatization and misunderstandings in healthcare, school, and family settings.
  3. The text provides resources for understanding healthcare needs, including a literacy guide from York University and general mental health tips applicable to both youth and adults.
  4. Healthcare professionals are advised to assess safety and understand underlying issues before prescribing medication for autistic individuals, focusing on stress, communication challenges, and psychiatric illnesses.
  5. Medications are prescribed for specific diagnoses or symptoms in autistic individuals, ranging from ADHD to anxiety, depression, OCD, self-regulation, and severe mental health illnesses.
  6. The text highlights the adaptation of psychotherapeutic modalities for autistic individuals, stressing the importance of tailoring treatments to their pace and thinking style according to the Universal Design principle.
  7. The text concludes with a mention of Dawn Triplett, the first autistic person reported in literature, and his life experiences as described in the book 'In a Different Key.'

Genetic factors affect both brain and body

  1. The presentation discussed the complexity of genetic factors in autistic individuals, highlighting that these factors are not solely neurodevelopmental but also have physical attributes. This complexity arises because genetic changes often occur early in life, affecting both brain and body development.
  2. The speaker noted that while rare genetic changes are associated with autism, they occur at a low frequency across the autistic population. These changes can have multiple outcomes, impacting both neurological and physical development.
  3. A question was raised about diagnostic overshadowing in autism, where symptoms of other conditions might be dismissed as part of autism. The speaker emphasized the importance of recognizing atypical presentations of conditions like anxiety, which may not fit traditional diagnostic criteria but still require attention.
  4. The discussion highlighted the need for individuals to be well-prepared when visiting healthcare providers to ensure their symptoms are not overlooked or dismissed. This preparation can help in avoiding diagnostic overshadowing.
  5. The speaker stressed that a formal diagnosis is not always necessary for treatment. Recognizing and addressing symptoms, even if they don't fit a specific diagnosis, is crucial for effective healthcare.

Misdiagnosis complicates autism-related mental health issues

  1. Dr. Meng-Chaun, a psychiatrist at CAMH, addresses the issue of misdiagnosis in autistic individuals, emphasizing the complexity of distinguishing between co-occurring mental health conditions and misdiagnosed ones.
  2. Anxiety is often misdiagnosed in autistic individuals. For example, anxiety related to changes in routine may be labeled as generalized anxiety disorder, but it is actually linked to autism.
  3. Misdiagnosis can lead to inappropriate treatments. For instance, autistic individuals might be wrongly diagnosed with psychotic disorders due to literal interpretations of screening questions, leading to unnecessary medication.
  4. Understanding an autistic person's experiences through the lens of autism is crucial. This approach helps in identifying what symptoms are misdiagnosed, co-occurring, or unrelated to autism.
  5. Autistic individuals can still develop other mental health conditions like schizophrenia, which need to be recognized and treated separately from autism-related symptoms.
  6. The concept of 'diagnostic overshadowing' is discussed, where significant autism symptoms might overshadow other mental health issues, leading to dismissal by clinicians.
  7. Dr. Meng-Chaun argues against the notion that mental health challenges in autistic individuals are 'just autism,' advocating for a nuanced understanding of their experiences.