Many of us will experience issues with our mental health at some stage in our lives. These difficulties can become mental health problems when they begin to affect our life in a negative and ongoing way. When a person feels overwhelmed, sad or worried for a prolonged period of time, this can develop into conditions such as depression or anxiety disorder. These conditions also affect children and adults with autism.
Autism is not a mental health condition, but mental health issues are common in autistic people. Approximately, 70-80% of autistic children and adults experience mental health problems, most commonly depression and anxiety.
Other psychiatric conditions which can affect children with autism include attentions deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and bipolar disorder to name a few. These are referred to as co-morbidities. Unlike autism, such conditions are treatable using psychiatric interventions, so we term all these conditions mental health problems.
It can be challenging to tell how a person with mental health problems is feeling, but if the person also has autism they may find it more difficult to express themselves. Some may not be able to speak. There are, however, other non-verbal ways in which people may communicate how they feel, such as through changes in their behaviour or through mechanisms such as self-harm.
What is the difference between autism and mental health issues?
Children who have ASD may present challenging behaviour and this behaviour is managed by early intervention and therapies. Behaviour is a way of communicating what they are feeling inside be it positive or negative. There can be a point, however, when their behaviour may change and it is important to differentiate whether the child is acting out as a result of frustration or whether there is an underlying psychiatric illness.
It is important to note, that the clinical expression of autism varies greatly, not only between different individuals but also within the same individual over time. Some symptoms may be more prominent and intense at one age and may fluctuate in nature and severity at another, leading to very different clinical profiles, yet all are expressions of the same spectrum.
If your child begins to behave very differently to their usual expression a thorough assessment is essential. In these cases, co-morbidities should be considered and require careful reappraisal of any intervention programme currently in place. In other
cases, any associated disorder may need treatment in their own right. This is where psychiatry and mental health illness will need to be treated as a separate entity to the ASD.
Autism and Medication
Several medications may benefit children with autism when other options are inadequate. These medications do not treat autism itself, but they offer relief from symptoms from diagnosed co-morbid conditions that commonly occur along with it. The first step for providers and parents is to collaborate in deciding on what most affects a child’s life and to balance the pros and cons in making a choice for or against medication introduction.
The First Steps…
To evaluate if medication is the right route to take, the following 3 steps will assist you towards making that decision.
- Baseline Assessment of your child’s behaviour and personality – creating a baseline/benchmark of your child’s behaviour and personality
- Establishing whether your child/teenager’s behaviour is a form of communication or are you dealing with a mental health issue
- Preparing the clear and concise information that you will need to present to the medical psychiatry team
What is a Baseline Assessment?
A Baseline assessment is a note of where a child is at, it identifies what is usual for that individual. A baseline provides a critical reference point for assessing change and its impact, as it establishes a basis for comparing the situation before and after an intervention. Baseline assessments should be carried out before the actual intervention starts so as to serve as a benchmark for examining what changes are triggered by the intervention. A baseline assessment is a crucial element in forming a current snapshot so that you can plan, monitor and evaluate any changes in behaviour and personality that is out of their day to day norm. both positive and negative.
Answering the following questions, will help guide you in creating your child’s baseline. Give as much detail and information as possible. Include any other information you feel is relevant to your child
- What energy level does my child have?
- What type of personality do they have? Are they easy going, highly strung?
- What is my child appetite like?
- What is their sleep routine like?
- My child is hyperactive and this is evident in their behaviour when they…
- What makes my child happy? How do they express this?
- My child is easily upset by...give examples?
- What usually calms my child down?
- What and why makes them angry, worried…give detailed examples
- Give as many details about incidences as you can.
- Does your child behave in such a way because they are frustrated?
Mental Health Illness Vs Behavioural Communication
Once you have outlined your child/teenagers baseline behaviour and personality, then it is important to established whether the behaviour that is being presented is a form of communication or a presentation of a mental health issue. The primary difference between behavioural communication disorder and a psychiatric mental health disorder is that a mental health illness is considered to be involuntary, i.e. they don’t have a choice.
