Autism and Mental Health

Greetings Earthlings! πŸ™‚

Did you know– autistic children have higher levels of depressive symptoms and are 28 times more likely to have thoughts of suicide than their neurotypical counterparts? 😲

bitmoji1256098968In recent years our awareness of and willingness to tackle mental health issues has increased significantly, however, the autistic community is often forgotten in our discussions.

Mental health issues such as OCD, anxiety, depression, eating disorders, ADD, psychosis, personality disorders and bipolar disorder are frequently co-morbid with ASD diagnoses, but aside from OCD and anxiety, you will rarely hear about these other issues in relation to autism. In fact, such mental health issues can even obscure ASD diagnoses in higher functioning autists as clinicians often diagnose the co-morbid condition without seeing the underlying ASD.

This is a particularly big issue for women on the spectrum as experts have found that we tend to exhibit greater depressive symptoms and higher anxiety levels than our male counterparts as we tend to internalize and ‘mask‘ our struggles. Moreover due to differences between male and female presentation of ASD’s and male bias in the development of the diagnostic criteria, women with autism are often misdiagnosed as having mental health issues, but the root ASD continues to evade.

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But are there any scientific reasons why mental health issues are so prevalent among autists?

A recently published study has suggested that perhaps the gut may influence an autists mental health. As gastrointestinal issues are often co-morbid with an ASD diagnosis, and as the microbes that live in the gut can have an influence on the brain and behaviours, it has been proposed that perhaps a “dysbiosis” or imbalance in gut microbes may have an influence on an autists mental health 😲

Interestingly studies have also identified an overlap between the genes that cause schizophrenia, bipolar disorder and autism wherein certain points on these genes encode proteins that are involved in the formation and strength ofΒ synapses (which act as chemical bridges between neurons) suggesting that these disorders may act through a similar neurological pathway. Moreover, dysregulation of neurotransmitters (biochemical messengers in the brain) has also been implicated in depression, anxiety, bipolar disorder, ADHD and autism (as we have discussed in multiple previous posts) indicating further neurological overlaps.

In short, it seems that the biological basis of both autism and mental health issues are intertwined, which could explain why so often the two walk hand in hand.

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Hope you enjoyed this post dear Earthlings! πŸ™‚

Until next time!

Aoife

 

 

Autism Management- Cognitive Behavioural Therapy (CBT)

Greetings Earthlings! πŸ™‚

Today I’d like to briefly examine one of the most commonly recommended therapies for autism management- cognitive behavioural therapy or CBT.

So let’s all lean back in our chez long as we dive in! πŸ™‚

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First off, what exactly is CBT?

Originally designed as a treatment for depression, CBT is a form of psycho-social intervention (i.e. counselling/psychotherapy) that is widely used to help improve mental health. Unlike other forms of therapy, CBT focuses on developing coping strategies to target our problems and to change unhelpful patterns in emotions, attitudes, negative behaviours,Β  and thought patterns.

In other words- CBT aims to change negative ways of thinking or cognitions in order to improve behaviour.

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As a result, CBT is widely used to treat anxiety, depression, eating disorders,Β OCD and a range of other psychological issues- many of which are co-morbid with an ASD diagnosis. It’s thought that CBT can be a particularly useful tool to treat anxiety and to help develop emotional recognition in autists.

CBT was personally recommended to me following my initial diagnosis in order help me to better understand autism and to conquer my social anxiety.

So what did I make of it?

Well, being honest (as we aspies must be πŸ˜› πŸ˜‰ ), my opinions are slightly mixed regarding CBT. Whilst initially I found it helpful as it taught me a lot about autism and the reasons behind my behaviours, after a time, I felt that I didn’t really need it- especially given that I was in my twenties and had already overcome many of the challenges associated with ASD’s. In many ways, simply knowing and understanding Asperger’s Syndrome was enough to assuage much of the mental anguish I had inflicted on myself for being different πŸ™‚

Nevertheless, I did find it beneficial to have a neutral party to talk to in those first initial months post diagnosis. It’s quite a lot to take on board, so it was nice to have that outlet to help guide me through the fog.

