Book: CBT Toolbox for Children and Adolescents

Book Title:

CBT Toolbox for Children and Adolescents: Over 220 Worksheets & Exercises for Trauma, ADHD, Autism, Anxiety, Depression & Conduct Disorders.

Author(s): Lisa Phifer.

Year: 2017.

Edition: First (1st).

Publisher: PESI Publishing & Media.

Type(s): Spiral-bound, Paperback and Kindle.

Synopsis:

The CBT Toolbox for Children and Adolescents gives you the resources to help the children in your life handle their daily obstacles with ease. Inside this workbook you’ll find hundreds of worksheets, exercises, and activities to help treat:

  • Trauma.
  • ADHD.
  • Autism.
  • Anxiety.
  • Depression.
  • Conduct Disorders.

Written by clinicians and teachers with decades of experience working with kids, these practical and easy-to-use therapy tools are vital to teaching children how to cope with and overcome their deepest struggles. Step-by-step, you’ll see how the best strategies from cognitive behavioural therapy are adapted for children.

Book: Camouflage: The Hidden Lives of Autistic Women

Book Title:

Camouflage: The Hidden Lives of Autistic Women.

Author(s): Dr Sarah Bargiela.

Year: 2019.

Edition: First (1st), Illustrated Edition.

Publisher: Jessica Kingsley Publishers.

Type(s): Hardcover and Kindle.

Synopsis:

Autism in women and girls is still not widely understood, and is often misrepresented or even overlooked. This graphic novel offers an engaging and accessible insight into the lives and minds of autistic women, using real-life case studies.

The charming illustrations lead readers on a visual journey of how women on the spectrum experience everyday life, from metaphors and masking in social situations, to friendships and relationships and the role of special interests.

Fun, sensitive and informative, this is a fantastic resource for anyone who wishes to understand how gender affects autism, and how to create safer supportive and more accessible environments for women on the spectrum.

What is the Gut-Brain Axis?

Introduction

The gut-brain axis is the biochemical signalling that takes place between the gastrointestinal tract (GI tract) and the central nervous system (CNS).

The term “gut-brain axis” is occasionally used to refer to the role of the gut flora in the interplay as well, whereas the term “microbiota–gut–brain (MGB or BGM) axis” explicitly includes the role of gut flora in the biochemical signalling events that take place between the GI tract and CNS.

Broadly defined, the gut-brain axis includes the central nervous system, neuroendocrine and neuroimmune systems, including the hypothalamic-pituitary-adrenal axis (HPA axis), sympathetic and parasympathetic arms of the autonomic nervous system, including the enteric nervous system and the vagus nerve, and the gut microbiota. The first of the brain-gut interactions shown, was the cephalic phase of digestion, in the release of gastric and pancreatic secretions in response to sensory signals, such as the smell and sight of food. This was first demonstrated by Pavlov.

Interest in the field was sparked by a 2004 study showing that germ-free (GF) mice showed an exaggerated HPA axis response to stress compared to non-GF laboratory mice.

As of October 2016, most of the work done on the role of gut flora in the gut-brain axis had been conducted in animals, or on characterising the various neuroactive compounds that gut flora can produce. Studies with humans – measuring variations in gut flora between people with various psychiatric and neurological conditions or when stressed, or measuring effects of various probiotics (dubbed “psychobiotics” in this context) – had generally been small and were just beginning to be generalised. Whether changes to gut flora are a result of disease, a cause of disease, or both in any number of possible feedback loops in the gut–brain axis, remained unclear.

Gut Flora

The gut flora is the complex community of microorganisms that live in the digestive tracts of humans and other animals. The gut metagenome is the aggregate of all the genomes of gut microbiota. The gut is one niche that human microbiota inhabit.

