Autism, Anxiety, and Depression: What You Need to Know About Comorbidity

The conversation on successfully managing the symptoms of autism spectrum disorder (ASD) often results in forgetting about the possibility of other mental health conditions. In fact, many people with autism experience a co-occurring mental health disorder. In a study by the Journal of Autism and Developmental Disorders , researchers found that 73-81% of adults and 70-95% of children with autism have at least one other co-occurring mental health condition, also known as a comorbidity. 

For example, the prevalence of depression as a comorbidity of autism is quite high. The CDC estimates that 26% of people with autism also have depression. The reasons for this vary. Some studies point to the attention to detail that many with autism exhibit. These studies argue that this attention to detail can cause individuals to ruminate on an upsetting topic, leading to feelings of depression. Other research points to difficulty with social interactions as another leading factor. 

Unfortunately, depression and anxiety are among the most common comorbid conditions affecting individuals with autism, and these people may exhibit rare or unusual symptoms of their respective mental health condition. As a result, you need to understand why the prevalence remains high, how it impacts those with autism, and what it means for autism treatment. 

How Individuals With Autism Are Affected by a Comorbidity 

People with autism also face challenges in obtaining an accurate comorbidity diagnosis. Changes in cognitive capacity as a result of autism may result in the presentation of unusual symptoms of anxiety or depression. 

For example, the characteristic symptoms of a depressed mood include the following: 

  • Irritability 
  • General feelings of worthlessness or sadness 
  • Impaired concentration 
  • Indecision 
  • Morbid, “dark” thoughts 
  • Unusual pains or aches 

However, individuals with autism may exhibit the following additional symptoms: 

  • Non-responsiveness
  • Self-stimulatory behavior
  • Potential increase in self-injurious behavior
  • Changes in thoughts and mood, e.g. ruminating on unpleasant thoughts

This expanded list of symptoms of depression can make diagnosing depression difficult. In addition, it may result in the misdiagnosis of a different comorbid condition. For example, non-responsiveness can present as a symptom of schizophrenia, but in this example it  indicates depression occurring as a comorbidity in a person with autism. Consequently, you must carefully monitor and manage treatment for depression or anxiety that occurs in conjunction with autism. 

CBT for Individuals With Autism and a Comorbidity 

The comorbidity of autism and depression or anxiety changes how therapists and caregivers approach individual treatment plans. In general, cognitive behavioral therapy (CBT) and non-medication therapies are first-step solutions to managing the possible presence of a comorbid condition. 

Part of the rationale for using CBT to treat comorbid conditions is its versatility. Therapists can successfully incorporate CBT into existing therapeutic sessions, including applied behavior analysis. Furthermore, CBT is based on teaching how irrational thoughts develop. This enables people with autism and comorbid conditions to stop the thought process before it continues. 

Additional strengths of CBT include its long-term usability in managing mental health disorders, usefulness in exposure-based therapies for helping people overcome specific phobias and fears, and low-risk side effects on the mind and body. In children, CBT may be included as part of a treatment plan in the form of role playing as well. 

Therapy Offers Other Options 

Therapists may also take specific steps to help family members and those with autism overcome their comorbidity. This includes the increased use of preventative screenings to identify signs and symptoms of anxiety or depression during routine therapy sessions. 

For example, a person seeing a therapist for management of autism should be screened frequently for the presence of any possible indicators of co-occurring mental health conditions. 

Therapists are also on the “front lines” of helping family members learn more about autism and comorbid conditions. Consequently, therapists need to provide educational materials and resources to family members to ensure everyone understands their roles in providing the best care possible. 

Medication-Based Treatment 

If therapy-based treatment approaches prove unsuccessful, therapists or other caregivers may move toward medications to manage the symptoms of the comorbid conditions. Although little evidence suggests selective serotonin reuptake inhibitors (SSRIs) are effective in treating depression in teens and young children with autism, they remain the standard antidepressant used in managing depression that presents as a comorbidity. However, additional monitoring of overall mental and physical health is necessary. For example, some SSRIs cannot be taken with certain foods or beverages. 

Treatment for depression or anxiety may also take several weeks to be effective when medications are used. Medications for mental health, particularly antidepressants, require a person to build up a suitable level of the medication in the body to be effective. As a result, individuals with autism and depression or anxiety should be carefully monitored to ensure they are not a danger to themselves or others until the appropriate serum levels have been reached. 

Final Thoughts

Unfortunately, society has forgotten that multiple mental health illnesses are common. However, you can change the dialogue by learning why individuals with autism can develop a comorbidity like anxiety and depression. After all, providing superior care means making sure a person’s whole sense of self is cared for, including co-occurring mental health problems. 

Jason Vanover

Working in health care since 2005, Jason's body of experience encompasses dozens of care settings, including Senior care, psychiatric facilities, nonprofit health service centers, group homes for those with developmental disabilities and beyond. Jason understands the need to tailor his skills to each setting to encourage the best treatment outcomes and promote an inclusive, healing environment.

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