On the subject of Mental illness and Autism

You say that the mental health side gets put on the back burner. HOWEVER, I would contend that by focussing on managing the autism, you treat the source of the MH problems, so not focussing on MH is not necessarily bad..

Mytwenty said:

You say that the mental health side gets put on the back burner. HOWEVER, I would contend that by focussing on managing the autism, you treat the source of the MH problems, so not focussing on MH is not necessarily bad..

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.

Consider the following statement from Medical Comorbidities in Autism Spectrum Disorder: A Primer for Health Care Professionals and Policy Makers pdf ~ which on page 4 of 19 states:

Widespread reports of severe medical conditions being attributed, without investigation and sometimes without physical examination, to autism behaviours have compelled the creation of this document in order to present relevant information to healthcare providers,policy makers and the wider audience. A summary of current research, including the positions of leading governmental and professional bodies, is hoped and expected to help bridge the knowledge and training gap, and as a consequence, decrease the premature attribution of physical symptoms to 'autism behaviours'.

Current research, shared below, offers support to health care and care providers in understanding the possible mechanisms, symptomatology, and consequences of common comorbidities in ASD, thus allowing improved patient care and reduced long-term costs.This document also provides a list of symptoms and behaviours that are indicative of health problems but often dismissed as ‘autism’, and offers common sources of such behaviour. Case studies highlight and contextualize some challenges faced in diagnosing this unique patient group and the possible outcomes of successful identification of underlying medical problems.

https://nationalautismassociation.org/pdf/MedicalComorbiditiesinASD2013.pdf

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

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

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’.

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

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

The disclaimer is rather odd too. I wonder who these people are?

“No information in this document should be construed as medical advice. Neither article authors, associated charities, nor individual contributors take any responsibility or liability for any decision taken as a result of the information contained herein.”