Autism and Depression and Anxiety (oh my!)

Carol Salber, Natalie L. Swift Author

04/06/2020 Added

57 Plays

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2020 ASD Conference Breakout session

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[00:00:00.160]Hopefully that one is working okay.
[00:00:03.720]My name is Carol Salber.
[00:00:04.770]I'm a licensed mental health therapist in Omaha, Nebraska
[00:00:08.730]and I started in the field quite a few years ago
[00:00:12.390]in the area of domestic violence and child abuse,
[00:00:15.750]but when my son was two years old
[00:00:18.100]he was diagnosed with an autism spectrum disorder
[00:00:21.070]which at that time was PDD-NOS,
[00:00:24.230]was his diagnosis and that really influenced
[00:00:27.284]my life both personally and professionally.
[00:00:30.540]So currently I am in private practice
[00:00:33.520]in Omaha at Skills 4 All Abilities
[00:00:36.340]and my primary emphasis is on working with teens, adults
[00:00:40.830]of all ages who have developmental disabilities,
[00:00:44.320]autism spectrum disorders and coexisting behavioral
[00:00:47.838]or mental health issues as well.
[00:00:50.370]So my son is now 22.
[00:00:52.567]So I've got what I feel like
[00:00:54.850]a lot of years of experience
[00:00:56.580]kinda personally and professionally under my belt
[00:00:59.104]I've just kind of seen what goes on in this arena.
[00:01:03.930]So I will now turn it over to Dr. Swift
[00:01:06.350]to introduce herself a little bit
[00:01:08.100]and we'll get started with the keynote.
[00:01:11.170]All right, can everybody hear me okay?
[00:01:13.610]Carol?
[00:01:16.533]All right great.
[00:01:19.421]I just wanted to double check to make sure
[00:01:21.890]that I can hear.
[00:01:22.723]Okay my name is Dr. Natalie Swift
[00:01:24.260]and I have private practice in Lincoln and Omaha.
[00:01:29.770]In Lincoln at Williamsburg Behavioral Psychology Clinic
[00:01:34.890]also in Omaha I work in Autism Center of Nebraska
[00:01:38.090]and practice(voice drawn out)Nebraska.
[00:01:42.124]And I have a history with working with individuals
[00:01:44.310]with developmental disabilities particularly
[00:01:46.550]those with intellectual disabilities(voice drawn out)
[00:01:51.330]However, I probably in about last three years,
[00:01:57.010]three to four years, no,
[00:01:59.060]I think it's probably longer than that maybe four,
[00:02:01.870]I came in contact with a mentor Dr. Diane Mart
[00:02:05.320]and worked alongside her and realized that
[00:02:09.090]I had a joy really to work and understand working
[00:02:16.810]with individuals on the autism spectrum.
[00:02:18.550]And now it's my heart passion my burden to work
[00:02:22.730]and advocate and support.
[00:02:24.200]I primarily work with young adults
[00:02:25.940]and adults on the spectrum, and that is me.
[00:02:31.760]So I look forward to getting into the presentation today.
[00:02:34.960]I'm really excited on what we're gonna talk about today
[00:02:37.227]as it's really close to my heart
[00:02:40.380]and a lot of the information
[00:02:41.600]that we'll share with you today yes,
[00:02:43.710]there's information that we'll reveal through research,
[00:02:46.450]but I would also like to be able
[00:02:47.910]to provide you information
[00:02:49.050]that is more indicative of
[00:02:50.530]what I see in actual clinical practice.
[00:02:59.061]We'll get started with the objectives today.
[00:03:02.350]My screen is a little stuck.
[00:03:03.720]So Carol if you're able to,
[00:03:06.570]you can able to kind of move that slide down
[00:03:08.650]a little bit, it's not going to the next page for us.
[00:03:12.717]All right, so let's talk about some of the objectives
[00:03:16.081]that we're gonna go over today.
[00:03:17.920]We want to be informed about the prevalence.
[00:03:20.570]How much?
[00:03:21.820]How existent?
[00:03:23.080]How prevalent it is in individuals
[00:03:26.220]that are diagnosed on the spectrum.
[00:03:28.630]When you're looking it's not to mention
[00:03:30.170]that someone would have autism spectrum disorder
[00:03:33.140]that they automatically will have a mental health disorder,
[00:03:36.030]but there is a strong number
[00:03:38.150]of percentage there's association.
[00:03:39.870]So we want to talk about that number and look at that.
[00:03:42.370]We also wanna be looking at just the number
[00:03:44.860]of just the symptoms.
[00:03:45.830]What would you see if someone is diagnosed
[00:03:48.370]is starting to show symptoms of anxiety and depression.
[00:03:52.264]What would that look like?
[00:03:53.919]Would that present itself?
[00:03:54.890]And I speak to not only individuals
[00:03:56.930]that I've diagnosed on this spectrum,
[00:03:58.810]but I'm also speaking to family members
[00:04:01.110]or a teacher or clinicians
[00:04:02.580]and what are some of those things
[00:04:03.500]that you would be able to see.
[00:04:05.760]And what are the strategies to manage
[00:04:08.010]some of those symptoms based upon the evidence treatment
[00:04:10.800]that we do know now.
[00:04:12.770]And what would we do to sort of refer
[00:04:15.370]or seek out that treatment.
[00:04:17.711]How would I know to read with,
[00:04:20.000]what point what I know to seek out
[00:04:22.220]or refer if I needed to.
[00:04:25.740]And how do I access the community-based supports
[00:04:28.630]that are available?
[00:04:29.463]What is available?
[00:04:31.160]What are some supports especially for social support?
[00:04:33.600]What is available?
[00:04:34.433]How would I access that
[00:04:36.100]as an individual and a family member?
[00:04:39.210]So that's what gets us in today or a presentation.
[00:04:42.560]If there was nothing else that I could say,
[00:04:45.460]I would probably, Carol and I would sum it up
[00:04:47.930]in these three bullet points;
[00:04:49.680]that the prevalence
[00:04:50.680]of mental health conditions is significant.
[00:04:53.620]I think it's enough for us to say we need to take a look
[00:04:56.790]and see why that is, what does that look like
[00:04:59.780]and how can we be better informed
[00:05:02.310]and offer to support.
[00:05:04.798]54 to 70%, I think that that's significant enough
[00:05:07.460]for us to straw back and say we'll find out
[00:05:10.780]a little bit more on what that is
[00:05:12.982]and what I is a clinician or a teacher or a parent
[00:05:16.070]can be more aware of.
[00:05:17.010]And also if I'm in an individual,
[00:05:19.010]what can I do to sort of be aware
[00:05:21.340]or how can I sort of manage those symptoms for myself.
[00:05:25.520]And part of the challenge, now we'll talk about is
[00:05:28.710]it's often times that I've noticed
[00:05:30.870]that mental health is going undetected,
[00:05:33.370]not everybody is able to sort of recognize
[00:05:36.220]or tease out some of the symptoms
[00:05:38.780]that are being presented.
[00:05:39.950]So it's very difficult for people
[00:05:41.760]to understand is this part of autism
[00:05:43.810]or is this something else.
[00:05:45.980]And what could there be?
[00:05:48.625]So it goes misdiagnosed as something else
[00:05:51.890]or it goes untreated which is the concern
[00:05:54.730]and the issue because if it goes untreated
[00:05:57.480]for long periods of time people
[00:05:59.430]are not able to get to the support,
[00:06:01.680]they're not able to get the resources
[00:06:03.550]and that's unfortunate and leads
[00:06:07.330]to a lot of other circumstances
[00:06:08.840]and also impacts that person's quality of life.
[00:06:11.480]So knowledge is power.
[00:06:13.420]The more that we know about these conditions,
[00:06:15.150]we can help, we can be of support,
[00:06:16.700]we can advocate, we can empower.
[00:06:18.710]Huge on advocating and empowering individuals
[00:06:21.760]to know what's happening in my mind,
[00:06:23.330]what's happening in my body, how do I communicate that,
[00:06:25.960]how do I get support, how do I get resources
[00:06:28.870]and how to help those in their lives
[00:06:32.090]to be able to support them as well.
[00:06:34.800]So what is the current situation we're facing.
[00:06:37.830]Mental illness is more common in individuals you know
[00:06:40.670]on spectrum than the general population.
[00:06:43.900]And some would say well, why would that be?
[00:06:47.310]And here's where I kinda take a step back
[00:06:49.840]and put on go back into my office
[00:06:52.710]and I hear the stories of individuals
[00:06:55.020]that I'm working with.
[00:06:56.290]We already know that there may be
[00:06:57.670]some obviously neurological biological differences
[00:07:01.600]as particularly with some of on autism spectrum,
[00:07:05.150]but I look at and I hear the
[00:07:07.633]sort of the long history for some,
[00:07:11.500]sort of the social challenges,
[00:07:13.190]some of the perceived and real issues
[00:07:16.520]that have happened through the consequences
[00:07:18.330]that have happened so through
[00:07:19.270]some of those social challenges.
[00:07:21.810]The stigma the discrimination, some of the not knowing
[00:07:26.600]or understanding that person and how they're presenting
[00:07:29.520]and so how some of the autism spectrum symptoms of that
[00:07:33.650]are presenting and not understanding that
[00:07:35.257]and how that's projected on someone
[00:07:38.220]can be very stressful.
[00:07:39.960]Not to mention, sort of lived experience
[00:07:42.830]those are trying to negotiate different stressors
[00:07:46.350]whether it's sensory social all of those cumulative
[00:07:49.960]make a big difference in how someone
[00:07:51.700]is able to cope day to day.
[00:07:53.410]So study suggests between 54-70% of people with autism
[00:07:57.440]they're gonna have one or more mental health condition.
[00:08:01.000]Partly because of some of the things
[00:08:02.270]that I've already mentioned whether genetic,
[00:08:04.320]whether it is the biologicals, the social
[00:08:06.050]and some of the other things that
[00:08:08.470]I mentioned are really gonna have an impact on
[00:08:10.660]that person's ability to regulate.
[00:08:12.860]And then the consequence of that if I can say it that way,
[00:08:16.330]will be symptomology of some anxiety and depression
[00:08:19.600]that can for some be very difficult
[00:08:21.360]to manage without appropriate support.
[00:08:24.470]And so, one of the things that I've come
[00:08:26.550]to realize and research really captures this as well
[00:08:29.320]is that mental illness is prone to develop during
[00:08:31.780]that late adolescent in early 20s.
[00:08:34.010]So if I'm a parent or if I'm an individual
[00:08:36.570]or you want to be a tune to
[00:08:39.400]what are some things that maybe had
[00:08:41.170]how is that person responding
[00:08:42.460]to significant changes in their lives,
[00:08:44.750]how are they responding to events that
[00:08:46.612]like what's going on right now.
[00:08:49.680]Because that can be the factor to lead into
[00:08:53.900]that onset of some kind of depressive episode or anxiety.
[00:09:00.128]So you start to see some of those changes in functioning.
[00:09:02.560]The changes on how they're responding to certain events
[00:09:05.790]and their like and start to see that earlier on.
[00:09:08.310]We'll talk about some of those behavioral symptoms.
[00:09:11.070]Because I mentioned it early that
[00:09:13.980]it goes undetected some of those symptoms
[00:09:16.290]can persist into full-blown on clinical diagnosis.
[00:09:20.460]And why is that the case ?
[00:09:22.925]I'm sure some of you all have heard this term before,
[00:09:24.450]looking at diagnostic overshadowing.
[00:09:26.440]What would that be?
[00:09:27.280]Well lots of times people are attributing
[00:09:29.887]parts of the the symptomology or the behavior
[00:09:33.040]that they were experiencing
[00:09:34.290]well it must be a part of autism.
[00:09:35.820]Well, that must be behaviorally to autism
[00:09:38.371]and not recognizing that there could be something else
[00:09:40.540]that's manifesting in that person's life
[00:09:45.340]and it's coming out and symptoms
[00:09:47.050]that are indicative of anxiety or depression.
[00:09:50.330]And so that is something that we as clinicians
[00:09:53.840]or we in the physicians or psychiatrists whatever
[00:09:58.200]really wanna be more informed on
[00:10:00.400]what is the symptomology that's being present.
[00:10:02.880]What are those atypical presentations
[00:10:05.300]so we can ask the right questions?
