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Director of Research, Graduate School, Interdisciplinary Council on Developmental and Learning Disorders
Assistant Clinical Professor, Voluntary Dept of Psychiatry, University of California at San Diego School of Medicine
Feder 411
Math, Engineering, and Developmental Disorders beginning 1978. US Navy Child Psychiatry Mike 1990 (1992) Greenspan and Wieder 1993 Career expansion: clinic, teaching, research, advocacy, tech development and arts & media.
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ICDL
CAPTN/Pfizer
SymPlay Cherry Crisp
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Commercials
Because we build ideas together And you can join us in the effort!
Parent Choice!
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Pasadena, California February 24-26, 2012 Pasadena Child Development Associates, Inc. (PCDA)
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Thank You!
Families say a silent thank you NAA Chantal Sicile-Kira! Mentors: Greenspan & Wieder Students at the ICDL Graduate School So many others
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Outline
Depression, and depression in ASD Suicidal thinking, and in ASD Normal sadness Risk Factors & Signs to look for When to worry &What to do Mental Health Care Conclusion: How to keep moving forward Questions
Depression
Sad, really sad Probably anxious Maybe mad too So bad that it gets in the way of things Negative about oneself, the world, the future Kids - withdrawal, irritability Babies listless, withdrawn, poor feeding
Depression in DSM-IV
Sleep - more or less, up early is classic Loss of Interest in usual activities, incl. sex Negative thoughts, often over and over Energy usually down, might be agitated Poor concentration, e.g., reading Appetite down, or up Sluggish body stooped, slow, leaden Suicidal thinking
Depression in ASD
Many reports, little data, likely high rates Chronic emotional pain from trouble relating and communicating with others, from sensory processing and modulation difficulties, etc. Excellent recall of negative life events e.g. bullying, but even minor disappointments May be even more persistent in negative thinking Might not show sadness the same way might be harder to tell Still, look for the usual kinds of signs
Suicide
Adults in emotional pain with no other options and a need to act now Top risk factors: depression and substance use Adolescents/ young adults at higher risk: less likely to consider consequences Highest risk in the elderly Children have trouble following through but some children do high risk things (run into traffic, jump into deep water)
When to worry
Always..? Always take suicidal episodes seriously Manipulation is a risk factor for real action ASD: tend to do what they say they will do Always working on prevention, i.e., on improving ability to cope with distress
Supervision
By whom? May need more people May need people with specialized training Issue of training law enforcement Psychiatric Emergency Response Team (PERT) May need a specialized place to be safe
Symbolic Solutions
Best ones we have generates creative solutions that can be portable and shared All around us so can be hard to see E.g., Anger becomes competition as in Olympics, or becoming a surgeon lets you cut people E.g., Fear mastered by cuddling a doll or by holding hands on the tarmac during takeoff, or opening fortune cookie E.g., Sadness expressed in creating or experiencing art (rocket shells to tulips), tearful movies or books
Hospitalization?
When all else fails and you need a safe place Staff might not understand ASD, and in particular your family members ASD Figure out now where they do a good job Create a quick guide three most important things to know about your family member Hard to get good communication Hard to get good transition Day treatment Residential care what happens afterward? Wraparound care
Medication?
Might be a lifesaver Probably will have side effects e.g. activation Probably prevents suicide: drop in suicide rates when SSRI prescription rose in the 1990s, rise in suicides with the fall in prescriptions to youth after the suicide warning in 2004 But people DO sometimes have suicidal thoughts specific to a medication, including SSRIs. So, as always, be careful and ask.
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Questions?