Mental health & wellbeing for students with autism

Mental illness affects one in five Australians and depression is the main cause of illness and disability for both boys and girls aged 10 to 19 years (World Health Organisation, 2013). People with autism spectrum disorder are more likely than other people to have a comorbid mental health difficulty such as depression and anxiety and oppositional defiant disorder (Autism Advisory Board, 2012). The following information aims to outline the mental health difficulties faced by people with autism and to provide strategies and sources of support for children and their families.

Recent research has found that 70% of adults with Asperger’s Disorder (now known as autism spectrum disorder without an intellectual disability) had experienced at least one episode of major depression while 50% had ongoing depressive episodes (Lugnegard, 2011). Similarly, a study in the United Kingdom found 71% of those with an ASD could be diagnosed with a psychiatric disorder as well as their autism (Simonoff et al 2008). A recent survey in Queensland of young adults with ASD found that 47% were experiencing clinically significant mental health difficulties as compared with 7% in the general population (Neary 2012). The We Belong study of Australian young people with ASD found that more than 70% described themselves as having a clinical mental health condition (Aspect, 2013).

In terms of young people, research has indicated that children with ASD are more anxious, withdrawn and had more severe social and attention problems compared with other children (Skokauskas & Gallagher, 2012). Teachers  similarly rated students with an ASD as being more anxious, withdrawn, depressed, inattentive, hyperactive, oppositional and aggressive Ashburner et al (2010). Research also has consistently found higher rates of anxiety amongst students with ASD than seen in typically developing students (Kim et al., 2000), and those with language disorder or intellectual disability (but without ASD) (Chalfant, et al., 2007). 

Quality of life is likely to be negatively impacted for a person with ASD by coexisting mental health conditions (McCoy 2012). The traits of autism may also mask mental health concerns or lessen the effectiveness of treatment or only having the condition that is most problematic being addressed by care providers (McCoy 2012).  It is also possible that unrecognised mood problems could partially explain high rates of challenging behavior in ASD (Simonoff et al 2012). As mentioned by Howlin (1997) “the inability of people with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states, particularly by clinicians who have little knowledge or understanding of developmental disorders”.

What can help?

Parents, carers and teachers are able to provide support for an individual’s mental health by considering the issues listed below.

Self-determination and independence

Self-determination is all about learning to make decisions and choices about one’s quality of life It includes choice making, problem solving, self-instruction, self-advocacy, and self-awareness (Ayres, et al., 2013). Research on self-determination indicates that teenagers and young adults with disabilities who have learned self-determination skills have enhanced academic performance, greater class participation, improved employment and independent living opportunities and more positive quality of life and reported life satisfaction. Teaching self advocacy skills and communication skills from an early age may assist with overall quality of life outcomes for students (Hart & Brehm, 2013).

Family Relationships

Strong family relationships, family harmony and stability are protective factors that can reduce a young person’s potential for mental health problems (Kidsmatter, undated). At the same times families of children with autism often experience more stress than other families. Families report several reasons for this including:

  • coming to terms with the diagnosis
  • feeling overwhelmed by the things they don’t yet know or understand about ASD and what it means for their child
  • feeling uncertain or  having little control over the future for their child with ASD
  • having trouble handling a child’s challenging behaviour, including how the child interacts with others, eats or sleeps
  • having trouble navigating the ASD service system, which is quite complex
  • managing daily life with a child with ASD – doing things with a child with ASD can simply take longer and can often be quite frustrating.

The following may help parents and carers:

  • getting organised
  • maintaining family traditions
  • using support groups
  • positive thinking and self talk
  • relaxation and breathing (such as in mindfulness)
  • implementing strategies for challenging behavior
  • developing a thorough understanding of a child’s autism characteristics
  • looking after oneself

Please see www.raisingchildren.net.au and the Positive Partnerships on Grief, stress and coping for more detailed information

Physical and Leisure Activities

The WHO recommends at least one hour of moderate to vigorous exercise per day. Indeed physical activity is important for those with or without a disability. Research indicates that increased aerobic exercise can temporarily decrease the frequency of certain self-stimulating behaviours often associated with autism such as hand flapping. Improvements in self-esteem, reduced stress and anxiety, improved levels of happiness and sleep, and even social outcomes have been identified as well (Oriel, et al., 2011; Autism Speaks, undated). In addition, participating in leisure activities on a regular basis has been shown to lead to lower stress and greater quality of life in young adults with ASD (García-Villamisar &, Dattilo, 2010). 