[00:10:06.910]We can do more assessments and be more informed.
[00:10:11.900]There's also, so speaking about the current situation
[00:10:14.440]there's challenging to accessing the services now.
[00:10:17.941]Where do I go?
[00:10:19.550]How do I access?
[00:10:21.250]Where are the services?
[00:10:22.840]How do I know what services are right for me at this time.
[00:10:25.890]How do I know that I need to sort of get this service
[00:10:29.160]and especially really important
[00:10:32.280]when I see a lot of young adults in the college
[00:10:33.670]and they're starting have difficulties
[00:10:35.920]where do I go to get that with support?
[00:10:37.770]In fact, I heard a study not too long ago
[00:10:39.870]that 60% of the young adults in general
[00:10:42.750]have a mental health disorder.
[00:10:45.326]60%, so if that is just a general population
[00:10:48.470]I can understand that being higher for someone
[00:10:50.480]that's a young adult in college.
[00:10:52.110]And so, if I'm having difficulties
[00:10:54.260]I've had several young adults in practice struggle on
[00:10:56.930]where am I going to get the support?
[00:10:58.740]Where on campus can I get the additional resources
[00:11:02.090]to help me mediate some of the factors
[00:11:04.370]that are causing the stress.
[00:11:06.010]Like with workload and things like that.
[00:11:08.470]So wanna be able to help people get access
[00:11:12.130]to the services part of the current situation
[00:11:14.330]that we're having is the challenge in accessing it.
[00:11:16.830]I want to make a quick note
[00:11:18.900]that there may be some clinicians
[00:11:20.460]that say part of the challenge
[00:11:21.810]I've seen also is that some clinicians
[00:11:24.860]may not feel comfortable
[00:11:26.050]if they've been refer someone
[00:11:28.130]that's on the spectrum and that's part of their diagnostic
[00:11:32.330]makeup but they may not feel comfortable
[00:11:33.860]because they don't have much experience with autism
[00:11:36.870]but I would say, if you do have some experience
[00:11:41.160]in managing sort of basic emotions or anxiety and depression
[00:11:45.710]and that can be of support.
[00:11:47.290]And I encourage clinicians to take an opportunity
[00:11:50.000]to learn more about,
[00:11:51.150]so that you can provide, so we can expand
[00:11:53.990]a little of the support that's available for clients
[00:11:56.560]that do need some of that help and that coping earlier on.
[00:12:01.860]So let's take a look at the current challenges
[00:12:04.750]in diagnosing and treating.
[00:12:06.710]I just finished talking about the current situation,
[00:12:10.150]but what is a challenge as far as diagnosing
[00:12:12.380]and treating some of the mental health?
[00:12:15.850]Some of the baseline challenges
[00:12:17.270]that you will see in research and also in my own practice
[00:12:20.840]it's that just knowing how to communicate distress,
[00:12:24.620]knowing how to communicate or relay
[00:12:26.600]how am I feeling about what's happening.
[00:12:29.130]I may not have the language,
[00:12:31.230]I may not have just sort of how to really identify
[00:12:34.880]what that is or be able to sort that out.
[00:12:37.320]When a clinician or physician is how are you feeling today,
[00:12:40.760]how is that different?
[00:12:41.870]When did you start feeling that way?
[00:12:43.680]They have very difficulty answering that question
[00:12:46.120]and really describing that.
[00:12:47.670]I know for my clients I've started to go...
[00:12:50.370]We still work on identifying labeling the feelings
[00:12:52.960]but I kind of go to a labeling of intensity of the feeling
[00:12:56.381]because sometimes that's a little bit easier.
[00:12:59.130]Is it zero level?
[00:13:00.250]Tiny?
[00:13:01.083]Small?
[00:13:02.391]Medium?
[00:13:03.287]Strong?
[00:13:04.120]Or really out of five.
[00:13:04.953]Like one, two, three, four, five
[00:13:07.085]and that seems to be a little bit easier
[00:13:08.304]to help people describe.
[00:13:09.137]But yet it is still a challenge for people
[00:13:10.930]to get the criteria and someone's not able to communicate.
[00:13:15.240]There's also atypical presentations of clinical symptoms.
[00:13:18.140]So if someone is going into their primary position
[00:13:21.160]or to the psychiatrist or to a counselor
[00:13:24.520]and someone's asking them about their symptoms
[00:13:27.070]and they look at them and they seem
[00:13:29.110]just as they've seen before
[00:13:30.360]there's not really any discreet disturbances,
[00:13:33.500]then there it's hard to detect
[00:13:35.090]is this person really anxious,
[00:13:36.330]are they really depressed?
[00:13:37.920]But for some individuals,
[00:13:39.380]there may not be sort of a change in their affect,
[00:13:43.922]there may not be some change in their actual
[00:13:46.780]some there some day-to-day functioning
[00:13:49.860]but once you ask more questions,
[00:13:51.700]once you'd be able to get in contact
[00:13:53.860]with a collateral support you will be able to discover oh,
[00:13:56.890]there is a little bit more intensity of certain behaviors.
[00:13:59.860]There is a little bit more changes in their functioning
[00:14:02.770]and so when that happens, that can let us know
[00:14:05.240]that there is something for us
[00:14:06.820]that could relate to a sense of anxiety of depression.
[00:14:11.090]Also, what's the challenge in the diagnosing
[00:14:13.000]is there's so much overlap with autism,
[00:14:15.190]so when I'm looking at how that person is relating,
[00:14:17.980]if I'm looking at how that person is responding
[00:14:20.340]to certain or having difficulty with transitions and changes
[00:14:25.060]and things of that nature,
[00:14:26.020]then I would automatically assume that's autism.
[00:14:28.820]There's a lot of overlap.
[00:14:30.400]If I'm really really anxious
[00:14:34.640]or really looking forward to a particular event
[00:14:36.257]so I'm asking a lot of questions,
[00:14:37.900]seeking insurance and things
[00:14:39.150]so that would look like anxiety
[00:14:40.420]or that look like autism.
[00:14:41.630]They're both overlapping that it's hard to discern
[00:14:44.900]is this a distinct episode of depression or anxiety?
[00:14:49.310]How would I tell the difference?
[00:14:50.750]Because of that overlap it's very hard to discern.
[00:14:53.990]The next thing is limited understanding
[00:14:55.790]of the relationship of ASD and mental health.
[00:14:58.750]So if the two they're going together,
[00:15:02.310]how is that going to impact the actual presentation
[00:15:05.310]of what how that person is functioning.
[00:15:08.320]And then the main thing that really captures
[00:15:11.399]I think this slide is limited knowledge
[00:15:13.480]and tools on how to recognize.
[00:15:15.240]And that's true.
[00:15:16.073]I mean research, there's the research
[00:15:18.000]that is available is they're developing tools,
[00:15:21.980]there are some additional treatment protocols
[00:15:25.420]but to be honest it is limited.
[00:15:27.790]And so, me as a clinician I can say this for myself
[00:15:31.690]it is a challenge to be able to sort of objectively
[00:15:37.060]be able to discern what is what.
[00:15:38.820]So that's why I have just started
[00:15:40.270]to really rely on the client.
[00:15:43.180]What's adaptive to them to be able to communicate
[00:15:46.220]what is going on and we'll talk a little bit
[00:15:48.460]about what that is.
[00:15:52.110]We talked about the current challenges, current situation,
[00:15:54.990]the current challenges with diagnosis and treatment.
[00:15:57.640]So what does that mean for the impact for the individual
[00:16:00.260]when someone is diagnosed with mental illness.
[00:16:03.260]So the concern and the issue
[00:16:05.760]is they're going to see increased absenteeism probably
[00:16:09.790]from school, not being able to show up to school,
[00:16:11.700]not be able to show up to their programs, college, work
[00:16:14.580]whatever their functioning
[00:16:16.220]or whatever they're assigned to do.
[00:16:20.600]We're gonna start to see sort of
[00:16:22.282]not being able to show up for those kinds of things.
[00:16:24.870]Why?
[00:16:26.050]Because there's a significant change of functioning.
[00:16:27.590]Why?
[00:16:28.877]Potentially there's some mental health symptoms at play.
[00:16:31.770]The decreased ability to sort of meet the daily life demands
[00:16:34.820]What I was able,
[00:16:35.670]what the individual was able to do before with ease
[00:16:39.180]without prompt, without support
[00:16:40.810]or whenever they're having
[00:16:41.870]a hard time being able to manage that.
[00:16:44.220]And some may confuse that with well,
[00:16:48.380]that person is being on seasonal defiant or not cooperative
[00:16:51.860]or they're not responding
[00:16:53.390]or they're just not showing the effort or the motivation.
[00:16:56.140]I would argue that we want to find out more of
[00:16:58.470]what's going on and why that is the case.
[00:17:00.780]Why are they not able to meet for things that were so...
[00:17:05.760]They were able to do that with ease
[00:17:07.190]or they were able to do it before without any problem
[00:17:10.030]or with support, now it's marked difficulty
[00:17:12.320]being able to do that.
[00:17:14.440]Greater decrease in treatment compliance.
[00:17:17.340]It's particularly from showing symptoms
[00:17:18.531]or having mental illness then,
[00:17:22.310]I may not want to be taking my medications,
[00:17:25.220]I may just not want to participate in therapy,
[00:17:28.020]I may just draw back and again
[00:17:30.020]a lot of that may be again
[00:17:31.720]not because that person is just defiant or not wanting to,
[00:17:35.690]it could be just a manifestation of
[00:17:37.560]that low motivation.
[00:17:38.690]Not being able to kind of connect
[00:17:40.690]and really just kind of withdrawing to self.
[00:17:44.120]And if there's not attention
[00:17:46.290]to the mental health sometimes over time
[00:17:48.960]what people will see is an increase
[00:17:51.350]in crisis stabilization in services.
[00:17:54.070]And that's what we want to decrease
[00:17:56.890]and not obviously have it all by early prevention,
[00:18:01.870]early support, early awareness of what's going on
[00:18:05.130]so that we could come in and provide that support.
[00:18:08.890]And we want to just review some of the risk factors
[00:18:11.130]for developing mental illness
[00:18:12.670]and this does not mean that just because
[00:18:14.360]they had a risk factor,
[00:18:15.430]they will automatically have the mental illness.
[00:18:18.010]It's just something that we want to be aware of
[00:18:20.280]as we move further.
[00:18:23.020]It's something that you want to be aware of
[00:18:24.900]so that you can provide the support earlier on.
[00:18:27.610]So certainly, if you have that there's a family history
[00:18:29.610]of mood or anxiety disorders know that as a clinician
[00:18:32.740]I find that an intake.
[00:18:33.990]Is there family, father side, mother side, grandparents,
[00:18:38.100]is there any family history of mood anxiety disorder
[00:18:41.135]because that lets me know that
[00:18:41.968]there could be sort of a genetic chemical imbalance
[00:18:46.300]that perhaps the individual has likely had
[00:18:48.880]in their family and that's something
[00:18:50.310]that we need to be aware of
[00:18:51.143]and how we're going to treat that
[00:18:52.740]and how the person knowing that
[00:18:54.810]if you're diagnosed on the spectrum
[00:18:56.910]and you know that your family history
[00:18:58.340]it's something you want to be aware of.
[00:19:00.061]'Cause that can impact how the development
[00:19:04.520]or the onset of a particular mental health disorder.
[00:19:07.930]The level of functioning.
[00:19:10.063]And we look at, you know,
[00:19:11.080]how was a person's functioning
[00:19:13.120]before the onset of the disability
[00:19:15.030]or the onset of illness.
[00:19:17.040]Were they, do they have support
[00:19:19.310]were they managing, how were they dealing
[00:19:21.700]with just sort of daily life stressors before?
[00:19:25.080]And I take a look at that at the intake.
[00:19:27.160]Were there difficulties even before that
[00:19:29.760]or were they coping and fairly doing well,
[00:19:32.410]but this particular stressor
[00:19:33.900]was so significant it really impacted them
[00:19:38.640]a lot to the point where there was
[00:19:40.280]a development of a mental illness at that time.
[00:19:42.220]So we want to look at the level
[00:19:43.690]of functioning prior to the onset.
