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Depression and Suicidal Episodesin Autism and Related Disorders
Josh Feder, MDNAA
February 15 2012
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Start recording.
canned intro
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Depression and Suicidal Episodesin Autism and Related Disorders
Josh Feder, MDNAA
February 15 2012
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Director of Research, Graduate School,Interdisciplinary Council on
Developmental and Learning Disorders
Assistant Clinical Professor, VoluntaryDept of Psychiatry, University of California
at San Diego School of Medicine
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Feder 411
Math, Engineering, and DevelopmentalDisorders beginning 1978.
US Navy Child Psychiatry Mike 1990 (1992) Greenspan and Wieder 1993
Career expansion: clinic, teaching,research, advocacy, tech developmentand arts & media.
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ICDL
CAPTN/Pfizer
SymPlay
Cherry Crisp
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Commercials
Because we build ideas together And you can join us in the effort!
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Working Together for
Parent Choice!9
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The Southern California
DIR/FloortimeRegional Training Program
Pasadena, CaliforniaFebruary 24-26, 2012
Pasadena Child Development Associates , Inc.(PCDA)
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Thank You!
Families say a silent thank you
NAA Chantal Sicile-Kira! Mentors: Greenspan & Wieder
Students at the ICDL Graduate School So many others
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Depression in DSM-IV
Sleep - more or less, up early is classic Loss of Interest in usual activities, incl. sex
Negative thoughts, often over and over Energy usually down, might be agitated Poor concentration, e.g., reading Appetite down, or up Sluggish body stooped, slow, leaden Suicidal thinking
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General Rates of Depression
General population: 20-25% Recurrence: 50%
Re-recurrence: 75%+ Suicide rates: 15%+ Earlier onset may mean worse condition
Family history adds to risk Bipolar: 1% overall; 20%+ of depressed youth
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Depression in ASD
Many reports, little data, likely high rates Chronic emotional pain from trouble relating and
communicating with others, from sensoryprocessing and modulation difficulties, etc.
Excellent recall of negative life events e.g.bullying, but even minor disappointments
May be even more persistent in negative thinking
Might not show sadness the same way mightbe harder to tell Still, look for the usual kinds of signs
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Suicide
Adults in emotional pain with no otheroptions and a need to act now
Top risk factors: depression and substance use Adolescents/ young adults at higher risk: less
likely to consider consequences Highest risk in the elderly
Children have trouble following through butsome children do high risk things (run intotraffic, jump into deep water)
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Suicidal Ideation in ASD
Chronic emotional pain High risk for substance abuse in ASD
Hard to see other options Often acting without reflecting May be more persistent in following through
with ideas to hurt self including chidren
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What about normal sadness?
Common losses, e.g. a pet dies, a friend moves People with ASD often react all or nothing, i.e.,
distraught or unemotional
We are relieved when our kids with ASD showempathy, e.g., for a hurt classmate We are worried when people with ASD do not
seem to mourn a loss they way others do
We work to help them build a range of emotions But how do we tell the difference betweennormal sadness and depression?
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They are different
Normal Sadness Depression
Might temporarily get in
the way of function
Really gets in the way of
functionUsually caused by a sadexperience
Not always triggered by asad experience (50%)
Understandably sad important to learn andgrow from it, becomingstronger and improvingfunction
Maybe understandablydepressed (e.g. cancer)or maybe not - but notgrowing from it, robsfunction
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When to worry
Always..? Always take suicidal episodes seriously
Manipulation is a risk factor for real action ASD: tend to do what they say they will do Always working on prevention, i.e., on
improving ability to cope with distress
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What to do:Supervision and Solving Problems
Safety first supervision, maybe 24/7 Build emotional range & regulatory range
Manage the environment Mental Health Care
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Building Better Stress Coping
Co-regulation: help someone be moreregulated and then learn self-regulation
Building emotional connection Repair of emotional connections Building range of emotions and ability to
tolerate emotions
Dealing with expectations the rule of life:nothing ever happens the way we expected
M gi g th W ld
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Managing the Worldsurrounding the person
Promoting connection in everyday life Supervision to prevent bullying
Facilitate social relating: slow it all down tohelp everyone be part of whats going on Giving cues and space to build initiation
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Symbolic Solutions
Best ones we have generates creative solutionsthat can be portable and shared
All around us so can be hard to see
E.g., Anger becomes competition as in Olympics,or becoming a surgeon lets you cut people E.g., Fear mastered by cuddling a doll or by
holding hands on the tarmac during takeoff, oropening fortune cookie
E.g., Sadness expressed in creating orexperiencing art (rocket shells to tulips), tearfulmovies or books
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Hospitalization?
When all else fails and you need a safe place Staff might not understand ASD, and in particular
your family members ASD
Figure out now where they do a good job Create a quick guide three most importantthings to know about your family member
Hard to get good communication
Hard to get good transition Day treatment Residential care what happens afterward? Wraparound care
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Quick Guide Example
Give him time to answer Do not assume that he understands you
Noises make him very upset sooth him withgentle reassurance and a quiet place to rest
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Medication?
Might be a lifesaver Probably will have side effects e.g. activation Probably prevents suicide: drop in suicide rates
when SSRI prescription rose in the 1990s, rise insuicides with the fall in prescriptions to youthafter the suicide warning in 2004
But people DO sometimes have suicidal thoughtsspecific to a medication, including SSRIs. So, asalways, be careful and ask.
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Questions?