Mental Health Flashcards
what are the criteria for a mental health problem to be diagnosed?
- needs to be causing significant distress
- meet set criteria in DSM-V
- clinical judegement
why can mental health difficulties be hard to diagnose in autistic people?
- many characteristics of autism overlap with characteristics of mental health problems and vice versa
- many clinicians not trained or experienced in autism so misdiagnosis and missed diagnosis is common
where were mental health difficulties first described?
Kanners clinical report in 1940s:
- fear and anxiety around objects and events
- depression also noted
- “Insistence on Sameness” part of current diagnostic criteria, and anxiety commonly seen
- “Intolerance of uncertainty” – - key component of anxiety
Recently been explored among other conditions to improve diagnosis and treatment
prevalence of a mental health problem in UK population?
23%, depression being the most common
prevalence for a psychiatric condition in autistic adults
- 79%, with depression most common
- Depression/anxiety present in 30 – 50% of autistic adults
- and 30% of children
what are the risk/protective factors for mental health difficulties to arise?
environment
- stress
- bereavement
- financies
- bullying
- unemployment
societal
- attitudes
- stigma
- policy - service
- poverty
Biological
- Genetic predisposition (family history)
- Brain structure and function
Psychological
- Thinking style
- Coping strategies
what are the levels of intervention
psychological intervention → psychological therapy
- CBT
Societal intervention → government policy
- IAPT (improving access to psychological therapies)
- “Think Autism” (recognizes gaps in support for autistic people, and provided services with recommendations and targets to meet)
- Awareness campaign
what difficult life experiences do autistic adults face?
- Exclusion from education
- Unemployment
- Poverty
- Abuse and exploitation
Psychological risk factor of thinking style
- Black and white / concrete thinking, difficulties in cognitive flexibility (DSM-V)
- Difficult to think of alternatives
- Difficult to problem solve
- Difficult to switch from one train of thought to another
what are the social difficulties experienced by autistic peopple?
- Autistic people experience difficulties particularly interacting with non-autistic people (double empathy problem) (Milton, 2012; Alkahaldi et al. 2019)
- Increased risk of:
Loneliness
Lack of social support
Exclusion from social spaces not designed for/accepting of autistic people - could lead to reduced protective factors such as protective factors - Lack of acceptance, feeling rejected, low self esteem
could experiences and thinking style common amongst autistic people increase risk of mental health difficulties in this group?
- Important to understand risk/protective factors
Are there unique risk/protective factors to autistic people? - Do mental health problems look different in autistic people
Do we need adapted assessments? - Do we need adapted interventions?
All levels, not just Psychological
what are the social challenges faced by autistic people?
- 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’
what is ‘Camouflaging’ or ‘masking’ autism to cope/fit in social situations?
- Argued to contribute to under / misdiagnosis, particularly of autistic women
- Takes a toll on mental health
- Loss of identity
- Exhausting
- Lack of acceptance
- But helps to fit in NT society
Camouflaging- “Putting on my best ‘normal’ Hull et al (2017)
- qualitative study with autistic adults described camouflaging as “putting on my best normal”.
- research identified three main components of camouflaging – assimilation, which was a motivation for camouflaging, in order to be functioning member of society, to be safe, and appear “normal enough”.
- Another was compensation, compensation for autism specific difficulties, such as learning the right kinds of facial expressions, and plotting out every conversation.
- and masking, which was trying to avoid being “too autistic” and playing the appropriate role to not stand out from the crowd.
- results in in anxiety at being found out, exhaustion, and feeling like they were not being true to themselves.
Camouflaging Autistic Traits Questionnaire
- CAT-Q captures camouflaging autistic traits in autistic and non-autistic people
- Research from the group also showed that similar to autistic traits, which are normally distributed in the general population, camouflaging autistic traits was also normally distributed in autistic and non-autistic people
- autistic traits, and camouflaging autistic traits tend to be higher in autistic compared to non-autistic people, but varying levels of these traits are present and normally distributed in both autistic and non-autistic people
Camouflaging and mental health study, Hull et al (2021)
- qualitative research
- 305 autistic adults (18-75 years)
- found higher camouflaging scores predicted higher depression, generalized and social anxiety
- Association strongest for anxiety
- Associations equally strong across genders