[00:19:46.280]And sometimes with the level of functioning
[00:19:48.570]someone would assume,
[00:19:49.460]Carol and I we're talking about this the other day
[00:19:51.230]or yesterday, that for some
[00:19:53.170]you would assume well, maybe if someone
[00:19:54.590]has a low maybe a limited level of functioning,
[00:19:57.450]well maybe they have such support,
[00:19:59.090]they may experience the level of mental illness
[00:20:01.530]and we would argue well even with the support
[00:20:04.350]they may have difficulty even communicating it
[00:20:07.230]and the feeling is so overwhelming
[00:20:09.100]that it is leaving them vulnerable
[00:20:10.990]to developing a mental illness
[00:20:12.410]because of the lack of communication
[00:20:14.540]to be able to say what's really going on inside.
[00:20:16.788]Firstly, those that may have higher level of functioning
[00:20:21.070]or have supports, they would say people
[00:20:23.600]would say well they're fine,
[00:20:24.520]they're working, they're managing, they're doing okay.
[00:20:26.570]but I have lots of adults that I see
[00:20:28.900]that they're tired of people,
[00:20:31.120]assuming that they have it all together,
[00:20:32.720]they don't need the support and that can really impact
[00:20:37.350]make it vulnerable to developing mental illness as well.
[00:20:40.540]Coping styles, what is the level of coping
[00:20:42.640]that someone has and just managing day-to-day life stressors
[00:20:46.340]that could impact, if it's very limited
[00:20:48.250]or it's not practiced, it's not harness, it's not known
[00:20:51.220]then that could make it very difficult
[00:20:53.460]to deal with stressors.
[00:20:55.727]The age, we spoke about that
[00:20:56.920]and that adolescence and that early 20s
[00:20:59.180]that you began to start seeing some
[00:21:01.210]of the development of mental illness
[00:21:03.652]and significant life events.
[00:21:05.800]So when especially the COVID-19,
[00:21:09.180]things that are going on right now.
[00:21:10.550]This is significant event I would consider as a risk factor
[00:21:15.240]for potentially developing an episode of depression
[00:21:18.920]or one or several of anxiety disorders.
[00:21:21.420]So we wanna be especially tuned to that this time.
[00:21:25.280]The good news is there's some protective factors
[00:21:28.620]that can help us manage.
[00:21:30.050]So even if I have whether it's autism
[00:21:32.680]and a mental health diagnosis,
[00:21:34.810]you still can thrive.
[00:21:36.380]You still are able to function
[00:21:37.710]and you're still able to do the things
[00:21:39.650]that would be important to you
[00:21:41.110]to live a wonderful quality of life.
[00:21:42.810]And I totally believe that.
[00:21:44.350]Why?
[00:21:45.609]Because I've seen that within
[00:21:46.967]my practice and other individuals.
[00:21:47.900]So what are those protective factors.
[00:21:49.711]Well, if I know or I have some quality social relationship
[00:21:54.330]that just doesn't mean that I have lots of friends
[00:21:56.780]it means that I have people that
[00:21:58.260]I know that I can ask for support.
[00:22:00.450]I know people.
[00:22:02.027]There places where I can go
[00:22:03.472]that I feel comfortable and safe.
[00:22:05.880]What are those quality relationships and right now
[00:22:08.440]since we have the limited opportunities
[00:22:11.520]to engage that can compromise that.
[00:22:13.470]So we have to be very creative on
[00:22:14.880]how to get people engaged in those relationships.
[00:22:18.390]So opportunities for regular healthy social interaction.
[00:22:22.040]And again that's not just meeting with friends
[00:22:24.660]it may be just interactions with an advocate
[00:22:28.190]or a support person or a neighbor
[00:22:29.848]or someone that I work with
[00:22:33.330]or someone that went to school with
[00:22:35.490]or some regular healthy social interactions.
[00:22:40.670]I know at Bloomsburg Behavioral Psychology
[00:22:42.670]Dr. Marty for some of her groups that we cannot,
[00:22:45.269]they're not able to meet in Lincoln
[00:22:46.280]so what they decided to do is do virtual groups.
[00:22:49.150]Where they're meeting doing the social skills
[00:22:51.150]and doing the social support via the computer, via Zoom.
[00:22:55.696]And again, it's another way to have
[00:22:57.930]that regular healthy contact even
[00:22:59.490]if it isn't in-person.
[00:23:00.440]So how do we recreate that in this situation
[00:23:02.923]that we're living in now.
[00:23:05.160]Healthy functional coping strategies,
[00:23:07.240]healthy functional coping strategies.
[00:23:09.270]When asked individual what your coping skills
[00:23:11.470]so most will say well, I listen to music
[00:23:13.751]or I'll draw this or I will you know play a video game
[00:23:18.480]but I argue what is the functional coping skill
[00:23:20.910]that can help you in the moment?
[00:23:22.517]You wanna have some coping skills
[00:23:24.070]that will help you regulate the intensity of that emotion.
[00:23:27.170]So I talked about...
[00:23:28.300]We want to teach those functional coping skills now.
[00:23:31.460]Not in time so much always in the time
[00:23:34.029]when they're at the peak of crisis
[00:23:36.240]but genuinely how can that be a part of a lifestyle.
[00:23:38.700]I mean learning and practicing and living out and coping.
[00:23:41.440]And then access the ability to community supports.
[00:23:43.760]If I have that, if I know where to go to get so for support,
[00:23:47.080]if my individual person is not available,
[00:23:49.070]I know I can go to this community,
[00:23:51.240]I know I can go to the support group
[00:23:52.960]I know that I can check in with
[00:23:55.190]this virtual online group to help me.
[00:23:56.800]And the final thing is engagement
[00:23:58.280]in positive goal directed activities.
[00:24:00.700]Things that help me kind of get into that frontal lobe
[00:24:03.150]and really help me to think, help me to problem-solve,
[00:24:06.660]help me just to consider or wonder
[00:24:11.449]or just to have other possibilities.
[00:24:13.650]I think it's wonderful to be able
[00:24:15.550]to tap into that frontal lobe.
[00:24:17.000]When we are not engaged in that goal directed activity
[00:24:20.120]which is some of what's happening now,
[00:24:22.160]people start to withdraw,
[00:24:23.570]people start to isolate within themselves
[00:24:25.930]and that's when I would say a feeding ground
[00:24:29.150]for that depressive episode it's set in.
[00:24:31.180]So if I'm directed in an activity,
[00:24:34.300]something that's necessary something
[00:24:35.850]that's routine and something that's fun, each day,
[00:24:39.110]necessary routine and fun
[00:24:41.090]and that can help me get into stay in that frontal lobe area
[00:24:44.920]and really can be a protective factor
[00:24:46.940]for helping to guard against some of the onset,
[00:24:50.700]some of the symptoms we talked about.
[00:24:53.430]So let's quickly get into the co-occurring diagnosis.
[00:24:56.152]As you can see here, I'm just gonna lay them on
[00:25:00.190]the line for you, that for anxiety clearly
[00:25:03.400]you're gonna see a lot of anxiety.
[00:25:05.435]You'll see a lot of anxiety in a general population
[00:25:08.560]but you're looking at it for just on the spectrum
[00:25:11.030]particularly young adults and adults,
[00:25:12.780]I'd say similar for children.
[00:25:14.310]You're gonna see a high amounts with anxiety.
[00:25:16.210]Definitely through ADHD, it's hard for some people
[00:25:18.530]to tease that out as a separate diagnostic presentation
[00:25:21.880]which is why I could and take a thorough assessment
[00:25:24.090]is very important such a widespread with that
[00:25:26.930]and then the depression is still significant
[00:25:28.710]along with OCD.
[00:25:30.110]I do wanna make a mention about PTSD.
[00:25:32.350]I think that the trauma and the complex trauma
[00:25:34.610]that people are experiencing in my mind
[00:25:37.160]is highly under reported,
[00:25:40.030]because it's being coded as an anxiety
[00:25:43.040]but as I'm finding out there's
[00:25:44.230]a layer of complex trauma, multiple experiences
[00:25:47.870]that individuals face that I think people are not able
[00:25:52.000]to really be attuned to what that is
[00:25:54.437]because it's not being expressed
[00:25:56.170]and it's hard for the individual sort of communicate
[00:25:59.262]what that is and what I'm now finding
[00:26:01.760]as a clinician is definitely trauma.
[00:26:03.780]So Carol and I decided it's really focused on
[00:26:07.480]or hone in on anxiety and depression
[00:26:09.900]because that is a common, those are the common symptoms
[00:26:12.250]that you will begin to see.
[00:26:13.920]In a separate presentation, maybe we'll come back
[00:26:16.400]and talk about trauma and autism
[00:26:18.180]because that is very prominent
[00:26:20.560]and something that's noteworthy to be discussed.
[00:26:25.070]So let's start out with autism and depression.
[00:26:27.260]I'm just gonna give you the brief prevalence right now
[00:26:30.410]to help you sort of get an understanding
[00:26:32.670]of what we're looking at.
[00:26:33.503]And so nearly half of adults
[00:26:34.860]with autism experience depression
[00:26:36.280]at least one time in their life.
[00:26:39.236]And so, that would be, I mean why would that be the case?
[00:26:44.030]Again, going back to the cumulative experiences
[00:26:46.780]and stories and the narratives that I hear and my office
[00:26:50.760]most people may have started out with an anxiety response
[00:26:54.600]to a social rejection or appear a social rejection
[00:26:58.610]or perceived social issue that has
[00:27:01.090]or the stigma of discrimination or their lived experience
[00:27:04.830]that may start it out anxiety
[00:27:06.250]but prolonged it ends up in depression
[00:27:08.430]and it really impacts that person's sense of self,
[00:27:11.510]their sense of efficacy, their sense of who I am.
[00:27:14.760]And you don't have a sense of that or that's not really
[00:27:17.420]when you have a chronic invalidating experiences,
[00:27:21.350]that's gonna impact your sense of self.
[00:27:23.210]That's core of who you are as a person
[00:27:25.670]and that can lead to this underlying chronic depression
[00:27:29.260]that of feeling just not quite right.
[00:27:34.140]So individuals and this is clear four times more likely
[00:27:36.980]to experience depression of life because of the things
[00:27:39.040]that I have described and five times more likely
[00:27:41.880]to commit suicide.
[00:27:43.810]And why?
[00:27:44.800]Because and this is what I hear,
[00:27:46.260]because it's sick and tired of being sick and tired.
[00:27:48.660]I'm tired of having to manage everyday of the stressors
[00:27:52.880]and the things that I experience
[00:27:54.010]and tired of having to assert or try to navigate things
[00:27:59.180]and having people not take it seriously
[00:28:01.940]or understand or me having to explain
[00:28:04.320]or saying or doing something that is not
[00:28:07.070]or perceived to be right.
[00:28:08.360]And that chronic and validation can lead
[00:28:10.480]to that sense of depression which is very hard
[00:28:12.970]for individuals to cope with,
[00:28:14.820]which is why it's we it is very important
[00:28:17.930]for family members and clinicians to help individuals
[00:28:21.670]to help them find their own sense of self,
[00:28:23.820]help them to navigate some of these issues
[00:28:26.240]so they will not consider their life to be useless
[00:28:29.370]or not of value.
[00:28:30.310]It's very much of value and very much useful.
[00:28:33.280]So we wanna be able to help them navigate
[00:28:35.350]those things that are impacting their the self
[00:28:37.960]to truly rise and be functional
[00:28:44.360]and live the quality of life that they deserve.
[00:28:48.290]So let's take a look at briefly some of them.
[00:28:50.620]Generally as a clinician you'll see you know the major types
[00:28:56.110]of depression diagnosed with autism.
[00:28:58.240]You mostly see major depressive disorder
[00:29:00.580]where you would see a clinical symptom
[00:29:02.670]of a two week presentation of very sad mood
[00:29:04.658]and I'll go into the symptoms in a moment,
[00:29:07.610]but just briefly the very sad or depressed mood
[00:29:11.300]for at least a two-week time period
[00:29:13.379]or withdrawing, they're isolating, can't concentrate,
[00:29:16.013]they're having a very difficult time, functioning.
[00:29:17.974]And at least some time for some people
[00:29:19.000]that sense of hopelessness that worthlessness
[00:29:20.960]not wanting to be alive can be present.
[00:29:24.270]Then there's also the persistent depressive disorder.
[00:29:26.970]Kind of like a low-grade depression.