In humans, the gut microbiota has the largest quantity of bacteria and the greatest number of species, compared to other areas of the body. In humans, the gut flora is established at one to two years after birth; by that time, the intestinal epithelium and the intestinal mucosal barrier that it secretes have co-developed in a way that is tolerant to, and even supportive of, the gut flora and that also provides a barrier to pathogenic organisms.

The relationship between gut flora and humans is not merely commensal (a non-harmful coexistence), but rather a mutualistic relationship. Human gut microorganisms benefit the host by collecting the energy from the fermentation of undigested carbohydrates and the subsequent absorption of short-chain fatty acids (SCFAs), acetate, butyrate, and propionate. Intestinal bacteria also play a role in synthesizing vitamin B and vitamin K as well as metabolising bile acids, sterols, and xenobiotics. The systemic importance of the SCFAs and other compounds they produce are like hormones and the gut flora itself appears to function like an endocrine organ; dysregulation of the gut flora has been correlated with a host of inflammatory and autoimmune conditions.

The composition of human gut flora changes over time, when the diet changes, and as overall health changes.

Enteric Nervous System

The enteric nervous system is one of the main divisions of the nervous system and consists of a mesh-like system of neurons that governs the function of the gastrointestinal system; it has been described as a “second brain” for several reasons. The enteric nervous system can operate autonomously. It normally communicates with the central nervous system (CNS) through the parasympathetic (e.g. via the vagus nerve) and sympathetic (e.g. via the prevertebral ganglia) nervous systems. However, vertebrate studies show that when the vagus nerve is severed, the enteric nervous system continues to function.

In vertebrates, the enteric nervous system includes efferent neurons, afferent neurons, and interneurons, all of which make the enteric nervous system capable of carrying reflexes in the absence of CNS input. The sensory neurons report on mechanical and chemical conditions. Through intestinal muscles, the motor neurons control peristalsis and churning of intestinal contents. Other neurons control the secretion of enzymes. The enteric nervous system also makes use of more than 30 neurotransmitters, most of which are identical to the ones found in CNS, such as acetylcholine, dopamine, and serotonin. More than 90% of the body’s serotonin lies in the gut, as well as about 50% of the body’s dopamine; the dual function of these neurotransmitters is an active part of gut-brain research.

The first of the gut-brain interactions was shown to be between the sight and smell of food and the release of gastric secretions, known as the cephalic phase, or cephalic response of digestion.

Gut-Brain Integration

The gut-brain axis, a bidirectional neurohumoral communication system, is important for maintaining homeostasis and is regulated through the central and enteric nervous systems and the neural, endocrine, immune, and metabolic pathways, and especially including the hypothalamic-pituitary-adrenal axis (HPA axis). That term has been expanded to include the role of the gut flora as part of the “microbiome-gut-brain axis”, a linkage of functions including the gut flora.

Interest in the field was sparked by a 2004 study (Nobuyuki Sudo and Yoichi Chida) showing that germ-free mice (genetically homogeneous laboratory mice, birthed and raised in an antiseptic environment) showed an exaggerated HPA axis response to stress, compared to non-GF laboratory mice.

The gut flora can produce a range of neuroactive molecules, such as acetylcholine, catecholamines, γ-aminobutyric acid, histamine, melatonin, and serotonin, which are essential for regulating peristalsis and sensation in the gut. Changes in the composition of the gut flora due to diet, drugs, or disease correlate with changes in levels of circulating cytokines, some of which can affect brain function. The gut flora also release molecules that can directly activate the vagus nerve, which transmits information about the state of the intestines to the brain.

Likewise, chronic or acutely stressful situations activate the hypothalamic-pituitary-adrenal axis, causing changes in the gut flora and intestinal epithelium, and possibly having systemic effects. Additionally, the cholinergic anti-inflammatory pathway, signalling through the vagus nerve, affects the gut epithelium and flora. Hunger and satiety are integrated in the brain, and the presence or absence of food in the gut and types of food present also affect the composition and activity of gut flora.

