The Autism Society Event and Education Recordings Archive

The genetic, epidemiologic, and clinical interrelationships between autism spectrum disorder (ASD) and mental illness will be reviewed. The argument that the ASD community needs to forge a strategic alliance with the mental health community, in order to achieve the best outcome for persons with ASD will be brought forward.

Background: The features of ASD exist on a continuum, with no bright line dividing persons with “normal development” from persons with atypical development. Likewise, there is no “bright line” separating persons with ASD from persons with disorders of Mental Health. ASD and mental illness share common underlying neurobiological roots, co-migrate within families, and are often expressed simultaneously or sequentially within individuals: Children with ASD may gradually “grow out of” most of their atypical features, only to “grow into” a mental health disorder -- often the same mental health disorder exhibited by one of the parents. Despite these linkages, mental illness is often regarded as a “separate problem” from ASD, and hence does not receive the attention it deserves within the autism community.

Content:

First, we will present several converging lines of information:

1. Basic science data demonstrating the shared neurobiological roots for ASD and mental illness
2. Clinical data illustrating that neuropsychological traits such as cognitive rigidity, dysregulation of attention, and dysregulation of arousal are shared by persons with ASD and persons with mental illness
3. Epidemiologic data demonstrating the co-migration of ASD and mental illness within families
4. Examples from the literature and the author’s own 30 year practice
5. Preliminary data from the field of Forensic Psychiatry

Next, we will discuss the immediate implications of these data:

1. It is untenable to argue that persons with mental illness represent a wholly separate population from the persons with ASD. In many instances, they are the same individuals, at different points in their lifespan.
2. Optimal outcome for the child with ASD includes addressing his or her mental health issues. Often, and especially for children with higher functioning ASD, the treatment paradigm needs to shift from a Developmental Disabilities model to a Mental Health model, somewhere during later childhood or adolescence, as issues such as anxiety and depression supersede developmental goals such as eliciting speech and eye contact.
3. Identifying ASD in a child is a red flag for the possible presence of a mental health disorder in one or both parents. The impact on a child with ASD of being reared by a parent with a mental health disorder has never been explicitly addressed, and needs to become a topic of discussion within the autism, healthcare, and research communities.

Finally, we will discuss strategic issues:

1. Services for adults with ASD need to include something akin to the services for adult survivors of childhood cancer. Adult “survivors” of childhood ASD require mental health services, job support, and the opportunity to socialize. There is presently no service delivery system in place that addresses these needs.
2. Rather than attempting to distance itself from issues of mental health, the autism community would be well-served to make common cause with the Mental Health community, in order to shape the national research and service agendas for individuals with ASD, and in order to de-stigmatize individuals with ASD and mental illness.

Learning Objectives: