Autism in Young People: Mental Health and Identity

Autism in Young People: Mental Health and Identity

• The lecture aims to cover; understanding the characteristics and needs of girls and women on the autism spectrum

Kanner (1943)

• Kanner noted children with markedly different conditions meriting detailed consideration due to their fascinating peculiarities
• Key characteristics included; inborn autistic disturbances of affective contact and a powerful desire for sameness

Autism in the 20th Century View

• Autism was considered a rare and severe neurodevelopmental disorder
• Autism mainly affects males and is usually associated with intellectual disability and delayed language development
• Autism was seen as categorically distinct from normal development and other disorders

The New Consensus of Autism

• Autism is now understood as a relatively common neurodevelopmental condition often associated with a normal-range IQ
• Autism represents a form of natural human variation, bringing both strengths and challenges

Autism Myths

• Myth 1: Autism is rare as current diagnostic conventions indicates autism occurs in 1-2% of children and adults

• Myth 2 assumes most people with autism have intellectual disability however, 50-70% have an IQ in the normal range and fluent language

• Myth 3 claims autism is just about having difficulties, autism involves both difficulties and strengths

• Myth 4 describes autism as a categorical disorder as opposed to seeing Autism as involving a dimensional syndrome model

Class Prep: Sex/Gender Differences and Autism

• The review examines the relationship between sex/gender differences and autism and proposes a 4-level conceptual framework to clarify the complex findings
• The methodology involved a literature review of 329 articles from PubMed and additional sources
• Search terms used were: "'sex OR gender OR females' AND autism"

Conceptual Framework

• The framework addresses distinct but interlinked questions regarding autism and sex/gender, structured into four levels

Nosological and Diagnostic Challenges

• Addresses the question of how autism should be defined and diagnosed in males and females
• Focuses on issues in autism definition and diagnosis across sexes/genders

Sex/Gender-Independent and Sex/Gender-Dependent Characteristics

• Addresses the similarities and differences between males and females with autism
• Examines autism characteristics that may/may not differ between sexes/genders

General Models of Etiology: Liability and Threshold

• Addresses how the liability for developing autism is linked to sex/gender
• Explores how sex/gender relates to autism susceptibility

Specific Etiological-Developmental Mechanisms

• Addresses what etiological-developmental mechanisms of autism are implicated by sex/gender and/or sexual/gender differentiation
• Investigates specific mechanisms in autism development related to sex/gender

Implications of Framework

• Helps summarize findings more clearly
• Enables better understanding of links between findings from different levels
• Guides future research directions, methodology, and specific topics in sex/gender differences and autism

Conclusion

• The conceptual framework provides a structured approach to understanding the complex relationship between sex/gender differences and autism
• A foundation for future research in this area is offered

Social Camouflaging in Adults with Autism Spectrum Conditions

• Qualitative study examines camouflaging in adults with ASC, involving masking/compensating for autistic traits to fit in/connect with others, exploring the nature, motivations, and consequences of camouflaging

Key Findings

Motivations for Camouflaging

• Fitting in: A desire to appear socially acceptable and avoid rejection
• Increasing connections: Building relationships and navigating social spaces more effectively

Camouflaging Techniques

• Masking: Hiding autistic traits by mimicking neurotypical behaviors like maintaining eye contact, using appropriate facial expressions, mirroring body language
• Compensation: Developing strategies to overcome social challenges, such as rehearsing conversations or using scripts

Consequences of Camouflaging

• Short-term impacts: Access to social opportunities
• Long-term impacts: Protection from bullying or harm, exhaustion, mental health issues, threats to self-perception, delayed diagnosis

Three-Stage Model of Camouflaging

• Motivations: Societal pressure, desire for acceptance as reason behind why individuals camouflage
• Techniques: Masking and compensatory strategies through which individuals camouflage
• Consequences: Effects of camouflaging on mental health, identity, and quality of life

Implications

• Camouflaging is a complex coping strategy with short-term benefits, but can lead to significant long-term challenges
• Highlights a need for greater societal awareness and acceptance of autism to reduce the pressure to camouflage
• Early recognition/support may mitigate the negative impacts on mental health and improve outcomes for autistic individuals

Future Directions

• Suggests further research into; the gendered experiences of camouflaging with women more likely to camouflage extensively
• Support for autistic individuals in reducing the need for, and strategies for promoting, societal acceptance, to improve mental health outcomes are also a key area

