Autism Spectrum Disorders and Depression

ASD and DepressionDepression is one of the most common problems facing people with an autism spectrum disorders (ASD). Rates of depression among individuals with ASD tend to range from approximately 50%, where rates of depression are about 2% in typical men and 9% in typical women. This rate may be underestimated, as depression often remains undiagnosed in people with ASD. About half of the people with ASD have severe depression, often requiring intensive treatment.

Often depression diagnoses are missed, as people with ASD may not present emotionally as typical individuals who are depressed. Usual signs, like flat emotional expression, bouts of crying, loss of interest in social activity, or change in appetite may be poor indicators of depression for someone with an autism spectrum disorder.

Normally emotional expression may be flat or unusual with people who have ASD. Often crying can mask frustration and rage. Social isolation is common from lack of friends or social skills. Eating habits change as sensory issues fluctuate. None of these are robust indicators of depression with someone who has ASD, although they are indications to watch for. Depression is also misdiagnosed or undiagnosed due to an old assumption that a person cannot have an autism spectrum disorder and a mental health problem.

How can you tell if someone with ASD may be depressed? Marked change in behaviour. Unusual withdrawal. Lack if interest in favorite activities. Change in perseveration. Skill or behavioural regression. Change in sleeping pattern.
Escape into fantasy worlds. Unusual increase in activity. Increased video game playing. Increase in rituals. Depression can result in suicidal behaviour, and should never be treated lightly. Suicidal language may indicate underlying problems. Suicide rates are higher with people who have ASD than that of the general population.

Adapted cognitive behavioural therapy (CBT) has been shown to be very effective in treating depression in people who have ASD. CBT treatment may be supplemented by antidepressant medication. CBT usually enhances the benefits of antidepressant therapy, and CBT strategies can have positive benefits if used after the medication is stopped.

Suggested reading: Paxton, K. & Estay, I. (2007). Counselling people on the autism
spectrum: A practical manual. London: Jessica Kingsley Publishers

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