New view on mental health

[Finallylostit]

Read this today. This Doctor is refreshingly honest and a thought provoking perspective on the explosion in the mental health industry

www.dailymail.co.uk/health/article-14576559/REAL-cause-explosion-autism-depression-psychiatrist-DR-ALISTAIR-SANTHOUSE.html

reasoning @AnnieMaud ?

Neither article offers the reality of "possible" explanations as to why people need labels for their struggles, it is definitely easier to process though, surely?

Life is hard, for the majority, no?

I don't think it's unreasonable to say that some autistic people have more disabling symptoms than others, or that someone who can never live independently is not affected differently than someone who can work and manage a family. The argument for the removal of the functioning labels and categories is simply that nobody could draw a line.

There was no consensus amongst psychologists and neurologists about where the difference actually lay between Asperger's syndrome and classic autism. Some people drew the line at whether or not a patient is verbal, others based on IQ, others based on the age of diagnosis. None of those are particularly reliable. When it comes to speech, a nonverbal child will not necessarily be nonverbal for life, and the old classifications don't account for autistic people who are semi-verbal. IQ only measures some facets of intelligence, and doesn't inherently correlate to one's ability to function in daily life. Age of diagnosis relies too heavily on doctors' opinions than the patient's symptoms. Numerous people suggested I was autistic from the age of four, but our family GP refused to refer me further because he "just knew" I couldn't be autistic. We know now that I almost certainly would have been diagnosed then, but instead I got by until my teens when everything fell apart. People's functioning levels can change over time as well. I have one family member who was diagnosed young with a more "classic" presentation, but with support and appropriate education she would no longer fit those classic criteria. I was diagnosed with Asperger's, and I have meltdowns, I am unable to keep a full-time job, can't drive, can't reliably provide food for myself, struggle to communicate even with my close family and two friends, need a chaperone/advocate for medical care and other appointments, and require daily support to function in life. Despite all of those needs, I was considered "high-functioning" because I'm good with words. That's not to say I consider myself "low-functioning" either; if we had to go back to those labels, I would like a "mid-functioning" category for those like me who fall between the two.

That said, I do think some differentiation needs to be made so that people with "classic" presentations and symptom profiles can receive adequate support and so we can ensure that neither the autistic community nor the medical community overlook such people. My favourite model is the "support needs" framework, in which differentiation is made not on the "severity" of symptoms but instead the level of support and treatment the patient requires. Those who need full-time care, adapted education and communication assistance would be considered "high support needs," people like myself and my family member who need part-time care and social/community assistance would be "medium support needs," and someone who functions relatively well with the assistance of anxiety medication and as-needed counselling would be "low support needs." This would allow support to be better targeted at those who need different things without taking such a prescriptive approach as previous diagnostic labels. That said, I'm always happy to hear others' thoughts and criticisms as it's important to adapt ideas to make sure people wouldn't be falling through the cracks!

There has been a lot of work in the last couple of decades on early intervention in autism.

many children are diagnosed at age 2 or 3, and increasingly when they have early intervention (portage, speech and language therapy, special needs nurseries) some of these children no longer meet the criteria for autism when they are teens.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5819743/

So I’ve read the Telrgrsph version and it’s still a non article in which the author of the book constantly contradicts himself. He says autism adhd and depression have historically been under diagnosed - no shit Sherlock. Doesn’t focus on the fact that women in particular have been dreadfully let down by the diagnostic process for autism and adhd. A crucial point. Which brings me to question why on earth is this thread yet again one focused on pulling apart autism diagnosis. The same posters pile on and turn any thread with a whiff of autism onto the same thing.It’s not what the article is about. He also says depression is unmistakable- ok so maybe focus on your contemporaries if you think it’s bring over diagnosed then which he doesn’t actually go as far as saying.

It’s interesting as being a neuro psychiatrist at the Maudsley he is only going to be seeing extreme cases who very much do meet their diagnosis. Somebody with the blues isn’t going to see a neurologist psychiatrist at a top London hospital. Also the Maudsley advocate autism not going undiagnosed. All their ED patients are now screened for autism prior to treatment which is a huge step forward as too many autistic women and girls are pushed into quite damaging genetic treatment which needs to be adjusted if there is autism in the mix. Autism and Anorexia are often linked.

