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Mental Health Flashcards

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1
Q

what are the criteria for a mental health problem to be diagnosed?

A
  • needs to be causing significant distress
  • meet set criteria in DSM-V
  • clinical judegement
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2
Q

why can mental health difficulties be hard to diagnose in autistic people?

A
  • 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
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3
Q

where were mental health difficulties first described?

A

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

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4
Q

prevalence of a mental health problem in UK population?

A

23%, depression being the most common

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5
Q

prevalence for a psychiatric condition in autistic adults

A
  • 79%, with depression most common
  • Depression/anxiety present in 30 – 50% of autistic adults
  • and 30% of children
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6
Q

what are the risk/protective factors for mental health difficulties to arise?

A

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

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7
Q

what are the levels of intervention

A

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

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8
Q

what difficult life experiences do autistic adults face?

A
  • Exclusion from education
  • Unemployment
  • Poverty
  • Abuse and exploitation
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9
Q

Psychological risk factor of thinking style

A
  • 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
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10
Q

what are the social difficulties experienced by autistic peopple?

A
  • 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
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10
Q

could experiences and thinking style common amongst autistic people increase risk of mental health difficulties in this group?

A
  • 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
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11
Q

what are the social challenges faced by autistic people?

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 is ‘Camouflaging’ or ‘masking’ autism to cope/fit in social situations?

A
  • 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
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12
Q

Camouflaging- “Putting on my best ‘normal’ Hull et al (2017)

A
  • 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.
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13
Q

Camouflaging Autistic Traits Questionnaire

A
  • 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
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14
Q

Camouflaging and mental health study, Hull et al (2021)

A
  • 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
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15
Q

Camouflaging and suicidality, Cassidy et al (2018)

A
  • Survey co-designed with autistic adults with lived experience who described camouflaging as a key risk marker for their experience of suicidality
  • 164 autistic and 169 non-autistic adults completed an online survey.
    Predictors of lifetime suicidality:
  • Autism diagnosis (4.5%)
  • Autistic traits in the gen pop (3.2%)
    Autistic adults:
  • ‘Camouflaging’ (3.5%)
  • Unmet support needs (3.1%)
  • Non-Suicidal Self-Injury (4%)
15
Q

Camouflaging and Mental Health, Cassidy et al (2020)

A
  • 160 undergraduate students (86.9% female)
  • High autistic traits associated with camouflaging, thwarted belonging and suicidality
16
Q

DEP model , Camouflaging and Mental Health

A
  • autistic people may be aware that they tend to be seen unfavourably by the neurotypical majority
  • so respond by camougflaging in an attempt to fit in
  • but may experience feelings of not being accepted for their true self
  • leading to feelings of thwarted belonging, increasing risk of mental health problems and suicidality.
  • The double empathy problem could increase risk of experiencing known risk factors for mental health problems, thereby increasing risk of suicidality.
  • The model predicts that social motivation may effect whether one engages in camouflaging, and insight into one’s own difficulties, also affect whether a person feels that they are not accepted despite their best efforts to camouflage their autistic characteristics.
16
Q

inconsistent findings of Camouflaging and mental health

A
  • Camouflaging no significant finding for depression (Cage et al. 2019)
  • Camouflaging linked depression (only in men, not women) (Lai et al. 2017)
  • Camouflaging no assoication anxiety (Lai et al. 2017; Cage et al. 2018)
  • Possibly due to small sample – not able to detect smaller effect size
17
Q

critical analysis of the studies

A
  • Autistic adults without co-occurring intellectual disability
  • Large proportion of females, where most autistic people diagnosed are male
  • Large proportion late diagnosed in adulthood (approx. 34 years in Cassidy et al. 2018)
  • Self-report measures - results need confirmation using other methods
  • Opportunity samples, self-selecting
18
Q

social and non-social difficulties studies

A
  • South et al (2020): 74 women with high autistic traits and social difficulties.
  • Difficulties in imagination and repetitive behaviours suicidality
  • Suggests feeling sad, stuck and difficulty in imagining alternative strategies increases risk of suicidal thoughts
  • Resonates with models of suicidality (O’Connor & Kirtley, 2018; Cassidy et al. 2020
19
Q

Social problem solving and depression, Jackson et al., (2016)

A
  • explored the associations between autistic traits, social problem solving skills and depression, where self-reported autistic traits were associated with depression, which was significantly mediated by problem solving skills
  • illustrated how there are increased social demands and expectations, autistic traits can lead to increased social struggles, with consequences in which could increase risk of depression, particularly if there are difficulties in social problem solving which could help to overcome some of these difficulties.
20
Q

What makes a good assessment tool for mental health?

