Sunday, May 14, 2017

IMFAR 2017: Mental Health Crises in Youth with Autism Spectrum Disorder

IMFAR 2017: Mental Health Crises in Youth with Autism Spectrum Disorder

IMFAR 2017: Mental Health Crises in Youth with Autism Spectrum Disorder

Clinical experience suggests such crises occur frequently among individuals with an Autism Spectrum Disorder (ASD). Despite the scope and impact of this issue, there is no systematic research on the measurement or management of mental health crises in individuals with ASD.
  1. Content note: Discussion of mental health issues, including suicide and other self-harm.
  2. Psychometric Analysis of the Mental Health Crisis Assessment in [Autistic] Youth #IMFAR2017
  3. What = mental health crisis? Settled on APA def: acute disturbance of thought mood, behavior that requires immediate intervention #IMFAR2017
  4. Opening mental health in autistic young people talk with great definition - crisis= acute&resources to manage are not available. #IMFAR2017
  5. About 3/4 of #autistic kids have a co-occurring psychiatric diagnosis, another 1/4 have 2nd diagnosis. #IMFAR2017
  6. Three biggest medical concerns for #autistic kids: sleep disturbances, seizures, GI disturbances. #IMFAR2017
  7. There’s a lot of literature re probs for #autistic kids accessing psychiatric care. Have higher rate of using emergency services #IMFAR2017
  8. Crises happen when ppl have acute psychiatric need but insufficient supports to get through them. #IMFAR2017
  9. "I'm in crisis research" response: "what's a crisis?" Awesome, what about beyond kids? #IMFAR2017
  10. We don’t have enough crises measures, and none are designed for kids, and all require clinician administration. #IMFAR2017 #autism
  11. Measures used is a unique 28 question parent report measure, 3 sections. Section 1: Mental health symptoms, 14 items. #IMFAR2017
  12. 2nd section: Select single most difficult behavior. 3rd section: acuity. #IMFAR2017
  13. In MH session hearing about the development of the Mental Health Crisis Assessment Scale - soon to be published in JCPP #IMFAR2017
  14. Great that ppl are developing a mental health crisis measure but STILL parent report. Can't truly know someone else's MH state! #IMFAR2017
  15. Developed measure through literature review, clinical experience, expert panel. (But not talking w/#autistic kids?) #IMFAR2017
  16. @Hopkins_WKC @JohnsHopkinsDMH  student / faculty affiliate Luke Kalb presenting in his mental health crisis panel at #imfar2017 https://t.co/OfXqP8zG9T
    @Hopkins_WKC @JohnsHopkinsDMH student / faculty affiliate Luke Kalb presenting in his mental health crisis panel at #imfar2017 pic.twitter.com/OfXqP8zG9T
  17. [image above: White man talking at a podium, next to a slide with a white background with the title "Measurement Gap" and the bullet points -Few Crisis Measures -None are designed for children, much less those with a developmental disability, -All require clinician administration -Single Reporting and limited psychometric testing.]
  18. The families in the study were recruited through the IAN network, and the survey was entirely conducted online. #IMFAR2017
  19. Also did clinician interview via phone with parents on subset re: crises in #autistic kids. #IMFAR2017
  20. This study does include adults, so it really would be more appropriate for those autistic adults to respond instead of parents #IMFAR2017
  21. Risk of danger to self and parental nervousness about MH crisis most significant factors in analysis of new measure #IMFAR2017
  22. "Danger to self," and “nervous" tend to be two biggest risk factors in mental health crises in #autistic youth,. #IMFAR2017
  23. Study also looked at whether parents could manage child's behaviour #IMFAR2017
  24. Did best to consider false positives with parent-reported risk factors. #IMFAR2017
  25. 79% of incipient #autistic youth mental health crisis cases were, however, accurately detected through parent interview. #IMFAR2017
  26. Kids who met the cutoff on the crisis measure were 24x more likely to avail themselves of service. #IMFAR2017
  27. 32% of families interviewed met the criteria for their #autistic kids being in mental health crisis. #IMFAR2017
  28. Ed. note: It is *absolutely necessary* to talk about parent stress in #autism families. But it is NOT OK to blame #autistic kids. #IMFAR2017
  29. Parent report on MH crisis accurate when comp to actual support use - & 32% of ppts were in crisis. Shocking stat&shows real need #IMFAR2017 pic.twitter.com/lhAytbWI8Thttps://t.co/lhAytbWI8Tpic.twitter.com/lhAytbWI8T
  30. [image above: Two slides featuring charts. The left-hand slide is a bar chart titled "Urgent Psychiatric Service Use" and the second is a pie chart titled "Prevalence."]
  31. The evidence doesn’t suggest that this measure will help clinical outcomes given that the survey was online. Refining needed 1st. #IMFAR2017
  32. Luther Kalb: Development of the Mental Health Assessment Scale, the only parent-report crisis assessment measure #IMFAR2017
  33. Now: Management of Mental Health Crisis in #autistic kids, based on a national survey of child psychiatrists. Roma Vasa. #IMFAR2017
  34. About to hear from Vasa about how psychiatrists can manage MH crises in young people with and without ASD #IMFAR2017
  35. Roma Vasa: How do providers manage mental health crises in youth with + without autism? #IMFAR2017
  36. Autistic kids in crises often end up not just in ER, but in boarding scenarios — up to 2 weeks. #IMFAR2017
  37. There is dire shortage of facilities that can support #autsitic kids in mental health crises in the US: Only **NINE** in country. #IMFAR2017
  38. We also have dire shortage of child psychiatrists in general, even fewer treat kids with DD. Some US counties have zero psychs. #IMFAR2017
  39. Wow. Dark blue = NO child psychiatrists in a county. USA, you're one of the richest countries in the world. This is shocking. #IMFAR2017 https://t.co/W5WJ7Wa8kC
