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Developmental > Mental Health > Flashcards

Mental Health Flashcards

1
Q

For mental health to be diagnosed:
It needs to be causing distress
Meet set criteria in DSM-V
Clinical judgment

A

Certain diagnoses can be made due to bias

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2
Q

Why may it be hard to diagnose a mental health disorder in autistic people?

A

Due to an overlap of symptoms, it can be hard to distinguish one disorder from another

Many clinicians are not trained/ experienced in autism,
leading to higher rates of common misdiagnoses

Mental health difficulties can be dismissed as an inevitable part of being autistic.

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2
Q

Mental health difficulties were first described in Kanner’s first clinical reports describing autism in the 1940’s, including fear and anxiety around objects and events, and depression was also noted.
One particular example is “insistence on sameness” which is part of the current diagnostic criteria. Explain this:

A

Fear and anxiety around objects and events
Depression also noted

“Insistence on Sameness” part of current diagnostic criteria

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3
Q

Name a key component of anxiety in people who are autistic and who also have mental health issues:

A

“Intolerance of uncertainty” – key component of anxiety

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3
Q

Prevalence of mental health in autistic people:

There is consistent evidence of increased prevalence of mental health difficulties in autistic people. 79% Of autistic adults meet criteria for a psychiatric condition at some point, with which mental health disorder being most common?

A

Depression most common

Then anxiety

present in 30 – 50% of autistic adults
and 30% of children

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4
Q

What are Risk/ Protective environmental factors of one having a mental health disorder?

A

Stress
Bereavement
Finances
Bullying
Unemployment

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4
Q

What are Risk/ Protective biological factors of one having a mental health disorder?

A

Genetic predisposition (family history) of mental health disorder
Brain structure and function

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5
Q

What are Risk/ Protective societal factors of one having a mental health disorder?

A

Attitudes (negative)
Stigma
Policy – service provision (long waiting list to access mental health)
Poverty - could be solved with the right policy

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5
Q

What are Risk/ Protective psychological factors of one having a mental health disorder?

A

Thinking style
Coping strategies

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6
Q

What affects the likelyhood of psychological, environmental and societal risk factors of generating mental health issues?

A

Autism

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7
Q

Levels of intervention: for mental health on autism:

How could government policy try and address societal risk factors?

A

IAPT (improving access to psychological therapies)
developed by gov to allow people to self-refer for psychological therapies

The “Think Autism” strategy:
recognizes gaps in support for autistic people
provide services with recommendations/ targets to meet
such as improving access to support, providing training to service providers in autism

Public health England’s awareness campaigns
use crease knowledge and public perceptions of autism.

Psychological level:
Psychological therapies CBT
used to address unhelpful thinking styles,
provide coping strategies to deal with unhelpful thoughts/ difficult situations

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7
Q

Which environmental risk factor might autistic people experience for mental health problems?

A

Difficult life experiences:
Questionnaire found

Autistic adults significantly more likely to report difficult life experiences than non-autistic adults

Exclusion from education
Unemployment
Poverty
Abuse and exploitation

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8
Q

Which psychological risk factor might autistic people experience for mental health problems?

A

Black and White or concrete thinking and difficulties in cognitive flexibility
May lead to:

Difficult to think of alternatives
Difficult to problem solve
Difficult to switch from one train of thought to another

Protective factors – finding solutions/way out of a difficult mood/ circumstance

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8
Q

What are the social difficulties that autistic people might experience for mental health problems?

A

Find it difficult to interact with non-autistic people

This may lead to:
Increased Loneliness
Lack of social support
Exclusion from social spaces not designed for/accepting of autistic people

Protective factors - Lack of acceptance, feeling rejected,
low self-esteem

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8
Q

Social challenges for autistic people:
Autistic people tend to be perceived negatively by non-autistic people what does this relate to?
What is the name of this problem?

A

Autistic people may be less readable by non-autistic people which may lead to being perceived negatively
‘Double Empathy Problem’

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9
Q

Autistic people have difficulty interacting with the neurotypical majority- is this a social or or environmental challenge for autistic people?

A

Social

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9
Q

Name some social challenges for autistic people:

A

Find it difficult to interact with non-autistic people

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

Argued to contribute to under / misdiagnosis, particularly of autistic women (seen as A only to men)
Takes a toll on mental health
Loss of identity
Exhausting
Lack of acceptance
But helps to fit into NT society

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10
Q

One qualitative study with autistic adults described camouflaging as “putting on my best normal”.

