NRS83001: Contemporary Mental Health, ASD, and Clinical Leadership

This report provides a comprehensive overview of Autism Spectrum Disorder (ASD), including its causes, diagnostic criteria, and various treatment approaches. It delves into the biomedical model, genetic factors, and environmental influences associated with ASD, as well as cultural perceptions of the disorder. The report highlights the effectiveness of Cognitive Behavioral Therapy (CBT) in managing ASD, discussing its components, adaptations, and benefits for patients. Furthermore, it explores the evolution of ASD treatments, from early interventions to contemporary practices, emphasizing the importance of clinical leadership in mental health nursing. The report also outlines the significance of professional development, effective communication skills, and building therapeutic relationships with patients. Finally, it presents a personal reflection on goals, objectives, and resources for improving communication and interpersonal skills in mental health practice, emphasizing the importance of non-discriminatory care and promoting social inclusion.

Running head: CONTEMPORARY MENTAL HEALTH TOPIC
CONTEMPORARY MENTAL HEALTH TOPIC
Name of the Student
Name of the University
Author Note

1
CONTEMPORARY MENTAL HEALTH TOPIC
Part A
Explanation of the causes of Autism Spectrum Disorder (ASD)
The disease that has been chosen from DSM V is Autism Spectrum disorder. It is a
neurodegenerative developmental disorder that is found to be affecting the communication
behaviour and the communication in patients. This is called a spectrum disorder as there is a
wide difference in the type and severity of indications. The disease is common in all racial,
ethnic and the economic groups. People suffering from ASD faces difficulties with social
communication, collaboration , restricted interest and repetitive behaviour, which can include
repetition of words and phrases, having overly focussed interests like moving objects of parts
of the object, being more or less sensitive than other people to sensory input like light nose
clothing or temperature. The biomedical model of the disease states that it is a brain disease
and pharmacological interventions can only bring about its changes (Deacon, 2013).
Historically, it was found that autism spectrum disorder stemmed from biological
differences in the development of brain. In 1980, it was clearly differentiated from
schizophrenia. Between 1994 and 2000, the definition was extended by including the
Asperger’s syndrome, where it was mentioned that children with ASD are clumsier and are
different from the normal kids in term of fine motor skills. The exact pathomechanism of
ASD is not understood as several factors has been found to be responsible for ASD. Among
all the causes, the genetic factors has long been implicated to have a strong evidence based
aetiology (Samsam, Ahangari & Naser, 2014). Some of the associated causes conditions
related with ASD is fragile X chromosome, tuberous sclerosis, Rett syndrome and others. It
has been noticed that siblings with autistic offspring possess a greater chance of autism than
the general population. Animal models and genetic investigations have stated de novo copy
number mutations causing abnormal alleles in person having close ancestry of a person

2
CONTEMPORARY MENTAL HEALTH TOPIC
having autism has been found to influence the behavioural and the neuroanatomical traits.
Banerjee, Bhat and Riordan, (2014) have shown that abnormality in the trans membrane and
the improper folding of the proteins have been involved in synaptogenesis as well as it is also
linked with the disregulation of the genes involved in the synaptic function. However, with
the discover of several genes as well as the interaction of more than one genes in a single
individual, the epigenetic factors and various environmental factors has been found to be
responsible for ASD. Some of the studies have referred to the fact that mutation in the
mitochondrial DNA cases impairment in the energy metabolism that plays a role in ASD.
The fact that the behavioural deficits will be reflected in the brain lesions has been
highly discouraged. However, one of the most important finding is that an increased in both
the size and the volume of the brain in largely associated with ASD. Neuroimaging studies
have proved that the components of the “theory of mind” such as the medial prefrontal
cortex, the temporal poles and the superior temporal sulcus are weakly developed and have
shown reduced connectivity. DNA methylation correlating with the close cromatin
confirmation and transcriptional silencing. DNA methylation has been found to be playing an
important role in neurodegenerative diseases (Eshragh et al., 2018).
Karimi et al., (2017) have stated that prenatal risk factors like age of the parent,
physical and mental health of the mother, the prenatal medication use of the mother and the
socioeconomic status of the family has been widely connected linked to development of
ASD. Some of the natal risk factors includes abnormal gestation period. Other risk factors
like bleeding at the time of pregnancy, umbilical cord complication and complications during
caesarean delivery affects the brain development of the foetus.
Keeping aside the biomedical reasons, various cultural groups have their own
perception about the causes of ASD. There are cultures where it is believed that it is the

