Autism Spectrum Disorder – Understanding the Sensory Crisis

  • Autism spectrum disorder, depression

and the sensory crisis,

that’s what I’m gonna

be talking about today.

I’m Dr. Tracey Marks, a psychiatrist,

and this Article is about

mental health education

and self-improvement.

Today’s Article topic is based

on a viewer question from Rosa,

and I’m gonna read excerpts of it.

Can you make a Article about autism,

sensory crisis and depression?

I was diagnosed with

autism spectrum disorder

and depression, I suffer

from sensory crisis

since I was very little.

I struggled with school

and social activities,

since I started my

treatment for depression

my sensory crisis went down a lot.

I still have them but not

as often as I used to.

I’m just taking my antidepressants,

sertraline, lamotrigine and clonazepam,

my question is how can the

medication cure or reduce

my sensory crisis once I’m in remission?

Thank you Rosa for this question.

First I’ll define autism spectrum disorder

that I’ll call ASD.

Then I’ll talk about how we address ASD

and comorbid illnesses like depression.

So first let me tell you

a little about autism.

How we define autism has

changed over the years.

It started out as

infantile autism in 1980,

then in 1987 it became pervasive

developmental disorder.

Then in 1994 other subtypes were added

like Asperger’s syndrome,

which was considered

a higher functioning level of autism.

Then in 2013, we incorporated

all these terms into one term,

autism spectrum disorder.

These changes are based on research

that increased our understanding of it.

ASD is a developmental disorder,

meaning it starts in childhood

but we no longer have a cut off

for when you need to notice the symptoms.

If it’s very severe it may be

noticeable when you’re a baby,

but if it a milder forms

it may not be noticeable

until late grade school

or early teen years

when the demands of socializing

exceeds your ability to adapt.

So here’s how we define it.

We have two broad categories.

You have deficits in social

communication and interaction

and restricted, repetitive

patterns of behavior,

interest or activities.

Those are the two categories of problems

and here’s how they break down.

For the social communication

and interaction,

you have three parts to this

and you must have all three.

Deficits in social and

emotional reciprocity.

This refers to things

like being able to have

back-and-forth conversation with someone,

or being able to share

their interests with people

or initiate conversations.

The second thing is problems

with nonverbal communication

that you would use in social interactions.

Examples of this would be

things like keeping eye contact

with someone when you’re talking,

or you might have a complete lack

of facial expressions when you’re talking.

And the third part of this would be

difficulty in maintaining relationships.

And this is not just being a bad friend

because you’re not calling someone back.

This would look like having

zero interest in people,

or having a serious

problem relating to people

in a way that allows you

to have a relationship.

Another reason for the

problem with relationships

may be that you can’t adjust your behavior

to fit a social situation.

So this social situation

and communication deficit

has all three components to it.

So I don’t want you to

think, I don’t like people,

so does that mean I have ASD?

This is a grouping of symptoms

that are all happening at the same time.

With the restricted and

repetitive patterns of behavior,

you have two of four

ways that this can look.

Stereotyped or repetitive

motor movements or speech.

This can be things like

hand flapping, rocking,

repeating things, or repeating

something that someone says.

Being extremely inflexible,

and insisting on things

being the same way or being

attached to a detailed routine.

Having very restricted but intense

interest in certain things.

Usually these interests are things

that other people might

think are odd or peculiar.

And these interests might make this person

very knowledgeable on certain topics,

almost like an eccentric professor.

And the person not only becomes consumed

with these interests, but these interests

can interfere socially

because you’re always

bringing it up in conversation.

If someone is in your

presence they will know

that this is something

you’re obsessed with.

Then there’s atypical sensory processing.

With this you can be hyper or hypo

reactivity to sensory input.

Examples of this are becoming anxious

around certain sounds or textures

or excessively touching

things or smelling things.

Then there’s a further breakdown

of this disorder by severity levels.

And I won’t get into a

lot detail about this,

I’ll just mention it.

Level one is when a person’s

symptoms and behavior

require just a little support.

Level two is substantial support.

And level three requires

very substantial support.

So this is Autism Spectrum disorder.

When you combine all of these behaviors,

it makes for a very diverse disorder.

No two people with ASD look the same.

So back to Rosa’s question.

She asked about how to deal

with sensory crisis and depression.

There are no specific

medications use to treat

the core symptoms of ASD,

and this would be the

problems with communication

and repetitive behaviors

including the sensory sensitivity.