Autism Spectrum Disorder - An Evolving Construct

• The study provides critical insights into the lived experiences of autistic adults and underscores the importance of addressing the societal factors driving camouflaging behaviors

Characteristics of ASD

• Neurodevelopmental condition affecting social relationships and communication and also involves inflexibility and atypical sensory processing

Gender Differences in ASD

• Females with ASD have a higher risk of internalizing problems and eating disorders compared to males
• Lower risk of conduct problems than males with ASD
• More likely to go undiagnosed or be diagnosed later than males

Masking Behaviors

• Many individuals with ASD attempt to mask autistic traits in social situations
• Females with ASD are more likely to engage in masking behaviors

Clinical Considerations

• Clinicians should be aware that ASD in girls may be less obvious or overlooked
• When assessing girls for ASD; presence of social motivation should not rule out ASD and having established friendships does not automatically exclude an ASD diagnosis

Implications

Increased awareness of gender differences in ASD presentation is needed

• The importance of considering masking behaviors in diagnosis, especially for females
• Potential for underdiagnosis of ASD in females due to different manifestations of symptoms

Six Ideas About How to Address the Autism Mental Health Crisis

• Early Intervention: Emphasizing early identification and support for mental health issues in autistic individuals
• Research and Evidence-Based Practices: Promoting more research into effective mental health interventions for autistic people

Points on Autistic Terminology

• The majority of the autism community= identity first language
• Person first language = Adult/Child with Autism/ Identity first language = Autistic adult/child

Diagnosis

• NICE Guidelines for Diagnosing Under 19s as of June 2021 include detailed information about concerns and interview/assessment with parent/carer
• Later experiences include; experience fo the ypunger person, developmental history, aassessment to check

Prevalence

• Systematic review found global prevalence is increasing at 1/100
• Increase in community awareness, public health response, case identification and community capacity all contribute to increased diagnosis

Diagnosis and Mental Health Problems

• The later the diagnosis has greater likelihood of comorbid mental health problems
• Mental health and social difficulties are also associated with difficulties that arise prior to autism diagnosis

Camouflage and Mental Health

• Camouflaging can result in later diagnosis and potentially poorer MH outcomes

• Camouflaging in adults is related to higher suicidality, generalised anxiety, depression and social anxiety

• *Key note: the relationship between camouflaging and depression and axiety is unproven and may need further testing.

Mental Health - Prevalence

• Increased incidence of psychiatric engagement and hospitalisation for mental health and suicidality and self harm noted particularly in girls
• The number of autistic children seeking support for mental health is increasing over time

Comorbidities

• ADHD is seen in around 28% of autistic population compared to 7.2% in general population
• Anxiety seen in 20% autistic population compared to 7.3% in general population
• Depression seen in 11% autistic population compared to 4.7% in general population
• Bipolar/Related Disorders seen in 5% autistic population compared to 0.71% /0.5 for Bipolar In general population
• BIMS - Burnout, Inertia, Meltdowns, Shutdowns

Eating Disorders

• High rates of eating disorders in autistic children and young person seen
• Possible difference between neurotypical and autistic

ARFID: Common in autistic children and young people

• Characterised by a severely restricted diet in both variety and volume Manifested by persistent failure to meet appropriate nutritional and/or energy needs
• Rigidity of routines → e.g. can't eat if they miss their time to eat

Pathological Demand Avoidance

• Options include; extreme demand avoidance, pervasive desire for autonomy, and demand avoidance phenomena

Gender Identity/Gender Dysphoria

• Higher rates of autistic children, with general feeling of not belonging and social difficulties
• 11% of those with Gender dysphoria were autistic

NICE Guidelines for Intervention

Support and management include; full access to health and social care services, training staff and reasonable communication

• Support and management of comorbidities includes; Emotion and visual recognition
• Adapted Behaviour that challenges includes Holistic Assessment, psychosocial intervetnio, pharmacological intervention and family assessment

Interventions for Autism that Should Not be Used

• Neurofeedback to manage speech/language problems, auditory integration training to manage speech/language problems in autism
• Omega-3 fatty acids to manage sleep problems
• Secretein and Chelation and Hyperbaric oxygen therapy are also not recommended