On the subject of Mental illness and Autism

I had a diagnosis of Asperger's in 1991 and schizophrenia in 2000. Then I developed depression in 2008 after my mum died.

The mental health aspect, on reflection, was misleading and that I should have focused on my Aspie side. Before the spells in mental health treatment, I was a motivated IT student. Then, the jobs I had didn't last long. Either through feeling sorry for myself, or the fact most were voluntary.

However, I am motivated and am able to use initiative. All because I was left to take responsibility for my family home. My parents and grandparents are all dead, and my brother is at University.

It is incredibly frustrating to deal with mental health services when you are autistic. Autism is classified as a disability, not a mental health problem. I’m okay with that. What I’m not okay with, is the lack of mental health services designed to meet the specific needs of autistic individuals. Given the prevalence of co-occurring mental health problems such as depression, anxiety etc., and the fact that our brains are wired differently the necessity of a distinctive approach seems obvious.

I have given up approaching mental health services for assistance. The correct help just isn’t available.

hi

i was told by dr who diagniosed me that i can have both at same time and they all feed each other and re enforce each other. i m currently under mental health and now all i seem to get is "its coz ur autistic" but not dealing with my problem caused me to walk out of session. i also knew what there plan was so i took a advocate. 

they keep fobbing me off with we dont have this person or a asd pathway whom my advocate later told me there telling lies. just same old being fobbed off

That sounds great Haha, I think I'd find it hard to learn from pictures too!

I agree - both should ideally be diagnosed ASAP.

I also agree that support should be tailored for autistic MH sufferers

My view is that both should be picked up on as soon as possible, and a failure to do so will result in substandard treatment of both . There would have been potentially a lot more I could have done if the Asperger's had been dxed in 1992 when I was 35, and help and support provided tailored to the combination of Asperger's and severe mental illness.

Mytwenty said:

So, the main point of contention here is whether accepting and managing autism is a more important factor with dealing with co-morbid conditions, or an equally important consideration. Can we agree to disagree?

Well through treatment programs autism has become known as a condition, and public awareness campaigns are rather dependent upon Doctor's reports in the first instance as have in many cases involved physical and or mental co-morbidities.

Rather than though agreeing to disagree with you as you request, I instead respect differences of opinion involving additional and alternative perspectives.

Mytwenty said:

I’m really interested as to how mental illness is left ignored and untreated, like you say. Do you mean that when you go to your GP, and they see that you have autism, they ignore your MH symptoms and attribute them to the autism? Is that what happens?

In terms of mental illness being left ignored and untreated ~ there are the examples already referenced in terms of autism masking or camouflaging other conditions, or those other conditions that have biological or sociological causalities that mask the condition of autism itself.

There is of course the problem of being prescribed antidepressants ~ but then receiving no treatment for the depression itself. Then there is the post code lottery problem of no available services for some and lack of funding where there are services ~ so long waiting lists, limited treatment options and no long term support.  

There is also the fact that people due to social stigma or shame of being considered mad would rather ignore or deny their poor mental health symptoms to the point of breakdown, isolating themselves and even committing suicide, or enforced interventions have to be carried out by the social and emergency services ~ with individuals being forcibly hospitalized on account of their mental health having deteriorated to a dangerous extent for themselves, and or other people.

Mytwenty said:

A disclaimer: I realise my experience may be different to usual, as my mental illness, type one bipolar disorder, has been recognised and treated before autism. I believe experiences stemming from my autism - namely, being bullied - caused the bipolar disorder in the first place. So, if my autism had been recognised and managed first, my bipolar may never have started. So my perspective with its slant towards the autism may be skewed.

My mental illness, Schizoaffective Personality Disorder (SPD), was diagnosed (originally as being "schizoid and or psychopathic") when I was 12 and updated to SPD and confirmed by different therapists during my twenties, thirties and forties, before getting my Autism Spectrum Disorder diagnosis when I was 45.

The original diagnosis of being schizoid and or psychopathic at school was due to an emotional breakdown because of bullying, which involved mental and emotional breakdowns at two and four year intervals ~ due to the instabilities 'learnt' at school for 5 years, and the socially shared and enforced abuse by others which was and continues to be normalized in society as Stockholm Syndrome. 