3
CONTEMPORARY MENTAL HEALTH TOPIC
punishment for the sins committed by the parents or by the child in the life before. Some
believe that child was a sign from god and keeps faith in god. It is their religion that gives
them patience and strength (Gona et al., 2015).
Nomothetic formulation for ASD
Cooper, Loades and Russell, (2018) have stated that psychological interventions can
be effective in treating conditions like ASD. It should be mentioned that autistic people needs
adaptations in the standard psychological treatments that are available. The adaptations
involve increased use of visual and written information, emphasising on behavioural change
over the cognitive approaches, incorporating special interest and avoiding ambiguous use of
languages. Some of the common changes includes involvement of parents, incorporation of
the child’s interest, coping statements and personalised metaphors. A behaviour monitoring
chart can be used like functional behaviour reinforcement, use of clear languages and
instructions, functional behaviour assessment and use of narratives for increasing the social
understanding. Systematic reviews have highlighted the efficiency of cognitive behavioural
therapy (CBT) in individuals with ASD. Furthermore, studies have proved that
implementation of the CBT is cost effective in comparison to the other measures. Russell et
al. (2013), have stated that modifications in the traditional CBT methods has been found to be
useful in treating ASD. Several varieties of CBT are present but most of them share common
goals. These includes structured as well as a goal directed method which is restricted to a
proper time frame and does not take more than 12-16 sessions. The therapy does not focus in
to the past but focuses on the present. A key part of CBT is psychoeducation that involves
providing education to someone about the illness that he/she has been suffering from ASD.
Traditional CBT involves a strong linguistic and the abstract thinking abilities, which can be
challenging for the individuals on the autism spectrum disorder. Kose, Fox and Storch,
(2018) have stated that there are five components of CBT like psych education, fear

4
CONTEMPORARY MENTAL HEALTH TOPIC
hierarchy development, cognitive strategies, exposure prevention, cognitive strategies and
prevention of relapse. The therapy focuses on the abilities and talent of the students that
helps them to keep engaged and motivated and building in frequent breaks or movements for
those who can have problems with over-reactivity. Studies have proved that CBT also
addresses the social skills in patients as it is due to the social deficits that patients with ASD
suffer from anxiety. CBT can be administered in variety of ways- in individual group or even
in presence of the other family members. Russell et al.,( 2013) have stated that the benefit of
group CBT is that persons with ASD get to learn that there are several individuals who faces
with the same problems. Friendship and social support gained from CBT might help people
with ASD. One of the advantage of family CBT is that, kit involves parents. The
psychotherapist can educate the families about the grievances and the needs of the children.
Involvement of the parents was not only restricted to the clinic, but parents are also
responsible for doing homework. Modifications in the CBT practice is not only conceptual,
but also procedural. Neil, et al., (2017) have stated that early sessions due to the protracted
cognitive sessions diminishes the ability of people to reflect on specific obsessions. A
functional behaviour assessment is necessary for the identification of the potential function of
the behaviour.
Evolution of treatments of ASD with time and perception
Earlier treatment of autism involved electroconvulsive therapy that is currently used
in the treatment of schizophrenia or bipolar disorders. In 1920, one of the school of thought
was that autism is due to toxic dietary factors and hence can be treated by revising the diet of
the child.
Nowadays, more and more parents are seeking for the biomedical mode of treatment.
Since the acceptance of the biomedical model of the disease, many treatments have started.
The currently prevailing thought among the doctors is to start the treatment by healing the

5
CONTEMPORARY MENTAL HEALTH TOPIC
gut. This can be done by recommending proper healthy food and elimination of processed
food. Organic food has been found to be having a lower level of pesticides (Masi et al.,
2017).
In the year 1943, autism was characterised as a social and emotional disorder, hence
believed that psychotherapy and other pharmacological intervention can decrease its
symptoms. With this concept, several types of therapies were introduced like Cognitive
holding therapy, touch therapy has evolved (Gillberg, 2013). Holding therapy is a
psychoanalytic treatment that stems from the notion that autism is caused due to a
dysfunctional parent child association. Till 1970, autism was still thought to be a behavioural
therapy and not a complex genetic and environmental developmental disease. In the late
1970s, auditory integration training (AIT) was used for the treatment of autism, which is
based on the theory that aggressive behaviour is mainly caused due to the hypersensitivity to
sounds (Masi et al., 2017). Autism is categorised as a biological condition, which greatly
altered the treatment approaches. In addition to the psychotropic medications. Alternative
medications and therapies use strength based approaches to treat individuals with ASD.
Behavioural therapies and special education has been found to be effective for patients
suffering from ASD.
It can be said that the reconceptualization of ASD has changed the landscape of the
treatment of ASD. Currently concepts like applied behaviour analysis, CBT has been
considered as the gold standard for behavioural treatment of individuals with ASD (Larsson,
2013).