Anti Bullying Policies and Practices

Children with autism are vulnerable to bullying. Key ASD characteristics such as those in the social domain are likely to interfere with the development of social supports that may offer some protection against bullying. (See Positive Partnerships Information Session on Bullying for references and support material).

Resilience

This refers to the capacity of an individual to overcome odds and demonstrate the personal strengths needed to cope with hardship or adversity (Noble, 2003). For young people resilience develops from strong positive relationships with their parents and other significant adults in their life such as teachers. Friends and classmates are also important in this area as is belonging to sporting teams or groups such as scouts. Resiliency can be assisted by providing opportunities to learn: social skills; empathy and other prosocial behaviours; self respect; managing strong feelings; optimistic thinking skills; helpful thinking skills; humour; goal setting and personal competence (McGrath & Noble, 2010).

Sleeping Habits

Children with autism often have problems with their sleeping and this has consequences for not only their overall wellbeing but for their parents and family as well. For more information and strategies, see the factsheet from Amaze Victoria “Sleep Issues in Poeple with Autism Spectrum Disorder”     

Resources & Websites

Mental health issues and general well being are a concern for many in the community, not just those with autism. As such, these resources are not necessarily autism specific.

Website
 
Who is the information for?
Description
ReachOut.com
au.reachout.com
 
Young people under 25
This is an online youth mental health service. Designed to help young people under 25 stay connected and get through tough times, the service provides practical tools, forums and information in a safe and anonymous online environment.
 
Headspace (The National Youth Mental Health Foundation)
Young people 12-25
This program is for those who are going through a tough time and looking for someone to talk to. Headspace and the online version, eheadspace, can help with: general health, mental health and counseling, education, employment and other services, alcohol and other drug services.
eheadspace is a confidential, free and secure space to chat, email or speak on the phone with a qualified youth mental health professional
The Black Dog Institute
All ages although has specific programs targeting school age children
The Black Dog Institute aims to improve the lives of people affected by mood disorders through research, clinical expertise and education programs.
 
Headstrong
Teachers of High School age children
The Black Dog Institute has developed teacher training modules that align with the national PDH&PE curriculum. Workshops and information are available via this website.
Bite Back
 
Children 8-12 years
Bite Back is an interactive space supported by The Black Dog Institute. Biteback aims to improve the wellbeing and mental fitness of young people, based on the principles of positive psychology.
Kids Helpline
Phone: 1800551800
 
Young people 5-25 years
Kids Helpline is a free, 24 hour counselling service. Counselling is offered by phone, email and over the web. Counsellors respond to issues ranging from relationship breakdowns and bullying, to sexual abuse, homelessness, suicidal thoughts, and drug and alcohol use.
Beyond Blue
Phone: 1300224636
 
All ages
Beyondblue’s work is aimed at achieving an Australian community that understands depression and anxiety, empowering all Australians, at any life-stage, to seek help.
There are a number of sites and services that have been developed in conjunction with Beyond Blue and are listed below.
Mindmatters
 
Teachers of High School age children
This website was developed in conjunction with Beyond Blue. It helps schools to support young people via a framework that aims to promote mental health, prevent problems and enable early intervention. This program supports schools around Australia to foster the mental health of their students. Learning modules and resources are available, along with a review of supporting evidence.
Kidsmatter
 
Teachers of Preschool & Primary School age children
KidsMatter Primary is a mental health and wellbeing framework for primary schools and is designed to make a positive difference to the lives of Australian children. This program is all about growing healthy minds and positive communities.
Youth Beyond Blue
 
Young people 12-25
This program by Beyond Blue aims to empower young people aged 12–25, their friends and those who care for them to respond to anxiety and depression. They support and promote environments and settings that build on strengths of young people and respond to ongoing change.
 
