Autism Speaks: What is a mental health crisis?
Dr. Kalb: It involves two things. One, an acute psychiatric event – such as attempted suicide, elopement (or wandering), self-injury and/or dangerous impulsivity – that requires immediate intervention. Second, it involves a lack of resources to immediately manage the event. By resources, we mean a parent or other caregiver’s ability to handle the child’s dangerous behavior.
Autism Speaks: Why are young people with autism at high risk for mental health crisis?
Dr. Kalb: From research and clinical experience, we know that many young people with autism have significant behavioral challenges that include self-injurious behavior, aggression and wandering. And recent research has made clear that suicidal behavior is particularly common among those who without an intellectual disability. These young people also have high rates of psychiatric disorders including anxiety, ADHD and mood disorders.
In addition to these issues, other autism-related health conditions can contribute to crisis episodes. These include disrupted sleep cycles and painful GI disorders.
There is also evidence of unmet needs among young people with autism. We see this in high rates of emergency room visits and inpatient psychiatric hospitalization among youth with autism.
Autism Speaks: Are there autism-specific treatments for these crises? What are psychologists and psychiatrists doing to address the special needs of people with autism?
Dr. Kalb: Naturally, there is no one treatment for a mental health crisis in any group of people – including those who have autism. Mental health professionals draw from many types of treatments to address each patient’s needs.
At the same time, experts agree that youth with autism likely have special needs in this area. Unfortunately, there are only a few evidenced-based mental health treatments for patients who have autism. These include atypical antipsychotic medications such as risperidone for aggression, cognitive behavioral therapy for anxiety and applied behavior analysis for aggressive, disruptive and self-injurious behaviors. Each of these approaches has limitations, and medications can have severe side-effects.
There is also emerging evidence for the effectiveness of what we call “wrap-around services.” This is where a team, which may include a physician, psychologist and service coordinator, works together to make sure the person’s needs are met in all areas of life, from the home to school or work setting.
Personally, I think we urgently need more accessible, on-call services for families and children in crisis. And we need strategies to prevent a mental health crisis.
As part of our Autism Speaks-funded research, we surveyed 866 psychiatrists across the U.S. about how they managed crises in youth with autism.
We found that psychiatrists who saw youth with autism felt they lacked the professional support they needed when these young patients were in crisis – for example, support from other mental health professionals with special expertise in crisis management or a crisis-evaluation center.
They also had low confidence in the ability of emergency first responders and hospital emergency room staff to manage youth with autism in crisis. I think psychiatrists were telling us exactly what we’ve been hearing from parents: “We need more autism-tailored support services, especially urgent on-the-spot care!”