Children’s Mental Health Week takes place from 5-11th February. This year the theme is “My Voice Matters”. We’ve teamed up with the Psychology department at The University of York to discuss the links between Autism Spectrum Disorder and children’s mental health, in order to empower you as parents and carers, and help you understand how to best support your child.
Most of us these days have heard of autism. We may have worked with an autistic person, and have autistic friends. In recent years, perceptions of autism have changed, and awareness has really improved, but autistic people (including children and teenagers) can still struggle with their mental health.
In this blog post, we introduce autism, and then focus in on mental health. We have used the terms “autistic children” and “autistic people”, because this is what autistic people have said they prefer (rather than “person with autism”). Just a final note on terminology - “Aspergers Syndrome” was a diagnosis that people used to receive, but since 2013 this diagnosis isn’t used - people would receive a diagnosis of autism instead (although some people still prefer to describe themselves as having Aspergers Syndrome rather than autism).
What is autism?
Autism (or Autism Spectrum Disorder) affects the ways in which information is processed, and impacts social communication and interactions. No two autistic individuals are the same, but trouble with social communication might mean a child has:
- Difficulty getting what people mean by what they say if they don’t *literally* mean what they are saying (e.g. trouble realising someone is being sarcastic, or joking).
- Trouble taking another person’s perspective and predicting what someone might do next.
- Differences in non-verbal communication e.g. eye-contact, facial expressions, gestures.
- Trouble making and maintaining friendships.
- Challenges when adapting to social rules within games, especially if they are not how the young person thinks they should be played.
Differences in information processing style mean an autistic person may want to engage in similar actions over and over. The exact behaviours and interests will be different for different autistic people, but for children it could include things like:
- Wanting to spin the wheels on a toy car over and over again.
- Lining up toys by colour or size (rather than engage in imaginative play).
- Wanting to talk about one’s special interests a lot.
- Preferring familiar routines, and finding it upsetting if things change.
Autistic peoples’ may also experience sensitivity to lights and sounds in the environment (and also smells, taste, texture or touch). Daily environments can feel very overwhelming, which can lead to meltdowns or shutdowns.
Around a third of autistic people have intellectual disabilities. Around 25-30% are minimally verbal, or don’t speak at all. Autism also often co-occurs with other conditions, such as ADHD. This means there is a lot of variation, and two autistic people can be totally different in their needs, strengths and abilities.
Are autistic children at risk of mental health problems?
The short answer is: yes.
However! Just because a child or young person is autistic does not mean they have to have mental health problems. This is important, because historically mental health needs have been minimised or missed in autistic people; it’s been assumed that mental health (such as being highly anxious) are “part and parcel” of autism. This is not right, and can lead to autistic peoples' mental health problems being dismissed, or seen as something that can’t be helped.
Mental health problems are not “part of autism”, but we do know that autistic young people are at a much greater risk of mental health problems than non-autistic young people. While around 25% of non-autistic people will develop a mental health problem in their lifetime, amongst autistic people that figure is 70%.
Why are autistic people at greater risk of mental health problems?
- Difficulties coping with the sensory environment, finding social interactions stressful, and struggling with unpredictability when routines are disrupted are all autistic traits that could increase daily stress.
- Autistic young people are at greater risk of bullying and victimisation: their difficulties with social interactions make them a target, but their autism might also make it hard for them to realise when they are being bullied, so they might be less likely to seek help.
- Many autistic children and people expend an enormous amount of energy “masking” or “camouflaging” their autism traits. For example, autistic people might force themselves to make eye contact with others, even though it feels unnatural or uncomfortable for them. They might also copy their friends’ behaviours and characteristics. Masking has been argued to be one explanation for why many girls and women who are autistic don’t get recognised as much as boys and men. While masking might in the short-term mean a child or young person “blends in”, in the long-term it is exhausting, and can lead to burnout.
An autistic young person’s experience of a school day
Remembering back to my school days brings up mixed emotions. I really enjoyed learning, but really struggled socially. Eventually my social struggles, along with other difficulties, accumulated to the point of needing time out of school and support with my mental health. Here are just 3 things I have pulled from my experiences that led to my mental health difficulties, and some ideas of how parents and teachers could support a young person with similar difficulties.
1. Bullying due to misunderstanding social situations
I would often misread social situations and my delivery in conversation was clunky to say the least. My peers knew I was “different” very early, but professionals did not always believe me when I said I was bullied as they did not always see it.
- Always validate the young person’s experiences, you don’t know how it feels to them.
- Support the young person to develop any social skills they would like to (but only ones they want to develop).
2. The environment and sensory elements of school were really difficult
Where I sat in the class really impacted on my ability to work. The smells in the canteen made me feel sick, the noise of the school bell physically hurt, and the strip lights of the corridors would cause me headaches.