My special interest is metaphysics, psychology and sociology, so my perspective with its slant towards recognizing autism 'and' facilitating treatment options ~ is as such inclusively biased.

Personally though ~ I do not think your perspective slant towards autism is skewed, as such, just exclusively biased ~ keeping in mind if it is not already that our specialized interests are biases, and recognizing and declaring yours is a credit to you.

So perhaps drop the skewed notion possibly?

Yes, your perspective is different to mine and many others. And you're also right; I have and still do get my mental health taken less seriously, what with having personality disorders. This could attribute to where you live, the type of doctors you have, etc. In my case, I don't live in an area very well funded, thus making it harder for me to find the correct person for my mental health. But believe it or not, even in areas with more access to care, not everyone has the financial backup at their fingertips to seek out professional help for their mental health conditions, leading to not only those worsening, but also their autism. They feed off of each other, but are in no way shape or form the same.

I've found healthy coping skills for my autism, resources, others who have the diagnosis, etc, but if you utter the simple words 'mental illness' to a select few uneducated professionals, they will indeed use ridiculous reasons for these issues as excuses. They won't refer you for treatment for the severe, debilitating illnesses. They like to pin the blame on one thing, which has nothing to do with it.

Sorry for the essay; To conclude; Imagine if you go to see a GP, mental health professional, and they pin the blame on your autism and refuse to treat you for mental health illnesses that have no relation to autism. That's why I wrote this forum post, because I'm not happy with how often myself and others have professionals latch onto that as an excuse to not treat us.

I'm so sorry to read that it took so long for you to get answers. I'm sure that now you can finally feel more at ease having the answers and the diagnosis. Even currently in 2019, a lot of people are still desperate for answers and are being given the cold-shoulder treatment. Again, I'm glad to know that you saw a proper professional in the end! I just hope that things will change and it won't take so long and people won't keep slipping under the cracks to be ignored.

It is well documented that the mental health problems of depression and anxiety are more prevalent in the autistic community than outside it. It is also well documented that the co-occurrence of the neuro-developmental conditions ADHD and OCD is also high. There appears to be little research into specific treatments for autistic individuals who suffer from these co-occurring conditions.

The neuro-diversity movement is known to advocate for research into autism specific treatments, but we are given the same treatments as the NT population with no dedicated scientific endeavour to research their efficacy.

Initial reports of the effects of GABA fortified oolong tea have been promising.

https://www.frontiersin.org/articles/10.3389/fnut.2019.00027/full

https://www.ncbi.nlm.nih.gov/pubmed/31060476

For the theory behind this: https://www.ncbi.nlm.nih.gov/pubmed/27559329

Graham Slight Return said:

It may be that my involuntary stay, for one month, in a private mental health hospital - paid for by the NHS - owned by Acadia Healthcare (HQ Tennessee), has led me to approach stylish documents with little substance, such as the one you link to above, with cynicism.

Regarding the 'with little substance' thing ~ here is the same information regarding the problem of autism spectrum conditions masking co-morbid symptoms (or vice versa) and preventing appropriate treatment, from another source that is scientific and pier reviewed:

Abstract

Several psychiatric conditions, both internalizing and externalizing, have been documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism (HFA). In this review we examine the interplay between psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three main issues. First, we examine which psychiatric disorders are more frequently associated with AS/HFA. Second, we review which diagnostic tools are currently available for clinicians to investigate and diagnose the associated psychiatric disorders in individuals with AS/HFA. Third, we discuss the challenges that clinicians and researchers face in trying to determine whether the psychiatric symptoms are phenotypic manifestations of AS/HFA or rather they are the expression of a distinct, though comorbid, disorder. We will also consider the role played by the environment in the manifestation and interpretation of these symptoms. Finally, we will propose some strategies to try to address these issues, and we will discuss therapeutic implications.Several psychiatric conditions, both internalizing and externalizing, have been documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism (HFA). In this review we examine the interplay between psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three main issues. First, we examine which psychiatric disorders are more frequently associated with AS/HFA. Second, we review which diagnostic tools are currently available for clinicians to investigate and diagnose the associated psychiatric disorders in individuals with AS/HFA. Third, we discuss the challenges that clinicians and researchers face in trying to determine whether the psychiatric symptoms are phenotypic manifestations of AS/HFA or rather they are the expression of a distinct, though comorbid, disorder. We will also consider the role played by the environment in the manifestation and interpretation of these symptoms. Finally, we will propose some strategies to try to address these issues, and we will discuss therapeutic implications.

