The Autism Society Event and Education Recordings Archive

Use this site to access recordings and presentations from National Conferences

Autism Society records most keynote and concurrent sessions at their annual conferences. You can see and hear those recordings by purchasing full online access, or individual recordings.

7063 Mental Health Disorders in ASD: The Elephant in the Room [CRC Session]


Friday, July 25, 2014: 2:30 PM-3:45 PM
201 (Indiana Convention Center)
MP3 Recorded Presentation PDF Slides Handout

Registered attendees have free access, please select the button above for the file you would like to access.

Purchase Access
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:

  • 3 Attendees will be able to articulate an advocacy agenda based upon an informed knowledge of the interwoven relationship between ASD and disorders of mental health, including the need to form strategic alliances beyond the autism community, and the need to tackle the stigma that still adheres to mental illness.
  • 1 Attendees will be able to list, define, and explain the significance of cognitive rigidity, dysregulation of attention, and dysregulation of arousal as these apply to persons with ASD, as well as the relationship between these features and disorders of Mental Health, such as anxiety disorder, OCD, and Bipolar disorder.
  • 2 Attendees will be able to list and discuss in layman's terms the genetic, epidemiologic, and clinical data linking ASD and disorders of mental health, including the concepts of pleiotropy (one gene, many outcomes), polygenic inheritance (different genes, similar outcome), and natural history (evolution of symptoms over time).

Content Area: Transition Planning and Options for Adulthood

Presenter:

James Coplan, M.D.
Developmental Pediatrician
Neurodevelopmental Pediatrics of the Main Line, PC

James Coplan holds sub-specialty certification in Neurodevelopmental Disabilities and Developmental-Behavioral Pediatrics, and is an author. He is a member of the Child Neurology Society, and is a Clinical Associate Professor of Child Psychiatry at the University Of Pennsylvania School Of Medicine.