[00:29:28.660]And that's more chronic for at least about two years
[00:29:31.590]that you will see a low self-esteem and the low mood
[00:29:34.500]and difficulty sleeping similar things
[00:29:37.050]that you would see and major depressive disorder
[00:29:38.860]but it would not be, it's more chronic,
[00:29:40.830]the presentation over a period of time.
[00:29:44.700]At least two years are seeing that that low mood.
[00:29:47.050]And then seasonal affective disorder.
[00:29:48.880]I mean there are time specially coming out of this winter
[00:29:51.330]when you don't have sufficient light
[00:29:53.310]that is going to impact especially
[00:29:55.160]if you already have a genetic vulnerability
[00:29:57.410]or biologically sort of a low concentration
[00:30:00.430]of that serotonin level, you will see
[00:30:04.179]that onset of seasonal affective disorder
[00:30:07.520]especially as we head into the winter months.
[00:30:11.150]So those are the kind of the main things
[00:30:13.650]or types of depression that you may see
[00:30:15.610]in the population and in individuals diagnosed with autism.
[00:30:20.130]So let's kind of take a look
[00:30:21.120]at some of the symptoms, okay?
[00:30:23.190]What you'll see is honestly a change in appetite.
[00:30:26.560]These are main ones and not in order.
[00:30:29.290]Definitely and/or sleep.
[00:30:30.930]Okay, not all the time most times
[00:30:32.550]or some type of even increase eating or not eating at all
[00:30:35.310]or staying up later and later or sleeping more and more.
[00:30:39.410]So even in this current situation
[00:30:41.340]I'm talking to my individuals telehealth
[00:30:43.480]and I'm either talking to them or the FH
[00:30:46.160]or the shared living provider
[00:30:48.329]and they're known to saying
[00:30:49.973]they're not really wanting to do much.
[00:30:51.267]They're sleeping in and they're sleeping longer times,
[00:30:54.090]not a lot of energy, no longer really taking pleasures
[00:30:57.740]in the things that they used to.
[00:30:59.299]So the things that they used to, like to do
[00:31:01.840]they're not wanting to do anymore.
[00:31:03.420]Even during this time in this COVID pandemic
[00:31:06.030]they're not wanting to engage in that.
[00:31:08.160]It's not wanting to enjoy they used to enjoy that.
[00:31:11.330]They're not really motivated to do some of
[00:31:14.049]those kinds of activities that they've done before,
[00:31:17.320]changes in weight, even the flat
[00:31:20.830]this will affect and we talked about that before,
[00:31:23.240]there may be more restricted range
[00:31:26.141]and affect most sullen look that you will see
[00:31:27.620]and I oftentimes like my clients I joke with them,
[00:31:31.211]I always like to pierce into their eyes and joke with them
[00:31:32.960]but I can usually see once they walk in the room
[00:31:34.770]or even when they go on to the telehealth
[00:31:36.470]as something is markedly different.
[00:31:38.380]There's just a glare that is just sort of an emptiness
[00:31:43.650]that I can see that lets me know something is different.
[00:31:47.890]Social withdraw, desire to just not really wanting
[00:31:50.540]to communicate not really wanting to engage.
[00:31:52.890]Unexplained emotional outburst
[00:31:55.280]and so many people confuse that
[00:31:56.780]they're having a behavioral episode or an issue
[00:31:59.280]but it could be I'm hurting, I'm crying,
[00:32:01.630]I'm depressed, I'm sad.
[00:32:03.740]That's why it's very important to understand
[00:32:05.920]that that behavior is a message to communicate
[00:32:08.170]that internal state.
[00:32:10.160]So let's kind of take a look at
[00:32:11.900]a particular case of someone with depression
[00:32:14.860]to get a greater picture of what that may look like.
[00:32:17.260]This is a great case from a research article
[00:32:19.960]that I thought was...
[00:32:21.755]So I'm just gonna read through it briefly
[00:32:22.930]and we can pick out some of the symptoms
[00:32:24.760]and that changes in functioning over the time.
[00:32:27.580]So this is Jack.
[00:32:29.470]Jack had been diagnosed with ASD at 30 months of age.
[00:32:32.590]Develop phrase speech at eight years of age.
[00:32:35.540]He was particularly interested in popular music
[00:32:37.790]and physical fitness.
[00:32:38.870]Interacted around these interests with family
[00:32:41.170]and adults in the neighborhood
[00:32:42.550]was very insisted on following his routines
[00:32:45.120]but had never been aggressive.
[00:32:48.140]Nine months before he came to the clinic
[00:32:49.830]he had graduated from high school at age 22
[00:32:52.010]and had begun working with
[00:32:53.070]a job coach at a local grocery store.
[00:32:55.410]His younger brother had also graduated
[00:32:58.250]and moved away to college.
[00:33:02.710]To me that sounds like a significant life event.
[00:33:05.100]So let's hold on to that.
[00:33:06.380]Things went well for the first few months
[00:33:07.880]but then he began to have difficulty sleeping
[00:33:09.817]and was eating less.
[00:33:11.030]He began exercising for more extended periods
[00:33:13.750]and complained to his parents that his muscles were melting.
[00:33:16.940]That's significant.
[00:33:17.870]Some individual will say to me.
[00:33:19.460]The physical(voice drawn out)if there's a change.
[00:33:23.760]He began to check his appearance in mirrors so frequently
[00:33:26.700]that it interfered with his daily activities.
[00:33:28.780]So it was more sort of preservative
[00:33:32.090]obsessive behavior compulsive behaviors
[00:33:34.710]that we're noticing.
[00:33:35.543]At the same time, he was more withdrawn
[00:33:37.160]and seldom talked with in neighbors anymore.
[00:33:40.555]So before we found out that he was interested
[00:33:44.020]and interacted with the adults in the neighborhood.
[00:33:45.740]Now he's doing that less.
[00:33:47.050]He was in constant motion pacing, playing basketball
[00:33:49.570]or walking the dog.
[00:33:50.440]He was more irritable that on occasion pushed furniture
[00:33:53.040]over when he felt others were interfering
[00:33:54.710]with his activities.
[00:33:56.520]On the mental status exam for the clinician
[00:33:58.920]he spoke very little and often seemed confused.
[00:34:02.760]So when asked about his mood he said, "not good"
[00:34:04.824]and talked about his muscles.
[00:34:07.350]It's not a have a good language or describe the mood
[00:34:09.480]but he's talking about his body so we pay attention to that.
[00:34:12.030]He said there was a black shadow coming over
[00:34:14.260]his arms and legs and he was not himself.
[00:34:17.100]His affect was irritable especially
[00:34:19.120]when asked direct questions.
[00:34:20.760]He denied any desire to hurt himself or others.
[00:34:24.010]He did not respond to questions
[00:34:25.520]about the duration of his problems,
[00:34:27.020]things that he enjoyed or things
[00:34:28.640]that may have been upsetting.
[00:34:29.840]So a clinician if they're not tuned to that
[00:34:33.360]so they didn't give it we don't have enough data
[00:34:35.330]to understand the severity
[00:34:36.930]but I feel that there's enough data
[00:34:38.410]to understand that there is a change in functioning.
[00:34:40.860]So his parents were primarily concerned
[00:34:42.590]about his withdrawal, irritability and agitation.
[00:34:45.050]Family history was positive.
[00:34:46.540]We talked about that being a risk factor for schizophrenia,
[00:34:48.990]depression and severe anxiety.
[00:34:51.010]So the parents they were reluctant to try on a medication.
[00:34:55.869]He was started on and then in three months
[00:34:57.056]he was sleeping better and was less physically agitated
[00:34:58.070]and less irritable.
[00:34:59.310]He no longer to looked in the mirror.
[00:35:00.670]He remained more of withdrawn and in his face line
[00:35:02.570]but after a year came back okay.
[00:35:04.497]I would say that in addition to the family chose
[00:35:07.840]to do with medication, I would also argue
[00:35:10.240]that there's definitely some behavioral support
[00:35:13.727]and therapy to sort of help sort of itself monitor
[00:35:16.810]that level of anxiety that I'm feeling.
[00:35:18.620]At a one I feel this way, at a two I feel this way
[00:35:21.240]and then what do I do to sort of help regulate
[00:35:23.830]when I'm out of three, or out of four or five
[00:35:26.110]so that I can respond if that should happen again.
[00:35:28.980]So this definitely component
[00:35:30.230]of the medication and therapy
[00:35:32.040]that I think would be helpful in cases like this
[00:35:34.200]when you see in a market ship
[00:35:35.830]and we don't know all the reasons why
[00:35:38.040]but the case study has given us some cues
[00:35:40.680]as what maybe changes in his life
[00:35:42.900]and starting out with his brother moving away
[00:35:45.900]and we wouldn't think that would be something major,
[00:35:48.130]but for some individuals that can be quite significant.
[00:35:51.030]A family member moving out of the home.
[00:35:55.020]So I want to do a warm shift over to talking about anxiety.
[00:36:00.936]We've kind of moved into we spoke about depression
[00:36:05.520]and what that looks like in some symptomology,
[00:36:08.000]but now we want to kind of look at anxiety.
[00:36:11.620]We had another case dirty before but due to time
[00:36:13.940]I think I wanna leave with the this case to you
[00:36:17.500]and we're gonna head over to anxiety.
[00:36:21.470]So when we're looking at anxiety,
[00:36:23.780]some of the numbers that we shared with you before
[00:36:25.530]the 40% adolescents and adults are thought
[00:36:28.050]to have at least one and often more anxiety disorder.
[00:36:31.500]One often more, so it may be generalized anxiety
[00:36:34.819]and it may be generalized anxiety
[00:36:36.317]and social anxiety disorders.
[00:36:37.800]So we wanna be familiar with not the person
[00:36:40.010]is just having a general anxiety
[00:36:42.150]what other things could manifest
[00:36:44.280]to cause that anxiety to be more insistent
[00:36:46.460]and more significant.
[00:36:49.630]And it is higher in the general population markedly
[00:36:53.390]because of some of the issues that I've shared before.
[00:36:57.590]Some of the general factors,
[00:36:58.880]some of the precede reactions, sort of the social anxiety,
[00:37:03.680]some of the uncertainty and sort of managing
[00:37:06.700]and not being able to predict
[00:37:08.120]even some of the sensory response.
[00:37:09.690]It's not even able to predict
[00:37:11.320]or understand social environmental triggers
[00:37:13.970]can be very anxiety-provoking for individuals.
[00:37:17.310]And so one of the things that you will see is common
[00:37:20.340]is that social anxiety is that I'm not certain
[00:37:24.091]about or have some really and worried
[00:37:26.350]and some concern about other people's reactions
[00:37:28.650]or feedback to you.
[00:37:29.920]And part way that's learned response of not knowing
[00:37:32.520]and not intuitively understanding
[00:37:34.100]and then getting a lot of negative consequence
[00:37:36.010]because of that and particularly phobias are common.
[00:37:39.360]So clearly right now when we're facing you know,
[00:37:42.712]wash your hands constantly, you can't touch this,
[00:37:44.990]you have write down this,
[00:37:46.302]there is some significant anxiety
[00:37:48.110]about being able to even just kind of generally
[00:37:52.100]do the things that we normally used
[00:37:53.340]to do because of the phobia and the fear
[00:37:55.850]is so imminent it makes
[00:37:57.160]it very difficult for people to function.
[00:37:58.910]So we want to be aware of that.
[00:38:02.380]I do want to make a mention in general
[00:38:04.030]what you'll see diagnostically because I do diagnose myself.
[00:38:07.890]There would be a lot of generalized anxiety
[00:38:09.930]where you are there's excessive worry
[00:38:11.880]about a lot of different things in life.
[00:38:14.820]It could be about family, it could be about work,
[00:38:17.168]it could be about relationships.
[00:38:18.001]It's multiple and one of the things
[00:38:19.640]that you'll markedly see with the generalized anxiety,
[00:38:22.170]I just want to make a note is that physical symptom.
[00:38:25.650]The soreness, the headache, stomachache, the nausea.
[00:38:29.050]You know, someone may say how are you doing?
[00:38:30.570]I'm fine but they'll speak to the physical symptom.
[00:38:34.330]So that can let us know that
[00:38:35.560]they're having an anxiety response,
[00:38:37.730]possible anxiety response.