6
CONTEMPORARY MENTAL HEALTH TOPIC
Part 2
Clinical leadership is extremely significant to the profession of nursing. While there are
several studies that continue to recognise the significance of clinical leadership in
contributing to the positive outcomes of the consumers, the role of clinical leadership in
professional development is not understand properly. Professional development in mental
health nursing extends beyond the continuation of the medical education and maintenance of
the competency. The journey is long encompassing a growth in the confidence, self-
knowledge, self-awareness skill and professional identity.
However, while working in the department of mental health at the time of placement,
I have understood that communication skills, networking and development of interpersonal
relationship with the patient is the most important part, which needs to be worked upon.
Goals
I will build a strong therapeutic relationship with the patient having mental health disorder,
by improving the communication and interpersonal skills.
Objectives
 To improve knowledge about mental illness and current treatment approaches.
 To be aware of the different verbal and the non-verbal communication techniques that
can be used to communicate with the patient.
 To acknowledge the diversity in culture, values and the belief system ensuring that the
care provided by me is totally non-discriminatory and rightfully promotes self-
determination and dignity.
 To actively disregard stigma related to mental health illness and promote social
inclusion and community participation for people suffering from mental health illness.

7
CONTEMPORARY MENTAL HEALTH TOPIC
Resources
Evidence based resources like articles, books and journals can be used as resources for
studying and developing my communication and the interpersonal skills.
Activities
In order to achieve the above mentioned goals, I will acquire knowledge that is
required to develop the communication skills, develop materials and will put in to place
individualised learning that is necessary for communicating with patients having mental
health disorder. If required, I will also register myself in communication skills training.
Literatures have suggested that communication training has effects like adherence to
treatment, mental state, satisfaction, service use and the quality of life (Papageorgiou,
Loke & Fromage, 2017).
It should be mentioned that many mental health patients does not have the cognitive
status to communicate with the health care professional. I believe that I should develop
enough confidence to communicate properly with the patients and the other health care
professionals. Active listening, empathy, compassionate care and keeping the interest of
the patient at the first place is an important part of nursing.
In most of the cases, mental health patients suffer from delusional thoughts that makes
them prone to the suicidal thoughts, harming others and misunderstanding others. This
can lead to non-adherence of the medicines, sudden withdrawal from the treatment.
Hence, it necessary to establish a conducive environment for the patient, such that he/ can
share the grievances freely. While conversing with patients with cognitive problems,
short and simple language needs to be used such that it becomes easy for them to
understand. In should be mindful about carrying on a conversation as several sensitive
questions might trigger extreme emotions on these patients. Studies have specifically said

8
CONTEMPORARY MENTAL HEALTH TOPIC
that most of the health care professionals lack professional non –verbal communication
skills. It is necessary that the nurses should notice all the cues but should draw
appropriate interpretation from the cues. I should remember that no single gesture of
behaviour always meant the same thing always. It is necessary to ensure the surrounding
environment where the interaction is occurring. For example, crossing the one arm’s
across the chest signifies that the patients is not very comfortable to discuss about a
particular matter (Foley & Gentile, 2010). As a nurse I should consider the typical
presentation of the patient at the time of the Mental State Examination.
Being a mental health nurse, I am well aware the principles of nursing ethics. It
should be mentioned that several ethical dilemma comes in to play while dealing with
mental health patients. The ethical problems mainly faced by the mental health nurses are
related to autonomy. Many mental health nurses faces difficulties in controlling the
negative feelings about the psychiatric patients. Nurses often have to face with several
ethical dilemma where an individual is left with options to choose between two
alternatives (Aydin Er & Ersoy, 2017). However, I should always opt for the greater
good. The action would be for the beneficence of the patient. If a patient is able to give
consent to his treatment, I should ensure that either verbal or written consent is obtained
from the patient. As informed consent is an important element of autonomy, considering
the patient in the decision making process.
Evaluation
An honest self-assessment, constructive group feedback and self-talk are the
important concept of self-evaluation (Siles-González & Solano-Ruiz, 2016). I would
evaluate my skills and competencies by self-reflecting on a journal or my seeking peer
feedback for the evaluation. Timely review can also be taken from the family of the patients.

9
CONTEMPORARY MENTAL HEALTH TOPIC
On getting the feedback, I will be able to understand the gaps left in my communication skills
and my strengths as well as the areas that requires improvement.
Time frame
I believe that, I will be able to build up my communication and interpersonal skills
gradually within a time span of six months.
In conclusion, it can be said that development of communication skills is an important
element of providing compassionate care to the nurses with mental health illness which can
be developed by practices like active listening, informed consent, autonomy to the patient and
engaging in lifelong learning.