All in all, I felt that perhaps CBT may be better suited for a younger person with autism in helping them to develop lifelong coping mechanisms that will enable them to thrive. Had I better understood myself earlier in life through CBT intervention, many things could have been so much simpler πŸ™‚

So if you think CBT may help you or your child, why not give it a try- get out your phone, book an appointment and take a seat on that couch (it’s surprisingly comfy πŸ˜‰ )

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Enjoy the weekend everyone! πŸ™‚

Aoife

Autism and “Stimming”

Greetings Earthlings! πŸ™‚

Today I’d like to touch on one of the most commonly observed autistic behaviours- “stimming”.

So what exactly is “stimming?”

Self-stimulatory behaviour, (also known as stereotypy or “stimming”), refers to many of the repetitive behaviours often exhibited by autists. Examples of these behaviours include scratching or rubbing the skin, noise making, smelling objects and the classic examples of rocking andΒ  hand flapping, although in my experience it’s a lot more like ‘Jazz hands’ than flapping!

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There are two psychological theories as to why autists stim:

  • As a response to overwhelming sensory stimuli
  • As a means of relieving stress and anxiety

From a physiological perspective, there are a number of possible biological reasons.

Some researchers believe that stimming provides the autist with sensory stimulation. Contrary to common belief, many people with autism have a reduced sensitivity to certain sensory stimuli. Dysfunctions in the circuitry of the brain mean that the body craves sensory stimulation, and so we adapt repetitive behaviours in order to stimulate and excite our nervous system.

Deficits in dopamine levels in the brain can also interfere with our reward pathways, leading autists to engage in behaviours, such as stimming, which will provide the extra hit of dopamine that the brain needs.

So that’s why I’m drawn to fluffy things! πŸ˜‰

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Aside from being drawn to stimulatory texures, I have a particular tendency to fidget with the silver chain around my neck. I just find something oddly soothing about the rough sensation of the metal against my skin! πŸ˜›

In my experience, I also find that stimming isn’t always a response to stress, but born from a need to keepΒ my hands busy.

As I’ve discussed previously, research shows that autists have higher levels of excitatory neurotransmitters such as glutamate, and lower levels of calming neurotransmitters in the brain. As a result, we are often hyper-stimulated. Stimulation of the brain’s reward system, i.e.Β  dopamine release through “stimming” behaviour, causes a decrease in glutamate levels, effectively calming the brain!

This would explain why I’ve often found that stimming sometimes helps me to concentrate and clear my mind by channeling any excess energy into a physical action. I find this particularly helpful when I’m studying, or writing, and for some strange reason while I’m waiting for the microwave to ping! πŸ˜› #excitedforfood

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Stimming can also be considered a form of self injurious behaviour, but I’ll write a separate post on this topic at a later stage πŸ™‚

So is there anything that can be done to control this type of behaviour?

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  • Try replacement behaviours– if the stim is not socially acceptable or harmful, as in the case of biting behaviours, attempt to replace the stim with another one such as a fidget toy or chewing rubber
  • Exercise– there is evidence to suggest that exercising can decrease the frequency of stimming behaviours, although the research is unclear why
  • Cognitive behavioural therapy (CBT)– is thought to be useful as self stimulatory behaviour operates in a similar way to OCD tendencies which are often managed through CBT techniques
  • Medication– Seems there’s a pill for everything these days! Medications can be used to help modify compulsive behaviours such as stimming, but I personally would not advocate this route

So there we have it Earthlings, a brief insight into stimming behaviours in autism! πŸ™‚

Enjoy the weekend everyone! πŸ™‚

Aoife

Repetitive Behaviours- Skin Picking

Greetings Earthlings! πŸ™‚

Today I’m going to give you an insight into a particular form of repetitive behaviour- skin picking.

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Ok- I know it sounds disgusting, but it is common for those with autism! The statistics are limited, but as many as 14.8% of autists exhibit this type of behaviour.

Skin picking, also known asΒ neurotic excoriation or dermatotillomaniaΒ  (I really do like the sound of these terms! πŸ˜€ ), is characterized by excessive rubbing, scratching, digging,Β squeezing and gouging of healthy skin. In chronic cases, the urge to pick and scratch can lead to scarring, tissue damage and infection.

If I were you though I probably wouldn’t look the condition up…some of the pictures of these chronic cases are disgusting!

In my own experience, I have a mild tendency towards skin picking. I prod and poke at bites and burns, pick at cuts and scabs etc., but squeezing my skin would be my biggest issue- I find it so addictive and it can be quite hard to stop! I also have a particular tendency to press hard against injured skin, like pinching an infected finger or pressing a sore toe against a hard surface- for some odd reason I find it comforting! It hurts, but I feel better about the injury after doing it. I suppose it must link back to the calming sensation of deep pressure stimulation or something!