Introduction

Asperger Syndrome (AS) and High Functioning Autism (HFA) are two conditions within the broad category of the Autism Spectrum Disorders (ASDs) that are often overlapping and characterized by social-communication impairment and over-focused, repetitive interests and behaviours, without any significant learning disabilities or language delay in the case of AS. Individuals suffering from AS/HFA typically show pedantic speech often with monotonous or exaggerated vocal intonation [1], poor nonverbal communication [2] and motor clumsiness. Despite AS and classic autism both belonging to the same category of ASDs, individuals with AS tend to show a distinct pattern of social impairment that seems to be milder than in classic autism [3], and it has been hypothesized that the differences between AS and classic autism may be both quantitative and qualitative [4].

The management of behavioral problems in children and adolescents with autism spectrum disorders is a challenge for clinicians and families and the psychiatric symptoms in comorbidities could even exacerbate the behavioral dyscontrol [5-7]. Individuals with AS and HFA may show an impairment in describing their own feelings and emotions [4], so it is not easy to detect and recognize another psychiatric comorbidity that could be masked by the autistic symptoms themselves. One of the main problems with individuals suffering from AS/HFA is that behavioral symptoms due to one of the comorbid conditions that often run together with this type of ASD (see section “AS/HFA and comorbid psychiatric conditions” and Table ​Table1)1) could arise in different social environments, including family and school, and during social activities. For these and other reasons in the daily clinical practice it is difficult to make a decision about the most appropriate diagnosis and therapeutic strategies.

In this review we examine the interplay between common psychiatric comorbidities and AS/HFA. In particular, we will discuss which psychiatric disorders have been more frequently reported in association with AS/HFA. We will also point out the difficulties that clinicians and researchers have to face when trying to make the correct diagnosis of a comorbid condition in AS/HFA basing on the currently available psychometric tools (i.e. scales, checklists and questionnaire).

Furthermore, we will discuss the important role played by the environment and finally we will outline some useful strategies to address these issues and challenges for therapeutic implications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416662/

I believe the Thinking Autism site is a perfect example of what is known as ‘astroturfing’.

 I first saw a pdoc in late 1973 just before I was 17. At 18 and a bit I had my first hospitalisation . I was dxed with schizophrenia . The dx changed over time, but I was still seen as having a severe mental illness. After being dxed with severe mental everything was seen as stemming from that. My own research let me to believe there was more going on than that . My previous mental health trust turned a deaf ear to bringing the subject of autism up.  In Sept 2017 I moved and came under a different mental health trust. I saw a pdoc there in Oct 2018 and with my input and my stepdaughter's he said ASD and schizophrenia was the best fit . By May 2019 I had an Asperger's dx.  Taken from when Asperger's became an official dx it had taken nearly 3 decades for that to happen . The result a poor level of support and treatment

So, the main point of contention here is whether accepting and managing autism is a more important factor with dealing with co-morbid conditions, or an equally important consideration. Can we agree to disagree?

I’m really interested as to how mental illness is left ignored and untreated, like you say. Do you mean that when you go to your GP, and they see that you have autism, they ignore your MH symptoms and attribute them to the autism? Is that what happens?

A disclaimer: I realise my experience may be different to usual, as my mental illness, type one bipolar disorder, has been recognised and treated before autism. I believe experiences stemming from my autism - namely, being bullied - caused the bipolar disorder in the first place. So, if my autism had been recognised and managed first, my bipolar may never have started. So my perspective with its slant towards the autism may be skewed.

It may be that my involuntary stay, for one month, in a private mental health hospital - paid for by the NHS - owned by Acadia Healthcare (HQ Tennessee), has led me to approach stylish documents with little substance, such as the one you link to above, with cynicism.

I was intrigued enough to look around their web site, whereupon I found the strange comments, “As autism is not a biological ‘thing’ in itself, it therefore cannot be cured, since a behavioural label is not a disease.It is always worth remembering that there is nothing else to an autism diagnosis, or ‘autism’ itself, apart from the surface symptoms.”  Treatments offered include ABA (not a favourite of the autistic community, but unfortunately common).