10
CONTEMPORARY MENTAL HEALTH TOPIC
References
Aydin Er, R., & Ersoy, N. (2017). Ethical Problems Experienced By Nurses Who Work in
Psychiatry Clinics in Turkey. Journal of Psychiatric Nursing/Psikiyatri Hemsireleri
Dernegi, 8(2).
Banerjee, S., Bhat, M., & Riordan, M. (2014). Genetic aspects of autism spectrum disorders:
insights from animal models. Frontiers in cellular neuroscience, 8, 58.
Cooper, K., Loades, M. E., & Russell, A. J. (2018). Adapting Psychological Therapies for
Autism - Therapist Experience, Skills and Confidence. Research in autism spectrum
disorders, 45, 43–50. doi:10.1016/j.rasd.2017.11.002
Deacon, B. J. (2013). The biomedical model of mental disorder: A critical analysis of its
validity, utility, and effects on psychotherapy research. Clinical psychology review,
33(7), 846-861.
Eshraghi, A. A., Liu, G., Kay, S. S., Eshraghi, R. S., Mittal, J., Moshiree, B., & Mittal, R.
(2018). Epigenetics and Autism Spectrum Disorder: Is There a Correlation?.
Frontiers in cellular neuroscience, 12, 78. doi:10.3389/fncel.2018.00078
Foley, G. N., & Gentile, J. P. (2010). Nonverbal communication in psychotherapy.
Psychiatry (Edgmont (Pa. : Township)), 7(6), 38–44.
Gillberg, C. (Ed.). (2013). Diagnosis and treatment of autism. Springer Science & Business
Media.
Gona, J. K., Newton, C. R., Rimba, K., Mapenzi, R., Kihara, M., Van de Vijver, F. J., &
Abubakar, A. (2015). Parents' and professionals' perceptions on causes and treatment

11
CONTEMPORARY MENTAL HEALTH TOPIC
options for Autism Spectrum Disorders (ASD) in a multicultural context on the
Kenyan Coast. PloS one, 10(8), e0132729. doi:10.1371/journal.pone.0132729
Karimi, P., Kamali, E., Mousavi, S. M., & Karahmadi, M. (2017). Environmental factors
influencing the risk of autism. Journal of research in medical sciences : the official
journal of Isfahan University of Medical Sciences, 22, 27. doi:10.4103/1735-
1995.200272
Kose, L. K., Fox, L., & Storch, E. A. (2018). Effectiveness of cognitive behavioral therapy
for individuals with autism spectrum disorders and comorbid obsessive-compulsive
disorder: A review of the research. Journal of developmental and physical disabilities,
30(1), 69-87.
Larsson, E. V. (2013). Is applied behavior analysis (aba) and early intensive behavioral
intervention (eibi) an effective treatment for autism? a cumulative history of impartial
independent reviews. autism, 27(1), 168-1792.
Masi, A., DeMayo, M. M., Glozier, N., & Guastella, A. J. (2017). An overview of autism
spectrum disorder, heterogeneity and treatment options. Neuroscience bulletin, 33(2),
183-193.
Neil, N., Vause, T., Jaksic, H., & Feldman, M. (2017). Effects of Group Functional Behavior-
Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth
With Autism Spectrum Disorder. Child & Family Behavior Therapy, 39(3), 179-190.
Papageorgiou, A., Loke, Y. K., & Fromage, M. (2017). Communication skills training for
mental health professionals working with people with severe mental illness.
Cochrane Database of Systematic Reviews, (6).

12
CONTEMPORARY MENTAL HEALTH TOPIC
Russell, A. J., Jassi, A., Fullana, M. A., Mack, H., Johnston, K., Heyman, I., ... & Mataix‐
Cols, D. (2013). Cognitive behavior therapy for comorbid obsessive‐compulsive
disorder in high‐functioning autism spectrum disorders: A randomized controlled
trial. Depression and Anxiety, 30(8), 697-708.
Samsam, M., Ahangari, R., & Naser, S. A. (2014). Pathophysiology of autism spectrum
disorders: revisiting gastrointestinal involvement and immune imbalance. World
journal of gastroenterology, 20(29), 9942–9951. doi:10.3748/wjg.v20.i29.9942
Siles-González, J., & Solano-Ruiz, C. (2016). Self-assessment, reflection on practice and
critical thinking in nursing students. Nurse education today, 45, 132-137.