Mental Health Issues in children

1
Mental Health Issues in children adolescents
with Autism/ASDa challenge for clinical
practice and research

• Ann Le Couteur
• July 2007

2
Picture taken from Anti-psychotic drugs in
children with autism Susan Morgan and Eric
Taylor, BMJ, 2007.
3
Mental Health Issues in Autism/ASDWhat are
the key issues?

• Recognition Assessment
• Autism Spectrum Disorders
• Ongoing needs Co-morbidity
• Interventions
• Implications across lifespan
• Research priorities

4

• Reality to an autistic person is a confusing,
  interacting mass of events, people, places,
  sounds and sights. There seem to be no clear
  boundaries, order or meaning to anything. A large
  part of my life is spent just trying to work out
  the pattern behind everything.                   
                                  - A person with
  autism  

5
Autism Autism Spectrum Disorder (ASD)

• Autism/ASD lifelong severe neurodevelopmental
  disorder with a considerable functional and
  financial impact on the individual and family
• ASDs are unique in their pattern of deficits and
  areas of relative strengths

6
Drawings by Nadia, a 3-year-old with severe
autism
7

• Aspergers syndrome is not a life sentence. Its
  a blessing, not a curse Andrew Cowan (2005)
• I wanted to show that people like me can live a
  normal life and also that were not what people
  think Andrew Cowan (2005)

8
Stephen Wiltshire drawing from memory
Stephen spent 30 minutes taking in 360 degrees of
Tokyo skyline from the roof top of Roppongi Hills
(270 meters up). Over the next seven days he
drew, from memory, a remarkably accurate panorama
of the Tokyo skyline
9
(No Transcript)
10
Drawing by Gilles Trehin www.urville.com
11
(No Transcript)
12
Definition

• Neurodevelopmental Disorders
• Autism Spectrum Disorders
• Specific language impairment (SLI)
• Dyslexia
• Attention deficit hyperactivity disorder (ADHD)
• For all these disorders persistence into adult
  life involves a mixture of the expected
  unexpected and substantial challenges remain in
  the identification of key mediating variables
  Rutter 2006

13
Definition

• Neurodevelopmental Disorders
• Early onset lifelong disorders
• Delay/deviance in maturationally influenced
  psychological features
• General tendency for impairments to lessen with
  age
• Some degree of accompanying general or specific
  cognitive impairment

14
Definition

• Neurodevelopmental Disorders
• Substantial overlap between disorders
• Genetic liability
• Environmental influences
• Marked male preponderance

15

• (Ann Le Couteur, chair)
• Published National Autistic Society 2003
• www.nas.org.uk

16
APPGA Manifesto

• Goals to be achieved by 2013
• 4 general principles
• Training, Research, Service provision, Tracking
  and planning of services.
• 11 Specific Objectives
• Diagnosis and Family Support, Early Intervention,
  Medical care, Respite provision, Mental health,
  Leisure, Welfare support, Social support, FE/HE,
  Employment, Housing.

17
Ongoing needs

• ASD specific needs
• Social, communication RBs
• sensory / perceptual difficulties
• developmental needs
• Behavioural and mental health problems
• Other co-morbid difficulties
• Independence/ self help skills
• Other dental health needs

18
Behavioural and mental health assessment

• Behaviour temperament current mental state
• Differential diagnosis/ co-morbidities
• Limited evidence base for using currently
  available mental health diagnostic assessment
  tools
• Few instruments for use with individuals with
  autism/ASD

19
What are the problems through childhood ?

• Most children adolescents with ASD are educated
  in mainstream provision
• Enormous training needs for school personnel to
  develop monitor effective IEPs
• Socialization,
• Education
• Mental health needs
• Rates of suspension expulsion (education
  provision). SENDIST- rates of tribunals

20
(No Transcript)
21
Daslne database

• 566 children (age 3-13yrs) (June 2007)
• 26 families with more than one child with ASD
• Additional problems
• Dyspraxia 10
• ADHD 13
• Learning difficulties 37
• Epilepsy and other medical conditions 9

22
47
38
26
51
39
40
36
23
Self care / independence(social emotional
functioning Gilchrist et al 1997)
24
Co-morbidityManchester adolescent study

• PSYCHIATRIC SYMPTOMS
• Parent report
• Conduct symptoms at home
• Restlessness, poor concentration, fiddling
• Unhappiness, loneliness, irritability
• Adolescent report
• Anxiety, obsessional symptoms
• Green, Gilchrist,
  Burton Cox (2000)

25
Postal survey with parents/carers

• Children aged 3 18 yrs
• Disruptive behaviours 52
• Anxiety 56
• Self-absorbed 43
• Communication disturbance 40
• Anti-social behaviour 48
• 
  
• 
  Bromley et al (2002)

26
2005 NAS Survey

• The Subjects
• Number 1,564
• Gender 80 male 20 female
• Age range 1 year 65 years
• Age 0-16 years 1,084
• Age 17 years 480
• NOT A PREVALENCE STUDY

27
Age at Diagnosis (All Subjects)
Autism
Asperger Syndrome
28
Place of Residence All
Ind
Res. School
Hosp
Supp. tenancy
Other
Res. Home
With parents
29
Co-existing conditions
Most frequently reported

30
Patterns of psychiatric disorder reported 109 cs
aged 5-17yrs using Autism Co-morbidity
Interview-PL (Leyfer et al, 2006)

• Phobias
• OCD
• ADHD
• Depression
• Other

• 44
• 37
• 31 (55) 10 (24)

31
Frequencies of number of DSM-IV diagnoses per
child with autism
32
Psychopathology in children adolescents with
autism (Brereton et al, 2006)

• 367 consec referrals
• 3.8- 24yrs
• DBC-P (Develop. Behav. Checklist- parent/carer)
• 73.5 scoring gt clinical cut-off score
• Disruptive gt66th percentile
• Self-absorbed gt 75th percentile
• Communication disturb gt75th percentile
• Anxiety gt 74th percentile
• Social relating gt 75th percentile
• Mean DBC-ADH Depression scales also high

33
Psychopathology in children adolescents with
autism (Brereton et al, 2006)

• Age gender
• Ability
• Verbal more problems with communication disturb
  anti-social behaviour
• Non- verbal self absorbed social relating
  behaviour
• High levels of anxious disruptive behavior
  persist thro childhood adolescence
• Impulse control deficits in attn., impulsivity
  HA disorganised behaviour
• Depression (irritability sleep appetite
  disturbpsychomotor retardation suicidal
  thoughts behaviour) ? Role of puberty in verbal
  Ss girls
• Lower scores for anti-social subscale

34
Implications for management/ intervention
planning

• Behavioural educational interventions
• Cs with autism may have impairing behaviours
  emotions for a variety of reasons
• Need to consider possibility of additional mental
  health disorder treat co-morbid condition

35
Research priorities

• Co-morbidity
• Rates are high
• ASD under-diagnosed in children w other diagnoses
• Specific disorders?
• Assessment instruments
• Evaluation of interventions
• Prevention / use of specific skills

36
(No Transcript)