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

A comorbidity is a condition that exists or develops in conjunction with another condition. For those living with autism, having comorbidity or multiple comorbidities is often a reality. While percentages vary based on the comorbidity under examination, most autistic individuals are living with at least one comorbidity.

This high rate of comorbidity in this population can pose serious challenges to direct support professionals (DSPs) and others working in the intellectual and developmental disabilities (IDD) field. To help your organization provide better care to its clients, we’ll discuss some of the most common comorbidities for those with autism and a few of the available treatment options.

Prevalent comorbidities among those with autism

ADHD

Attention deficit hyperactivity disorder (ADHD) and autism often co-occur. In fact, studies have found that roughly half of children with autism experience ADHD as a comorbidity.

Researchers have yet to figure out why these two conditions so often coexist. But we do know that they are both neurological conditions that affect the ability to focus, control impulses, manage time, keep organized, and interact socially with others.

Anxiety

Anxiety may be the most common comorbidity for those with autism. Research indicates that up to 84% of autistic individuals also live with anxiety. Elevated levels of anxiety can exacerbate certain complications of autism, such as social withdrawal and repetitive behaviors.

While genetic factors and insufficient supports play a role in the comorbidity of autism and anxiety, experts also point to:

• Language processing abilities: Some people with autism may have difficulty expressing their wants and needs, leading to frustration and anxiety.
• Sensory sensitivity: Enhanced sensitivity to light, sound, taste, and other sensations can prove overwhelming, which can lead to or enhance anxiety.
• Difficulty with social situations: Some autistic individuals have a hard time understanding social cues, which can cause feelings of isolation.
• Task frustration: Some individuals with autism may experience difficulties with motor skills, cognition, and other functions which are used for completing tasks.
• Detail-focused temperament: It’s common for autistic individuals to have hyper-focused attention to detail. This can make changes in routines or shifting focus hard.

Depression

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 autistic individuals 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 a leading factor.

Epilepsy

Epilepsy is another common comorbidity with autism. Approximately one-in-three individuals with autism are also diagnosed with epilepsy. While the two conditions share genetic markers, researchers do not fully understand why they so often co-occur.

It is common for autistic individuals to have abnormalities detected on an electroencephalography (EEG), with some studies showing that up to 60% of those with autism will show EEG abnormalities. This does not mean that these individuals will experience seizures. Rather, researchers believe it is a secondary symptom of their brain’s physiology which reflects differences in neural pathways among autistic individuals.

Gastrointestinal issues

Research has found that those with autism are four to six times more likely to experience gastrointestinal issues than their neurotypical peers. These issues can present in a variety of ways, the most common being:

• Constipation
• Diarrhea
• Abdominal pain

While the link between gastrointestinal distress and autism remains unclear, one possible cause for this comorbidity could be food selectivity among autistic individuals.

Sleep disorders

Sleep disorders present in individuals with autism far more commonly than their neurotypical peers. Studies have found that sleep issues are twice as common among autistic children than other populations.

The most common sleep disorders among those with autism include:

• Breathing dysregulation, such as sleep apnea
• Insomnia
• Restlessness
• Night walking
• Sleep anxiety

This increased link between autism and sleep disorders could stem from other comorbidities. If an autistic individual is experiencing gastrointestinal distress or anxiety, for example, it can make comfortable sleep much harder to achieve.

Treatment options for those with autism and comorbidity

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 good first-step solutions for managing the possible presence of a comorbid mental health 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 anxiety or depression 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.

Medication

Therapists or other providers may recommend medications to manage the symptoms of the comorbid conditions. Although research is ongoing in regard to the efficacy of selective serotonin reuptake inhibitors (SSRIs) for treating depression and anxiety in teens and young children with autism, they remain the standard antidepressant used in managing these comorbidities. 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, autistic individuals with 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.