SenseAbility
 
Educators and others working with young people 12-18 years
This is a strengths-based resilience program designed for those working with young Australians aged 12-18 years. It consists of a suite of modules developed to enhance and maintain emotional and psychological resilience and can be used in classrooms or other learning environments (such as TAFE). The SenseAbility Communications Portal acts as a gateway to accessing a range of free useful resources to support adults with delivery and implementation of the SenseAbility program.
The Safe Schools Hub
 
Educators, Parents and Students
Underpinned by the National Safe Schools Framework and funded by the federal government. Contains separate sections for schools, parents and students.
The Brave Program  -Child
 
Children 8-12 years and their parents
There are 2 programs, one for children (aged 8-12 years) and one for parents. Any child who worries about things may find the program useful. Any parent wanting to learn more about how to help their child overcome worries can also do the program. Children can also do the program with their parents
The Brave Program  -Teen
 
Young people 12-17 and their parents
A teenager who worries about things may find the teen program helpful. Parents of teens who worry or suffer from anxiety may also benefit. There are two self-directed programs available: one for teenagers aged 12 – 17 years old and one for parents of teenagers aged 12-17 years old. The programs can be completed individually or at the same time.
The Desk
TAFE and University students
This site aims to support Australian tertiary students to achieve mental and physical health and wellbeing. By providing resources online more people should be able to get help to improve their wellbeing and be able to study more effectively. The Desk offers free access to online modules, tools, quizzes and advice.
ThinkUKnow
Young people 11-17, their parents, educators and carers
This site is all about online safety. Created by the UK Child Exploitation and Online Protection (CEOP) Centre, ThinkUKnow Australia has been developed by AFP, Microsoft Australia and Datacom, supported state Police services across Australia, Neighbourhood Watch and ninemsn. The website has sections for parents, carers and teachers and another section for children 11-17.
Those involved with the care of Preschool, Primary and High School age children
This UK site contains several modules relevant to supporting the well being and mental health of students with complex needs.
 
Raising Children Network
Those involved with the care of Preschool, Primary and High School age children
This site offers information to parents, carers and others about a range of topics related to child health and development. There are specialised sections for families of children with autism spectrum disorders/ In addition, the site aims to offer personal support by helping to connect people through their forums.
Lifeline
Phone: 131114
Available to all Australians
Lifeline is a national charity providing all Australians experiencing a personal crisis with access to 24 hour crisis support and suicide prevention services.
Services for parents, carers and other adults
Mycompass
Over 18 years of age
MyCompass (The Black Dog Institute) is an interactive self-help service that aims to promote resilience and wellbeing for all Australians.
Adults
The mindhealthconnect website aggregates mental health resources and content from the health focused organisations in Australia. Mindhealthconnect, is operated by Healthdirect Australia, on behalf of the Australian Federal Government
Mindspot
Adults
The MindSpot Clinic is a free service for Australian adults with stress, worry, anxiety, low mood or depression. They provide mental health screening assessments, treatment courses or help people find local services that can help. The MindSpot Clinic is fully funded by the Australian Government Department of Health and Ageing.

 

References

Ashburner, J., Ziviani, J. & Rodger, S. (2010). Surviving in the mainstream: Capacity of children with autism spectrum disorders to perform academically and regulate their emotions and behaviours at school. Research in Autism Spectrum Disorders, 4, 18-27.

Autism Advisory Board on Autism Spectrum Disorders (AAB), (2012). The Interface between autism spectrum disorders and mental health: the ways forward, Discussion Paper. Accessed October, 2014, from:  www.autismadvisoryboard.org.au/uploads/file/pdfs/The%20Interface%20between%20ASD%20and%20Mental%20Health%20AAB.pdf

Autism Speaks (undated). Sports, exercise and the benefits of physical activity for individuals with autism. Accessed October, 2014, from: www.autismspeaks.org/science/science-news/sports-exercise-and-benefits-physical-activity-individuals-autism

Autism Spectrum Australia. (2013). We Belong: the experiences, aspirations and needs of adults with Asperger’s disorder and high functioning autism. Accessed from: www.autismspectrum.org.au/content/we-belong-report.