Research identified three main components of camouflaging:

A

Motivations of camouflaging:

Masking:
-avoid being too autistic
-play the appropriate role (do not stand out)

Assimilation:
-to be safe
-appear normal enough

Compensation (autism specific difficulties)
-every conversation plotted out
-learning the right facial expressions

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10
Q

What can be a consequence of camouflaging
(Masking, Assimilation, Compensation)? CAT-Q’s

A

Anxiety at being found out that they are autistic
for camouflaging too well.
Exhaustion/ feeling like they were not being true to themselves.

NOTE: these traits overlap across the autistic and non-autistic general population, everyone reports these traits but this is higher in autistic individuals

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10
Q

Camouflaging Autistic Traits Questionnaire:
I monitor my body language or facial expressions so that I appear relaxed is an example of which type of Camouflage?

A

Masking - (strategies used to present a non-autistic or less autistic persona to others)

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11
Q

Camouflaging Autistic Traits Questionnaire:
In social situations, I feel like I’m “performing” rather than being myself (can also be reversed) is an example of which type of Camouflage?

A

Assimilation - (strategies used to fit in to uncomfortable social situations)

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11
Q

Camouflaging Autistic Traits Questionnaire:
When I am interacting with someone, I deliberately copy their body language or facial expressions is an example of which type of Camouflage?

A

Compensation - (strategies used to compensate for social and communication difficulties)

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11
Q

Camouflaging and mental health:

305 autistic adults (18-75 years): questionnaire camouflaging scores predicted highly for which 2 mental health disorders?

A

Depression, and generalized social anxiety.

Association strongest for anxiety
Camouflaging is present in both genders and impacts mental health!

12
Q

Camouflaging and suicidality:

Online survey co-designed with autistic adults with lived experience who described camouflaging as a key risk marker for their experience of suicidality found what when compared with non-autistic adults?

A

Found Camoflaging acts as a Significance predictor of suicidal behaviour above other life, mental health and environmental stressors

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%)

12
Q

Which model describes autistic people feeling a loss of belongingness and a lack of meaningful social connections that can increase the risk of experiencing suicidal thoughts?

A

The interpersonal psychological theory of suicide

13
Q

Autistic people and those with high autistic traits experience external indicators of?

A

Thwarted belongingness

-eg. being misunderstood, excluded, and experiencing social difficulties particularly with non-autistic people.

13
Q

Few studies show that autistic traits are associated with which 2 things?

A

Suicidality, through thwarted belongingness.

13
Q

What is the Double Empathy Problem (model)?

A

Wider society is built in a neurotypical way creating a general gap from how autistic people do not think/ behave in the NT way

-autistic people may be aware that they tend to be seen unfavourably by the neurotypical majority
-this may lead to pressure which induces social camouflaging to fit in

-may experience feelings of not being accepted for their true self, leading to feelings of thwarted belonging, increasing risk of mental health problems

Double empathy problem could increase risk of experiencing known risk factors for mental health problems, thereby increasing risk of suicidality.

14
Q

In research, why might there be inconsistencies with findings that camouflaging does not lead to anxiety/depression?

A

Due to the small ass sample sizes used they not able to detect smaller effect size

15
Q

What are criticisms of camouflaging?

A

-Not well-defined items in questionnaires overlap with ones that measure anxiety

-Unique to autism, or present in everyone and other conditions such as general anxiety disorder

-Gender differences? Need to include non-binary participants in sufficient numbers to allow analyses

-most Large proportion of females, where most autistic people diagnosed are male

-large proportion LATE diagnosed in adulthood

16
Q

Non-social difficulties:
Difficulties thinking of alternatives
Problem solving difficulties
Increase risk of mental health problems

South et al (2020): found what symptom is associated with suicidality in women?

A

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

A problem for undiagnosed autistic people

16
Q

Self-reported autistic traits :
If people report lower social problem-solving skills and higher autistic traits they were more likely to experience?

A

Current depression

-current self-reported depression, significantly mediated by difficulties in social problem-solving skills

17
Q

Info slide:

A

Camouflaging challenges theories which view autism as an extreme case of diminished social motivation, or see autistic people as lacking insight into their own difficulties
Part of preventing/treating mental health problems in autistic people will involve changing societies views of autistic people and tackling stigma
Also helping autistic people with low self-esteem, social problem solving skills, other protective factors

17
Q

What is needed in order to diagnose MAJOR Depressive Disorder on the DSM Criteria for Autistic people?

A
17
Q

What are challenges for measurment when diagnosing mental health disorders in autistic people?

A

Behavioural (similarity in signs and symptoms – diagnostic overshadowing)
Cognitive (interpretation of questions)

18
Q

What makes a good assesment tool?