[00:38:39.180]Let's talk about some of the symptoms.
[00:38:42.620]Uncontrollable feeling of ease and restlessness.
[00:38:45.370]Just really cannot and it's more than just
[00:38:48.630]what you would see I would say
[00:38:49.700]from a hyperactivity or impulsive
[00:38:51.950]something related to ADHD, it's just a general feeling
[00:38:54.810]of I just don't feel right inside constantly on edge.
[00:38:59.100]Not able to relax.
[00:39:01.777]Emotional flooding feeling as though
[00:39:04.350]that the emotions are just sort of flooding the brain
[00:39:06.870]and that I have a hard time being able to process.
[00:39:09.780]And a lot of individuals that I see
[00:39:12.130]and especially on the spectrum really feel the emotion.
[00:39:16.670]It's very pronounced and I always say
[00:39:19.611]you have an a beautiful amazing gift
[00:39:23.090]to be able to feel some emotions
[00:39:25.110]and some of those emotions can be very intense
[00:39:27.920]and can feel very overwhelming and very daunting.
[00:39:30.820]And so, when that emotional part of our brain
[00:39:34.257]the amygdala is overwhelmed, it has impact your ability
[00:39:37.290]to sort of focus and sort of feel calm and feel safe
[00:39:40.160]if it's all coming at you at one time.
[00:39:43.250]Strong need to shut down or feel go
[00:39:45.730]into complete shutdown because
[00:39:47.380]the amount of information overload
[00:39:50.440]or the sensory experience is so intense
[00:39:53.050]that the nervous system really feels
[00:39:55.030]a connect to need to I've got to shut down.
[00:39:58.260]So you start to see that with that person
[00:40:00.210]whether it's the speech been able to,
[00:40:02.800]it's slowing down verbally,
[00:40:04.230]they're not able to communicate and process.
[00:40:07.139]They're not able to process the amount of information
[00:40:09.130]that's being received.
[00:40:10.350]So that's what makes it difficult for individuals
[00:40:12.260]that are in school,
[00:40:13.093]the teacher is asking multiple questions
[00:40:15.287]and the individual is appearing
[00:40:16.440]that they're being defined are not responding
[00:40:18.050]but really neurologically the processing
[00:40:20.140]has gone down, cause the anxiety has gone up.
[00:40:23.300]And that's also the case for sensory .
[00:40:25.420]If my sensory overwhelm is beyond the capacity
[00:40:28.810]that I can manage right now,
[00:40:30.310]my anxiety is going to go up.
[00:40:31.860]So I always tell people how to,
[00:40:33.320]let's focus on getting on the anxiety down,
[00:40:35.040]getting body calm so that my sensory input
[00:40:38.280]will also begin to come down.
[00:40:40.800]May develop challenging behaviors,
[00:40:43.505]aggression self-injury and that also makes
[00:40:44.560]it very difficult for people are calling it
[00:40:46.470]a behavioral issue not recognizing this is a response to,
[00:40:52.394]my anxiety is a response to this
[00:40:53.420]but the environment of what's happening.
[00:40:55.520]Lower tolerance for uncertainty.
[00:40:57.500]So I deal with are you know what's not knowing
[00:41:01.900]what's to come and this is
[00:41:02.930]a definitely a current situation that
[00:41:04.830]we're having now and just general excessive worry
[00:41:07.150]that we can't control which leads into
[00:41:09.470]that increase obsessive ruminative thinking
[00:41:12.360]that I can't get out of that loop.
[00:41:13.850]I constantly think about it
[00:41:15.300]and I can't sort of get out of that rabbit hole.
[00:41:18.925]And it's preservative process
[00:41:21.180]and it makes it difficult because the more
[00:41:23.132]that we perseverate the more that we worry,
[00:41:25.050]the more that the stress cortisol
[00:41:27.110]that cortisol hormone is released and it takes 20 minutes
[00:41:31.249]to an hour for that to sort of continue out
[00:41:33.309]through our body before the next brown
[00:41:34.870]to the next stressor.
[00:41:35.760]So it can be very,
[00:41:36.890]there's some neurological consequences
[00:41:39.490]when we have that ruminative thinking
[00:41:41.460]but that's what you can see
[00:41:42.600]and of course the physical symptoms.
[00:41:46.447]I do have have a video that
[00:41:48.220]I wanted to share briefly,
[00:41:52.320]but I don't know we're gonna double check to see
[00:41:55.170]if I can play it for now.
[00:41:58.070]I'll play it for about a minute.
[00:42:01.421]Let's see here.
[00:42:02.890]And Dr. Swift this is Ashley.
[00:42:05.120]It might work best,
[00:42:06.697]if you don't share and then you share again
[00:42:09.510]and then it should ask you two questions
[00:42:11.540]and you'll say yes to both of them
[00:42:13.160]so that your audio connects the best way.
[00:42:15.910]Okay, let me see if I can do it.
[00:42:17.670]If I can't am I gonna keep moving on.
[00:42:36.520]Can everybody hear(voice drawn out)
[00:42:38.720]Nope, so if you'll stop share real quick
[00:42:41.350]and then re share your screen
[00:42:43.580]and then I think we'll be able to hear it.
[00:42:46.750]Stop and then re share okay, awesome.
[00:42:53.682]And share computer sound.
[00:42:55.250]Good.
[00:43:04.030]All right,
[00:43:07.557]there we go.
[00:43:08.390]Let's see.
[00:43:09.866]Different kind.
[00:43:10.764]Can you hear now?
[00:43:12.147](Ashley's voice drawn out)
[00:43:14.122]okay let me start.
[00:43:15.720]I'm just gonna show probably about a minute.
[00:43:22.716]It's not saying anything now,
[00:43:23.549]but I'll come on in just a second.
[00:43:26.270]Just to give an understanding of what in the day
[00:43:28.130]in the life of experience some of the anxiety
[00:43:31.390]what that may be like for someone.
[00:43:41.230]Challenges which I have to think of my feet.
[00:43:45.430](upbeat music)
[00:43:52.690]Every day is a challenge of a different kind.
[00:43:55.670]It mainly consists of getting a day safely
[00:43:58.050]and with limited damage.
[00:43:59.890]Although my week is structured and quite routined
[00:44:02.800]each day throws up for in challenge.
[00:44:05.320]Challenges in which I have to think of my feet
[00:44:07.800]and of which there are no routine answers.
[00:44:10.290]These challenges are not the everyday challenges .
[00:44:12.850]The sort of challenges that everybody has to face.
[00:44:15.590]I am talking about the everyday life challenges
[00:44:17.520]that most people take for granted.
[00:44:19.957]A slight change in tone from somebody
[00:44:22.653]I say hello to you on the way to the bus stop.
[00:44:23.950]Can throw up all sorts of confusion
[00:44:26.010]and can set the tone for the day ahead.
[00:44:28.060]Yesterday they said hello, and they were all over me.
[00:44:31.615]Today they seemed distant and cold.
[00:44:33.540]I wonder what it is I've done.
[00:44:35.940]I begin to reproach myself.
[00:44:38.060]Did I come across cold or unlovable.
[00:44:40.840]Then I related to an incident from the past.
[00:44:43.620]from school maybe, I go over and over conversation
[00:44:47.804]I had 20 years ago in my head.
[00:44:49.770]Repeating over and over in my mind.
[00:44:51.940]I didn't mean that when I said this.
[00:44:54.320]What I meant was something else.
[00:44:56.770]I lose my concentration half way through
[00:44:59.300]and think of last weekend's match.
[00:45:01.200]I have to talk about Sunderland football club.
[00:45:03.820]And no matter what has happened to them that weekend
[00:45:06.110]I have a thinking ritual in which I tread carefully
[00:45:09.060]through what I say.
[00:45:10.200]To us not to tempt fate,
[00:45:12.070]I mean things collapse for the team.
[00:45:14.540]I repeat this freeze several times
[00:45:16.620]and then halfway through it, I remember I haven't finished.
[00:45:23.983]All right, I'm gonna go back to our presentation
[00:45:26.620]'cause it is a little bit longer
[00:45:28.530]and I'm going to stop share and go back to our presentation.
[00:45:37.644]And I'll share again so that can go back.
[00:45:41.620]But that's just giving you an example of sort of
[00:45:47.230]what the experience of what I hear in clinical practice
[00:45:51.140]is that constant thought.
[00:45:52.760]There was one triggering the day someone did not speak to me
[00:45:55.840]or I wasn't, and what I think it is
[00:45:57.930]it's not being able to predict what that input is
[00:46:01.260]and it's something different
[00:46:02.460]and then that's now being internalized
[00:46:04.830]and the reason why it's internalized
[00:46:06.540]because before if I didn't respond or it didn't know
[00:46:10.320]then that had sort of a negative response.
[00:46:12.350]So there's that level of hyper vigilance creating an anxiety
[00:46:15.550]and so now that it begins that ruminative,
[00:46:17.380]how do I reconcile, how do I make it right
[00:46:20.410]and that just starts that that worried rabbit hole.
[00:46:23.930]So what are some of the main maintenance factors or triggers
[00:46:26.940]that impact the anxiety and depression.
[00:46:29.950]And I would say any kind of onset
[00:46:31.810]for a mental health disorder.
[00:46:33.920]I would say going back into overload of
[00:46:36.700]that sensory input change in sensory predictions
[00:46:41.240]it's what we talked about.
[00:46:42.868]You know, what I predict is gonna happen is not happening
[00:46:45.040]so that makes it difficult for me to cope or manage.
[00:46:48.430]If I don't have the right team routine
[00:46:50.500]and structure in place.
[00:46:52.465]The constant heightened arousal that I may have again
[00:46:55.550]from previous life history.
[00:46:58.326]I'm a hyper vigilant because of those things.
[00:47:00.593]I may not have and as a result again
[00:47:03.861]may have a degree of emotion regulation.
[00:47:06.640]Relationship issues and family stressors could be issue.
[00:47:12.690]Something happening in the family that's going on
[00:47:15.260]and I may not know exactly how best to respond
[00:47:18.090]to that difficulties problem solving.
[00:47:21.120]And I'm trying to make navigate certain situations
[00:47:25.190]and unexpected changes in my life
[00:47:27.500]that could cause or maintain
[00:47:29.220]some of the mental health issues
[00:47:30.510]that I'm experiencing and environmental changes.
[00:47:34.990]There's a few more that I want to talk about
[00:47:37.060]that is really important.
[00:47:38.010]If I have some past traumas,
[00:47:39.410]that I have not dealt with
[00:47:41.231]and process that is going to maintain
[00:47:42.670]my anxiety response any new
[00:47:45.090]or different social situations,
[00:47:46.820]it's definitely going to have a degree
[00:47:49.610]of difficulty for me to be able to respond appropriately.
[00:47:54.640]Planning and organizational problems.
[00:47:56.860]If I'm having trouble planning and sorting out
[00:47:59.260]in making and prioritizing tasks
[00:48:02.140]I'm going to be overloaded,
[00:48:03.430]I'm gonna feel stressed
[00:48:04.300]and then I'm gonna feel bad about that.
[00:48:06.679]So a lot of my clients they talk to you they feel bad
[00:48:08.820]about the problem and then feel bad
[00:48:10.330]that they're feeling bad about the problem.
[00:48:12.390]So how can we support and helping to get
[00:48:15.140]a plan and support in place.
[00:48:17.543]So to be able to help with those things
[00:48:18.580]that impact the the emotional response.
[00:48:21.700]The ruminative brooding we've talked about that.
[00:48:24.230]The minimum coping resources to be able
[00:48:26.060]to manage whether they're physical, tangible, social
[00:48:28.750]what are those tokens to help you manage daily life
[00:48:31.910]and social isolation obviously that could be
[00:48:35.260]if it's prolonged, we're not saying that people
[00:48:37.700]may enjoy a period of downtime to recoup
[00:48:40.920]but if for an extended period
[00:48:42.980]that could lead into more of depression
[00:48:45.980]and active avoidance of people in events not
[00:48:48.110]because it's too overwhelming but if it's prolonged
[00:48:51.010]and the lack of support.
[00:48:52.990]So let's get into diagnosis and assessment.
[00:48:55.340]What do I do if I'm a clinician or a parent or family,
[00:48:58.730]how will I be able to diagnose and speaking definitely
[00:49:01.970]to the clinicians that may be present,
[00:49:04.450]I want to may want to provide some type of structure.