That said, most of the work that has been done on the role of gut flora in the gut-brain axis has been conducted in animals, including the highly artificial germ-free mice. As of 2016, studies with humans measuring changes to gut flora in response to stress, or measuring effects of various probiotics, have generally been small and cannot be generalised; whether changes to gut flora are a result of disease, a cause of disease, or both in any number of possible feedback loops in the gut-brain axis, remains unclear.

The history of ideas about a relationship between the gut and the mind dates from the nineteenth century. The concepts of dyspepsia and neurasthenia gastrica referred to the influence of the gut on human emotions and thoughts.

Gut-Brain-Skin Axis

A unifying theory that tied gastrointestinal mechanisms to anxiety, depression, and skin conditions such as acne was proposed as early as 1930. In a paper in 1930, it was proposed that emotional states might alter normal intestinal flora which could lead to increased intestinal permeability and therefore contribute to systemic inflammation. Many aspects of this theory have been validated since then. Gut microbiota and oral probiotics have been found to influence systemic inflammation, oxidative stress, glycaemic control, tissue lipid content, and mood.

Research

Probiotics

A 2016 systematic review of laboratory animal studies and preliminary human clinical trials using commercially available strains of probiotic bacteria found that certain species of the Bifidobacterium and Lactobacillus genera (i.e. B. longum, B. breve, B. infantis, L. helveticus, L. rhamnosus, L. plantarum, and L. casei) had the most potential to be useful for certain central nervous system disorders.

Anxiety and Mood Disorders

As of 2018 work on the relationship between gut flora and anxiety disorders and mood disorders, as well as attempts to influence that relationship using probiotics or prebiotics (called “psychobiotics”), was at an early stage, with insufficient evidence to draw conclusions about a causal role for gut flora changes in these conditions, or about the efficacy of any probiotic or prebiotic treatment.

People with anxiety and mood disorders tend to have gastrointestinal problems; small studies have been conducted to compare the gut flora of people with major depressive disorder and healthy people, but those studies have had contradictory results.

Much interest was generated in the potential role of gut flora in anxiety disorders, and more generally in the role of gut flora in the gut-brain axis, by studies published in 2004 showing that germ-free mice have an exaggerated HPA axis response to stress caused by being restrained, which was reversed by colonising their gut with a Bifidobacterium species. Studies looking at maternal separation for rats shows neonatal stress leads to long-term changes in the gut microbiota such as its diversity and composition, which also led to stress and anxiety-like behaviour. Additionally, while much work had been done as of 2016 to characterise various neurotransmitters known to be involved in anxiety and mood disorders that gut flora can produce (for example, Escherichia, Bacillus, and Saccharomyces species can produce noradrenalin; Candida, Streptococcus, and Escherichia species can produce serotonin, etc.) the interrelationships and pathways by which the gut flora might affect anxiety in humans were unclear.

In one study, germ-free mice underwent faecal transplants with microbes from humans with or without major depressive disorder (MDD). Mice with microbes from humans with MDD displayed more behaviours associated with anxiety and depression than mice transplanted with microbes from humans without MDD. The taxonomic composition of microbiota between depressed patients and healthy patients, as well as between the respective mice, also differed. Germ-free mice in another study also displayed behaviours associated with anxiety and depression as compared to mice with normal microbiota, and had higher levels of corticosterone after exposure to behavioural tests. Using rodents in microbiome and mental health studies allows researchers to compare behaviour and microbial composition of rodents to humans, ideally to elucidate therapeutic application for mental disorders.

Additionally, there is a link between the gut microbiome, mood disorders and anxiety, and sleep. The microbial composition of the gut microbiome changes depending on the time of day, meaning that throughout the day, the gut is exposed to varying metabolites produced by the microbes active during that time. These time-dependent microbial changes are associated with differences in the transcription of circadian clock genes involved in circadian rhythm. One mouse study showed that altering clock gene transcription by disrupting circadian rhythm, such as through sleep deprivation, potentially has a direct effect on the composition of the gut microbiome. Another study found that mice that could not produce the CLOCK protein, made by a clock gene, were more likely to develop depression. Stress and sleep disturbances can lead to greater gut mucosal permeability via activation of the HPA axis. This in turn causes immune inflammatory responses that contribute to the development of illnesses that cause depression and anxiety.

