For a couple of years now I have been grappling with the topic of mental illness and autism, both personally and now professionally in my research. So when the National Autism Society announced a conference on Mental Health and Autism I, very cautiously and with great planning, jumped at the chance to go, dragging my partner up to Manchester with me for support.
Despite NHS cut backs and plans for the government to reduce the social support it gives to autistic individuals and their families, there is still an encouraging number of professionals fighting for better mental health support and awareness for those with autism spectrum disorders. I should begin by saying how thoughtfully NAS sets up its conferences, and was particularly impressed with the quiet room intended for those actually on the spectrum themselves. It proved a fantastic spot to take breaks! I was also impressed by the number of clinical psychologists and team leaders in attendance, it was extremely positive to see professionals going that extra mile for a small number of the individuals they must work with on a daily basis. It was, however, noted by all the lack of psychiatrists present, a group which I believe would have benefited most from learning more and developing their understanding of this dual diagnosis. Clearly there are still bridges to be made within the mental health services, but hopefully the message will eventually get through, one Psychiatrist at a time. I will attempt to summarise the main and most interesting points here, but obviously will have to miss quite a lot of stuff out; there will be links at the bottom for more information.
The conference was chaired by Dr Tom Berney, Consultant in Development Psychiatrist. Dr Berney’s current focus is increasing adult mental health services expertise in autism. Initial speaker, Consultant Psychiatrist and Clinical Director Dr Juli Crocombe, spoke about the differential diagnosis of ASD and mental health and why it is important. The take home message was that autism spectrum conditions (ASC) are not a mental illness and that psychotropic medications can only help coexisting mental health problems and not autism itself. A lot of emphasis was placed on psychiatrists making the right diagnoses, not assuming features of autism were down to a mental illness and not assuming features of a mental illness were just down to autism. There are significant difficulties assessing individuals with autism due to problems reporting symptoms and communication problems which can lead to misinterpretation. For example Dr Crocombe explained how conspiracy theories and speaking to oneself are a common feature for those on the spectrum and shouldn’t be put down to a psychotic or delusional disorder.
Clinical Professor of Psychotherapy Digby Tantam spoke on a more specific issue, that of anxiety and the distinction between a disorder and just anxiety. Anxiety disorder is described as when arousal is discrepant of reality, it is the second most common co-morbid condition for those with an ASC. The disorder is thought to be so common is ASC because those with the condition are more susceptible to bullying and stressful life experiences. Biologically it is possible that those with ASC have more of a fear response and could be more susceptible to PTSD. Professor Tantam described how a lot of people with autism ruminate over past events more and often live in the past. Specific disorders like separation anxiety, social phobia and panic disorder are the most common anxiety conditions for those on the spectrum.
Next to speak was Associate Professor Tim Williams, Clinical and Educational Psychologist, who spoke on the comparison of autistic ritualistic behaviour and the repetitive behaviour seen in Obsessional Compulsive Disorder. This was a really interesting and lively talk. In many studies OCD is seen as one of the most common psychiatric disorders to coexist with autism, but a difference in distinguishing similar types of behaviour are often ignored. Associate Professor Williams described how he best way to distinguish OCD from ASD was to ask ‘is the repetitive action/activity causing you distress whilst you are doing it?’ those with ASD find these repetitive actions soothing whereas those with OCD are often filled with lots of horrible and compulsive thoughts alongside the behaviour. Treatment options were discussed, therapies like CBT were seen to work not very well for those with ASD and a different approach was necessary.
Bipolar disorder in young people with autism was closely examined by psychiatrist Dr Aditya Sharma. A worryingly common comorbid condition which has been a controversial topic for some time. Typically Bipolar is characterised by extreme highs and extreme lows, however those on the autism spectrum with the mood disorder more often than not experience mixed episodes of the two and are often missed. Significant autistic traits have been found in adolescents with Bipolar Disorder who do not have ASD. However, for those with autism it is hard to communicate mood so a possible diagnosis of Bipolar might be missed. A very careful approach should be made in medicating those with an ASD, most importantly the minimal dose should be used for the least amount of time.
All these talks were academically fascinating and enlightening but the most thought provoking was that by Callum McCrosson, an individual with autism and an Employment Support Worker for NAS. Callum was diagnosed at 23 after many years of incorrect therapy and drug treatments, never finding the right kind of support or support that fully understood his experience. This had massive implications on his family, work, education and social life. Since his diagnosis he has been sharing his story publicly, emphasising the importance of earlier diagnosis and more effective support.
Other talks were given on children and mental wellbeing, as well as depression and suicide risks and interventions. All these can be purchased from the National Autistic Society, and this blog post has really only touched on some of the important topics covered.
A quick stop off to Coronation Street before travelling home and I am putting together all this new information for my own research. I would love to hear of any of your experiences with mental health and autism.
You can read my earlier blog post on autism and therapy here.