There are only two medications

FDA approved to treat ASD

and these are Risperidone

and Aripiprazole or Abilify.

These medications are what we

call neuroleptic medications

or antipsychotic medications.

And they’re only approved

to treat the irritability

or aggression that can come with ASD,

particularly in young children.

However as of the date of this Article ,

the drug Balovaptan is under development

by the drug company Hoffmann-La Roche,

and is in phase three clinical trials

for the treatment of the

core symptoms of ASD.

(crowd applauding)

The FDA granted breakthrough

therapy designation

for the drug, which is a way

to fast track it to market.

This drug would be the

first one of its kind

to treat the social problems

like extreme social anxiety

that you get with ASD.

Now I’m not privy to the

drug company’s timeline

to get to market, but if

you’re interested in this

keep your eyes open.

We do use some medications off label

to treat some of the other issues

like the sensory sensitivity.

Off label just means

they’re not FDA approved

for this purpose, but

have been found in studies

to be helpful, so clinicians

will use them anyway.

Some medications we use

for sensory sensitivity

are alpha agonists like

Guafacine and Clonidine.

Neuroleptics like Risperidone,

Aripiprazole and Quetiapine.

We also use anti-convulsants

like Valproate,

Lamotrigine, and Gabapentin.

These medications can also be helpful

with the other symptoms

such as overactivity,

anxiety, aggression and irritability,

as well as the repetitive behavior.

If a person with ASD

also has a depression,

we would use antidepressants,

usually the selective

serotonin reuptake

inhibitors like Sertraline,

Fluoxetine, Escitalopram

just to name a few.

These medications can also help

with the obsessional

behavior and the anxiety.

Rosa specifically asked if the medication

would cure her sensory crisis.

I don’t expect realistically

that the sensory crises

would be completely resolved.

It may greatly reduce your sensitivity

like you said it did, but there

usually remains some level

of sensitivity to sounds,

touch, light, texture,

but it’s usually more manageable

and doesn’t have to be

to the crisis level.

Some people use their

sensitivity reactions

as a soothing mechanism.

For example, suppose you’re someone

who becomes overwhelmed in a crowd.

One way to help with that

is you can take a break,

and maybe go stroke a

rough object or something

to help you calm down.

For some people that helps.

With ASD there’s an intolerance

to certain types of sensory input,

but some sensory input is like

receiving a burst of energy

that rejuvenates you in a way

that it doesn’t in a person without ASD.

The different types of sensory stimulation

that are aggravating versus soothing

is gonna be different for the individual.

So this is where it becomes important

for you to know yourself

and know what you need

to stay away from and

what you need to embrace

and use as a coping mechanism.

As I mentioned, no one

person with ASD is the same

but here are some examples

of calming techniques.

Using a weighted blanket to sleep under,

wearing a compression vest.

For some people that

pressure around your trunk

can be very soothing.

Taking a bath, using

noise canceling headphones

if you’re sensitive to sounds.

There’s a company called Stimtastic

that sells textured toys that you can use

to help soothe you and calm you.

They’ve got things like chewable necklaces

and spinner rings, lots of lovely things.

One more thing that I want to mention

that Rosa didn’t specifically ask about.

And this is the issue of

difficulty recognizing

and expressing emotions.

This actually has a

term called alexithymia.

And alexithymia is an

altered emotional awareness.

With it you’re unable to

express emotions verbally

and have an impoverished imagination.

In other words, there’s not

much to your fantasy life.

Alexithymia can be found in

other neurological disorders

like strokes for example,

but there’s a lot of overlap

between alexithymia and ASD.

How you’re feeling can contribute

to internal distress and low mood.

What can help with this

is not medication so much

as the behavior therapies

and skills training.

The younger you are when you start this,

the more you get out it.

But it’s never too late to work on

recognizing your emotions.

I have a download for you

to help you with this.

It’s my set of emotions cards.

These cards help you

recognize a basic emotions

that you may be experiencing

and look at other emotions

that are related to it.

For example, sadness is very general.

There’s different

reasons you can feel sad.

But if we could break it

down a little further,

sadness could be

hopelessness, disappointment,

or gloominess as an example.

There’s a big difference

between hopelessness

and disappointment, but on the surface

they can both look sad.

So these cards are designed

to increase your emotional vocabulary.

So you can take the

broader, generic emotions

and more specifically

identify your real emotion.

My hope is that this

will improve your ability

to quickly recognize how

you’re feeling about something.

This exercise can be good for anyone

who has trouble recognizing

how they feel about something.