He also includes trauma in his spiel. Interesting as if I had a pound for every time some ( and it’s always the same posters) accuse autism diagnosis of actually being trauma because.It’s fact ND people are more likely to suffer with poor MH, suicidal idealisation, EDs and trauma ( due to the increased likelihood of things happening to them in treatment and life due to vulnerabilities ). Masking is a massive issue for women and girls. As a Neuro psychiatrist at the Maudsley he should know this. It isn’t mentioned.

A really poor article and going by the article one assumes book. I’d focus on The Lost Girls of Autism which highlights an absolute disgrace in diagnostics and one in which women are still being let down in via the media which seems to attract obsessed posters berating better diagnostics and women finally getting answers and help in a variety of ways.

No many children are not diagnosed at 2 or 3. It’s nigh on impossible to get children diagnosed at school let alone 2! Did you actually read the article?

This is the summary

“Those most at risk for intellectual disabilities and ASD can be reliably identified at an early age to receive comprehensive treatment. Findings also suggest that some cognitively able children with ASD who participate in early intervention have very positive outcomes, although replication with randomized, larger samples is needed. In order to improve understanding of very positive outcomes in ASD, future research will need to identify how variations in child characteristics and environmental factors contribute to the nature and timing of growth across individuals and areas of development.“

It referred to 9% of children diagnosed and acknowledged it was a small study. Also it doesn’t mention how the need for support can fluctuate hugely throughout life for all or masking which many autistic women and girls do in the teenage years leading to burnout. The word treatment is worrying as it has a whiff of conversion to it.

It’s not underfunded. ASD is costing a fortune. In my town alone (medium size) 2 specialist SEMH schools have opened primarily for autism, and many schools now have autism wings. 121s, transport, EHCPs, the staggering cost of special school places, the reason councils are basically bankrupt is because of the rise of needs in ND school children. That’s not a value judgement of the kids, they’re entitled to what they get. But as a society in the last 5 years alone we have had to give a staggering amount to a couple of conditions that seem to have skyrocketed from nowhere.

Even Labour have said there is no more money for SEN as it’s had everything.

Um it is massively underfunded and don’t be ridiculous ASD isn’t “costing a fortune”

An autism diagnosis does not get you an EHCP, transport, SN places, 121or anything. Even an EHCP ( which the vast majority don’t have) doesn’t get you those things in most cases.

ASC /ADHD diagnosis and MH support is massively underfunded. The NHS is saying this and education. It’s a false economy as these things don’t go away. Poor provision , support and lack of diagnosis lead to MH and SEN getting worse which has a knock on effect on hospital beds, prisons and the benefit system. Our local paeds was full of girls with ASD who were battling EDs and overdoses whenever my autistic girl needed long admissions caused by late diagnosis and lack of provision. Do you have any idea how much those beds on a paed ward cost per night?Their education is destroyed and then their future is so much harder and more expensive to the state.

It’s ludicrous.

Totally disagree.

Understanding why life is so bloody difficult is helpful in itself and whilst everyone has difficulties in life spend a day in my daughter's world and you might have a different view.

She can't bear noise to the point that people breathing in earshot hurts. She can't organise her time at all. She tries to interact with other humans but often they don't get her. She doesn't process at the same pace as everyone else so people think she is mentally subnormal but she isn't she's as intellectually switched on as everyone else if not more so. She has had to learn reciprocal conversations, tries to learn eye contact so she can fit in. She has made rules around everything and routines. Her life is not bloody difficult in the way a NT person's life is difficult, everyone does have day to day stresses but the whole world itself isn't normally a stress.

This!!!!

So much ignorance as to ND

Have you ever asked yourself what is it about mainstream schooling that is so difficult for autistic people?

What do you want to happen to children who can't be in mainstream school?

Because to get a place at one of these special schools you literally have to be at the point of not being able to be educated at mainstream. The LAs fight tooth and nail not to make these provisions.

The government has a choice, either to properly look at making mainstream education better for all children including autistic children. Everyone would benefit from moving away from the rigid structure that is already in place , or they have to provide alternative education for children who can't be educated in mainstream, or they just don't educate these children?

I find it fucking horrendous that Labour has come in an launched a wholesale attack on vulnerable people including autistic children. I mean for fucks sake, what kind of society does this to vulnerable people? It's a small wonder that the leader of our Labour led council and a number of other members have recently resigned their membership. It was bad enough under the Tories.

