BOOK REVIEW: Mental Health Aspects of Autism and Asperger Syndrome

BOOK REVIEW: Mental Health Aspects of Autism and Asperger Syndrome

By Mohammad Ghaziuddin (2005) Jessica Kingsley Publishers

Leaping in at the deep end is something I do occasionally. Recently I committed to doing what I do – deliver mental health awareness and first aid courses; this time to the staff and support workers at a residential college specialising in teaching young people (16+) affected by Asperger syndrome and high functioning autism.

Now, I have to admit, my knowledge of Pervasive Developmental Disorders including the autistic spectrum, was brief, from work I did years ago with people affected by ADHD. Back then I saw almost every condition including ADHD due to the generally inadequate support of childhood conditions where I was living. So knowing I needed to brush up my knowledge I asked my LinkedIn network for recommendations of specialists I could approach for advice on the overlap of mental health conditions and pervasive developmental disorders (PDD’s). Following a couple of recommendations, I bought a copy of Ghaziuddin’s book. Quite frankly, for the layperson/psychotherapist and possibly as an introduction to the subject for trainee psychologists/psychiatrists, I think this book is brilliant.

The main focus is autism, but once you understand autism the other PDD’s fall into place by exception and their uniquely different traits. For example, people diagnosed with Asperger syndrome are generally communicative with a “normal” or higher IQ; those with autism are non-communicative and can have a low IQ; those with high functioning autism are also non-communicative and have a normal or high IQ.

Mental Health Aspects of Autism & Asperger Syndrome

Mental Health Aspects of Autism & Asperger Syndrome by Mohammad Ghaziuddin

For each PDD he explains what it is, it’s historical background and prevalence, causes, clinical features, diagnosis, conditions it may be confused with (and why) and what treatments/therapies or interventions are applicable. Each chapter has an extensive reference list for further study.

There follows a chapter on medical conditions in autism, something I had not previously thought about, but which make a significant impact on an affected individual and their family when combined with PDD’s. Such medical conditions include mental retardation and seizures (or forms of epilepsy) and a whole range of specific conditions including gene disorders (Fragile X and Down syndrome) and disorders caused by viruses (cytomegalovirus, herpes, etc).

Next Ghaziuddin covers general psychiatric disorders that occur in people affected by PDD’s. He writes “All psychiatric disorders cause distress, and affect the life of the individual in a negative way.”  At this point, I was gaining an understanding of just how complicated PDD’s can be with multiple conditions affecting an individual (the PDD, the medical and the psychiatric).  He has an insightful diagram in this section that shows how the comorbidities overlap each other.  This explains why no two cases present the same and why treatment programmes must be individualised to address the individual’s particular needs. It also explains why getting a diagnosis can be challenging and why treatment may be a complicated matter posing the question of what to treat first (and why). We must also remember that no individual is alone; there are a family and a community of people around each one that may need support too.

Useful case studies are included with many of the explanations of the conditions throughout the book which help the reader gain understanding of them. A whole chapter addresses ADHD and PDD. Further chapters are dedicated to depression and mood disorders; anxiety disorders; Schizophrenia and psychotic disorders; tic disorders and Tourette syndrome and “other” psychiatric disorders.

The issue of violence is addressed late in the book but we are challenged to think about the definition of violence (should it include verbal threats or just behaviour resulting in a criminal conviction?). The role of the media and the perceptions it fosters are another issue – are people with PDD more likely to be the offenders or the victims of violence? The assessment and treatment of violent behaviour need to be handled carefully. Think about how frustrating it must be to be unable to communicate what your needs are and to not have them met?

The final chapter is a long-term view – the task ahead.  Ghaziuddin quite rightly points out that “Carrying a diagnosis of autism and Asperger syndrome does not confer immunity against other medical or psychiatric disorders.” Whilst research into the mental health conditions affecting people with PDD’s is in its infancy and the need for early diagnosis and treatment is important, getting that diagnosis and treatment is another challenge complicated further where there are overlapping conditions. Hovering in the background is the family of the affected person and the attendant discrimination applied against any mental health disorder in the media and often by the community at large. The need to disseminate facts not fantasy about PDD’s and all mental health conditions will be one small change in making society more supportive of all such conditions.

You can order your own copy of this book here.


We must talk about mental health more

We must talk about mental health more

I received some sad news last night – the death of a bright, talented young man deeply affected by depression.

This morning I am sitting at my computer; there is a To-Do List with several items on it to my left, in my current notebook. The relevant papers are around me and on the work table behind me for the things on that list. Yet, I am distracted; distracted by that sad news. It is the sort of news that motivates me to do what I do, and to do more of it – to teach people mental health first aid – enough to make a difference to lives and communities. We must talk about mental health more. #changeonething

One way people are talking about mental health more is clearly demonstrated by the railways working in conjunction with the Samaritans. They have made a brilliant short film about the importance of talking to people, if in doubt, talk to them. They have a Small Talk Saves Lives campaign and it really does. They have calculated that for every completed suicide, six are prevented (yes, SIX!). It can be as simple as engaging with them and talking about the weather. You can make a difference. The 90-second film is available to view here.

We all have mental health. Some of us have good mental health and some of us are affected by mental ill-health. There is no health without mental health. We must talk about mental health more. Small talk saves lives.