[00:49:06.590]I start out with a structured diagnostic interview.
[00:49:09.770]So that I can get an understanding of
[00:49:11.180]what that history looks like.
[00:49:13.330]I look at, do some objective screening measures
[00:49:16.370]which I'll share with you in just a moment.
[00:49:18.510]I get a chance to do direct interaction and observation
[00:49:21.040]so I can see myself how that person
[00:49:23.090]is presenting and for the client
[00:49:25.520]if it's not as adapted to communicate
[00:49:27.850]how I feel then what are some ways
[00:49:29.310]that I can get a picture of that.
[00:49:33.690]Can I drawing, writing samples, journals
[00:49:37.060]all of those kinds of things.
[00:49:38.370]How can I get a good understanding
[00:49:41.470]of what that person is feeling in their world.
[00:49:49.800]Carol, if you could keep pressing down
[00:49:53.620]I think you joined and I need some help going right down
[00:49:56.820]to the next bullet.
[00:49:58.193]Thank you.
[00:49:59.094]Collateral information, we're talking to family
[00:50:00.270]and we're finding out what is the change
[00:50:03.128]in severity or behaviors of functioning prior to.
[00:50:05.960]That's really important if I'm talking,
[00:50:07.650]I'm understanding I just don't take that direct interview.
[00:50:10.340]I use the time to get collateral information
[00:50:12.730]to understand the change in functioning.
[00:50:14.790]Is there another alternate way that
[00:50:16.700]the person communicate versus just the one-to-one.
[00:50:19.020]Is there some communication device or pictures
[00:50:21.810]that I could use to identify
[00:50:23.410]what exactly is am I feeling inside.
[00:50:26.640]And Carol, you wanna talk about FBAs.
[00:50:29.410]Sure FBA is also can be part of the diagnosis
[00:50:35.630]and assessment process especially if you are working
[00:50:38.870]with someone that may have
[00:50:40.650]some limited communication abilities
[00:50:42.830]to really be able to observe them
[00:50:45.260]in different settings if possible
[00:50:47.000]and also to talk to other people
[00:50:48.620]and other individuals to get some more input on
[00:50:51.230]what's really going on, what are they seeing
[00:50:53.910]because sometimes people can't give
[00:50:56.030]their best assessment of what's going on themselves
[00:50:59.570]they may not have the words for it,
[00:51:01.820]may not be able to you know completely articulate
[00:51:04.510]what's going on.
[00:51:05.343]So that can really add another dimension
[00:51:07.210]to the whole assessment process.
[00:51:09.890]So now I think we're going to,
[00:51:13.048]if I can click to the next screen.
[00:51:15.260]So I just want to make an it quick mention
[00:51:18.120]about some measures.
[00:51:19.100]So just for the clinicians out there that
[00:51:21.878]to be honest there's not a whole lot of measures
[00:51:24.500]that have been(mumbles)
[00:51:26.870]as a relates to fourth on the autism spectrum with anxiety.
[00:51:29.170]And so there's some more developing out there.
[00:51:31.280]These are certainly ones that you can take a look at.
[00:51:33.460]The ones that are bolded are the ones that
[00:51:35.240]have been researched and validated
[00:51:37.859]as a relates to autism and anxiety.
[00:51:39.720]Particularly the ones before they have been used
[00:51:42.610]but they may not have been a strong link or support
[00:51:47.370]as far as their data on working particularly
[00:51:49.570]with those on the spectrum.
[00:51:52.834]Although these are measures that I use
[00:51:54.270]to sort of get a quick understanding from session to session
[00:51:57.900]where the severity and changes in symptomology.
[00:52:01.537]And carol I'll give some more and talk about treatments.
[00:52:05.000]I know we're starting to run
[00:52:07.790]a little bit close on time, so I'm going to go
[00:52:10.540]a little bit quicker through this
[00:52:12.260]There's quite a bit of overlap
[00:52:13.910]in some of the treatment areas
[00:52:15.200]as we talk about different treatments
[00:52:16.570]for depression and anxiety.
[00:52:18.140]So I will kind of summarize those up
[00:52:20.660]a little bit as best I can.
[00:52:22.400]And please feel free to add in questions
[00:52:24.310]in the chat box as we go.
[00:52:26.982]Treatments for depression.
[00:52:28.900]I like to start with education,
[00:52:30.470]making sure that people know what depression is
[00:52:33.180]because there's a lot of misinformation
[00:52:35.710]about what really depression is.
[00:52:37.000]I hear a lot of people say
[00:52:38.170]well, I'm not sad, I'm not depressed.
[00:52:40.020]And I really try and take the time to emphasize
[00:52:42.780]that depression is more than just being sad.
[00:52:45.180]It can be a lot of different things
[00:52:46.620]that we talked about earlier
[00:52:48.000]in different symptomologies of depression.
[00:52:51.240]So things I really look for especially
[00:52:53.790]when I'm working with someone with an spectrum diagnosis
[00:52:57.210]is do they feel hopeless?
[00:52:59.170]Do they feel worthless
[00:53:01.250]and definitely do they have any thoughts
[00:53:03.290]or actions of self-harm or suicidal?
[00:53:06.740]So those are things that I definitely look for
[00:53:09.670]and emphasize that depression
[00:53:11.240]is more than just being sad.
[00:53:14.860]Let's see if we can go to the next click here.
[00:53:17.030]Also knowing what your triggers are whoops,
[00:53:19.859]I think I went back too far.
[00:53:20.692]Natalie I don't know if you can go back
[00:53:22.724]to there for me or not.
[00:53:25.970]Also knowing what your triggers and red flags are
[00:53:28.430]and knowing what your individual triggers are
[00:53:32.340]and what is your baseline.
[00:53:33.610]So part of it is, I guess from what I've heard
[00:53:36.790]from some individuals is well,
[00:53:38.530]I'm always kind of irritable and negative
[00:53:40.820]or I always kind of keep to myself.
[00:53:43.240]Are you more irritable than you are,
[00:53:45.820]kind of what is your baseline.
[00:53:46.840]So knowing what your baseline is
[00:53:49.055]and what you're experiencing is it more in intensity
[00:53:52.870]or how often it is than what your baseline is.
[00:53:58.410]So knowing kind of your red trigger,
[00:54:00.140]your triggers and your red flags is really important.
[00:54:05.580]See next we're going to talk about biological treatments,
[00:54:09.070]talking about things that I think are really important
[00:54:11.940]for all of us right now.
[00:54:13.410]Knowing what is going on with your sleep.
[00:54:16.781]What dimension are you sleeping in?
[00:54:18.860]That can be a sign of depression.
[00:54:20.680]Is your sleep off?
[00:54:22.010]Are you eating?
[00:54:22.843]Are you not eating well?
[00:54:23.860]Are you skipping breakfast,
[00:54:25.530]forgetting to eat things like that.
[00:54:27.270]What's your physical activity level?
[00:54:29.210]Oftentimes I emphasize physical activity
[00:54:31.920]as opposed to exercise.
[00:54:33.460]Sometimes people hear the the e word
[00:54:35.390]and think oh I don't wanna exercise,
[00:54:36.750]I don't want to go to the gym.
[00:54:38.260]So I'm emphasize physical activity.
[00:54:39.990]And there is actually research
[00:54:42.375]that supports physical activity and exercise
[00:54:44.610]is very very helpful in moderating mood disorders.
[00:54:47.990]So physical activity can be really really important piece
[00:54:51.520]of helping to boost your mood and maintain wellness.
[00:54:57.090]Medications as Dr. Swift has mentioned,
[00:54:59.773]medications are often a piece of treatment
[00:55:02.500]and also making sure that you're taking medications
[00:55:05.120]as they're prescribed and also sharing
[00:55:06.870]if you have any sort of side effects with your provider
[00:55:10.830]because that's another important piece
[00:55:12.680]that I hear people not wanting to take medications
[00:55:15.090]because that made me really sleepy
[00:55:17.250]or it gave me a headache or it upset my stomach.
[00:55:19.760]And those are really important things
[00:55:21.260]that you need to share with you care providers
[00:55:24.027]so that they know what's going on
[00:55:25.930]and they can make adjustments as needed.
[00:55:28.620]Also sensory based treatments for depression,
[00:55:31.988]looking at staying grounded, staying whether
[00:55:36.830]it's I think some of the really good things
[00:55:38.443]that were talked about in the keynote
[00:55:41.040]from this morning that Kelly Mahler and I talked about
[00:55:44.080]some of the sensory based things of knowing
[00:55:46.760]what helps you feel good is really important.
[00:55:52.890]Also relaxation physiological distressing exercises
[00:55:56.311]things like that that help you feel good.
[00:55:59.320]So doing some time to take some do some things
[00:56:02.340]like yoga or stretchy, getting some of those things
[00:56:07.230]where you feel relaxed.
[00:56:09.110]I know a lot of people talk about not knowing
[00:56:11.130]what it is to even feel relaxed,
[00:56:13.360]so taking that time to identify for yourself
[00:56:16.460]what am I like?
[00:56:17.540]What is my body like when I'm feeling relaxed?
[00:56:20.150]So it might even need to be starting at that point
[00:56:22.810]of what is relaxation.
[00:56:26.970]Go on to the next screen.
[00:56:28.430]There's also the psychological treatments for depression.
[00:56:31.870]Kinda one of the big ones is cognitive behavioral therapy
[00:56:36.560]and I'm just for the sake of time
[00:56:38.600]I'm not going to go into much detail of that,
[00:56:40.900]that's pretty well known and pretty well versed,
[00:56:43.240]but it really focuses on how do you manage your thoughts
[00:56:46.660]to manage your emotions and your behaviors.
[00:56:49.220]Also adding a behavior activation.
[00:56:51.490]Making sure especially in this day and age
[00:56:56.289]are we doing things that kind of keep our routine going,
[00:56:57.770]that can help us stay grounded?
[00:56:59.560]Are we doing things that we know we need to do
[00:57:02.420]that are necessary?
[00:57:03.690]We need to get some of those things done
[00:57:05.370]but also making sure that we're doing things
[00:57:06.960]that we find pleasurable and enjoyable
[00:57:08.920]so that we can continue to get through the day
[00:57:11.670]to day at the new norm especially right now.
[00:57:14.450]Self monitoring is important,
[00:57:17.000]but that can also be difficult for someone
[00:57:18.730]who is on the spectrum to be able
[00:57:20.490]to effectively self monitor.
[00:57:22.510]So that might be important to have someone close
[00:57:25.530]to them help them monitor kind of what's going on.
[00:57:28.440]How long am I sleeping?
[00:57:29.410]Am I getting up on the same time?
[00:57:32.240]Am I sleeping in too much.
[00:57:33.730]Am I making sure that I'm getting some good nutrition,
[00:57:36.810]things like that how is my depression,
[00:57:38.470]checking in on a daily basis of where is my depression
[00:57:42.200]or my anxiety at today.
[00:57:44.600]Also some mindfulness based therapy can be very helpful
[00:57:48.220]for both depression and anxiety.
[00:57:50.720]And I think Kelly Mahler and the other
[00:57:53.924]from the keynote is also talking about different ways
[00:57:57.620]to apply some of the mindfulness-based therapy techniques
[00:58:01.790]and really starting with doing things like guided meditation
[00:58:06.570]doing things like a body scan.
[00:58:09.290]A body scan can really help you identify
[00:58:11.990]what's going on in my body,
[00:58:13.410]where am I feeling that maybe that heaviness of depression
[00:58:16.610]or that that agitation maybe in my hands to my leg bouncy.
[00:58:21.710]So doing body scan and really focusing on
[00:58:24.215]what's going on in your body can really help tie you back
[00:58:27.578]and be grounded to what's going on and calm you down.
[00:58:37.300]And next, we're gonna talk
[00:58:38.602]a little about social treatments for depression.
[00:58:42.060]Engaging social support systems.
[00:58:44.840]Huge piece of that.
[00:58:45.750]But especially if you're self isolating
[00:58:48.530]that can be really hard to do
[00:58:51.260]or hard to feel like you're doing
[00:58:52.740]and in this time we're we're not connecting with people
[00:58:57.020]the way we usually do and in the age right now
[00:58:59.300]of social distancing it can be really difficult
[00:59:01.960]to engage with those social support systems.
