Detecting and Treating Mental Health Conditions in People with Autism

Those who have autism spectrum disorder (ASD) are at a greater risk than most of developing a mental health disorder, which is referred to as a comorbid or co-occurring disorder.

Prevalence rates vary widely, but some research estimates that as many as 85% of children with autism have also been diagnosed with a co-occurring mental health disorder. Anxiety, depression, and attention deficit hyperactivity disorder (ADHD) are the most commonly diagnosed comorbidities.

While the core symptoms of ASD impair functioning, co-occurring mental health disorders can be a “significant source of further impairment.” Co-occurring conditions often exacerbate ASD symptoms. Anxiety or depression symptoms, for example, can further distort social cues, deepening communication difficulties.

Here, we’ll highlight some warning signs along with a number of effective treatment options.

Causes

Co-occurring mental health disorders in those with ASD appear to develop from a number of factors, including genetics, brain chemistry, and the severity of the ASD.

Karen Yosmanovich, M.Ed., BCBA, LBS, the Clinical Manager at Potential, a nonprofit in Newtown, Pennsylvania, that works with people of all ages who have autism and other developmental disabilities, suspects that it’s not a coincidence that many with ASD are first diagnosed with a co-occurring mental health disorder in their early teens.

“It’s around then that groups become so important. So much at that age is driven by peer acceptance,” she says. “But for someone with autism, communication can be impaired, especially for someone who’s nonverbal, and that can bleed into breakdowns in responding to social cues.”

Bullying, she notes, also becomes much more prevalent during teenage years.

Research indicates that people with autism are at a greater risk of being bullied and are more likely to endure difficult experiences, which can increase stress and risk for depression and anxiety. Other behaviors associated with ASD like cognitive rigidity, problems with regulating emotion, and intolerance of uncertainty can also make someone more susceptible to developing anxiety and depression.

Treatments

Treating co-occurring disorders has been shown to significantly reduce the mental health disorder symptoms of people with ASD and greatly enhance their overall functioning and quality of life. An undertaking like this is generally best served by a team of specialists that includes an applied behavioral analyst, a psychologist, and a psychiatrist.

At Potential, Yosmanovich, a board-certified behavior analyst, says she typically consults a client’s mental health providers before implementing a treatment plan. “We want to know their recommendations before proceeding. It’s also important for us to discuss any medications the client’s been prescribed and what the potential side effects of those drugs are,” she says. “Only then are we in a position to determine how we can best support their progress.”

Of course, before any of this, there needs to be an accurate diagnosis. Because features of ASD can overlap with symptoms of other mental health conditions, it can be difficult for mental health providers to differentiate them, let alone concerned parents. That said, there are several tools that have been developed specifically to assess for co-occurring disorders in children and adults with ASD.

For parents, it can be helpful to become familiar with the most pronounced symptoms for the most common co-occurring mental health disorders.

Anxiety symptoms

• Hyperactivity
• Restlessness
• Excessive worry or fear
• Trouble falling asleep

Depression symptoms

• Loss of motivation
• Sadness
• Irritability
• Poor sleep and/or appetite

ADHD symptoms

• Unable to sit still, especially in a quiet environment
• Hyperactivity
• Constantly fidgeting
• Increased compulsions

More general indicators of a change in behavior include talk about self-harm, complaining about a lack of friends, and becoming more withdrawn.

“None of them are necessarily cause for concern,” Yosmanovich cautions. “But in certain contexts, they can be the first warning sign that the child is struggling.”

Yosmanovich says it’s also important to keep in touch with everyone who has regular contact with your child, including teachers, because a child can behave differently in various settings. They can be struggling at school even as everything appears normal at home.

Once a diagnosis is made, a number of treatment options are available, including:

• Medication management
• Cognitive behavioral therapy
• Systematic desensitization
• Acceptance and commitment therapy

Potential uses a curriculum called AIM (Accept, Identify, Move) that incorporates mindfulness, which also has been shown to be beneficial.

Ultimately, determining which treatment is appropriate will depend on the individual, Yosmanovich says. “We look at the scope of our practice and try to determine what we can do to best support their goals,” she says. “For our part, much of applied behavioral analysis is about meeting the individual where they are and incrementally progressing toward their goal.”

In the midst of the struggle, the diagnosis, and the ensuing treatment, it’s easy for parents to buckle under the burden of their expectations. “It should go without saying, but I’ll say it anyway: It’s no one’s fault,” Yosmanovich says. “So try to be kind to yourself.”