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Now before we call the men in the white coats, let’s see if there’s a physiological reason for all of this! πŸ˜›

Research suggests that the dopamine pathway may play a particular role in this behaviour.

Dopamine is involved in reward motivated behaviours in the brain. Drugs such as cocaine and methamphetamine activate dopamine, which is thought to contribute to the sensation of skin crawling and subsequent picking often experienced by addicts. So experts believe that dopamine dysfunction may be at play in this behaviour.

As I’ve discussed in other posts (sleep, ADHD, curiosity, inside the autistic brain etc.) dopamine is often dysregulated in the case of autism, so it stands to reason that this neurotransmitter may play an important role in skin picking behaviour in ASD’s.

Other experts point to a psychological reason for the behaviour as there is a strong link between skin picking and co-morbid psychiatric diseases. Skin picking is thought to act as a form of Β communication in times of stress in the case of autism and is believed by some to act as a sensory outlet for sensory stimulation and or soothing.

Furthermore, as I’ve previously discussed, we autists tend to have more sensitive skin than the average person, this too could influence our tendency towards picking and scratching our skin.

Ah- so I’m not crazy after all! πŸ˜‰

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But is there anything we can do to manage it?

Dermatologists and physicians find this one particularly difficult to treat and often seek drug and behavioural interventions to counter skin picking.

For me personally, this is difficult to advise as the reasons for picking differ from person to person, annnnnnd I tend to indulge the behaviour rather than avoid it πŸ˜›

However, I have been making conscious attempts to reduce the frequency in recent years to help protect my skin, and to avoid looking like a weirdo in public! Don’t want people thinking I have fleas if I persistently keep scratching myself!

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The best advice that I can give is to keep your hands busy- if they’re occupied, you won’t pick! Gaming and crafting I find can be useful to keep my hands from wandering πŸ™‚

So there we are Earthlings! πŸ™‚ Hope I didn’t disgust you all with this post! πŸ˜›

Enjoy the weekend everyone! πŸ™‚

Aoife

 

Autism Management- Concerts

Greetings Earthlings! πŸ™‚

Ah, live music! There’s nothing I love more than a decent rock concert!

“But wait- wutt?!Β 

You’re autistic! Surely you can’t enjoy a loud, flashy, crowded rock concert?!”

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Plleeeeeeeeeeeeeeease! πŸ˜›

What do I always say? No two autists are alike!!!!

Sure, sudden noises can make me jump, but in actual fact I love the noise! I relish the chaos of alternative rock! The vibration of the music through your body, the bright lights, the pyrotechnics, the showmanship- it’s really hard to beat a decent concert.

That being said, my love for gigs has not come without it’s challenges.

At my very first gig (Paramore’s Brand New Eyes tour, 2009), I suffered both a meltdown AND a shutdown! The crowd made me very unsettled and uncomfortable moshing during Paramore’s opening number, so I spent the remainder of the concert on the sidelines crying and alone! πŸ˜› We subsequently almost missed our bus home, the stress from which brought on a shutdown.

Certainly a memorable and eventful night! πŸ˜›

Indeed, concerts can be overwhelming for both neurotypical and neurodiverse alike, but that does not mean that a concert can’t be an enjoyable experience. It’s all about finding what works for you πŸ™‚

Here are my tips for finding comfort at a concert:

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  • Outdoor vs indoor venues: This is one that I’m learning the hard way. Outdoor gigs, whilst a little easier on the ears than indoor venues, can be a real mixed bag in terms of enjoyment. Crowds are bigger, snagging a good vantage point can be tricky and security have far less control over crowd behaviour. I spent much of my last gig being kicked in the back by a girl sitting on her boyfriends shoulders. Take my advice- choose indoor gigs for your favourite artists.
  • Choose seating– After my first “pit” experience, I have made a point of always choosing to pay a few euros more for a decent seat in large arenas. This way you avoid strangers touching you, claustrophobia, tall people, reduce exposure to potentially unpleasant odours (outdoor gigs are a real pain if you hate smoking as I do) and prevent being unexpectedly hit by stray “balloons”, flying glasses of beer and, on one random occasion, black nail varnish! Don’t you just miss the emo kids of the mid noughties? πŸ˜›

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Alternatively, if you’d rather be closer to the action, smaller venues (< 2000 capacity) generally offer more comfortable standing experiences. Crowds are spaced out more and are better behaved with security always close at hand πŸ™‚