Ayres, M.A., Mechling, L. & Sansosti, F. (2013). The use of mobile technologies to assist with life skills/independence of students with moderate/severe intellectual disability and/or autism spectrum disorders: considerations for the future of school psychology. Psychology in the Schools, 50 (3), 259-271.

Chalfant, A.M., Rapee, R. & Carroll, L. (2007). Treating Anxiety Disorders in Children with High Functioning Autism Spectrum Disorders: A Controlled Trial. Journal of Autism and other Developmental Disorders,37(10),1842-1857.

García-Villamisar D.A. & Dattilo, J.J. (2010). Effects of a leisure programme on quality of life and stress of individuals with ASD. Intellectual disability research, 54(7), 611-619. www.ncbi.nlm.nih.gov/pubmed/20500784

Hart, J.E. & Brehm, J. (2014). Promoting self-determination: a model for training elementary students to self-advocate for IEP accommodations. Council for Exceptional Children May/June.

Howlin, P. (1997). Interventions for people with autism: Recent advances. Advances in Psychiatric Treatment, 3, 94-102.

KidsMatter. (undated). Mental health and protective factors. Accessed October, 2014, from /www.kidsmatter.edu.au/primary/mental-health-information/mental-health-ba....

Kim, J.A., Szatmari, P., Bryson, S.E., Streiner, D.L., & Wilson, F.J. (2000).  The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132.

Lugnegard, T., Hallerbäck, M.U. & Gillberg, C. (2011). Psychiatric co-morbidity in young adults with a clinical diagnosis of Asperger’s syndrome. Research and Development Disabilities, 32, 1910-1917.

McCoy, K.A. (2012). Mental health issues of adolescents and adults with ASD: depression and anxiety. Counseling and Human Development, 45(1). Accessed October, 2014, from: http://go.galegroup.com/ps/i.do?id=GALE%7CA334709545&v=2.1&u=nysl_me_tci&it=r&inPS=true&prodId=AONE&userGroupName=nysl_me_tci&p=AONE&digest=ee3b8dcedeb89c7e504cd380d8631ed4&rssr=rss

McGrath, H. & Noble, T. (2010). Supporting positive pupil relationships: Research to practice. Educational & Child Psychology, 27(1), 79-90.

Neary, P. (2012) Parents’/ carers’ perceptions of post-school circumstances and service requirements of teenagers and adults with high-functioning autism or Asperger’s syndrome. Unpublished masters dissertation, Queensland University of Technology, Brisbane, Australia.

Noble, T. (2003). Teaching Resilience, helping kids bounce back. Independent Education, November, 2003.

Oriel, K.N., George, C.L,, Peckus, R, & Semon A. (2011). The effects of aerobic exercise on academic engagement in young children with autism spectrum disorder. Pediatric Physical Therapy, 23(2), 187-93.

Simonoff E., Jones, C.R., Pickles, A., Happé, F., Baird, G., & Charman, T. (2012).  Severe mood problems in adolescents with autism spectrum disorder.  Journal of Child Psychology and Psychiatry, 53 (11), 1157-1166.

Skokauskas, N. & Gallagher, L. (2012). Mental health aspects of autistic spectrum disorders in children. Journal of Intellectual Disability Research,  56, (3), 248-257.

World health organization (WHO). (2013). Meeting report.Autism spectrum disorders & other developmental disorders: From raising awareness to building capacity. World Health Organization, retrieved October 2014, from: www.who.int/mental_health/maternal-child/autism_report/en/ Link no longer available

 

Further resources and readings

What is good mental health? www.abc.net.au/health/features/stories/2014/09/11/4085497.htm

Exercise for mental health: a no brainer

http://www.abc.net.au/health/features/stories/2014/08/26/4074904.htm

Information Sheet – Sleep Issues in Individuals with an Autism Spectrum Disorder, www.amaze.org.au