How to Treat Overlapping Autism & Depression

People with autism have quadruple the risk for experiencing depression in their lifetime than those without the disorder. Autism presents many social and communication difficulties that can increase the risk for also suffering from depression.

Depression may not look the same in someone who has autism as it does in the general public. It can also be harder to diagnose in people with autism.

Treatment for depression in the autistic community often starts with prevention. Parents can help children to manage symptoms of autism and increase social skills in order to help minimize the risk.

Both autism and depression are complex disorders that require specialized treatment methods and models that typically focus on behavioral therapies.

The Connection Between Autism & Depression

Autism is a developmental disorder that involves issues with socialization, communication, and ritualistic and repetitive behaviors. Depression is a mood disorder characterized by feelings of sadness, hopelessness, and isolation.

People with autism are more likely to struggle with depression than neurotypical individuals. When autism and depression co-occur, it is referred to as comorbid disorders.

There are a variety of reasons that someone with autism may be more prone to also suffer from depression, including:

Genetic factors. Both autism and depression are potentially heritable disorders.
Social and personal isolation. Autism can make it tough for people to communicate and socialize effectively, which can lead to loneliness as well as difficulties forming and maintaining friendships.
Bullying. Children and teens with autism can often be mistreated, leading to feelings of negative self-worth.
Repetitive thoughts and actions. People with autism engage in ritualized behaviors, which can lead to pervasive negative thoughts and emotions and a tendency to dwell on them.
Low self-esteem. Frustration with educational and academic abilities and challenges, as well as a recognition of being different from peers, can contribute to negative views of oneself.

Comorbid autism and depression can lead to more physical health problems, greater complications with treatment, more issues with socializing and isolation, and increased difficulties functioning in daily life and within the community.

Another major risk for comorbid depression and autism is self-harm. People with these co-occurring disorders have an increased rate of suicide and suicidal thoughts compared to the general population.

Recognizing Depression With Autism

Depression and autism often go hand in hand, but in the past, depression has often been overlooked in the autistic community. Recent research is showing the overlap of these two disorders is much more common than was previously recorded. Recorded rates of comorbid autism and depression range from as low as 1.4% all to way up to 57%.

It is likely that more people with autism struggle with depression than reported rates since it can be more difficult to diagnose or recognize depression in someone who is autistic.

Depression is a mood disorder based on internal thoughts and emotions. A person with autism often has difficulties labeling and expressing their thoughts and emotions effectively. Symptoms of depression in someone with autism can look different than they do in a neurotypical person. As a result, the diagnosis is often missed in autistic individuals.

Common signs of comorbid depression with autism are:

Sleep disturbances.
Eating issues and weight fluctuations.
Aggression.
Self-injury.
Social withdrawal.
Obsessive behaviors.
Emotional outbursts.
Increased irritability.
Decreased and low self-esteem.
Drop in energy levels.
Lack of interest in things and activities that were once pleasurable.
Decreased motivation.

People with autism often have a flat affect, which means they converse in a flat monotone or robotic-type voice. This can be difficult to read and know what emotions might be underneath.

A person with autism also struggles to understand their own emotions and express them. It can also be hard to separate symptoms of depression from those of autism. Again, this further complicates the diagnosis of depression in people with autism.

The best way to spot depression in someone with autism is to pay attention to changes. Parents are the best advocates for their children. Take note of changes in sleeping and eating patterns as well as behavioral shifts.

Supporting Mental Health in Autistic Children

There are several things you can do to help protect your child’s mental health and lower their risk for depression. Preventing depression by safeguarding mental health is important for children with autism.

Early intervention for autism is paramount. The earlier a child is diagnosed and starts treatment, the more likely they are to develop healthy coping skills and habits for socializing and communicating more effectively.

Early treatment for autism can help to improve communication and socialization skills, which can minimize social and personal isolation. This helps an autistic child to better understand and express their thoughts and feelings, thus lowering the risk for anxiety and depression.