    Wow. Dark blue = NO child psychiatrists in a county. USA, you're one of the richest countries in the world. This is shocking. #IMFAR2017 pic.twitter.com/W5WJ7Wa8kC
  40. [image above: Slide of a choropleth map demonstrating how few child psychiatrists are available, by county, in the United States.]
  41. Goal of study: examine how child psychiatrists manage mental health crisis in youth with ASD compared to non-#autistic. #IMFAR2017
  42. Factors: Will psychs see kids in crises? Do they feel prepared? etc. 10 question survey total #IMFAR2017
  43. Survey: Psychs who will see #autistic kids: Do they accept kids in crisis, is office designed for crisis, keep open appointments? #IMFAR2017
  44. Survey: preparedness: Is psych comfortable treating kids in crisis as outpatient, do they have proactive emergency plan. #IMFAR2017
  45. Survey: access to external resources to manage crises: access to other professionals, access to crisis evaluation centers, etc. #IMFAR2017
  46. Note: Survey has two different groups: One of psychs who routinely treat #autistic kids, 2nd those who did NOT usually do so. #IMFAR2017
  47. Child psychs who usu. treated #autistic kids tended to keep open apps available for crises, but did less emergency planning etc. #IMFAR2017
  48. Good: Many psychs see & accept ASD kids in practice, but BAD: emergency & multidisciplinary resources. #IMFAR2017
  49. Turns out, psychs with more experience w/#autistic kids less likely to refer to ER or police, worried about patient mistreatment. #IMFAR2017
  50. Vasa also highlights autism training need for doctors - YES!  https://theconversation.com/gps-urgently-need-training-on-autism-77301  #IMFAR2017 - not just psychiatrists but all doctors
  51. Future needs: need more first responder training for #autistic kids in crises, more community-based crisis teams, & *more psychs* #IMFAR2017
  52. 'Good news' that psychiatrists 'ready and willing' to see autistic children & yp people? Sad that the 'good news' bar set so low #IMFAR2017
  53. Vasa wants to train responders, professionals, enforcement, create intervention teams, increase mental health prof, crisis plans #IMFAR2017
  54. Short term: need to train child psychiatrists to develop crisis prevention and intervention plans for #autistic kids. #IMFAR2017
  55. We need to have our #autistic kids meet local law enforcement, identity facilities, know what yr insurance coverage is. #IMFAR2017 #autism
  56. Roma Vasa: 1. Clinicians who see children w/ autism in crisis are less likely to coordinate with other healthcare professionals #IMFAR2017
  57. Great to hear Rosa Vasa talk about need for emergency services to be trained in #autism: v important in relation to mental health #IMFAR2017
  58. Roma Vasa: 2. Because there is a shortage of other healthcare professionals trained in autism, due to lack of resources #IMFAR2017
  59. Now Siegel presenting on talking to autistic young people about death & suicide. Looking forward to this #IMFAR2017
  60. Now: Pediatrican/child psych Siegel: re pilot study on clinical correlates for talking about death & suicide in #autistic kids. #IMFAR2017
  61. Siegel runs one of few (now 13, not 9) inpatient crises centers in US that can support #autistic kids in mental health crises. #IMFAR2017
  62. Siegel: increased suicide ideation and success rates in autistic people. Worrying and upsetting. #IMFAR2017
  63. Suicidal ideation is higher in #autistic youth, based on studies & clinical observation. So is suicide itself. :( #IMFAR2017
  64. Mentioning the Hirvikoski 2016 study on significantly contribute to higher rate of premature mortality #IMFAR2017
  65. Mood & anxiety disorders are suicide/suicidal ideation risk factors, & #autistic kids tend to have higher rate of those factors. #IMFAR2017
  66. There are no validated screening methods for suicidal ideation in #autistic kids WHAT. #IMFAR2017
  67. M.Siegel: suicide &autism - shocking stats: suicide contributes to increased premature mortality x7 vs non-ASC Hirvikoski, 2016 #IMFAR2017
  68. Clinicians have a hard time teasing apart SIB behavior from suicidal ideation behavior. (Maybe survey #autistic ppl?) #IMFAR2017
  69. Problems with #autistic self-reporting include problems with identifying self-states (alexithymia), #IMFAR2017
  70. Also, intense interests in horror/violent media may be #autism trait rather than indication of suicidal ideation. #IMFAR2017
  71. Concerns around possible under report/false -ve/false +ve in autistic young people problem of qnres mistaking traits for ideation #IMFAR2017
  72. Talking about interests and hobbies may score as false positives, same with dramatic statements #IMFAR2017
  73. Again, there’s a conflation with repetitive and SIB behavior, rarely interpreted as suicidal ideation or intent. #IMFAR2017
  74. How do we screen for suicidal ideation across verbal and intellectual ability in #autistic kids? #IMFAR2017
  75. @autism_women We've recently done that on a #mentalhealth project - the input of the autistic ppl co-designing the research was invaluable. #IMFAR2017
  76. If #autistic people screen pos or negative, how do we know if these are false results? What are gold screening standards? #IMFAR2017
  77. Talking about death isn’t necessarily suicidal risk factor, for instance my son talking about his grandpa dying 10 yrs ago. #IMFAR2017
  78. Matthew Siegel: Challenges measuring suicidal ideation in autism #IMFAR2017
  79. Siegel: Clinicians need population-specific validated tools to guide them in assessing suicide risk for #autistic kids. #IMFAR2017
  80. Dr. Siegel at #IMFAR2017: ADHD in autistic individuals tends to have a protective effect against suicide (opposite of non-autistics).
  81. Matthew Siegel: Suicidal ideation in autism: Need population-specific tools #IMFAR2017