And yes I know that there is no magic money tree but failing to appropriately educate children kicks the problem further down the line, you end up with adults who can't function. That's pretty fucking short sighted , no?

Yes - so what you are assessing is not their ‘autism’ itself (or making a value judgment that, therefore, autism in and of itself is either acute or minor) you are assessing the whole person and how their autism and associated (co-morbid) diagnoses impact the individual.

Much as PIP does - you don’t get it for autism, you get it if the way your autism presents means you need help and support. My DS does not qualify for PIP as, although he has both ASD/ADHD with crippling migraine triggered by anxiety and overwhelm, we are able to manage his symptoms with medications/support systems/planning - and his early diagnosis and and IEP (not ECHP as we were in the private education by that point) really helped to do this. His ASD/ADHD is still acute, but the way it impacts his life is manageable with GP/family/social support. MY DD, however, gets almost full PIP because the ADHD, which was the major factor in her emotional dysregulation, was not diagnosed until 18 and the ASD that was diagnosed a few years earlier was then not supported, so she was deeply disabled by it. We are hoping that when her PIP award expires in 2029 and she is reassessed, we may have scaffolded her into independent living of sorts and she may no longer need PIP as she will less acutely impacted by her ASD/ADHD.

For some/many the acuteness of the impact may be life-long; for others it may be intermittent. There is no one-size-fits-all or even a ‘my DC’s autism is more serious than yours’. There are just thousands of individuals with varying and fluctuating levels of symptoms, disabilities and support needs - we need to be compassionate and inclusive whilst having nuanced conversations about individuals, rather than falling into a ‘who is more deserving’ narrative when as we know people who fall under the autism umbrella are not a homogenous group. All people under that umbrella deserve assessment and diagnosis.every single one. And all people with that diagnoses will likely require support at some stage in their lives.

How to make sure those assessments and that support is funded and available is the conversation we need to be having, not jostling for position within a hierarchy of disability.

And some of these kids are in giftedness programs because they are reading from age 2 or super advanced. They don't get recognised or any intervention because they are so far ahead. Typically, for these kids, the struggles don't begin in earnest until their preteens.

You can't get undiagnosed with autism. You either are or aren't. Maybe you can learn to mask better. Or maybe they weren't autistic in the first place?

This is so true, I have two children, one is now a young adult and the other is a teen.

Their needs are totally and utterly different despite having the same diagnosis.

Yes very similar to my dc. One on PIP, one not. We’re hoping to get to independence with the child on pip but supported living didn’t work out.We will try again.

Late diagnosis(15 and 20)has cost the state masses and in so many ways with both my children.

It’s America - “interventions” make money for providers.

The Maudsley has an ED unit and the vast majority of girls there are given a diagnosis of an ED - mostly anorexia nervosa - before they are diagnosed with autism. It’s long been known there is a link.

downs syndrome doesn't have a range though. it's a chromosomal abnormality which is very very easy to test for.
The way that impacts a person may differ but the actual syndrome is black and white that you either have it or you don't

Rather like autism…

They screen for autism on admission for treatment- it’s part of the pathway. This should be happening everywhere.

Hmm? What is partial ND? A little bit of autism you can just ignore and get on with life just fine? You do realise that contradicts the diagnostic criteria, right?

autism is a chromosomal abnormality??
News to me.

I know it’s beyond ignorant.There is no partial autism. Autistic people dont have much choice as many can’t get a diagnosis and their whole life is playing to the tune of others.

downs syndrome [autism] doesn't have a range though. it's a chromosomal abnormality which is very very easy to test for.
The way that impacts a person may differ but the actual syndrome is black and white that you either have it or you don't

reading comprehension tip: ‘is like’ does not mean ‘is the same’ and comments may refer in part to a post, rather than the whole of it.

no need to be facetious…

I think the clinical definitions of a lot of conditions have widened in the last few decades, and that this has often been genuinely helpful in allowing people to get assistance for things that would previously have been overlooked. I also think there are serious questions about the ways in which lumping quite differently presenting cases together might sometimes have less than helpful consequences.

Yes, I think removing the ‘aspergers’ diagnosis for example has fed into this (because of political correctness, I do get that, Herr Asperger was a monster). ‘Autism’ is as useful and precise a diagnosis in some ways as ‘cancer’ now.