Borrowing directly from the Samaritans website:

Signs someone may need help

  • Looking distant, withdrawn or upset

  • Standing alone or in an isolated spot

  • Staying on the platform for long periods of time/failing to catch trains that stop

Someone looking out of place or a feeling that ‘something isn’t quite right’. If you feel that way about someone, trust your instincts and try to help.

Approaching someone in need

We know that when a person is suicidal having someone to talk to them and listen to them, and showing that they are not alone, can encourage them to seek support. There is no evidence that talking to someone who could be at risk will ‘make things worse’.

A little small talk can be all it takes to interrupt someone’s suicidal thoughts and help start them on a journey to recovery. If you think that someone might need help, trust your instincts and strike up a conversation, with a comment about the weather for example. Life-saving questions used by rail staff to help people have included:

  • Do you need any help?

  • What’s your name?

  • It’s a warm evening isn’t it?

  • What train are you going to get?

So strike up a conversation if you feel comfortable and it’s safe to do so. Or tell a member of staff or call 999. Your involvement could help save someone’s live.

Tram by Michele Piacquadio

Waiting for a train – you too can use small talk and save a life.

One of the ways I make a difference is by having the Samaritans phone number on my mobile – I can contact them with a few quick keystrokes for someone if needed. That number is 116123. Why not add it to your phone right now?

There is a lot more information on the Samaritans website.


Why not take a look. You too could save someone’s life.


Mental Health First Aid to make Guernsey the happiest place in the world to live.

Mental Health First Aid to make Guernsey the happiest place in the world to live.

In October I was lucky enough to be a speaker at Thrive 2020, a one-day convention exploring how to make Guernsey the happiest place in the world to live by 2020.

My contribution sums up what mental health first aid is and how it may be used in Guernsey, but also in general.

Take a look.  My section is number 18 on the list of 21 (see each talk listed on the right-hand side of the screen).

Enroute to Making MHFA Training a Legal Requirement

Enroute to Making MHFA Training a Legal Requirement

MHFA is just as important as physical first aid

MHFA is just as important as physical first aid

For a while now I have been saying that mental health first aid needs to be a legal requirement in businesses, in the same way, that physical first aid is. The two should be treated on parity. There is no health without mental health.* I even predicted within the next 5 to 10 years it will become law. The process is starting.

According to Mental Health First Aid England, an announcement is due today. “The Right Honourable MP Norman Lamb will lead a call on the government to make MHFA part of the first aid regulations for employers.” The timing is no coincidence – today Monday 10th October 2016 is World Mental Health Day 2016.

What does this mean for business? You have two options –

  1. Wait until it’s law and then join the rush (with all the others) to comply.
  2. Get ahead of the game, make the most of the CSR** opportunity this presents for your marketing and HR announcements and get your staff trained NOW. Who would not want to work for an organization that is not supportive of mental health issues?

As a Mental Health First Aid Course Trainer accredited to Mental Health First Aid England let me train your team. Let’s get your course(s) setup – contact

*Link here

** CSR  = corporate social responsibility

What happens on a Mental Health First Aid course?

There seems to be so much stigma and discrimination around anything to do with mental health issues that sometimes even mentioning a training course related to it get’s overlooked. We need to remember this course is about first aid for mental health issues. It’s got nothing to do with diagnosis nor counseling or therapy.

DSCN6788_001                         DSCN6791_001

These pictures aren’t great quality but they do show a Mental Health First Aid standard course in progress – it is like any other training course you may attend.

The course is much like any other good training course and is specifically designed to enable everyone to benefit including different learning styles and different abilities. You do not need to be medically minded or have a prior knowledge of psychology. Everyone who attends whether experienced or not benefits from the course material itself and from the knowledge of other members of the group. Together we take your knowledge to a new level. There are slides with pertinent and relevant information and techno-graphics, film clips where people share their lived experience, group work, discussions and case studies to consider. We contribute together to such topics as “What is mental health” and “Do you think people with schizophrenia are dangerous?” Even people with diagnosed mental health issues have benefitted by expanding their knowledge of their own and other conditions. There are a workbook and a 108-page manual full of information and resources. We also have a 33-page line managers resource book.

It is important to us the Trainer that our Trainees feel safe and maximise their learning experience. Mental health can be such an uncomfortable topic for some people, for example, due to personal experience (own, families, friends and/or colleagues) that just occasionally breathing space is needed. Breathing space is given, you may step outside for a bit. But rest assured the trainer will follow you and check you are okay.  Our groups are from 8 to 16 people. Any less and the group dynamic is affected and any more dilutes the quality of the training. I am always amazed at the knowledge our Trainees have about mental health that they did not previously realize. Together we create few ground rules for the course too – like what’s said in the group stays in the group and there is no such thing as a daft question, etc. Active participation is encouraged.

The course is divided into 4 sections. In the first, we discuss what mental health is and isn’t, the impact of mental health issues, the 5 steps of mental health first aid and start looking at depression (the disorder most well known and probably the one having the greatest impact). In section 2 we look at suicide and spend more time on depression. In section 3 we cover the huge topic of stress and anxiety including phobias, panic disorder, self-harm, eating disorders, and the impact of drugs and alcohol on anxiety. In section 4 we explore the psychoses – bipolar disorder and schizophrenia. In each section, we revise the 5 steps of mental health first aid and apply them to the disorders being discussed so that at the end of the 2 days each trainee is comfortable in using the process.

Want to know more? Want to join a course? Let me know via the contact page.