Teenagers, Autism & Depression

Adolescent autistic children may require extra attention from parents and therapy providers. The social pressures and increased changes that come with transitioning into adulthood can potentially raise the risk for depressive and suicidal ideations. This population is at an especially high risk for depression.

Children on the autism spectrum who are entering adolescence are also becoming more aware of their differences from their peers, and they can start to feel even more isolated. Academic pressures and challenges often increase during this time as well.

Change is hard for someone with autism. Puberty, along with the turbulence of high school and beyond, can present even more drastic life and personal shifts. While adolescence and the teen years can be tough for everyone, the difficulties are more pronounced for people with autism.

Keep the lines of communication open with your child’s teachers to ensure that you are aware of any possible red flags. Continue dialogue with your child as much as possible and help them to focus on positive thoughts and relationships — what they can do versus what may be more difficult for them. Social skills training can help an autistic teenager to better manage transitions, social pressures, and academic expectations.

Adult Depression & Autism

Adults with autism are going to have different needs and risk factors for depression than children. Depression in autistic adults is often more severe, more difficult to treat, and can more commonly lead to suicidal thoughts and actions than it does in children.

An autistic adult is often even more socially isolated. The communication issues related to autism can mask depressive symptoms, making it harder for it to be recognized, diagnosed, and managed. Caregivers should stay aware of any changes in behavior, attitude, motivation, and interests as well as sleeping and eating patterns. Support systems are especially important for adults with autism. Social skills groups, continued therapy, and support groups can provide resources and outreach to adults with autism.

Treatment Options for Comorbid Autism & Depression

Behavioral therapies are considered the optimal way to manage comorbid autism and depression. These therapies are beneficial in treating both depression and autism separately, and they can also be effectively used when these disorders overlap to treat both at the same time.

Each person is different, and there are varying levels of severity in both autism and depression. A full evaluation is needed so medical and mental health professionals can determine the best treatment approach.

Treatment plans may include:

Applied behavior analysis (ABA). ABA is a type of therapy that can help people with autism learn desired behaviors through positive reinforcement. ABA aims to encourage positive behaviors and develop real life skills in people with autism. By setting small goals and learning skills to attain them, a person can build up healthy habits. ABA also helps to decrease negative behaviors by not reinforcing them. Specific goals are tailored to the individual and evolve as needs change. ABA can teach a variety of life skills and help with communication and socialization, both of which can help to decrease depressive thoughts and emotions in someone with autism. Applied behavior analysis is considered the primary type of therapy for autism, and it is regularly included in most autism treatment plans. Because it is adaptable and flexible, it can also aid in the treatment of comorbid disorders, including autism and depression.
Cognitive behavioral therapy (CBT). This is one of the most used behavioral therapies to treat depressive symptoms in people with autism. This therapy type focuses on thought patterns and emotions, and how they relate to actions and reactions. CBT can help to evaluate negative thoughts and reframe them. It can also work to address some of the inflexibility that is a symptom of autism. CBT can also focus on coping strategies. Tools for managing stressors can be taught, and maladaptive coping methods can be shifted into more positive ones. CBT for comorbid depression and autism regularly focuses on outward manifestations of the disorders, such as aggression and anxiety. CBT can help someone to learn how to better recognize how they are thinking and feeling, and how to better handle and manage emotions, which in turn shapes behavior. Mindfulness-based interventions can promote emotional regulation. When someone has a better idea of how what they are feeling relates to what they are thinking and how to express themselves properly, depressive symptoms can be lessened.
Creative and expressive therapies. Individuals with autism often struggle with verbal communication. Identifying complex emotions can be hard. Creative expression can help. Creative arts therapy can provide a method of nonverbal expression and a way to work through emotions that can be difficult to otherwise process. Creative expression can be very therapeutic and provide someone with a sense of accomplishment. This increase in self-esteem can help to lessen depression symptoms. Creative expressive therapies may include music therapy, drama and role-playing exercises, dance therapy, and play therapy in addition to art creation. All these forms of creativity can serve as methods of expression and growth.
Family therapies. These therapies provide a way for parents, siblings, and autistic family members to learn how to work together and support each other as a cohesive family unit. Sessions involve the entire family and often take place in the family home. Family therapy can teach family members and parents how to best deal with autistic behaviors while also improving understanding and communication between all family members. Systemic Autism-Related Family Enabling (SAFE) is a type of family therapy designed specifically for people with autism, addressing the mental health challenges that are common with the disorder. SAFE uses therapeutic methods to change negative behaviors related to autism and poor mental health. Sessions often include playing with clay, drawing, and role-playing exercises.
Medications. While medications, such as antidepressants, are often effective in managing symptoms of depression in the general population, they have not been proven effective for people with autism. In some cases, antidepressants may cause more harm than good in autistic individuals due to their side effects. The decision to use medications must be made on a case-by-case basis. Sometimes, they can be helpful for treating some symptoms of depression in autistic adults. Talk to your doctor about the possible risk factors and benefits of medication in your situation.
Social skills and support groups. Groups can be effective for helping people with autism connect and feel less isolated, which can also help to reduce depression. Social skills groups provide the opportunity to learn and practice new skills that can be used for daily life functioning. These groups are especially helpful for adolescents, teens transitioning into adulthood, and adults with autism. Support groups provide an outlet where people are surrounded with others facing similar struggles and issues. The sense of camaraderie can improve depressive symptoms and help to build healthy relationships. In these groups, autistic individuals can also build communication and social skills.