Autism

Around 70% of people with autism also have gastrointestinal problems, and autism is often diagnosed at the time that the gut flora becomes established, indicating that there may be a connection between autism and gut flora. Some studies have found differences in the gut flora of children with autism compared with children without autism – most notably elevations in the amount of Clostridium in the stools of children with autism compared with the stools of the children without – but these results have not been consistently replicated. Many of the environmental factors thought to be relevant to the development of autism would also affect the gut flora, leaving open the question of whether specific developments in the gut flora drive the development of autism or whether those developments happen concurrently. As of 2016, studies with probiotics had only been conducted with animals; studies of other dietary changes to treat autism have been inconclusive.

Parkinson’s Disease

As of 2015, one study had been conducted comparing the gut flora of people with Parkinson’s disease to healthy controls; in that study people with Parkinson’s had lower levels of Prevotellaceae and people with Parkinson’s who had higher levels of Enterobacteriaceae had more clinically severe symptoms; the authors of the study drew no conclusions about whether gut flora changes were driving the disease or vice versa.

Book: Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing

Book Title:

Avoiding Anxiety in Autistic Children: A Guide for Autistic Wellbeing.

Author(s): Luke Beardon.

Year: 2020.

Edition: First (1st)

Publisher: Sheldon Press.

Type(s): Paperback and Kindle.

Synopsis:

One of the biggest challenges for the parent of any autistic child is how best to support and guide them through the situations in life which might cause them greater stress, anxiety and worry than if they were neurotypical.

Dr Luke Beardon has put together an optimistic, upbeat and readable guide that will be essential reading for any parent to an autistic child, whether they are of preschool age or teenagers. Emphasising that autism is not behaviour, but at the same time acknowledging that there are risks of increased anxiety specific to autism, this practical book gives insight into the nature of the anxiety experienced by autistic people, as well as covering every likely situation in which your child might feel anxious or worried. It will help you to prepare your child for school, to monitor their anxiety around school, and also to be informed about the educational choices available to your child. It will give you support to help make breaktimes less stressful for them and how to help them navigate things like eating at school and out of the house.

Educationally, this book will take you and your child right up to the point of taking exams and leaving school; socially and emotionally it will cover all the challenges from bullying, friendships, relationships, puberty and sex education. It will give suggestions for alternatives in the scenarios that might cause anxiety or confusion in your child; it will also give a full understanding of your child’s sensory responses and such behaviours as masking, or echopraxia.

As the parent of an autistic child, you may find their path to adulthood different to the one you had expected to take, but as this book makes clear, autism should be celebrated and affirmed. Avoiding Anxiety in Autistic Children helps you to do just that, with practical strategies that will help happiness, not anxiety, remain the over-riding emotion that colours your child’s memories of their early years.

Book: Women and Girls with Autism Spectrum Disorder: Understanding Life Experiences from Early Childhood to Old Age

Book Title:

Women and Girls with Autism Spectrum Disorder: Understanding Life Experiences from Early Childhood to Old Age.

Author(s): Sarah Hendrickx.

Year: 2015.

Edition: First (1st)

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

The difference that being female makes to the diagnosis, life and experiences of a person with an Autism Spectrum Disorder (ASD) has largely gone unresearched and unreported until recently. In this book Sarah Hendrickx has collected both academic research and personal stories about girls and women on the autism spectrum to present a picture of their feelings, thoughts and experiences at each stage of their lives.

