What is Autism?
Autism is a neurological and developmental disorder that affects communication, learning, socialization, and behavior. Autism can be diagnosed at any time, but it first occurs in early childhood. When someone has autism, it does not necessarily mean they have an intellectual disability, but that their neurodevelopment in childhood was not typical. As a result, their brains are ‘wired’ differently, and how they respond and react to stress and life events will be different from the way most neurotypical people would react.
However, not all people with autism think or behave in the same way. Although there are common challenges and behaviors that many autistic people share, autism is considered to be a ‘spectrum,’ because there is a wide variety of types and severity of symptoms.
Autism often causes problems with social communication and managing relationships with others. There is no cure for autism, but the symptoms can be managed with certain types of therapy, individual coping tactics, and mental health counseling.
What Mental Health Conditions Co-occur With Autism?
There are a few mental health conditions that often co-occur with autism, including anxiety, depression, and obsessive-compulsive disorder. Anxiety and depression are two of the most common comorbidities. Anxiety and depression are more prevalent in the autistic community, compared to the general population. 40% of autistic people have elevated levels of anxiety or an anxiety disorder.
The Simons Foundation Powering Autism Research (SPARK) autism research project surveyed adults with autism and found that 47% scored above clinical cut-offs for depression and 83% had been diagnosed with depression. SPARK also found that people with autism are four times more likely to experience depression, compared to the rest of the population.
Why Are Depression and Anxiety More Prevalent in the Autistic Population?
Autistic individuals face certain challenges that may be the cause behind the elevated levels of anxiety found in the community. Some things that might cause anxiety in someone with autism include:
- Disruptions to their routine, even small ones
- Unfamiliar or unpredictable social situations
- Situations where it’s hard to know what other people are thinking or feeling
- Their own thoughts and feelings, especially unfamiliar or unpleasant ones, or the physical symptoms that can accompany them
Because many autistics struggle with social interaction and communication, stress and anxiety can be caused by navigating difficult social situations. The autistic brain also can struggle with changes in routine or any type of unexpected change, and identifying, understanding, and managing emotions (a condition known as alexithymia). Many autistics also experience sensory or emotional overwhelm, often resulting in intense anxiety or agitation.
These issues are caused by the different neurology of the autistic brain, but sometimes other causes are behind mental health conditions in autism. A significant cause of depression in autistic people is feeling misunderstood or not accepted by neurotypical people. Many autistic children are bullied, and a lot of autistic people – both children and adults – do what’s called ‘masking’ or ‘camouflaging.’
When someone is masking, they’re trying to appear more like a neurotypical person in the way they talk or behave in order to ‘fit in.’
Masking can increase anxiety and depression and have a negative effect on the individual’s overall mental health and sense of self.
Some things that might cause depression in individuals with autism include:
- Being bullied or mistreated
- Low self-esteem
- Loneliness – often caused by difficulties socializing and forming and maintaining friendships
- Lower quality of life
- Genetic factors – some studies indicate that both depression and autism may be hereditary
Autism can often severely limit individuals’ capacity for managing activities of daily living and can impact quality of life. Many autistic adults struggle to find and keep a job or live independently. All of these issues may contribute to the high levels of depression and anxiety in autistic people.
How Do Depression and Anxiety Present in Someone Who’s Autistic?
The symptoms of depression and anxiety may be harder to recognize in individuals with autism because they may mimic some of the symptoms of autism. For example, lack of interest in socializing, sleep problems, and trouble concentrating are all potential symptoms of both autism and depression.
One reason depression in individuals with autism might be overlooked is that instead of looking sad or tired, an autistic person experiencing depression might be more likely to be irritable or agitated or to have emotional outbursts. In a child with autism, depression is more likely to show up in the form of insomnia or restlessness and in autistic children overall, depression is more likely to look like anxiety.
Depression in Autism
Depression may present in autistic individuals in the form of:
- Sleeping problems – either insomnia or sleeping more
- Physical symptoms, like feeling more tired than usual
- Losing interest in the things they used to love
- Rumination – repetitive thinking about negative events and emotions
- Feelings of hopelessness
- Increase in some behaviors associated with autism, like stimming, self-injury, social withdrawal, aggressive behavior, and intense or highly focused interests
Anxiety in Autism
Anxiety may present in autistic individuals in the form of:
- Behavioral issues, like aggression, irritability, and self-injurious behaviors (these issues are more common in autistic individuals who also have intellectual disabilities or communication limitations)
- Increase in some behaviors associated with autism, like stimming, social withdrawal, aggressive behavior, and intense or highly focused interests.
