Mental health in typical and atypical development

What are environmental problems of mental health?
Stress, bereavement, finances, bullying, unemployrment
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What are societal problems of mental health?
Attitudes, stigma, policy - service provision, poverty
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What are the biological causes of mental health?
Genetic predisposition (family history), brain structure and function
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What are psychological causes of mental health?
Thinking style, coping strategies, resilience
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What are co-occuring conditions?
Such as autism could effect likelihood of experiencing many of these factors, however, challenge with effectively identifying mental health problems
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What are maladaptive coping strategies?
Drinking, drugs rather than dealing with the actual problem
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What are narrow interests?
Unusual narrow circumscribed interfere with carrying out day to day activities, an cause distress when interrupted. May include ritualised behaviours (Eg having to do things in a certain way or order) and be repetitive
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What is imagination?
Difficulty putting yourself in another's shoes
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What is sensory problems in autism?
Difficulty coping with strong smells, noise, lighting, texture and touch
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What are mental health difficulties?
Described in Kanners first clinical reports in 1943: Fear and anxiety around objects and events
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What unusual specific phobias are developed?
Phobia of bridges, pigeons, social events, travelling on buses
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What has been seen?
Part of current diagnostic crtieria and anxiety common seen in autism
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What has recently been explored?
Among other conditions to improve diagnosis and treatment
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What is diagnosis for autism?
5 years for classic autism Vs 11 years or even adulthood for ASD
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What is lack of support for?
Post diagnosis for children and adults, bullying and peer victimisation
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What is the transition to adulthood lead to in autism?
• Lack of support services (Pilling et al. 2012) • Health and social difficulties (Balfe and Tantam, 2010) • Poor quality of life, low occupational achievement (Howlin et al. 2013) • Social exclusion and isolation (Howlin 2000; Baron-Cohen, 2008)
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What are social challenges of autism?
- Autistic people have difficulty others emotions, interpreting and predicting others behaviour, and responding appropriately - Additionally, autistic people may be less readable by non autistic people
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What could this lead to?
Could contribute to social exclusion, this could result in a double empathy problem
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What is a potential impact?
Autistic people more likely to experience: Social isolation, loneliness, those with high autistic traits more likely to experience thwarted belongingless, associated with depression and self harm
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What is research yet to explore?
The direct impact of double empathy on mental health in ASD
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What are social challenges?
Camouflaging autism to cope in social situations, argued to be more common in autistic women and contribute to under of this group
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What was reported as a social challenge of autism?
Reported to take a toll on mental health, loss of identity, exhausting, but helps to fit in NT society
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What is prevalence of depression in UK population?
23% of Uk population
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What is prevalence of depression of autistic people?
79% of autistic adults meet criteria for a psychiatric condition at some point with depression most common
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What happened in depression of autistic adults and child?
30-50% and 30%
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Why is there an increase of depression in autistic people?
- Increased experience of psycho-social risk factors? - Social isolation - Unemployment - Loneliness - Awareness of own shortcoming and struggles
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What is cognitive style?
Inflexible thinking, unable to see a way out of current mood or circumstance, difficulty in changing behaviour, increased rumination, memory biases, difficulty with AB memory in autistm - important protective factor against MH problems in GP
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Why?
Overlap of symptoms in autism and depression, over estimate depression in autism, lack of autism specific/relevant items, under estimate depression in autism, cognitive style affecting interpretation of question
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What is the psycho-social factors?
- Self reported autistic traits associated with current self reported depression, significantly mediated by difficulties in social problem solving skills - Autistic traits lead to difficulties in social problem skills which then leads to depression
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What is part of the diagnostic criteria for depression?
Suicidality
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How many die by suicide who have been diagnosed with depression?
Over 90%
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What is there evidence of those with autism and suicidality?
Increased risk of suicidality in people with autism
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What are the statistics of people with autism?
374 newly diagnosed adults with asperger syndrome; suicidal ideation, 66%; suicide plans: 35%, depression 31%
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What happened in a large study in sweden?
- Adults with autism significantly more likely to die by suicide than the general population - Being female, autism without ID, and depression are risk factors (Hirvikoski et al. 2015) - Opposite to the general population where men are more at risk
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What happened?
Mental health problems and suicidality highest in autistic women, could camouflaging and late diagnosis help explain this
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What can lack of social support in ASD increase?
Depression and in turn suicidal ideation
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What are feelings of loneliness increase?
Depression and thoughts of self harm
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What is autism associated with?
depression and suicidality through perceived burdensomeness and thwarted belongingness
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What are perceived burdensomness?
I am a burden Autistic traits predict PB caregiver burden, unemployment, physical and mental illness, poor self esteem, agitation
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What is thwarted belonging?
I am alone Increased risk of social isolation, loneliness, difficulties establishing, reciprocal relationships
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What is between thwarted belonging and perceived burdensomeness?
Weakening of association between PB and TB and suicidal behaviour due to autistic traits, lethal suicide attempts
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What is the last circle?
Capability for suicide
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What is crucial to effectively diagnosing depression in ASD?
Cognitive (Interpreation of questions) Behavioural (similarity in signs and symptoms - diagnostic overshadowing