To help establish this, asking yourself the following questions can assist you in differentiating between a behaviour communication or the development of a mental health issue. Behaviour that has a communication is likely to be functional, therefor serves a purpose. Behaviour that appears to serve no purpose or possibility of gain or reward, is more likely to be related to mental health. Existing behaviour that has suddenly intensified or ‘taken over’ and that the child seems to not be aware of, may indicate mental illness.
- Ask yourself “what is the message”?
- Is my child trying to convey something to me?
- Are they banging their head because they want something and didn’t get it?
- Are they lashing out because they want to use their ipod and it is not their designated time?
- Are they trying to communicate something?
- Is their behaviour as a result of their frustration because they did not get their way?
- If they got what they wanted would their behaviour stop?
- The key is to look for a distinct change from baseline and or episodes
- Is there a deviation of autistic symptoms from baseline? Have they become more intense or exaggerated?
Guidelines on how to present information to a medical team
Once the above is examined and it is clear that there is a mental health issue as opposed to behaviours associated with Autism, then it is time to prepare and present information to a medical team so that they can best treat your child.
The following information is important to give to the medical team as it will allow them make a full and informed decision as to what is the best treatment for your child. The more detailed information that you present in a clear and concise manner, the better a medical judgement can be made to help your child. It is important to note here that it is your child’s mental health issue that needs to be diagnosed and treated and not their ASD. Best practice would be to have your child assessed by a Psychiatrist. Referral can be made by your child’s GP.
Questions to ask yourself
- Why are you seeking an appointment now? What are the child’s present symptoms?
- What is particularly problematic for the child now?
- It is important to present your child’s baseline – what their normal baseline and personality is. This will allow the medical team/psychiatrist to differentiate between ASD symptoms and the mental health symptoms.
- How long have the present symptoms being going on for?
- When was your last good day?
- Is there a family history of mental health – perhaps some will not have a diagnosis but you know there is something present
- What is your child’s past history?
- What is their diagnosis?
- Do they have any significant health issues (e.g. epilepsies, diabetes…anything that could interfere with medication)?
- Has there been any significant emotional events in the child’s life – has there been a bereavement, a separation, an emotional trauma?
- Any significant life events for the child – have they changed schools, entered puberty.
- Any medication the child is on? Give timeline of medication. Any medication that they were on but have been removed…because and why? What worked and what didn’t work
- Child’s weight and height – have this done and recorded before appointment to alleviate stress on the day.
- What is their appetite like?
- What is their sleep pattern like? Do they have trouble falling asleep? Do they have trouble staying asleep? Do they wake very early, e.g. 3am?
- Are they able to make choices for themselves and express/communicate themselves?
Questions to ask when your child is prescribed medication for the treatment of psychiatric illness
Before administering medication, it is important for you and your medical team to weight up the benefits for your child against the possible negative impact. Here are some questions that are important for you to ask and get answers to.
- What are the usual side effects to taking this drug?
- Do the side effects settle down with use i.e. nausea or constipation only while the body adjusts to the medication?
- Do any of these side effects conflict with health or existing medication being taken?
- What would be a deal breaker in terms of side effects ie rash?
- How long until we see some effect of the drug?
- What effect will we see first and then after?
Set realistic expectations – medication is not a quick fix. Medication should only be prescribed in cases where the child’s mental health issues like OCD, general anxiety disorder, depression and ADHD is preventing them from daily living and functioning in their lives. The purpose of the medication is to reduce the symptoms of the mental health issue, allowing the severity of the symptoms to settle so that you can begin to work on a behaviour management plan.
Disclaimer: The information contained in this article should not be substituted for the advice of a qualified and licensed psychiatrist or of other health care providers. The information here is for information/guidance purposes only.