A

High-quality studies assessing measurement properties:

Structural validity and Internal consistency “Do the items measure the same latent construct?” (most important)

Hypothesis testing “Does the tool perform the way we expect it to?”
Group differences (depressed vs. non-depressed)
(Mild-moderate correlations with other measures, and clinical diagnosis of depression)

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?”

18
Q

Diagnostic criteria can overshadow Behavioural aspects of Autism:

A

Overlap with presentation of depression
– leads to diagnostic overshadowing
Over-estimate (overlapping behaviours)
Under-estimate (fail to capture autism specific factors)
Lack of autism-specific items

18
Q

What is needed in order to diagnose PERSISTANT Depressive Disorder on the DSM Criteria for Autistic people?

A
19
Q

Adapting depression tools for autistic people:

Researchers argue that we need to include autism specific items to capture unique presentation of depression in autism

A

Include Loss of interest in a previously intense interest
Change in: eating, sleep, movement
Include Q’s on: sensory sensitivity, camouflaging?

eg. one’s ability to camouflage was increasingly worse when experiencing time of depression, may be more sensitive to environment

19
Q

Cognitive aspects of autism:
Literal Interpretation of language is also known as?

A

Taking things at face value

19
Q

Cognitive aspects of autism:
What is Alexithymia?

A

Difficulty verbalising internal thoughts and feelings prevalent in autism

19
Q

The structural validity of a questionnaire must make sure all the questions measure a factor of the mental health disorder (Depression). What is different about the way it must be measured for autistic people?

A

It measures 2 criteria:

Cognitive Affectiveness
eg. littile interest in doing things

Somatic
eg. appetite problems over or undereating

19
Q

Cognitive aspects of autism:
Which theory can be known as difficulty putting yourself in another’s shoes?

A

Theory of Mind

19
Q

The thinking style and content validity of questionnaires for autistic people:

Need to ensure questions are relevant and understandable

“Feeling down ….” Alexythymia
“Feeling down …” Literal interpretation

A

“FEELING down ….” Alexythymia
Difficulty verbalising internal thoughts

“Feeling DOWN …” Literal interpretation
Taking things at face value

20
Q

Cognitive aspects of autism:
Sticking on one train of thought, difficult to consider other alternatives is known as?

A

Reduced flexibility in thinking

20
Q

Anxiety in autism is associated with which 2 things?

A

Intolerance of uncertainty, RRBs and sensory processing

These could affect the presentation of anxiety in autism, and must be taken into account in assessment

20
Q

Wigham et al (2015) developed a model of anxiety in autism.
What did they find?

A

Found relationships between sensory over-responsiveness
(hypersensitivity to environment)
was associated with repetitive motor behaviors, feelings of uncertainty

21
Q

Anxiety:
Anxiety and worry are associated with three or more of which of following six symptoms (with some present for most days over 6 months)?

A

Restlessness or feeling on edge
Easily fatigued, difficulties concentrating
Irritability
Muscle tension
Sleep disturbance

21
Q

Which anxiety disorder is fear of negative evaluation for normal people, but for autistic people, it is fear of violation of logical rules or unpredictability of social situations?

A

Social Anxiety

21
Q

Gaps in support/ treatment:

Participatory research project showed autistic young people have difficulty obtaining a mental health diagnosis and appropriate treatment.

What do they most likely report?

A

Difficulties evaluating their mental health (Alexythymia)
Report high levels of stigma
Often face severe obstacles when trying to access mental health support
Also showed that autistic adults have difficulty obtaining treatment and support for mental health problems (adapting CBT)

21
Q

What is the main problem for administrating mental health questionnaires to autistic people?

A

Most items are not autism-specific which leads to a lack of understanding of the question.

21
Q

What are implications for treatment?

A

Presentation of autism can affect ability to engage with traditional
treatments so we need to Adapt CBT

-DEP take time to establish rapport and therapeutic relationship between autistic and non-autistic people
-requires high degree of emotional literacy
-an area autistic people find difficult
Alexythymia – may need training in emotional literacy first

Autistic adults can benefit from psychological therapy to treat mental health difficulties such as anxiety,
however it takes much longer

21
Q

Virtual reality to treat anxiety in Autism:
Individualised VR environment gradually exposed 9 autistic
children to specific phobias (e.g. pigeons, crowded buses) Individualized.
Found?

A

After study 8/9 children were able to tackle their phobia situation

21
Q

Do not assume that mental health problems are part of autism as:

A

Needs diagnosis and treatment in its own right

21
Q

Do not assume that it is not possible to treat mental health conditions in autism:

A

It is possible, but may need adaption and could take longer than usual
Difficult to do if there is fixed option and number of sessions (6 sessions of CBT)

Developmental (10 decks)

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