- Ask the young person and their family what would help. Some ideas include offering alternatives to the canteen at lunch time, sitting in a specific area of the classroom, wearing earbuds or defenders.
3. I masked my way through school, hiding my difficulties and differences from peers, family, and professionals
This caused constant anxiety and eventually contributed to my burnout.
- Ensuring young people have a safe space that they can retreat to during and after the school day is the most important thing that professionals and families can do.
Should I seek a diagnosis for my child if I think they have autism?
Autism assessments are done by a team of clinicians, including psychologists, speech and language therapists, paediatricians and/or psychiatrists. It is a very personal decision for you and your family about whether to seek a formal diagnosis. Not all families want the formal diagnosis, even if they strongly suspect their child is autistic.
Some potential positives include:
- An autism diagnosis might help you and your child to understand their strengths and difficulties better: they might feel less like they need to mask their differences, for example.
- A diagnosis may also make getting extra support easier for your child. Even if they are coping okay at school now this could prove useful later, for example if they later go to university, and if they get a job in the future, as autism is covered by the Disability Rights Act.
However, you might also consider:
- Some young people may not want to seek an assessment. Autism is a lifelong condition and will not go away, and some people may find this difficult and not want the “label”. This is ok. It is important to discuss fully with your child what an assessment and possible diagnosis could mean for them where appropriate.
- Unfortunately, the waiting times for an autism assessment can be very long, so if you do decide you would like to pursue an assessment, it can take some time.
I have an autistic child / I work with autistic children. What can I do to support their mental wellbeing?
As we mentioned before, every autistic person is different. Although there are some strategies that work for most autistic people, they won’t work for everyone. The best way to support an autistic individual is to consider their current needs, work out what their strengths and difficulties are, and support them to enhance their strengths and minimise their difficulties. Below are some tips:
- Check and challenge autism stereotypes / myths. Not fitting the conventional “picture” of autism can mean that children and young people get a diagnosis earlier - but it can also mean that even after getting a diagnosis they face assumptions about what they can and can’t do, which aren’t true for them. Some “myths” include the idea that autistic people are all “loners” and are not interested in having close relationships with others. Autistic children and young people might need extra support to make and maintain friends, but many want close friendships and romantic relationships. Another myth is that autistic people totally lack empathy; while autistic people might not cotton on to the feelings of others as easily as non-autistic people, when they realise someone is upset they can feel very upset themselves.
- Support young people to recognise their own emotions. We tend to think of autistic people as having trouble recognising others’ emotions, but around half of autistic people find knowing their own emotions very difficult (something called “alexithymia”). Being able to recognise feelings and name them helps us to regulate our emotions. Find ways to support autistic children and young people to check in with their own emotions and communicate how they are feel.
- Protect your batteries! One strategy that many health professionals use to support autistic individuals is “energy accounting”, illustrated using a battery. This is where you help your child consider what uses up their energy during the day, and what activities or strategies they can use to fill up their energy levels again. The aim is to balance the energy draining and recharging activities in a day to support the young person to not reach the point where they have no energy left in their battery.
If you'd like to explore more . .
Overall, while autistic young people are at greater risk of mental health problems, more and more we are hearing of autistic people who are flourishing, who are using their voices to speak out about their experiences and advocate for others, and who are breaking negative autism stereotypes. If you would like to explore more about autism, we’d recommend the following resources:
- The National Autism Society / National Autism Society Wales
- The Curly Hair Project is an organisation that supports autistic people and their families. Set up by Alis Rowe, autistic author, they have produced many books, comic strips and other media to help provide information and guidance for autistic youth and their families.
- Can I tell you about autism? Book by Jude Welton – A book aimed at the friends and family of autistic young people.
- The Little Senses book series by Samantha Cotterill is a series of picture books aimed at children aged 3-7 years that consider different environments / experiences (a loud beach, new food) that can be challenging for any sensitive child, but has autistic children in mind in particular.
- A Kind of Spark (book and TV series) – a fictional series about an autistic girl campaigning for a memorial about the witch trials that happened in her home town.
Dr Hannah Hobson is a Lecturer in Psychology at the University of York
Dr Melanie Forster is a Lecturer and Clinical Psychologist at the University of York
Miriam Harmens is a clinical psychology trainee, and has published about the experiences of autistic women and girls with their mental wellbeing.
Thank you so much to Hannah, Melanie and Miriam, for sharing their huge expertise with us this week, we are very thankful for their help.
Mini First Aid x
This week's competition!
To tie in with Children's Mental Health Week, and our Family Health podcast on Children's Body Image we have a wonderful competition for you this week. Molly Forbes from Body Happy Org has written a book, Body Happy Kids which is jam-packed with information on how to help your child love the skin they're in. The prize also includes Molly's Pocket Booster Card Deck, containing cards and games to boost your child's self-esteem. And if that's not enough, we're throwing in our award winning Family First Aid Kit to look after your child's physical health!
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