Under a banner about everolimus treatment, it comments, “there is at this point in time no definite, large, placebo-controlled double-blinded study that establishes beyond doubt that any single ONE approach could be an effective treatment for everyone affected by autism,” strictly true, but infers there has been no large, placebo-controlled double-blinded study on everolimus. Again not strictly false, but “In this 12-month, randomized, double-blind, placebo-controlled trial, we attempted to enrol 60 children with TSC and IQ <80, learning disability, special schooling, or autism, aged 4-17 years, without intractable seizures to be assigned to receive everolimus or placebo.” The conclusion: “Everolimus did not improve cognitive functioning, autism, or neuropsychological deficits in children with TSC. The use of everolimus in children with TSC with the aim of improving cognitive function and behavior should not be encouraged in this age group.” (Younger children will probably be used to experiment further with this drug.)

I haven’t checked all the treatments on offer, the trajectory and direction of these charities are all too familiar to those who, like me, read the blurb on shiny these corporate offerings.

So, I decided to go to the site’s “Who We Are” page. It doesn’t say who they are. I then checked the site on Whois. It didn’t tell me who they is. At the Charity Commission site, there are some names, which it would obviously wrong for me to reveal. I can say that salaries paid amounted to over 50% of income. The biggest grant came from the Big Lottery Fund, so presumably they have passed some sort of financial propriety process.

I am not accusing this organisation of anything illegal. Thinking Autism used to be called Treating Autism. The infamous Autism Speaks has set up something call the Autism Treatment Network.

My cynicism leads me to wonder whether this charity is positioning itself to be in the vanguard for USA private health groups hoping to gain contracts from a post Brexit UK. It may just all be a figment of my overdriven autistic mind.

Any emphases that survive my cut and paste on to this forum were in the original documents.

By the way, have you seen the research published last week that presents more evidence for the prenatal origins of autism?

https://www.cell.com/cell/fulltext/S0092-8674(19)31072-4#.XamzRMOLiGs.twitter

Deepthought said:

So I state that accepting and managing autism as a condition is a very important consideration ~ most certainly, just as certainly as having access to treatments for co-morbid conditions is as well an equally important consideration also.

As is supported by the following statement that I underlined from the following article:

Conditions that accompany autism, explained

More than half of people on the spectrum have four or more other conditions¹. The types of co-occurring conditions and how they manifest varies from one autistic person to the next.

These conditions can exacerbate features of autism or affect the timing of an autism diagnosis, so understanding how they interact with autism is important.

Here is what researchers know about the conditions that often accompany autism.

Which traits or conditions commonly accompany autism?

The conditions that overlap with autism generally fall into one of four groups: classic medical problems, such as epilepsy, gastrointestinal issues or sleep disorders; developmental diagnoses, such as intellectual disability or language delay; mental-health conditions, such as attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder or depression; and genetic conditions, including fragile X syndrome and tuberous sclerosis complex.

How common are these conditions among people with autism?

It depends on the condition, and estimates vary widely. For instance, between 11 and 84 percent of autistic children also have anxiety². Similarly, serious sleep problems may affect anywhere between 44 and 86 percent of children on the spectrum³. Differences in diagnostic criteria and other study variables may explain these wide margins. And the age, sex, race and intelligence quotient of the person being evaluated can all influence whether and when they are diagnosed. For instance, autistic black children are more likely than autistic white children to be diagnosed with intellectual disability⁴. And if a child doesn’t speak, mood disorders may be difficult to detect. Certain conditions, such as anxiety, may also look different in people with autism than they do in other people, adding another layer of complexity.

What’s more, the tools used to identify the conditions may not work as well in people with autism. Researchers are developing autism-specific scales, such as a depression-screening questionnaire, to help solve these diagnostic puzzles.

What can scientists gain from studying these conditions?

Nearly all conditions that accompany autism can have serious effects on well-being. And some have more severe consequences than autism does.

A better understanding of these conditions could improve quality of life for autistic people. For instance, identifying the genes involved could lead to early detection — and treatment — of the conditions.

“We really need to understand the roots of problems in mood and depression, as well as problems of impulsivity,” says Paul Lipkin, director of the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore. “As we identify better understandings of the neurologic roots of these, we can hopefully develop more and better targeted medical treatments for them.”

