MFON speaks to Child and Adolescent Consultant Psychiatrist at Active Care Group (ACG), Dr Nishchint Warikoo, about mental ill health in autistic children.
MFON: How has the pandemic heightened mental health challenges for autistic young people?
Dr Nishchint Warikoo: We could almost compare the pandemic to a war-like situation. There was a great fear for life and the pandemic had a major impact on public sector services and customer support networks. People having to isolate meant the social support networks also weakened. I think it had a major impact on young people with autism because they like routine – things to be planned well in advance – to help them manage things better.
Due to the pandemic, children were suddenly not in school. If children had sensory needs or needed speech and language support, these needs would likely be met in school. That support disappeared almost overnight, so that was a major change for young people with autism.
The fear surrounding the pandemic created major anxiety in young people, particularly those with autism. Add to that any anxiety from parents transferring to the children and you had all-round anxiety, a lack of professional support and a lack of structure to the day. Not only did it increase the anxiety or low mood a child might already have had, but it also triggered anxiety in those who weren’t already affected. During the pandemic, I worked in both England, with ACG, and Sydney, Australia. The situation in the two countries was similar: we saw an increase in inpatient admissions, young people who had no problems beforehand presenting with severe anxiety or OCD, and young people struggling much, much more than previously.
MFON: What are some of the signs and symptoms parents and carers can be aware of to prevent reaching crisis point and how can they manage that?
NW: It’s a very good question and there are multiple ways of answering it. We need to remember that parents are experts in their own children, so a key thing parents can do is to compare their child’s behaviour – their interactions in social situations or at home – with how the young person was behaving before. So, if they see a major change in the presentation – if they see the young person spending too much time on their own, not enjoying things they used to enjoy, not participating in things they used to do, not eating, reducing their self-care and, in some extreme cases, becoming aggressive verbally or physically, or self-harming – these changes would be an indication that something is going on and parents need to be watchful of their child and consult their GP.
In terms of managing it, try to get as much structure as possible into the week. If there’s a lockdown and children cannot go to school, build a plan with the child, which the child leads on. All the other family members are part of the team.
It’s important to emphasise that young people with autism have difficulty in blocking out different types of sensations and may have sensory sensitivities. Let’s say we’re at a party and there’s lots of noise and lights but there’s someone next to us who we want to talk to. We can almost black out everything else to listen to each other but the person who has autism can’t do that. They’re having to process visual, auditory and sensory stimulation all at the same time, so when we’re communicating with young people with autism it’s better to reduce the sensory stimulations, particularly if they have sensory sensitivities. Find a quiet room, if possible close the door, don’t make it an issue if they are unable to look you in the eye (sometimes parents get upset about this and take it personally), speak in very clear, short sentences, give them chance to ask questions and then give them time to process the information. You need to be patient with them.
MFON: Can you give an idea of therapies and treatments for mental health for people on the autistic spectrum?
NW: Early diagnosis of autism is key to any support being provided to the young person. Then, accordingly, support can be put in place in the form of individual therapy and family therapy, enabling the young person to learn how to understand more social cues and how to use them to communicate with other people. Research has found that the earlier this is done, the better the outcome – support should ideally start in the early years of the child’s development. If that’s not put in place, struggling in interpersonal relationships can lead to low self-esteem, which over time can lead to other comorbidities like anxiety and depression.
The National Autistic Society has lots of courses and information leaflets that parents and carers can access. Then, locally, we have GPs and CAMHS teams, which is where parents can get support in the form of assessment and therapies. The useful links and groups are below:
- National Autistic Society: www.autism.org.uk
- Ambitious about Autism (for autistic children and young people, their parents and carers): www.ambitiousaboutautism.org.uk
- Healthtalk (to listen to other people’s experiences of autism): www.healthtalk.org
You can also search for local groups using:
I’ve had one or two young people admitted to my ICU ward in Huntington Hospital with different mental health disorders, but we found that autism spectrum disorder was the key reason why they had presented to the hospital. Once we put support, tailored to their specific need, in place, it was easier to discharge them back into the community.
MFON: What is the best approach if a parent or carer needs to speak to their child’s school?
NW: Schools have various provisions: SENCo, or the special educational needs co-ordinator; psychologists, who will do a functional assessment on the young person, helping to guide them to further assessment for autism; links with local children’s services; and, of course, the Education, Health and Care Plan (EHCP). If the child needs admission to an inpatient unit, there is the Care, Education and Treatment Review (CETR), which is where the school, health services and children’s services come together to provide a co-ordinated and comprehensive support package.
MFON: And what about the provision for those admitted to hospital?
NW: For children with autism, currently the waiting lists are quite high in the community – there is up to two years between referral to CAMHS and a child being diagnosed. If they need inpatient admission, they require a specialist bed because of the sensory issues. Nationally, that limits the availability of beds for young people with autism.
MFON: Please tell us more about your role in supporting autistic young people who have mental ill health.
NW: In the Active Care Group (ACG), for which I am a clinical lead for mental health, we look to empower the young person. We look at their needs and understand the difficulties they are facing, but also at the same time look at the positives they have in their life and their strengths. To do that, we have really good specialists and a team to work on these assessments, comprising psychiatrists, specialist nurses, psychologists, family therapists and occupational therapists. The ACG provides a complete, holistic pathway of care – a multidisciplinary approach. If a person has depression, that diagnosis does not define the person – we look to understand what has led to the depression and what is keeping it going. From that we can create a holistic programme for the young person. Not only that but we also have very good co-ordinated care plans with the teams in the community – the educational services and children’s services – so discharge from the hospital can be done in the best possible way.
Dr Nishchint Warikoo
Dr Warikoo is a Child and Adolescent Consultant Psychiatrist who has over 10 years’ experience in the field. Qualifying in India, Dr Warikoo worked for the Indian navy as a GP for five years before training at Southampton to qualify for membership of the Royal College of Psychiatrists. Dr Warikoo has extensive experience working with high-risk and complex patient cases, and in a clinical and forensic setting, using therapies including CBT, CAT and family therapy. Additionally, Dr Warikoo is a qualified educational supervisor and trainer with an MBA in health and healthcare administration. He was appointed Clinical Lead for mental health at ACG earlier this year.