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

The conversation on successfully managing the symptoms of autism spectrum disorders (ASDs) often results in forgetting about the possibility of other mental health conditions. In fact, many people with an ASD suffer from a co-occurring mental health disorder. In a recent study by Spectrum News, researchers found up to 86 percent of adult men with autism have at least one other co-occurring mental health condition.

When a person has more than one mental health condition, the combination of conditions is referred to as comorbidity. 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 the respective mental health condition. As a result, you need to understand why the prevalence remains high, how it impacts those with an ASD and what it means for autism treatment.

Prevalence of Autism and Comorbid Conditions

The prevalence of autism and depression vary dramatically from source to source, explains the Journal of Childhood and Developmental Disorders. Some studies have found prevalence rates ranging from 0.9 to 10 percent, but more importantly, the likelihood of suffering from depression is enhanced in higher-functioning people with autism. Ultimately, researchers believe the increased risk for depression is the result of greater self-awareness of one’s limitations or disabilities.

Yet, the information on anxiety and autism is also slightly skewed depending on the level of function. Statistically, 41.9 percent of all children with ASD met the criteria necessary for diagnosis with an anxiety disorder. In lower-functioning children, the likelihood of being diagnosed with anxiety rose. Moreover, the types of anxiety were significantly different from those commonly expressed in peers.

For example, elementary students with ASD exhibited more frequent situational phobias and medical fears. This may reflect fears created by previous experience in social or medical contexts. In other words, a child with autism who has been extensively hospitalized may be more likely to fear visiting a clinical setting than a child who has only seen a physician rarely.

There are also a few problems with researching the prevalence of anxiety and depression in young children and adolescents with autism. Underreporting of the disorder may result in inaccurate findings. Yet, the prevalence of depression increases even further in teens with autism. As a result, a multimodal approach to treating comorbid conditions is recommended.

Impact of Comorbidity on Individuals with Autism

People with autism also face challenges in obtaining an accurate diagnosis of a comorbid condition. Changes in cognitive capacity as a result of autism or intellectual disability 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:

  • Mild, moderate or extreme aggression and hostility.
  • Dramatic changes in level of functioning.
  • Regression of behavioral understanding.
  • Decreased ability to care for oneself.
  • Self-injurious behavior.
  • Catatonia.
  • Hyperactivity.
  • Dramatic changes in communicative ability.

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, aggression and catatonia can be symptoms of schizophrenia, but in this example, they are simply indicators of depression in a person with autism. Consequently, treatment for depression or anxiety that occurs in conjunction with autism must be more carefully monitored and managed.

How Does Comorbidity Affect Treatment of Autism?

The comorbidity of autism and depression or anxiety changes how therapists and caregivers approach management of the respective disabilities and disorders. In general, cognitive behavioral therapy (CBT) and non-medication therapies are first-step solutions to managing the possible presence of a comorbid condition, explains Autism Speaks.

Part of the rationale for using CBT to treat comorbid conditions is its versatility. CBT can be successfully incorporated into existing therapeutic sessions, including applied behavior analysis. Furthermore, CBT is based on teaching how irrational thoughts develop, enabling 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 forum of role playing as well.

If therapy-based treatment approaches are 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 comorbid depression. 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.

Therapists may also take specific steps, describes Dr. Katherine Vanderbilt, to help family members and those with autism overcome their comorbid disabilities. 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.

Final Thoughts

Individuals with autism face challenges throughout life, and the risk of suffering from another mental health disorder is higher among these individuals. Unfortunately, society has forgotten that multiple mental health illnesses are common. However, you can change the dialogue by learning why anxiety and depression rank among the top comorbid disorders affecting people with autism. After all, providing superior care means making sure a person’s whole sense of self is cared for, including co-occurring mental health problems.


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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