Outlining how autism presents differently and can hide itself in females and what the likely impact will be for them throughout their lifespan, the book looks at how females with ASD experience diagnosis, childhood, education, adolescence, friendships, sexuality, employment, pregnancy and parenting, and aging. It will provide invaluable guidance for the professionals who support these girls and women and it will offer women with autism a guiding light in interpreting and understanding their own life experiences through the experiences of others.

What is World Autism Awareness Day?

Introduction

World Autism Awareness Day is an internationally recognised day on 02 April every year, encouraging Member States of the United Nations (UN) to take measures to raise awareness about people with autistic spectrum disorders including autism and Asperger syndrome throughout the world.

Background

It was designated by the UN General Assembly resolution (A/RES/62/139).

World Autism Awareness Day”, passed in council on 01 November 2007, and adopted on 18 December 2007. It was proposed by the UN representative from Qatar, Her Highness Sheikha Mozah Bint Nasser Al-Missned, Consort of His Highness Sheikh Hamad Bin Khalifa Al-Thani, the Emir of the State of Qatar, and supported by all member states.

This resolution was passed and adopted without a vote in the UN General Assembly, mainly as a supplement to previous UN initiatives to improve human rights.

World Autism Day is one of only seven official health-specific UN Days. The day itself brings individual autism organisations together all around the world to aid in things like research, diagnoses, treatment, and acceptance for those with a developmental path affected by autism.

Components

The original resolution had four main components:

  • The establishment of the second day of April as World Autism Awareness Day, beginning in 2008.
  • Invitation to Member States and other relevant organisations to the UN or the international societal system, including non-governmental organisations and the private sector, to create initiatives to raise public awareness of autism.
  • Encourages Member States to raise awareness of autism on all levels in society.
  • Asks the UN Secretary-General to deliver this message to member states and all other UN organisations.

Themes

For the past years, each World Autism Awareness Day has focused on a specific theme determined by the UN:

  • 2012: “Launch of Official UN “Awareness Raising” Stamp”.
  • 2013: “Celebrating the ability within the disability of autism”.
  • 2014: “Opening Doors to Inclusive Education”.
  • 2015: “Employment: The Autism Advantage”.
  • 2016: “Autism and the 2030 Agenda: Inclusion and Neurodiversity”.
  • 2017: “Toward Autonomy and Self-Determination”.
  • 2018: “Empowering Women and Girls with Autism”.
  • 2019: “Assistive Technologies, Active Participation”.
  • 2020: “The Transition to Adulthood”.

Notable Initiatives

Onesie Wednesday

In 2014, WAAD coincided with Onesie Wednesday, a day created by the National Autistic Society to encourage people in England, Wales and Northern Ireland to show their support for anyone on the autistic spectrum. By wearing a onesie or pyjamas, participants are saying, “it’s all right to be different”.

Outcomes

United States

In a 2015 Presidential Proclamation, President Obama highlighted some of the initiatives that the US government was taking to bring rights to those with autism and to bring awareness to the disorder. He highlighted things like The Affordable Care Act, which prohibits health insurance companies from denying coverage based on a pre-existing condition such as autism. He also pointed out the recent Autism CARES Act of 2014, which provides higher level training for those who are serving citizens on the autism spectrum.

Book: A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder

Book Title:

A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder: It’s Not Just Their Autism!.

Author(s): Alvina Ali, Michelle O’Reilly, and Khalid Karim.

Year: 2013.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

Exploring the relationship between ASD and mental health difficulties, this book offers practical guidance to help parents and professionals recognise and handle co-morbid conditions, and dispels the myth that they are just a part of autism. The authors cover a wide range of common mental health problems experienced by children with ASD, including Obsessive Compulsive Disorder (OCD), anxiety, ADHD, eating disorders, psychosis, stress, tics and depression, and illustrate these issues with case studies. They also provide vital advice in an accessible format and suggest strategies to ease the difficulties which arise from these co-morbid conditions. This book is essential reading for professionals working with children on the autism spectrum and is an accessible and practical resource for parents and carers.

