Teens and Mental Health

Teenagers with Autism Spectrum Condition (ASC) are aware of their social deficits. This can cause a variety of responses from shutting down and becoming an introvert to developing anger at being different. I see this regularly in my teaching. Statistics tell us that co-morbid (at the same time) mental health conditions are common in teenagers with ASC and are in fact more prevalent in those teens with high functioning ASC (Hammond & Hoffman, 2014).

The starting of adolescences is the peak time for the onset of anxiety (Ehrenreich-May et al., 2014) and those teens with stronger deficits in social communications difficulties also have an increased risk of developing internalizing disorders such as depression and anxiety (Memari, Ziaee, Mirfazeli, & Kordi, 2012). Somewhere between 30 – 80% of people with ASD will develop a mental health condition such as anxiety or depression and this is more prevalent in those who present as more typical teens (Ehrenreich-May et al., 2014).

People with ASC use adaptive strategies of emotional regulation however the timing of use is problematic (Mazefsky, Borue, Day & Minshew, 2014). Adaptive strategies such as problem solving and cognitive flexibility are used when people with ASC are not in stressful situations. However in stressful situations and those situations that require immediate reactions result in the use of maladaptive strategies (Mazefsky et al., 2014). When adaptive strategies are used, these are likely to be used with less effect than neuro-typical people (Mazefsky et al. 2014). The persistent use of maladaptive strategies leads to the development of internalization disorders such as anxiety (Hammond & Hoffman, 2014). The diagram below gives an indication of adaptive and maladaptive strategies and where they are used. Maibeth’s emotional regulation strategies are mostly in the Involuntary Engagement and Voluntary disengagement sectors of this diagram.

Conner-Smith, Compas, Wadsworth, Thomsen, & Saltzman, 2000. A diagrammatic representation of Emotional Regulation strategies

Part of the reasons for the overuse of maladaptive coping strategies is tied into how the brains of people with ASC work. The ASC brain is different to a neuro-typical person’s brain with disruptions in connections across brain areas (Mazefsky, Herrington, Siegal, Scarpa, Maddox & Scahill, 2013) . This underlying neuro-biology is best described by the following interview with Dr Eric Courchesne (Autism Science Foundation, 2011).

Essentially, within the second trimester of pregnancy, the fetal brain develops multiple unnecessary connections between parts of the brain. The brain of a person with ASC does not remove these connections until decades after the brain of a neuro-typical person (Autism Science Foundation, 2011). This results in a person with ASC still having many non useful connections well into adulthood. These excessive number of connections in the brain seem to explain why people with ASC tend to use maladaptive strategies in involuntary situations (Mazefsky et al., 2013). There is a focus on internalizing strategies such as rumination, denial, avoidance, shutting down, self-blame as well as externalizing strategies of aggression, defiance, self-harm and tantrums (Mazefsky, Borue, Day & Minshew, 2014). The more you use these connections, the stronger they become. This then compounds on skills deficits in the social communication domain.

An analysis of Maibeth’s behaviors and the underlying characteristics is shown below. It shows clear triggers such as doing something she does not want to do, the behaviors and the end result. Maibeth’s triggers often result from impaired perspectives such as Science not being relevant as she does not use it. Maibeth is also triggered because of her strong cognitive inflexibility such as being told a therapy would work and therefore it should work overnight – when it does not, all therapies will not work. This then leads to the use of maladaptive emotional regulation strategies.

ABC Iceberg for Maibeth – a 15 year old with ASD and Anxiety. Based on the Underlying Characteristics Checklist – HF (UCC-HF) self questionnaire and the UCC-HF completed by her teachers. (Aspy & Grossman, 2011)

The ABC Iceberg indicates that Maibeth has two main areas of skills deficits being in her social abilities and in her use of maladaptive emotional regulation strategies. The first underlying characteristics (up til 39) are indicative of social communication issues with the majority of the remainder focusing on emotional dysregulation. The current intense use of maladaptive strategies that Maibeth uses are preventing growth in adaptive behaviors and can be explained by neuroscience. It is therefore imperative that Maibeth be provided with interventions that she will engage in to promote the strengthening of her adaptive emotional regulation strategies.

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