A
  • Structural validity and Internal consistency “Do the items measure the same latent construct?”
  • Hypothesis testing “Does the tool perform the way we expect it to?”
  • Criterion validity “Does the tool correlate with the gold standard assessment?”
  • Content validity “Are the questions relevant, understandable to the target group?”
  • Reliability “Do you get the same results from different assessors and/or at different times?”
21
Q

Diagnostic overshadowingBehavioural aspects of Autism

A
  • overlap with presentation of depression- leads to diagnostic overshadowing
  • for example depressed mood in DSM-V criteria for depression could look like social withdrawal, reduced eye contact which are normal symptoms for autism
  • Lack of autism specific items (Stewart et al. 2006)
  • could lead to over diagnosis or under diagnosis for depression
22
Q

structural validity of depression PHQ1 questionnaire

A
  • item could be different for different groups
  • e.g. PHQ1 is a depression self report tool, in general population all of the statements tap into one factor → depression
  • factors of PHQ1 for autistic people tap into 2 factors suggesting that depression looks different in autistic group
23
Q

Structural validity of measuring depression, Uljarević, M., (2018)

A
  • Same factor structure in autistic vs. typical controls and other studies of the HADS
  • Acceptable internal consistency for both subscales (anxiety and depression) in autism
24
Q

Hypothesis testing for depression (Uljarevic et al. 2019; Gotham, Unruh and Lord, 2015)

A

Mild-moderate correlations with other measures, and clinical diagnosis of depression

25
Q

what are the Cognitive Aspects of Autism?

A
  • Alexythymia: difficulty verbalising internal thoughts and feelings prevalent in autism (Bird et al. 2010)
  • Theory of Mind: difficulty putting yourself in another’s shoes (Baron-Cohen et al. 1985)
  • Literal Interpretation: of language, taking things at face value, difficulty ‘reading between the lines’ (Happe, 1995)
  • Reduced flexibility in thinking: Sticking on one train of thought, difficult to consider other alternatives – Executive Function (Ozonoff, 1997)
26
Q

Thinking style and Content Validity for autistic people

A
  • Need to ensure questions are relevant and understandable
  • “feeling down” → Alexythymia, dont know how they feel on a regular day so can’t answer
  • “feeling down” → Literal interpretation, down is a direction so autistic people struggle to understand the metaphor
27
Q

Adapting depression tools for autistic people

A
  • Include autism specific items to capture unique presentation of depression in autism (Cassidy et al. 2018; Stewart et al. 2006) for example Loss of interest in a previously intense interest and Change in: eating, sleep, movement
    Include Q’s on: sensory sensitivity, camouflaging?
  • Associated with depression in ASD (Hull et al. 2017; Serifani et al. 2017; Bitsika, Sharpley and Mills, 2016)
  • BUT sensory hypo-sensitivity and depression look similar
28
Q

what is anxiety and worry associated with?

A

three or more of the following six symptoms (with some present for most days over 6 months)
- Restlessness or feeling on edge
- Easily fatigued, difficulties concentrating
- Irritability
- Muscle tension
- Sleep disturbance

29
Q

Anxiety in Autism, south et al., (2017)

A
  • Part of initial clinical reports – insistence on sameness, rituals
  • Associated with intolerance of uncertainty, RRBs and sensory processing (see sensorimotor lecture; Wigham et al. 2015)
  • These could affect the presentation of anxiety in autism, and must be taken into account in assessment
30
Q

Wigham et al (2015) anxiety in autism

A
  • relationships between sensory under responsiveness and links with reppetitive motor behaviours, sameness repetitive behaviours
  • sensory overresponsivess was associated with restricted repettive behvaiours, intolerance of uncertainity and anxiety
31
Q

Structural validity, Uljarević et al., (2018)

A
  • Same factor structure in autistic vs. typical controls and other studies of the HADS
  • Acceptable internal consistency for both subscales (anxiety and depression) in autism
31
Q

social anxiety in autism

A

fear of violation of logical rules or unpredictability of social situations (Kerns et al., 2014; Zainal et al., 2014)

32
Q

Anxiety Autism Assessment, Rodgers et al., (2016)

A
  • Revised Child Anxiety and Depression Scale (RCADS) adapted for children with autism (ASC-ASD)
  • Literature search identified additional autism specific areas to include in the measure (sensory anxiety, intolerance of uncertainty, and phobias)
  • Focus groups with parents to refine content validity
  • Survey established factor structure
33
Q

Gaps in support/treatment

A

Participatory research project showed autistic young people have difficulty obtaining a mental health diagnosis and appropriate treatment (Crane et al. 2019)
- Difficulties evaluating their mental health (Alexythymia)
- Report high levels of stigma
- Often face severe obstacles when trying to access mental health support

Participatory research project showed autistic adults have difficulty obtaining treatment and support for mental health problems (Camm-Crosbie et al. 2018)

34
Q

Implications for treatment

A
  • Presentation of autism can
    affect ability to
    engage with traditional
    treatments
  • Cognitive behavioural therapy
    requires high degree of emotional literacy – an area autistic people find difficult (Camm-Crosbie et al. 2018)
  • Alexythymia – may need training in emotional literacy first
  • High sensory sensitivity, and rigidity associated with anxiety in autism
  • DEP – could take time to establish rapport and therapeutic relationship between autistic and non-autistic people
  • Autistic adults can benefit from psychological therapy to treat mental health difficulties such as anxiety, but it takes much longer
35
Q
A

Developmental Psychology (10 decks)

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