- Insisting on even more routine and sameness
- Sleep problems
- Autistic ‘meltdowns’ or emotional outbursts
- Common symptoms of anxiety, like feeling restless or worried, digestive issues, a fast or irregular heartbeat, faster breathing, sweating or hot flashes, and panic attacks
Treating Depression and Anxiety in Autistic Individuals
Thanks to research, we know more about depression and anxiety in children and adults with autism than we used to, but there’s still a lot that we don’t know. Studies have shown that people with autism often respond to traditional depression and anxiety treatments including:
- Antidepressant or antianxiety medications, especially Selective Serotonin Reuptake Inhibitors (SSRIs), like Prozac and Zoloft
- Mental Health Counseling
- One specific type of mental health counseling in particular, cognitive behavioral therapy (CBT), which helps someone change their distorted thoughts
- Another type of counseling, mindfulness therapy, which involves breathing and relaxation techniques
Sometimes these treatments need to be changed for autistic people. For example, people with autism may be more likely to have certain side effects from SSRIs, such as impulsive or irritable behavior and trouble sleeping. That appears to be especially true in children and teens. So, a doctor may recommend starting at a low dose and slowly increasing if necessary, especially for a young patient.
Increase in suicidal thoughts is a possible side effect for teenagers taking these types of medications, so it’s recommended that these medications are prescribed to young people with caution, and that they are closely monitored. Medication can be very helpful for many people, but it works best when paired with talk therapy or other types of mental health counseling.
Mental Health Counseling for Treating Depression and Anxiety in Autistic Individuals
Mental health counseling can be extremely helpful for anyone experiencing depression or anxiety, and can be especially beneficial for autistic individuals, if they work with a counselor who understands autism and how to approach it. Two types of mental health counseling that have been shown to work well for autistic individuals are cognitive behavioral therapy and mindfulness therapy.
Cognitive Behavioral Therapy for Autistic Individuals
In cognitive behavioral therapy, or CBT, a counselor helps the client to identify and change negative thought patterns. The process typically works like this:
- The counselor will help the individual to identify the situations or conditions in their life that are causing them to experience mental distress
- Then, the patient will be encouraged to share their thoughts about these situations in their life. These thoughts include how they talk to themselves about the situations (self-talk) and their beliefs about and interpretations of the situations
- The counselor will help the individual to recognize patterns of negative or inaccurate thinking that is contributing to their depression or anxiety.
- Through talk therapy, journaling, or other activities, the counselor will help the individual reshape their negative or inaccurate thinking. This can take some time, and effort on the part of the individual, but it is well worth it – CBT has been shown to be very effective in relieving anxiety and depression
Mindfulness Therapy for Autistic Individuals
In mindfulness therapy, individuals are encouraged to pay attention to what they’re experiencing in the present moment, without judgment. Mindfulness therapy teaches patients how to focus on the present moment, and not on the past or future. It also teaches how to accept what is happening and the feelings we’re experiencing.
One study involved researchers teaching 20 autistic adults to use mindfulness through focusing their thoughts on the present moment in an accepting and nonjudgmental way and by using breathing exercises and meditation. The group showed a decrease in depression and anxiety symptoms, compared to the control group. These results indicate that mindfulness-based therapy could be helpful in treating depression and anxiety in people who have autism.
Why It’s So Important to Address Depression and Anxiety in Individuals with Autism
More than 70 percent of autistic youth experience mental health conditions, like depression or anxiety, which can often persist or worsen into adulthood. Major depression can severely impair their “independence; their coping, daily living and social skills; and their communication – all things they may already find challenging.” It can also trigger suicidal thoughts. A recent study found that individuals diagnosed with autism were three times more likely to attempt suicide than their neurotypical peers.
People who have autism are at a higher risk for mental health conditions, especially depression, anxiety, and suicidal thoughts, and the symptoms of these conditions can often present differently than in neurotypical people. That’s why it’s so important to raise awareness of mental health conditions that often co-occur with autism, and of how they may present in autistic individuals.
A Community of Hope
WTCSB is your single point of entry for access to mental health services, developmental disabilities support, and substance abuse services for Franklin and Suffolk and the counties of Isle of Wight and Southampton, but we’re more than that – we’re a community of hope and caring.
We are dedicated to our community, and that includes our neurodivergent members. If you want to know more about how we can help treat mental health conditions in our autistic community members, you can read more here.
If you’re ready to see what mental health counseling can do for you or a family member, make an appointment online for same-day access.