[00:59:04.300]So it might be finding creative ways to engage.
[00:59:08.020]It's texting, its FaceTime, its Zoom, its calling,
[00:59:12.090]it's whatever you can work out to stay connected
[00:59:15.300]with your social support system whoever that is.
[00:59:18.280]It can also be helpful to have
[00:59:19.410]an accountability plan partner.
[00:59:21.600]Someone that you're checking in with.
[00:59:23.250]I encourage people to have somebody
[00:59:25.730]that they reach out to and check in
[00:59:28.230]with at least on a daily basis.
[00:59:30.480]So that they're kind of helping work their treatment plan.
[00:59:36.200]Think about it, a lot of us when we were going to the gym
[00:59:39.320]we would have workout buddy
[00:59:41.780]or if you're going through anything like that
[00:59:43.537]you have somebody in your life
[00:59:45.140]who's kind of helping you do these things.
[00:59:48.460]So accountability plan partner it
[00:59:50.070]can be really helpful in that.
[00:59:51.800]One thing I've also worked on doing
[00:59:54.430]is helping people with social person-centered planning.
[00:59:57.950]Because I've noticed that many times with the depression
[01:00:02.810]will pop up for or at least get more significant
[01:00:05.830]when people are at that age of being that teens,
[01:00:10.040]young adults and realizing that school is changing
[01:00:14.840]that they are going on one path
[01:00:16.650]and maybe some of their peers or other people
[01:00:19.030]are going on another path
[01:00:20.610]and they're not sure what that future for them looks like.
[01:00:24.090]So starting to help them figure out
[01:00:27.160]what's next in my life and how do I get there
[01:00:30.410]instead of sitting kind of at the edge of their program
[01:00:35.150]either in high school or transition age program
[01:00:37.440]and figuring out what's next
[01:00:39.600]because it looks very blank and very anxiety-producing.
[01:00:44.160]So doing some person-centered planning
[01:00:46.210]and reaching out to figure out some
[01:00:48.040]of these specifics of what do I do next can help
[01:00:51.720]with that depression as well.
[01:00:56.100]So a few of the treatments for anxiety.
[01:00:58.890]This is a little bit different from the depression piece
[01:01:02.380]is also knowing what am I feeling,
[01:01:05.160]what is anxiety and if you're involved
[01:01:08.570]in the or participated in the keynote earlier this morning
[01:01:12.700]that talked about the inner reception
[01:01:14.410]which was amazing.
[01:01:15.420]I'm so glad these are being recorded
[01:01:17.260]so that people can go back
[01:01:19.030]and get that information if you didn't.
[01:01:21.450]Kelly talked about introception as one of the other senses
[01:01:24.730]that probably for most of us
[01:01:27.580]isn't really talked about or well known.
[01:01:29.710]I'm going to throw you another one
[01:01:31.906]it's called neuroception.
[01:01:33.530]Neuroception is a concept that was created
[01:01:36.660]by Dr. Stephen Porges if you're familiar
[01:01:39.500]with the polyvagal theory that he kind of introduced
[01:01:44.800]a few years back.
[01:01:46.480]I encourage you to look that up.
[01:01:48.050]If you're familiar with Asperger experts website,
[01:01:52.440]I know Danny Reed and the Asperger experts website talks
[01:01:56.160]a lot about Dr. Porges
[01:01:57.717]and polyvagal theory and neuroception.
[01:02:00.070]Neuroception basically is another sense.
[01:02:03.110]Think about it for you Marvel fans like your Spidey sense
[01:02:06.960]and I think a lot of us right now probably
[01:02:10.950]can identify with our neuroception
[01:02:12.840]being a little bit thrown off.
[01:02:14.640]It's an involuntary process where our brain
[01:02:18.610]and our body have an unconscious surveillance
[01:02:21.650]of safety and threat in the environment.
[01:02:23.860]Now under normal circumstances many of us
[01:02:26.050]have probably what we would consider normal neuroception
[01:02:30.460]but right now I'm thinking if for those of you
[01:02:34.130]maybe if you're thinking about going
[01:02:35.300]to the grocery store later today or later this weekend,
[01:02:38.930]we might have a little bit more anxiety of something even
[01:02:42.050]as little as a month ago we wouldn't have the anxiety about.
[01:02:45.380]We wouldn't have the anxiety a month ago
[01:02:46.790]about maybe grabbing on to the shopping cart.
[01:02:48.810]Is that or walking by someone who's coughing
[01:02:51.670]but right now we might have that that sixth sense
[01:02:54.220]if you will that Spidey sense of
[01:02:56.170]is there danger in the environment.
[01:02:57.990]So if our neuroception or that Spidey sense is off
[01:03:01.820]and we feel like oh goodness, is there a germ,
[01:03:04.640]is there this and is there that,
[01:03:07.300]that really can kind of throw off
[01:03:09.437]our sense of safety and awareness
[01:03:11.761]and I think if we maybe feeling a little bit of kind of
[01:03:16.190]what people on the spectrum might be feeling
[01:03:18.530]on a daily daily basis.
[01:03:20.700]And I think it's really interesting
[01:03:23.210]if you think about the video that we watched
[01:03:25.540]that Dr. Swift shared about the gentleman talking about
[01:03:29.440]his anxiety is just overwhelming.
[01:03:32.360]It's everywhere.
[01:03:33.580]So if we have faulty near reception
[01:03:35.160]and we're meeting situations that may
[01:03:37.420]or may not as dangerous when they really aren't,
[01:03:41.270]that increases our anxiety.
[01:03:43.740]Also Alexithymia is I think really in my mind
[01:03:48.750]anyway kind of ties really well into the interoception piece
[01:03:52.090]of kind of knowing or or not really accurately knowing
[01:03:55.180]what's going on in my body
[01:03:56.510]and how does that feel and making sure
[01:03:58.220]that I'm connecting with my physical sensations
[01:04:01.350]as to how that affects what am I really feeling.
[01:04:05.210]Also important for anxiety,
[01:04:07.490]just like with depression knowing
[01:04:09.200]what your triggers are red flags are
[01:04:10.890]and knowing what your baseline is
[01:04:12.700]what you kind of figuring out
[01:04:14.260]this is how I typically feel
[01:04:16.130]and am I feeling even more so.
[01:04:18.970]I mean maybe it's more maybe there are red flags
[01:04:21.980]that are triggers of just things going on right now
[01:04:24.360]and in the world kind of triggering the anxiety.
[01:04:31.210]I'm going to quickly I would
[01:04:33.880]go over these since I know we've talked a lot about
[01:04:37.700]all of these already.
[01:04:38.960]Treatments for anxiety again sleep, nutrition,
[01:04:41.740]a lot of the themes that are kind of your basics
[01:04:44.320]and your foundation for health and wellness,
[01:04:48.200]medications relaxation very very important.
[01:04:55.060]Psychological treatments.
[01:04:57.190]Again, cognitive behavioral therapy
[01:04:59.050]is kind of the first-line treatment for mental health,
[01:05:04.296]treatment for anxiety disorders
[01:05:07.030]There's also the reappraisal
[01:05:09.500]and emotional acceptance strategies.
[01:05:11.020]Reappraisal is reframing an event
[01:05:14.070]to modulate one's experience
[01:05:15.770]a positive or negative emotions.
[01:05:17.970]So think about in terms of for example
[01:05:22.030]if you have lost your job maybe,
[01:05:25.010]you're not working right now.
[01:05:28.240]Do you see that as a negative oh my gosh,
[01:05:31.200]how am I going to pay the bills
[01:05:32.500]which is true but taking it to an extreme
[01:05:35.639]I'm never going to work again versus
[01:05:38.875]this is what it is now but maybe it's an opportunity
[01:05:42.850]to take some time to reevaluate
[01:05:47.210]what kind of work I wanna do,
[01:05:48.690]it take some time to be at home.
[01:05:50.400]So it's that reappraisal and how do I look
[01:05:52.620]at a situation that's going on.
[01:05:55.860]Emotional acceptance strategy can be really helpful
[01:05:58.675]because what that really focuses on
[01:06:00.810]is you're not trying to control your feelings.
[01:06:03.670]You're not trying to change anything,
[01:06:05.520]you're acknowledging this is where I'm at,
[01:06:07.610]this is what's going on
[01:06:09.980]and I'm just going to sit with it and be with it.
[01:06:13.470]Exposure therapy is really really helpful
[01:06:18.590]for people who have phobias.
[01:06:21.250]A very common phobia I think all people
[01:06:23.420]will think about is fear flying.
[01:06:25.300]So exposure therapy would then walk
[01:06:27.010]through helping individual walk through
[01:06:29.030]how do I get closer to maybe I drive by an airport,
[01:06:33.120]starting at something very very low intensity.
[01:06:37.190]Maybe then the next step will be I get out of my car
[01:06:41.330]and go into the airport.
[01:06:42.360]So you're working incrementally way up to the event
[01:06:45.940]or the action that is very very anxiety-producing for you.
[01:06:50.130]Coping with uncertainty.
[01:06:52.480]I think we're all doing that right now
[01:06:54.590]to the best of our ability.
[01:06:56.800]But that is a huge piece that I think is missing
[01:07:01.440]from a lot of people on the spectrum
[01:07:04.460]of how do I handle when things are up in the air.
[01:07:08.560]And one of the handouts that I had shared with with Ashley
[01:07:12.500]I think that we can afford that on
[01:07:15.475]and fit it in the link.
[01:07:16.800]But there was a really good resource that I sent up
[01:07:19.107]recently and sent out recently that talked about
[01:07:21.344]how do you help someone on the spectrum navigate unsettling
[01:07:26.690]or uncertainty things like that.
[01:07:29.430]And one of the the handouts in there talked
[01:07:31.330]about how specifically right now is face COVID.
[01:07:36.040]So what it does, it makes it an acronym which I love,
[01:07:39.420]so it breaks it down.
[01:07:40.910]So like for example face, the f focus on
[01:07:43.930]what you can control,
[01:07:45.500]a, acknowledge your thoughts and feelings
[01:07:48.190]c, come back into your body.
[01:07:50.350]So it's really focusing on your body.
[01:07:52.290]Awesome things actually point out
[01:07:53.700]all the resources are online.
[01:07:56.020]So it really ties in that body piece,
[01:07:57.900]what's going on in your body right now.
[01:08:00.300]So you can stay grounded and focused.
[01:08:02.680]E, engaging in what you are doing
[01:08:04.190]if that's really focusing and being present in the moment
[01:08:08.100]which is kind of a mindfulness-based therapy technique
[01:08:11.150]and figuring out what's going on right here right now
[01:08:15.090]instead of spiraling kind of out of control
[01:08:18.300]and into really an anxiety mindset.
[01:08:23.720]I'm gonna go on to the next ones but it's take time.
[01:08:30.810]I think my screen is froze.
[01:08:40.603]Okay, social treatments for anxiety.
[01:08:41.770]Again, engaging support systems is huge,
[01:08:43.760]having a partner, social skills practice,
[01:08:46.250]practicing some of those things that
[01:08:47.980]can make you feel very anxious.
[01:08:50.310]Maybe I feel anxious about maybe wanting
[01:08:52.910]to talk to somebody on the phone until practicing that
[01:08:55.570]even using social stories.
[01:08:57.680]Social stories I know for younger kids can be helpful
[01:09:00.140]but they can also be helpful for it for us adults.
[01:09:03.460]There's also a really good social story on
[01:09:05.340]how do you talk to people on the spectrum
[01:09:08.140]or how do we talk in general about what is COVID,
[01:09:10.630]what is this new normal that we're living at.
[01:09:12.930]How do we try and explain something so abstract
[01:09:18.491]and odd for most of us.
[01:09:19.960]How do we make that understandable for those around us.
[01:09:23.750]Also using visuals for supports and anxiety treatment.
[01:09:32.915]I'll try and go to the next screen here.
[01:09:35.270]Let's see, observations and changes.
[01:09:43.770]Let's see.
[01:09:45.167]I think the big thing I will kind of summarize this
[01:09:46.710]observation and changes, when to seek help.
[01:09:48.843]If you are seeing a significant change
[01:09:52.040]in what is your baseline?
