Autism and depression often co-occur. In fact, according to Ghaziuddin et al it’s considered the most common mental disorder for autistic people, with around half of autistic people experiencing depression in Mayes’ research. Depression is also closely linked to anxiety. But what can we do about it?
How common is depression?
The World Health Organisation identified depression as the world’s third largest public health burden. It’s a big deal and has impacts on life satisfaction, productivity, physical health, health care costs and more. And yet for autistic individuals, this impact is even greater due to increased prevalence.
Barbara van Heijst says “recent large studies show that the prevalence of a lifetime depression diagnosis is up to 40.2% among autistic adults”. This is more than double the prevalence of depression in the general population in Australia. However, other research by Hudson et al indicate that “compared to typically developing individuals, individuals with ASD are 4-times more likely to experience depression in their lifetime.” So autism and depression are interrelated, but it’s not clear how or why this co-occurrence happens.
What does depression look like in autistic people?
To show what depression might look like across the years, we’ve drawn on a review by Magnuson and Constantino that describes the presentation of depression in children and adults with ASD. We have two imaginary children, Blake (a male with autism) and Susanna (a female with autism).
Blake, even as a preschooler, was irritable and had times of sadness. As he grew up and entered primary school, his teacher noticed that his play activities were often focused around death. He didn’t talk about death due to his limited verbal ability, but observations of his play showed people dying. In upper primary, he was socially withdrawn and had low energy and mood. He would say things like “I’m no good at anything” and was overly self critical when he made mistakes. Blake started head banging and hitting himself more, displaying self-injurious behaviour as a response to stress, negative self-view and frustration. He continued to be irritable and show hyperactive behaviour.
Susanna, when she was 4 years of age, often didn’t display any pleasure of happiness in activities around her. In middle school as an adolescent, she was often tired during the day and slept for long periods at night. She often said she wasn’t very hungry, and was upset at the end of the school day with tears in the car on the way home. She didn’t seem to have much self esteem, experienced anxiety, and was disinterested in extra curricula activities. Her grades started declining and some of the skills she had mastered like toileting and dressing herself regressed. At times, Susanna increased her compulsive and obsessive behaviours such as stimming and repeating phrases.
What factors are associated with depression?
The older a child and the more severe autism is, the more likely depression will be experienced according to Mayes. But Magnuson reports that higher functioning and more socially adjusted children with autism are more likely to have lower self-perception and hence more depression. The higher an IQ and the greater the insight into their own condition, the worse the depression.
There are also some established links to family history – Ghaziuddin and Greden found that autistic children who suffer from depression are more likely to have a family history of depression.
In van Heijst’s study, autistic people, compared to age-matched neurotypical adults, reported more depressed symptoms, less mastery, less control over their lives and more worries. But depression wasn’t linked to gender, attention deficit, hyperactivity or sleep problems.
When we consider some of the protective factors for depression such as meaningful work, connection to social groups/family, a sense of autonomy and control, and hope for the future, we can see how autistic people may have greater risk of depression than others. Autistic people often have difficulties engaging in the work force, are more likely to be social isolated, feel out of control or overloaded with sensory information, and so are more likely to feel anxiety about life.
How can depression be treated in autistic children?
Anti depressants may not be helpful for autistic individuals, with side effects being more common for people with ASD.
However, some recent research in 2023 points to some interesting approaches to building preventative factors for depression.
Self-compassion: This study by Galvin and Richards surveyed 456 adults, about half of whom had autism. They found that lower self-compassion was reported by autistic adults, but increased levels of depression and anxiety. So, they conclude that teaching self-compassion skills may help support autistic adults as a preventative factor for depression.
Contextual chat-bot: Promising results were found in this study. Chatbots were used to provide responses to questions, advice and recommendations for autistic children. It is hoped that a “non-human companion” could provide social support and understanding, and hence prevent depression.
Social capital: In a large study of almost 4000 adolescents in a general population, they found that school social capital reduced the likelihood of depression. Social capital includes having a sense of belonging, friendships, not being lonely but being connected. Having supportive friendships, dinner with parents, and trust for friends are some of the factors that mediate for depression. It’s a clear link, as seen in the graph below.
References
Ahmed Hadri, S & Bouramoul, A. (2023). Towards a deep learning based contextual chat bot for preventing depression in young children with autistic spectrum disorder, Smart Health, 27. https://doi.org/10.1016/j.smhl.2022.100371.
Galvin, J., & Richards, G. (2023). The indirect effect of self-compassion in the association between autistic traits and anxiety/depression: A cross-sectional study in autistic and non-autistic adults. Autism, 27(5), 1256-1270. https://doi.org/10.1177/13623613221132109
Ghaziuddin, M., Ghaziuddin, N. & Greden, J. Depression in Persons with Autism: Implications for Research and Clinical Care. J Autism Dev Disord 32, 299–306 (2002). https://doi.org/10.1023/A:1016330802348
Ghaziuddin, M., Greden, J. Depression in Children with Autism/Pervasive Developmental Disorders: A Case-Control Family History Study. J Autism Dev Disord 28, 111–115 (1998). https://doi.org/10.1023/A:1026036514719
Hudson, C.C., Hall, L. & Harkness, K.L. Prevalence of Depressive Disorders in Individuals with Autism Spectrum Disorder: a Meta-Analysis. J Abnorm Child Psychol 47, 165–175 (2019). https://doi.org/10.1007/s10802-018-0402-1
Magnuson KM, Constantino JN. Characterization of depression in children with autism spectrum disorders. J Dev Behav Pediatr. 2011 May;32(4):332-40. doi: 10.1097/DBP.0b013e318213f56c. PMID: 21502871; PMCID: PMC3154372.
Mayes, S.D., Calhoun, S.L., Murray, M.J. et al. Variables Associated with Anxiety and Depression in Children with Autism. J Dev Phys Disabil 23, 325–337 (2011). https://doi.org/10.1007/s10882-011-9231-7
Mori, H., Hirota, T., Monden, R. et al. School Social Capital Mediates Associations Between ASD Traits and Depression Among Adolescents in General Population. J Autism Dev Disord 53, 3825–3834 (2023). https://doi.org/10.1007/s10803-022-05687-9
van Heijst, B. F., Deserno, M. K., Rhebergen, D., & Geurts, H. M. (2020). Autism and depression are connected: A report of two complimentary network studies. Autism, 24(3), 680–692. https://doi.org/10.1177/1362361319872373