  • Sunglasses-Not as crazy as it sounds I promise! Sunglasses are my best friend as they really help to take the edge off bright lights. I’ve even been known to wear them on a night out in the club on occasion! Don’t worry about what other people think- it’ll be dark and everyone will be too focused on the stage to notice πŸ™‚
  • Earplugs– This one may seem a little bit counter productive, but lot’s of people do it. Loud music is part and parcel when it comes to gigs, but sometimes the noise can be a little excessive. Take my most recent concert just last week. I was standing in front of a girl who insisted upon screaming every 5 seconds for 2 and a half hours- not like your average fangirl, but a murder victim (the kind of piercing scream that makes you jump every time you hear it)! Quite frankly, she’s lucky she wasn’t my murder victim! πŸ˜œπŸ˜‚Β I was rather envious of a nearby concertgoer for having had the sense to bring a pair!

So there we have it, my top tips for managing autism at a gig!

As I always say, you should never allow an autism diagnosis to hold you back- if you can’t climb the mountain, there’s always a way around it πŸ™‚

So rock on dear Earthlings! πŸ˜‰

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Aoife

Autism Management- Fidget Spinners

Greetings Earthlings! πŸ™‚

So today I’m going to take a look at the latest craze- Fidget Spinners. I couldn’t take more than 50 steps in Dublin the other day without someone trying to sell me one! πŸ˜›

So what exactly are they?

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In case you’ve been living under a rock, Fidget Spinners are a handheld device where the centre is held between your fingers and you spin the device. They come in all shapes and sizes and are designed to relieve stress.

Here’s a video discussing them and some of the crazy things that people have been using them for:

But what have Fidget Spinners got to do with autism?

Whilst they may have only surged in popularity in recent months, Fidget Spinners were actually invented in the 1990’s to help people who have trouble focusing, such as those with ADHD, anxiety and autism, to channel excess nervous energy and stress into the spinning device. The thinking is that by diverting the excess energy into a physical action, this frees up certain areas of the brain from distraction, allowing you to better pay attention. It is also thought that fidgeting can relieve the brain of negative and obsessive thoughts.

But do they really work?

Opinions are polarizing as to whether or not they actually help. There is very little scientific evidence to support these claims. Of the studies that are out there, most focus on general fidgeting such as foot tapping, where it has been shown that movement can help to maintain alertness and improve working memory, but there are no studies specific to the Fidget Spinner itself.

Some experts warn that these toys may actually prove to be even more of a distraction for people with attention disorders.Β In theory, the toys occupy the hands so that you can focus your mind on the lesson (like stress balls), however, experts believe that the visually pleasing spin of the blades could add a further element of distraction.

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For teachers, they are proving to be a distracting nightmare in the classroom with many banning the device.

As opinions are divided, I decided to get one for myself and, pardon the pun, give it a whirl πŸ˜‰

There is definitely something oddly satisfying about holding the device between your fingers as it whirs into life, and there have been several moments where I’veΒ felt the addictive urge to spin it throughout the day.

However, I did not find it soothing from an anxiety perspective. In fact it actually really annoyed me when it would stop spinning and I would have to get the rotors spinning again! πŸ˜› I also found that it didn’t substitute as a calming “stim” and that I still reached to fidget with my necklace whilst I was using the Fidget Spinner!

That being said, autism is a spectrum where no two are alike. The Fidget Spinner may not work for me, but it could still be a nifty little tool to help manage ADHD and anxiety in another autist πŸ™‚

So by all means, go on! Give it a spin!! πŸ˜‰

(I have got to stop with these terrible puns… πŸ˜› )

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Aoife

Discussion:Women & Autism

Greetings Earthlings! πŸ™‚

Today, I’m going to discuss a very important issue within the autistic community- gender bias and the misdiagnosis of women with autism.

If I asked you to close your eyes and picture a person with autism, the majority of you will have pictured a man (most likely Dustin Hoffman! πŸ˜› ).

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The current ratio for male to female diagnosis of autism is estimated at 4:1 as the condition is thought to be rarer in women; however, many experts now believe that this figure may be as low as 2:1.

So why the discrepancy?

Did you know: Women with autism present differently to males on the spectrum?!

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Yep- as neurotypical men are from Mars and women from Venus, so too are autistic men and women from entirely different planets (maybe Krypton and Daxam for the DC nerds out there πŸ˜‰ )!

