Mental Health Super Summit 2021

Depression

One in three autistic adolescents and adults have episodic depression

Exploring Depression Programme

Santomauro, Sheffield and Sofronoff (2016) JADD 46, 572-588

Characteristics of Depression Associated with Autism

•A change in the special interest to a morbid or macabre topic

•Watching movies with a theme of death and despair

•An attempt to understand morbid thoughts and deep negative inner emotions

Assessment 1: Reasons why someone who has Autism can sometimes feel sad. Tick those that

apply to you

Loneliness

Being rejected or humiliated by people at school

Being bullied and teased by people at school

Feeling exhausted from trying to be accepted and liked

Believing the criticisms of students at school

Being sensitive to the suffering of others

Depression Questionnaire

Exhaustion from always feeling anxious

Being aware of your faults and being a perfectionist

Taking corrections in school as personal criticism

Being bored at school/work

Not feeling understood by teachers and friends

Not getting the school grades to match your intelligence

Worry about whether you will ever have a relationship

Depression Questionnaire

Worry about whether you will have a successful career

Believing that past bad experiences will continue forever

Feeling constant pressure to fit in and be like everyone else

Experiencing the loss of a friendship, pet or family member

Not being able to cope with intense sensory sensitivity

Experiencing too many changes in your life

Being diagnosed with Autism

Depression Questionnaire

Getting into trouble because of your anger

Not having enough strategies to feel happy again

Not being understood by your parents

Feeling invisible at school

Over-analysing your performance in social situations

Being aware of and troubled by social injustice

Experiencing or having experienced abuse

Distress regarding gender identity

Qualities and Abilities

• Alexipersona A lack of vocabulary to describe personality characteristics is an associated characteristic of Autism

• A list of positive personality adjectives as prompts to describe personality qualities

Positive Personality Adjectives

Adventurous

Affectionate

Ambitious

Articulate

Artistic

Careful

Cheerful

Compassionate

Considerate

Courageous

Courteous

Creative

Curious

Dependable

Determined

Easy-going

Empathic

Energetic

Enthusiastic

Fair

Forgiving

Friendly

Funny

Generous

Gentle

Helpful

Honest

Imaginative

Inventive

Kind

Loyal

Mischievous

Neat

Persistent

Polite

Practical

Proud

Quick-witted

Quiet

Rational

Reliable

Reserved

Serious

Shy

Silly

Sincere

Studious

Sympathetic

Thoughtful

Tolerant

Tidy

Trusting

Wise

This is Who I Am Book: Qualities in Personality and Abilities

Personality

• Kind

• Caring

• A loyal friend

• Honest

• Forthright

• A perfectionist

• Determined

• Brave

• Humourous

Abilities

• Drawing and art

• Creating Lego models

• Exceptional long term memory

• Talented in mathematics

• Noticing details

• Expert on ……

Ring Binder or Computer Programme

• Each quality at the top of a page

• Record examples of the expression of that quality (a diary)

• Photographs, copies of reports and grades, compliments from friends and family

Ring Binder or Computer Programme• Qualities of a hero in the family or

character in a film or TV programme (e.g. Dr Who)

• Each admired quality of the hero has a page

• Add entries throughout and after the programme

• Confirming progress towards a valued personality

• The book is an antidote to depression and builds a positive self-image

Energy Accounting

• Maja Toudal: Concept of an energy bank account

• Energy withdrawals and deposits throughout the day

• Risk of energy depletion leading to depression

• Energy depletion a major cause of depression for those with Asperger’s syndrome

Energy Bank Account: Withdrawals and Deposits

Withdrawal• Socializing

• Change

• Making a mistake

• Sensory sensitivity

• Daily living skills

• Coping with anxiety

• Over analysing social performance

• Sensitivity to other people’s moods

• Being teased or excluded

• Crowds

• Government agencies

• Body shape

• Perceived injustice

• Certain people

Deposit• Solitude

• Special interest

• Physical activity

• Animals and nature

• Computer games

• Meditation

• Caring for others

• Nutrition

• Sleep

• Reading Harry Potter books

• Mental health vacation day

• Information on the Internet

• Being with pets

• Certain people

Energy Accounting

Currency: numerical measure or value of how much an activity or experience is energy draining or refreshing from day to day

Energy range rated from one to 100 for each activity or experience in the withdrawal or deposit columns

On some days, socializing can drain energy at a value of around 20 but on other days could be 100

Daily Energy Account Form

Withdrawals Deposits

Activity/Experience (0-100) Activity/Experience (0-100)