Treating a related condition may also ease autism traits. For instance, treating seizures early may decrease cognitive and behavioral problems in children with tuberous sclerosis complex⁵.

Resolving sleep or gastrointestinal problems may also offer behavioral benefits. Sleep quantity and quality can affect mood and the severity of repetitive behaviors, for example.

How might co-occurring conditions complicate autism diagnosis?

Some autism traits, such as poor social skills and sensory sensitivities, overlap with those of other conditions. For instance, people with autism and those with schizophrenia both have trouble picking up on social cues. When a person presents with one of these common traits, her doctor may simply assign to her the most plausible diagnosis. “It can be very hard to figure out what the root of a behavior is,” says Carla Mazefsky, associate professor of psychiatry at the University of Pittsburgh.

ADHD traits may also mask or be mistaken for those of autism — and delay when a child receives an autism diagnosis.

Autism diagnosis may be particularly tricky in people with intellectual disability or severe language delays.

What can studies of co-occurring conditions reveal about the biology of autism?

Some of these conditions may share biological mechanisms with autism. For instance, a study published this year revealed that gene-expression patterns in the brains of people with autism are similar to those in people with schizophrenia or bipolar disorder⁶. People with these conditions may also share genetic variants and traits, such as language difficulties or aggression.

In other cases, the relationship to autism may be multifaceted. For instance, about one in three people with autism has epilepsy — and people with epilepsy are at an eightfold risk of autism compared with the general population. The connection may be partly genetic, but it is also possible that early seizures pave the way for certain autism features.

https://www.spectrumnews.org/news/conditions-accompany-autism-explained/

Graham Slight Return said:

That’s a rather odd paper, from a rather odd charity. A charity that charges a membership fee?

I cannot state that I have ever known a charity that does not have membership chargers. Membership of this charity (the National Autistic Society) is for example currently as of October 2019 ~ £24 for an individual, £30 for a joint membership of two people living at the same address, and £60 pounds for organization memberships involving businesses, groups and other bodies:

https://www.autism.org.uk/get-involved/membership/join-now.aspx

Mytwenty said:

I was speaking with specific reference to MH comorbidities, not physical ones with 'physical symptoms' whose erroneous conflation with autism is dispelled in the report you cite.

When I stated that:

Deepthought said:

Providing the symptoms are on account of the condition of autism spectrum disorder itself, better managing the condition will ameliorate those symptoms. When though we refer to co-morbid symptoms, we are referring to illnesses and or diseases that occur alongside the condition of autism spectrum disorder, and require separate or additional therapeutic treatment, whether it be medical, clinical or verbal.

I was not only then referring to medical treatments (for physical illnesses and or diseases) but also clinical ones (involving mental illnesses such as Bipolar Disorder that require medicinal treatment such as Lithium to balance the manic and depressive states of mind that are involved with this condition) or verbal treatments (such as Cognitive Behavioral Therapy (CBT) or Transactional Analysis (TA)) as being 'Talking Therapies'.

I do apologize as I thought the medicinal analogy would carry over to the clinical and verbal treatments quite readily, I was though too tired to explain things so used the paper instead.

Mytwenty said:

It's a well-known fact that having autism engenders MH issues in the first place, so I just believe that foremost managing and accepting the autism spectrum condition is the way to alleviate those MH symptoms.

Autism does not engender mental health issues in all cases as some autistic people find their way into society and employment and live productive and contededly fulfilling lives ~ whether they be scientists, doctors, artists, teachers or whatever.

Better managing the condition of autism is not though 'the' way ~ but is 'an' important way to prevent (in developmental terms) or when viable helps to alleviate (in co-morbid terms) mental health conditions,

When management is not viable though; another important way involves the necessity of therapeutic treatments for co-morbid conditions ~ which if left untreated would make the management of the autistic condition impractical.

Just maintaining for instance a healthy routine for autistic people will not be enough whilst they have obsessive, suicidal, paranoid and catastrophic ideation involving inferior, mediocre and superior fantasies, delusions and Post Traumatic Shock Syndrome (PTSD as being memorial or behavioral flashbacks) where they (regarding internalization) and or others (regarding externalization) get to experience their abusive history daily, weekly or monthly.

So I state that accepting and managing autism as a condition is a very important consideration ~ most certainly, just as certainly as having access to treatments for co-morbid conditions is as well an equally important consideration also.