So how do women with autism differ from men?

For starters, several neurobiological studies have shown distinct anatomical differences between the male and female autistic brain (which I will explore in a separate post at a later stage πŸ™‚ ). Girls with autism are thought to have more active imaginations than boys and participate more in pretend play, often creating elaborate fantasy worlds (I had a particular penchant for this. My sister and I created an elaborate world for our teddies each night, so elaborate that our star couple had their own imaginary portable mansion when we went on holidays!! πŸ˜€ ). Reports also indicate that women have lower levels of restrictive and repetitive behaviours than men.

Evidence has also shown that women are better at recognizing emotions than males, almost as well as their neurotypical peers in fact, and demonstrate signs of better attentiveness in social situations.

As a gender, women are more socially inclined than men, and so female autists feel a greater need to make an effort socially.It is expected that women should be more social than men when it comes to communication, and as a result, we are often held to greater social standards. I can’t count how many times a teacher/my mother pulled me aside to advise or chastise me for my social ineptitude! πŸ˜› It was thought that I struggled, not because something was wrong, but that I simply didn’t try hard enough socially. Had I been a boy this would not have been the case.

One of the biggest differences between men and women with autism is the tendency among women towards social mimicry. Girls are particularly adept in masking their symptoms through observation of their peers, obscuring them from the view of parents, teachers and medical professionals.

I’m particularly guilty of doing this. For example, when someone asks ‘How are you?’, I honestly don’t know how to respond! Should I just say fine? Should I reciprocate the sentiment? Should I detail the many ways my life sucks at present?! Three of the simplest words in the English language and I struggle to respond! I eventually developed a mental phrase card in my head for common questions like these so that I would have a standard answer when called for, and 90% of the time you pass for a functioning human being! Other times you get caught off guard and situations like this happen πŸ˜› :

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My life is full of these little social coping mechanisms, which I’ll expand on separately at a later stage πŸ™‚

Finally, as previouslyΒ discussed, when it comes to specialist interests, female autists tend to have interests resembling those of their neurotypical peers (horses, Harry Potter, soap operas, Justin Bieber etc.), which can additionally hide them from view. Psychologists have also noted a ‘mothering’ tendency among peers of autistic girls, taking autists under their wing and adopting them into a social group. This further creates an illusion of social functioning for teachers, allowing these women to further slip beneath the radar.

As a result of all these differences, women are diagnosed much later than men, (men on average are diagnosed in childhood (~7 years); women as teenagers or adults) Β if at all.

But why it it only now that these gender differences are emerging?

Gender bias in autism can trace it’s lineage to the original observations of both Leo Kanner (described autism) and Hans Asperger (described Asperger’s syndrome) in the 1940’s. In Kanner’s work,Β β€˜Autistic Disturbance of Affective Contact’ (1943), Kanner observed a group of 8 boys, but only 3 girls with autism. Hans Asperger on the other hand, exclusively observed groups of boys, believing that AS was uniquely male! As a result, AS was not described in women until the 1990’s!!

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I know!

Consequently, the diagnostic criteria for autism has been largely based on the male model of the condition, and as such, many women like me have slipped under the diagnostic radar.

Due to our inherent talent for social mimicry, women with autism unknowingly find themselves hidden from view. The warning signs that are obvious in males are not always visible, and as a result thousands of women go un-diagnosed, or worse still are misdiagnosed.

Mental health issues such as OCD, eating disorders, ADD, bipolar disorder, anxiety and depression are frequently linked with ASD’s and are particularly prevalent among women.
Experts believe that women with autism tend to internalize their autistic symptoms, leading them to exhibit greater depressive symptoms and experience higher levels of anxiety than male autists.

Women are frequently mis-diagnosed with mental health issues, whilst the underlying root ASD goes unnoticed.

The internet is filled with stories of these women who spent years in mental anguish without receiving the one diagnosis they needed. I recently came across an article where it tookΒ “10 years, 14 psychiatrists, 17 medications and 9 diagnoses” before a 21 year old girl got her autism diagnosis! You can read the article here: (https://spectrumnews.org/features/deep-dive/the-lost-girls/).

Researchers and clinicians have in recent years begun to adapt the diagnostic criteria to better serve autistic women, but there is much work still that needs to be done.

Rain Man‘ has dominated for too long- we need now to focus on “Rain Woman”.

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Aoife

 

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