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What is alexythymia?
Difficulty verbalising internal thoughts and feelings prevalent in autism (Bird et al, 2010)
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What is theory of mind?
Difficulty putting yourself in another's shoes
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What is literal interpretation?
Of language, taking things at face value, difficulty reading between the lines
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What is reduced flexibility in thinking?
Sticking on one train of thought, difficult to consider other alternatives, executive function
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What is the DSM criteria for depression?
Depressed mood, loss of interest or pleasure, change in weight or appetite, insomnia, psychomotor retardation, loss of energy, worthlessness, indecisiveness, thoughts of death
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What is the symptoms of autism?
- Social withdrawal - Difficulties with sleep - Flat affect - Reduced eye contact - Overlap with presentation of depression – leads to diagnostic overshadowing - Lack of autism specific items
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What are high quality studies assessing measurement properties?
Structural validity and internal consistency, hypothesis testing, criterion validity, content validity, reliability
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What are the depression tools in ASD?
Systematic review assessed quality of previous studies using research tools, only 1 low quality study assessing BDI- II in autistic adults, weak evidence compared to general population
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What is the depression measurement in autism?
Study assessed measurement properties of BDI-II in verbal adults with autism, mild moderate correlations with other measures, and clinical diagnosis of depression, many properties not assessed.
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What is content validity?
Need to ensure questins are relevant and understandable, taking into account cognitive characteristics of autism
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What is needed to include?
Autism specific items which capture unique presentation of depression in autism
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For example?
Loss of interest in a previously intense interest, change in eating, sleep, movement, include Qs on sensory sensitivity and camouflaging
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What is hypothesis testing?
- Check that autistic people with depression score higher than autistic people without depression - Compare structural validity and internal consistency of original to adapted measures
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What is criterion validity?
- Tricky – what is the ‘gold standard’ to compare? - Could compare performance of original and adapted tools against clinical assessment
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What is anxiety?
- Anxiety and worry are 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 disturbance
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What is sensory difficulties a core feature of?
Autism and associated with RRBs and anxiety
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What is repetitive behaviours?
also a core feature = insistence on sameness and repetitive motor movements - “What time is it?” – anecdotally, these behaviours associated with anxiety in autism - “Intolerance of uncertainty”
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Are these related?
Social anxiety
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In general population what is this a fear of?
Negative evaluation
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In autism what is there a fear of?
Violation of logical rules or unpredictability of social situations, need to reconceptualise anxiety for this group and in assessments
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What scale is for children with autism?
Revised child anxiety and depression scale
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What does literature search for?
Identified additional autism specific areas to include in the measure (sensory anxiety, intolerance of uncertainty and phobias)
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What do focus groups with parents do?
Refine content validity
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What is there an overlap in?
Symptoms between BPD and autism: social difficulties, emotion regulation difficulties, frequent suicidal gestures
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What can appear to have?
Very unstable and chaotic lifestyle, frequent changes or inappropriate friendships
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What is camoflauging in autism?
Present as a problem with identity
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What is more diagnosed in females?
BPD
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What is it like in autistic females?
High prevalence of suicidality/self injury
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What can it lead to?
- Could potentially lead to misdiagnosis of autistic females as BPD or miss co-occurring conditions
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What is autism diagnosis as?
Over represented in BPD population
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15% of BPD paitents met criteria for what?
Co-occuring autism assessed with clinical interviews, patients with ASd and BPD were at significantly higher risk of suicide attemps than BPD only
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What is there significantly lower what/
More negative self image
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What are mental health problems?
The most common area of first concern prior to adults obtaining an autism diagnostic
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Many psychiatrists are not what?
Trained in autism or developmental conditions
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WHat does this lead to?
Autistic adults slipping through the net
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What did the participatory research project show?
young autistic adults have difficulty obtaining a mental health problems
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What are the difficulties of?
Evaluating their mental health
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What is reported?
High levels of stigma
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What is often face severe obstatcles of?
When trying to access mental health support, lack of tailored support staff trained in aSD
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What treatment is there?
- Cognitive behavioural therapy requires high degree of emotional literacy – an area autistic people find difficult (see emotional development lecture) - Alexythymia – may need training in emotional literacy first
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What is the implications for treatment?
High sensory sensitivity, and rigidity associated with anxiety in autism, makes it difficult to treat, autistic adults can benefit from psychological therapy to treat mental health difficulties such as anxiety but it takes much longer
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What is the use of virtual reality to treat anxiety in ASD?
• Individualised VR environment gradually exposed 9 autistic children to specific phobias (e.g. pigeons, crowded buses) • After study 8/9 children were able to tackle their phobia situation
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Card 2

Front

What are societal problems of mental health?

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Attitudes, stigma, policy - service provision, poverty

Card 3

Front

What are the biological causes of mental health?

Back

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Card 4

Front

What are psychological causes of mental health?

Back

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Card 5

Front

What are co-occuring conditions?

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