Depression and Suicidal Ideation in Autism and Related Disorders NAA 021512

7/28/2019 Depression and Suicidal Ideation in Autism and Related Disorders NAA 021512

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Depression and Suicidal Episodesin Autism and Related Disorders

Josh Feder, MDNAA

February 15 2012


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Start recording.

canned intro


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Depression and Suicidal Episodesin Autism and Related Disorders

Josh Feder, MDNAA

February 15 2012


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Director of Research, Graduate School,Interdisciplinary Council on

Developmental and Learning Disorders

Assistant Clinical Professor, VoluntaryDept of Psychiatry, University of California

at San Diego School of Medicine

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Feder 411

Math, Engineering, and DevelopmentalDisorders beginning 1978.

US Navy Child Psychiatry Mike 1990 (1992) Greenspan and Wieder 1993

Career expansion: clinic, teaching,research, advocacy, tech developmentand arts & media.

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ICDL

CAPTN/Pfizer

SymPlay

Cherry Crisp

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Commercials

Because we build ideas together And you can join us in the effort!

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Working Together for

Parent Choice!9


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The Southern California

DIR/FloortimeRegional Training Program

Pasadena, CaliforniaFebruary 24-26, 2012

Pasadena Child Development Associates , Inc.(PCDA)

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Thank You!

Families say a silent thank you

NAA Chantal Sicile-Kira! Mentors: Greenspan & Wieder

Students at the ICDL Graduate School So many others

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Depression in DSM-IV

Sleep - more or less, up early is classic Loss of Interest in usual activities, incl. sex

Negative thoughts, often over and over Energy usually down, might be agitated Poor concentration, e.g., reading Appetite down, or up Sluggish body stooped, slow, leaden Suicidal thinking


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General Rates of Depression

General population: 20-25% Recurrence: 50%

Re-recurrence: 75%+ Suicide rates: 15%+ Earlier onset may mean worse condition

Family history adds to risk Bipolar: 1% overall; 20%+ of depressed youth


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Depression in ASD

Many reports, little data, likely high rates Chronic emotional pain from trouble relating and

communicating with others, from sensoryprocessing and modulation difficulties, etc.

Excellent recall of negative life events e.g.bullying, but even minor disappointments

May be even more persistent in negative thinking

Might not show sadness the same way mightbe harder to tell Still, look for the usual kinds of signs


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Suicide

Adults in emotional pain with no otheroptions and a need to act now

Top risk factors: depression and substance use Adolescents/ young adults at higher risk: less

likely to consider consequences Highest risk in the elderly

Children have trouble following through butsome children do high risk things (run intotraffic, jump into deep water)


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Suicidal Ideation in ASD

Chronic emotional pain High risk for substance abuse in ASD

Hard to see other options Often acting without reflecting May be more persistent in following through

with ideas to hurt self including chidren


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What about normal sadness?

Common losses, e.g. a pet dies, a friend moves People with ASD often react all or nothing, i.e.,

distraught or unemotional

We are relieved when our kids with ASD showempathy, e.g., for a hurt classmate We are worried when people with ASD do not

seem to mourn a loss they way others do

We work to help them build a range of emotions But how do we tell the difference betweennormal sadness and depression?


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They are different

Normal Sadness Depression

Might temporarily get in

the way of function

Really gets in the way of

functionUsually caused by a sadexperience

Not always triggered by asad experience (50%)

Understandably sad important to learn andgrow from it, becomingstronger and improvingfunction

Maybe understandablydepressed (e.g. cancer)or maybe not - but notgrowing from it, robsfunction


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When to worry

Always..? Always take suicidal episodes seriously

Manipulation is a risk factor for real action ASD: tend to do what they say they will do Always working on prevention, i.e., on

improving ability to cope with distress


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What to do:Supervision and Solving Problems

Safety first supervision, maybe 24/7 Build emotional range & regulatory range

Manage the environment Mental Health Care


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Building Better Stress Coping

Co-regulation: help someone be moreregulated and then learn self-regulation

Building emotional connection Repair of emotional connections Building range of emotions and ability to

tolerate emotions

Dealing with expectations the rule of life:nothing ever happens the way we expected

M gi g th W ld


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Managing the Worldsurrounding the person

Promoting connection in everyday life Supervision to prevent bullying

Facilitate social relating: slow it all down tohelp everyone be part of whats going on Giving cues and space to build initiation


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Symbolic Solutions

Best ones we have generates creative solutionsthat can be portable and shared

All around us so can be hard to see

E.g., Anger becomes competition as in Olympics,or becoming a surgeon lets you cut people E.g., Fear mastered by cuddling a doll or by

holding hands on the tarmac during takeoff, oropening fortune cookie

E.g., Sadness expressed in creating orexperiencing art (rocket shells to tulips), tearfulmovies or books


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Hospitalization?

When all else fails and you need a safe place Staff might not understand ASD, and in particular

your family members ASD

Figure out now where they do a good job Create a quick guide three most importantthings to know about your family member

Hard to get good communication

Hard to get good transition Day treatment Residential care what happens afterward? Wraparound care


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Quick Guide Example

Give him time to answer Do not assume that he understands you

Noises make him very upset sooth him withgentle reassurance and a quiet place to rest


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Medication?

Might be a lifesaver Probably will have side effects e.g. activation Probably prevents suicide: drop in suicide rates

when SSRI prescription rose in the 1990s, rise insuicides with the fall in prescriptions to youthafter the suicide warning in 2004

But people DO sometimes have suicidal thoughtsspecific to a medication, including SSRIs. So, asalways, be careful and ask.


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Questions?

Documents

Depression and Suicidal Ideation in Autism and Related Disorders NAA 021512