Tips for Preventing & Minimizing Depression With Autism

When an autistic child is feeling stressed or anxious, this often comes out in temper tantrums or outward signs of aggression or self-harm. The same can be true for depression, but depressive symptoms may be less obvious.

Autistic children often prefer to be left alone and would rather play by themselves than with others. This does not necessarily mean that they are depressed. However, socialization and healthy relationships are important to a child’s mental health. It’s important to foster connections between autistic children and others, to prevent potential onset of depression.

Therapies for both autism and depression can teach healthy ways to express oneself and better techniques for socializing, communicating, and sustaining relationships. At home, parents and other family members can reinforce what is learned in therapy sessions and provide opportunities to practice new skills in a safe space.

There are additional measures you can take as a parent to minimize the chances of depression in children with autism.

Help your child to eat a healthy and balanced diet. Nutritional deficits or low blood sugar can lead to mood issues.
Stick to a sleep schedule to ensure your child is getting enough sleep. As with all children, lack of sleep can lead to poor mood.
Encourage regular exercise to boost natural endorphins.
Use active listening skills, and make sure your child knows that you hear them. If your child feels heard, they are less likely to experience episodes of depression.
Encourage healthy peer relationships and social interactions. It’s a common myth that children with autism don’t want friends. In fact, most children with autism are looking for some kind of connection with others.
Aim to modify negative thoughts with redirection so they do not become a fixation.
Remind your child of positive interactions and truths about themselves.
Reinforce positive thoughts, actions, and behaviors.
Promote self-esteem by focusing on your child’s strengths and what they are doing well.

Resources for Parents

There are many resources for parents of children with autism and depression. Here are a few places you can turn for help:

National Alliance on Mental Illness (NAMI): NAMI has local chapters throughout the country to provide support and resources to families in need.
Behavioral Health Treatment Services Locator: Operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), this tool provides information on local treatment providers for mental health support.
National Suicide Prevention Lifeline: This hotline offers confidential support and crisis resources for individuals and family members of those in need.
National Autism Association (NAA): NAA provides resources for families through both online information and local chapters. They also offer assistance finding autism support groups.
Autism Speaks: This organization offers a range of online resources and information as well local autism support group listings.

Your child’s pediatrician can often be one of the best sources of information on your child’s mental health and medical conditions. They will be able to offer you support and referrals to specialists and local groups and organizations that can help.

If you think your child with autism may be struggling with depression, reach out for help today. The sooner you get your child appropriate care, the better treatment outcomes will be.