[01:09:55.230]What are you doing over in your overall functioning
[01:09:57.410]or if you are seeing this
[01:09:58.410]in someone that you care for it and a family member
[01:10:01.350]or if you are seeing these things.
[01:10:04.480]These are things that might be okay,
[01:10:06.640]I'm starting to see some red flags.
[01:10:08.220]Increased irritability and education.
[01:10:10.130]Again, that's different from what is their baseline.
[01:10:12.030]So it's more intense.
[01:10:15.840]Emotional outbursts, increased negative processing
[01:10:18.510]or brooding, so again it's an increase in
[01:10:20.270]what is their norm, what is their baseline.
[01:10:22.830]Difficulty thinking clearly.
[01:10:25.560]I've had people reach out and ask,
[01:10:28.780]well I don't know if my loved one is dealing
[01:10:32.440]with depression or not but they can't make decisions.
[01:10:35.640]That's a really big hallmark sign
[01:10:37.670]of really the depression getting
[01:10:39.070]a little more I guess intense,
[01:10:43.950]so that you can't make decisions.
[01:10:45.330]It's really difficult to think about,
[01:10:47.580]what do I need to do.
[01:10:48.413]I don't know how to take that next step.
[01:10:51.010]Suicidal ideation.
[01:10:52.220]That's a obviously a really big one
[01:10:54.530]if anytime that you feel that you are thinking
[01:10:58.010]about hurting yourself or if someone mentions this to you
[01:11:01.060]that these are really important things to take seriously
[01:11:03.490]and to seek help for that
[01:11:06.220]because that's another big red flag.
[01:11:09.600]Also recurrent panic attacks
[01:11:10.890]or heightened reactions to stressors.
[01:11:12.300]Again, the big piece is it's this different
[01:11:14.540]than what is kind of your regular everyday operating
[01:11:19.400]where you're at on a normal typical day.
[01:11:22.370]Also increased isolation and withdrawing from others.
[01:11:28.330]And feeling hopeless or worthless.
[01:11:29.970]I think I mentioned that when we talked about depression
[01:11:35.610]and those are the big red flags.
[01:11:39.388]Let me see if we can go to our next screen.
[01:11:42.380]Accessing communities for supports.
[01:11:48.430]Looking at the school.
[01:11:49.263]If the school can have resources that you may
[01:11:52.440]or may not know about.
[01:11:54.020]I know the schools especially in the last few years
[01:11:56.140]have really faced unfocused and an emphasis on
[01:11:59.230]what is mental health and connecting people
[01:12:00.900]with mental health services.
[01:12:02.350]So reaching out to your school to see
[01:12:03.890]what kind of resources they have available
[01:12:06.100]or referral systems.
[01:12:07.490]Speaking with your physician.
[01:12:08.980]If you're as person has services through
[01:12:12.630]the state reaching out to your service coordinator.
[01:12:15.440]Other families and online forums.
[01:12:17.720]I think this is also really important
[01:12:19.328]to check these things because a lot of times
[01:12:23.577]you're gonna get your best resources
[01:12:25.430]and referral suggestions from other families
[01:12:29.610]who've been there.
[01:12:30.780]Online forums.
[01:12:32.670]Reaching out hey, where are places I can go.
[01:12:36.130]Does anybody know somewhere I can reach?
[01:12:38.660]So checking in with that.
[01:12:39.660]Social support groups, peer mentors,
[01:12:41.990]even your insurance company.
[01:12:43.310]I hate to emphasize this but it's a fact of life.
[01:12:47.830]Knowing what your insurance will cover,
[01:12:49.810]finances are important.
[01:12:51.760]So if you find someone that you are really interested in
[01:12:55.770]or maybe you get a name from your insurance company,
[01:12:58.080]then maybe taking that back
[01:12:59.300]to reaching out to other family members
[01:13:00.660]to say hey, I've got a list of you know
[01:13:04.059]a couple therapists or people that are covered
[01:13:06.270]by my insurance, what do you guys think
[01:13:08.679]what's your experience?
[01:13:09.643]I've gotten a lot of good feedback
[01:13:10.999]from other families and other parents
[01:13:13.480]just myself personally and working with my family
[01:13:16.627]of kind of finding services that way.
[01:13:19.850]You can also look at what local
[01:13:21.670]and national autism groups for resources things like that.
[01:13:26.520]All right, and there's only one minute
[01:13:28.040]we've got our one minute warning.
[01:13:32.215]All right, quick rundown.
[01:13:35.690]Being a support person.
[01:13:36.650]Don't go down the rabbit hole with the person
[01:13:39.370]if you're a caregiver or a support person.
[01:13:42.200]If they're getting anxious or depressed,
[01:13:44.270]don't go with them.
[01:13:45.780]Right now, I'm just gonna emphasize
[01:13:47.277]put on your own oxygen mask
[01:13:49.120]and actually I put this on before COVID-19 hit
[01:13:52.900]but if you're familiar with the analogy
[01:13:55.120]of getting on an airplane
[01:13:56.530]and putting on your own oxygen mask,
[01:13:58.220]take care of yourself.
[01:13:59.530]We've got to be able to take care of ourselves
[01:14:01.020]as caregivers before we can help other people
[01:14:03.950]which kind of ties into co-regulation.
[01:14:07.050]Helping someone else regulate and chill and relax.
[01:14:10.330]We can't do that if we're just regulated ourselves.
[01:14:12.890]So we need to be able to know what we need
[01:14:15.400]to do as a support person to take care of ourselves
[01:14:18.130]and fill our own bucket and regulate ourselves
[01:14:20.490]so that we can help somebody else regulate.
[01:14:23.690]And I know, we're about at a time
[01:14:25.920]so I am going to I guess kick it over to questions.
[01:14:31.020]I know we have a lot of other resources,
[01:14:33.760]references things like that
[01:14:35.140]but do we have other questions.
[01:14:36.410]Ashley anything else we need to do?
[01:14:42.150]I haven't seen any questions yet in the chat box
[01:14:45.432]I would just say thank you so much to both of you.
[01:14:49.580]This was a wonderful and informative presentation
[01:14:52.810]and if you're willing to stay on
[01:14:55.850]for a little bit if people have questions for you,
[01:14:58.570]otherwise, it is lunch break for the next hour.
[01:15:02.530]So the afternoon sessions will start at 12:45 Central Time.
[01:15:08.900]Also, I can stay on for a bit
[01:15:10.510]if anyone wants to pop in questions.
[01:15:13.920]And feel free participants to unmute yourselves,
[01:15:16.680]now you can ask using your microphone
[01:15:18.860]or put it in the chat box.
[01:15:22.180]Carol I can't see the questions so, let's see.
[01:15:27.930]I don't have a question.
[01:15:29.120]I just want to say hi Natalie.
[01:15:35.500]Hello.
[01:15:39.280]Let's see someone had asked,
[01:15:41.110]do either of you take Iowa Medicaid for payment.
[01:15:43.630]I am not proof for Iowa Medicaid.
[01:15:46.834]I don't know about you Dr. Swift unfortunately.
[01:15:48.220]I do take Nebraska Medicaid and most insurances.
[01:15:52.630]I don't know about you Dr. Swift.
[01:15:56.610]Yes, I have an Iowa client
[01:15:59.040]and there I am Medicaid but we,
[01:16:03.350]so yeah I don't know how that's working my billing
[01:16:06.500]but it's kind of a challenge you know
[01:16:07.960]for like for some reason I can see them in the office
[01:16:10.705]but we can't do telehealth caused I'm not licensed in Iowa
[01:16:12.110]so it's kind of an issue though.
[01:16:16.190]And everything's even changed
[01:16:18.623]in the last couple of weeks so.
[01:16:20.446]Sure.
[01:16:39.570]Let's see is it better for someone on the spectrum
[01:16:41.540]to be treated with experience
[01:16:43.090]with autism versus having much experience?
[01:16:48.299]You talked about that a little bit.
[01:16:51.900]I'm sorry, I'm just now getting the question
[01:16:53.510]what can you see on your screen?
[01:16:55.190]Can you see the Zoom chat or you just see the presentation?
[01:16:58.950]The group chat.
[01:17:02.220]I just wanted to make sure...
[01:17:04.020]Is it better for someone on the spectrum to be treated
[01:17:07.160]with experience with autism versus
[01:17:09.690]not having much experience.
[01:17:13.680]You know and this is where in my mind
[01:17:17.330]I feel like I wanted to come in with my
[01:17:20.480]and I hope I'm answering the question,
[01:17:21.830]meaning if someone that has experience treating autism
[01:17:25.541]is that what you're saying,
[01:17:27.794]is that it person more equipped or better
[01:17:29.810]if they have that experience?
[01:17:31.570]Yes, as a professional.
[01:17:33.146]I came in as a professional working
[01:17:36.010]with intellectual disability
[01:17:37.280]but not the experience necessarily,
[01:17:40.150]the autism I had it from assessment in graduate school
[01:17:43.180]and postdoc but not necessarily treating.
[01:17:45.550]And I feel like I wasn't equipped to be able to provide that
[01:17:50.157]and what I realized in just in my own experience
[01:17:52.960]and in prayer that the experience is not coming
[01:17:55.930]from all the journals.
[01:17:56.830]The experience was not in the knowledge
[01:17:58.360]was not coming from all the different research
[01:18:00.470]which is available,
[01:18:01.340]the experience came from just being able
[01:18:03.830]to meet and understand the lived experiences
[01:18:05.860]of the individuals that I was sitting with
[01:18:07.167]and that became the impetus, my knowledge,
[01:18:10.010]my encyclopedia, if you will for really understanding
[01:18:13.236]that person how to treat.
[01:18:14.069]So I would argue that
[01:18:14.902]if you do not have as much experience
[01:18:16.097]you definitely want to operate
[01:18:17.560]in your scope of practice and competency,
[01:18:20.050]but if you have someone you're able to consult
[01:18:21.890]or seek supervision with who has more experience
[01:18:24.270]with working with individuals on the spectrum
[01:18:26.610]and you definitely want to have that support
[01:18:29.920]but I would not be reticent and been able
[01:18:33.190]to especially if you have some other tools
[01:18:34.790]or other experience with anxiety and depression
[01:18:37.470]then I would open the door and allow the client
[01:18:39.650]to be the expert in their experience
[01:18:41.470]which is who they are.
[01:18:43.230]And I think that that would really help in my experience
[01:18:46.130]to me that expand with treatment options
[01:18:48.260]or availability or accessibility
[01:18:50.410]for people to be able to to work.
[01:18:54.480]So that's a long way to your answer
[01:18:56.913]but I'm just saying my experience I was not an expert
[01:19:00.420]if you will or had a lot of experience before I began.
[01:19:04.240]Dr. Swift I would second that.
[01:19:06.508]I think if the therapists isn't maybe particularly
[01:19:12.620]well versed in autism but is open to learning
[01:19:14.680]and if you have a really good connection
[01:19:17.950]or have a good rapport relationship with that therapist
[01:19:20.450]and they're open to learning,
[01:19:21.640]I would say go for it.
[01:19:23.250]I wouldn't want that to be the barrier
[01:19:26.080]to reaching out to someone oh well,
[01:19:28.910]I've got a good relationship and I really like them,
[01:19:30.970]I really connect with them
[01:19:31.890]but they don't have a child living autism.
[01:19:34.270]But if they're willing to learn
[01:19:36.173]and you've got a good rapport
[01:19:37.801]I think those are two really important caveats.
[01:19:51.310]Wonderful.
[01:19:52.143]Okay, any other questions?
[01:20:04.280]All right, I'm gonna say no then.
[01:20:08.740]And you both have your emails there on that final slide
[01:20:12.230]and so, okay if people have questions
[01:20:14.620]is it okay for them to just email you?
[01:20:17.670]Sure, absolutely. That's work for me.
[01:20:20.334]Thank you so much.
[01:20:21.167]And again, those resources
[01:20:22.480]and handouts are linked in
[01:20:23.860]to you guys's virtual conference schedule.
[01:20:26.470]So thank you wonderful presentation
[01:20:28.950]and have a great lunch everybody
[01:20:30.550]and we will see you on for afternoons season.
[01:20:34.770]All right, thanks.
[01:20:36.140]Thank you so much.
[01:20:36.973]Thank you Ashley for your support, I appreciate it.

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Autism and Depression and Anxiety (oh my!)

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