Book: A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum

Book Title:

A Guide to Mental Health Issues in Girls and Young Women on the Autism Spectrum: Diagnosis, Intervention and Family Support.

Author(s): Judy Eaton.

Year: 2017.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

This book addresses the specific mental health needs of girls and young women with autism spectrum disorder (ASD). Looking at the ways autism presents differently in girls than in boys, and the mental health conditions that occur most frequently in girls with ASD, this is the essential guide for clinicians and educators on tailoring interventions and support to meet girls’ needs.

Describing the current assessment process for autism diagnosis, the book explains why girls are under- or mis-diagnosed, leading to later mental health issues. It outlines the types of intervention that are particularly helpful for working with girls to reduce anxiety, improve social interaction skills, and manage self-harm. The book also covers how to manage eating disorders and feeding difficulties, focusing on working with girls with sensory processing difficulties. There is advice on how to deal with the emotional impact on parents, carers and families, and the challenges they face when negotiating appropriate psychological and educational support.

In Vogue: ASD

Research Paper Title

What is Austism?

Background

The term “Autism spectrum disorder” (ASD), in vogue at present, has evolved after continual substantial developments taking place over more than a century.

ASD is a heterogeneous, multi-factorial, developmental disability in which an unusual pattern of development takes place during infant and toddler years.

As per DSM-5, Autism spectrum disorder is a combined phrase for a family of complex developmental disabilities inclusive of “Autistic Disorder, Pervasive Developmental Disorder not Otherwise Specified (PDD-NOS), and Asperger’s Disorder”.

“ASD is characterized not only by persistent impairments in reciprocal social communication and social interactions, but is also manifested by restricted, repetitive patterns of behavior, interests, or activities”.

The classical clinical signs that exist in two major domains, viz. the ‘social domain’ and the ‘behavioral domain’ for the precise diagnosis of ASD have been tabulated and major differences between DSM-5 and DSM-4 are depicted with the help of a figure in this basic review article.

A sharp rise in the incidence of ASD cases has been observed worldwide owing to various risk factors such as genetic predisposition coupled with adverse environmental conditions, gynaecological interventions, etc.

Two official manuals viz. the “Diagnostic and Statistical Manual of Mental Disorders” (DSM) (published by the American Psychiatric Association), and the “International Classification of Diseases” (ICD) (published by the World Health Organization) is being regularly updated to facilitate diagnosis of ASD.

ICD-11 guidelines being prospectively implemented with effect from January 2022 have attracted global attention.

Reference

Joon, P., Kumar, A. & Parle, M. (2021) What is Autism? Pharmacological Reports. doi: 10.1007/s43440-021-00244-0. Online ahead of print.

Book: A Clinician’s Guide to Mental Health Conditions in Adults with Autism Spectrum Disorders: Assessment and Interventions

Book Title:

A Clinician’s Guide to Mental Health Conditions in Adults with Autism Spectrum Disorders: Assessment and Interventions.

Author(s): Eddie Chaplin, Debbie Spain, and Jane McCarthy.

Year: 2019.

Edition: First (1st).

Publisher: Jessica Kingsley Publishers.

Type(s): Paperback and Kindle.

Synopsis:

This comprehensive and much-needed guide addresses the issues faced by clinicians in assessing and treating the range of mental health conditions, which can affect adults with Autism Spectrum Disorder (ASD). Its particular focus on adults fills a notable gap in the ASD professional literature, with an extensive array of contributors from across the psychology and healthcare professions.

Covering a wide variety of common co-occurring mental health conditions including mood disorders, anxiety, psychosis, OCD, personality disorders, and eating disorders, this guide also explores broader issues to do with promoting positive mental health and wellbeing. Authoritative and detailed, this is an essential resource for all clinicians and professionals looking to understand and tailor their approach to mental health in autistic adults, and the need for specific methods and strategies to enhance assessment and treatment.