DANGEROUS AND HARD TO SPOT: DEPRESSION AND AUTISM.


Depression is more common in individuals on the spectrum than it is in neurotypical individuals, both adults and children. It is also harder to diagnose.


Here are some statistics:


Compared to neurotypical individuals, individuals on the spectrum are 4-times more likely to experience depression in their lifetime. Approximately one in ten adults on the spectrum experiences clinical depression at any given time. The depression rate for young people on the spectrum aged 18 and under is around eight percent.


Depression is one of the contributors to an increased risk of suicide among individuals with autism, with as many as two-thirds of adults reporting having contemplated it. A recent study shows that more autistic traits in children are correlated with more suicidality (suicidal ideation, suicidal plan, or suicidal attempts).Suicidal ideation is partially associated with depression and anxiety. This means that other factors can also contribute to suicidal ideation. Quality of family interactions and academic performance do not seem to decrease the chances of depression.


The Toll of Depression.


Depression is a serious life-long risk for mental and physical health, suicide, as well as the ability to learn, socialize, work, and function in other ways. It always needs to be addressed.


In Autism, Depression can be Hard to Spot.


So, why can it be hard to notice or diagnose depression in someone who is on the spectrum? There are several contributing reasons.

  • Self-reporting depression is difficult for many autistic people due to challenges with self-awareness or communication. At the same time, self-report is the most reliable way for clinicians to identify and assess depression.

  • Traditional diagnostic instruments have generally not been validated on autistic individuals.

  • Depression in autistic individuals often presents atypically, i.e. differently than in neurotypical individuals.

  • Symptoms of depression can mimic some of the autistic traits, such as the high need for solitude, flat affect, fatigue, catastrophic thinking, etc. Depression gets "covered up" by autism.

How to Spot Depression.


The good news is that some observable behaviors can indicate depression to an attuned family member or a professional. These observable signs are specific to autism and related to autistic traits. They are often present along with the "classic" symptoms of depression, as defined in DSM-V. These are:

  • A decline in performance or regression of skills

  • Catatonic behavior

  • Decrease in self-care

  • Decreased ability to function in usual contexts (family, school, work, friends)

  • Increase in self-injurious behavior

  • Increased aggression, irritability, agitation

  • Quickly changing (labile) moods

  • Increases or decreases in following routines or engaging with special interests

  • Hyperactivity

  • Any change in usual behaviors related to autistic traits


It's Important to Seek Help.


If you or your child are being assessed for depression, keep these in mind. If you think your child might have depression but a professional disagrees, keep asking for help. Some studies show that parents' assessments of their children's depression are usually more accurate than teachers' assessments.


If you are an adult who is depressed, please seek help from professionals who are sensitive to autism. There is no shame in having depression. You can start with a primary care physician, or reach out to a psychiatrist, psychologist, social worker, or therapist. Anyone on the spectrum should be routinely assessed for depression by a professional experienced in autism. They are not easy to find and that can be discouraging, but it is worth it.

References:


Ying‐Yeh Chen, Yi‐Lung Chen, & Susan Shur‐Fen Gau. Suicidality in Children with Elevated Autistic Traits. Autism Research, 08 July 2020.


Hudson, C.C., Hall, L, & Harkness, K.L. Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis. Journal of Abnormal Child Psychology. 2019; 47(1):165-175.


Lai, M.C., Kassee, C., Besney ,R., et al. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):819-829.


Magnuson, K. M., & Constantino, J. N. (2011). Characterization of depression in children with autism spectrum disorders. Journal of developmental and behavioral pediatrics. 32(4), 332–340.


Sarah Cassidy, Paul Bradley, Janine Robinson, Carrie Allison, Meghan McHugh, Simon Baron-Cohen. Suicidal ideation and suicide plans or attempts in adults with Asperger's syndrome attending a specialist diagnostic clinic: a clinical cohort study. Lancet Psychiatry, Volume 1, Issue 2, July 2014, pp 142-147.