Range of Energy Depletion and Refreshment15 Year Old Girl with ASD Level 1

Withdrawals• Late to school 10-40

• Crowds 20-60

• Mum being cranky 30-100

• Friends not being nice to each other 20-30

• Friends’ own problems 20-90

• Noise in class 20-30

Deposits• Reading Harry Potter 30-80

• Dancing freestyle in bedroom 30-50

• Talking to boys at school 10-30

• Quiet time in bedroom 20-80

Balancing the Books

•Add all the numerical values in each of the two columns to see if the energy bank balance at the end of the day is in debit or credit

• If needed, schedule more energy-infusing activities into the next day or week

Alexithymia

• “How are you feeling”

• “I don’t know”

• ‘I don’t know how to mentally grasp the intangible negative emotions swirling in my mind, identify and label them accurately and communicate those feelings in speech so that you will understand’

Strategies for Alexithymia

• “I need a language for my worries”

•Using music or art to express the emotion or thought

•Poetry, lyrics and novel writing

•Reading fiction (Hermione, Harry Potter)

• Scenes from movies, passages from a book

Strategies for Alexithymia

• Typing rather than talking (email)

• Yoga and meditation

• Heart rate monitoring via sports watches

Emotional Toolbox: To Fix The Feeling

Physical Activity ToolsQuick release of emotional energy

•Personal trainer

•Physical exercise, walk, run, trampoline

•Sport (Basket Ball, golf, weight lifting) or dancing

•Creative destruction (recycling)

Relaxation ToolsSlow release of emotional energy

•Relaxation training

•Solitude

•Massage

•Sleep

Relaxation Tools

•Time in nature(walking, fishing, camping)

•Being with animals(pets, horses, birds, even reptiles and insects)

Awareness Tools: Interoception

•Mindfulness•Meditation• Yoga/QiGong/Tai Chi/Tai

Kwon Do•Awareness of bodily

sensations•Aware of thoughts and

feelings

Social Tools

• Time with a family member or friend

• Disclosure (typing, music, poetry)

• Seek advice

• Validate feelings

• Being with a pet

Social Tools: Affection

•Approval

• Intensity

•Duration

“I fail to understand why the exertion of pressure on the human body should be considered comforting."

Thoughts and Perspective

•Put the events in perspective

• Imagine what you would like to do or say

•Being calm is being smart (IQ)

Adaptive Thinking

Maladaptive

• Catastrophizing*

• Black & white thinking*

• Suppression*

• Avoidance*

* Characteristic of ASD

Adaptive

• Self-soothing

• Alternative perspectives

• Disclosure

• Positive reappraisal (optimism)

• Seeking and responding to compassion and affection

Self-affirmation Pledge Liane Holliday Willey

• I am not defective

• I am different

• I will not sacrifice my self-worth for peer acceptance

• I am capable of getting along with society

• I will ask for help when I need it

• I will be patient with those who need time to understand me

• I will accept myself for who I am

Appreciation

List at least 5 things you are grateful for

Create a collage to express the main things that you are grateful for in your life such as your:

• Intelligence

• Pet

• Parents

• Computer

• JK Rowling

• Star Trek

Special Interests

•A means of relaxation, pleasure

•Knowledge to overcome fear

•Keeps anxiety under control

•Thought blocking

•Energizer when exhausted or sad

Special Interest

• Distraction during a meltdown.

• The ‘off switch’

• Motivation and conceptualization (Dr. Who)

Sensory Tools

• Sounds. Ear plugs, headphones.

• Light. Irlen Lenses, hat, sun glasses.

•Aroma. deodorants, cleaning products.

• Tactile. Clothing.

Medication

• Treatment of a clinical depression (SSRI)

•Vasa et al (2014) : JADD 44:12

•50% had behavioural activation (increased activity level, impulsivity, insomnia, disinhibition)

Unhelpful ToolsUnhelpful tools

•Alcohol or drugs

•Self-harm: Soothing, mind/body connection, punishment, block emotional pain

•Hurting someone else

‘Depression Attack’

•Arrive unexpectedly and are extremely intense

•An emotional ‘implosion’

•A desperate need to end the despair

•Can be intense but fortunately brief

A Safety Plan for a ‘Depression Attack’

Strategies for you:

• Immediately seek practical or emotional help. This is an emotional emergency

• Try to remove yourself from the situation that triggered the depression attack

• Try not to injure yourself

• The special interest may be an ‘off switch’, distraction or barrier to intense despair

A Safety Plan for a ‘Depression Attack’

Strategies for your support person:

• Stay calm and reassuring (no interrogation)

•Not ask what is causing the distress

• Stay with you

• Try not to ‘fix the problem’

•Not move in too close without your prior approval

• Try not to be jolly

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