Depression is more common among teens with ASD than
teens without ASD. Rates of major depressive disorder have been reported as
high as 37% in adolescents with ASD compared to about 5% of adolescents in the
general population. Studies that measured parent reports of depressed mood have
revealed a rate as high as around 50%. There is also emerging research that has
shown an increased risk for suicidal thoughts and tendencies among teens with
ASD. This means that parents and school staff need to be on the lookout for the
signs of depression.
Recognizing Depression
Recognizing depression in individuals with ASD can be
challenging as some of the characteristics of ASD can resemble some of the
signs of depression. For example, some individuals with ASD may not interact
much with peers or identify many friends, which may also be signs of depression
in adolescents. Another challenge is that some of the characteristics of ASD
may actually mask signs of depression. Some teens with ASD may not show much
emotion, so depression may not be as observable as a look of sadness on the
teen’s face. Additionally, the communication difficulties of individuals with
ASD may impact one’s ability to recognize depression in this population. Even
students with ASD who communicate in full sentences may have difficulty
communicating their feelings.
It is important for teachers to get to know their
students with ASD well, and share their observations of any behavior changes
with parents, as well as with other team members who are working with that
student. Parents should periodically contact their teen’s teachers to check in
regarding any observed changes in behavior. See the list on the following pages
for some of the signs of depression that have been observed in teens with ASD.
Signs of Depression in Teens with ASD
Emotions and Mood
Increased moodiness which may include increased:
anger, irritability, sadness, tearfulness
- In the past two weeks Terri has been crying for her
mom and dad to come pick her up from school every day after lunch.
Feelings of worthlessness or fixation on mistakes
- Alex is noticing that he is different from his peers
and this awareness is causing great concern. He often makes comments that he is
“not normal” and “will never be normal.”
Need for excessive reassurance
- Joel is increasingly fearful of black holes and
requires frequent reassurance that he will not disappear.
Loss of interest or pleasure in previously favorite
activities
- Rolando always enjoyed swimming at the YMCA but
recently is resisting the pool and does not even want to put his swimsuit on.
Behaviors and Skills
Aggression
- Caleb is not typically aggressive but in the past
month has hit his younger sister several times and pushed his mom when he
became frustrated.
Indecisiveness
- The choices in the cafeteria suddenly seem
overwhelming for Taneisha and she has been getting “stuck” in line.
Noticeable decrease in self-care
- Adam has started to move very slowly during his
morning routine and is often leaving for school without brushing his teeth,
washing his face, or combing his hair.
Regression of previously learned skill
- Charity, who usually navigates to the cafeteria and
back without assistance, lately is found wandering the halls telling everyone
she is lost.
Changes in autistic symptoms which may include
increased stereotypic behavior or decreased interest in restricted interests
- Kevin used to flap his hands and rock on the floor
when he was young. Since he started high school, he is rocking again every day
after school.
Thoughts or expressions of suicide or self-destructive
behavior
- During poetry week Jaylen turns in a poem about
loneliness and suicide.
Suggestions for School Staff and Parents
- Check in with the teen with ASD. Although some
individuals with ASD may struggle to communicate emotions and feelings, it is
important to check in with teens and see how they are feeling. You can
incorporate some type of visual representation of emotions like an emotion
meter or a 5-point scale for a regular check-in.
- Look for changes in behavior. Since individuals with
ASD often have characteristics that can mimic or mask depression, it is
important to look for changes in behavior. For parents, it might mean paying
attention to eating and sleep habits, and looking for changes in mood and
behavior around the home and community. For teachers, it might be looking for
changes in mood or behaviors during class, or paying particular attention
during other times such as transitions, lunch, or clubs.
- Communicate regularly with team members. Given that
behaviors changes may be subtle or may manifest differently across
environments, it is important that families and school staff are staying in
touch with each other. Parents and school staff should be in regular
communication about any changes in behavior in home, school, and community
environments.
- Seek out professional help. If you are concerned about
possible depression in a teen with ASD, talk to a professional. Parents can
talk to a health care professional (who should be knowledgeable of ASD), and
then determine if a referral to a mental health professional is needed. For
school staff, schools or school districts typically have counselors and
psychologists who are trained in recognizing depression, and may be able to
support the student.
If you will be meeting with a health professional,
make a list of:
- Any major stresses or recent life changes
- Anything different observed lately, even if it does
not seem related to depression
- Information from discussions with other people in the
teen’s life such as school personnel
- All medications, vitamins, herbal remedies, and
supplements the teen is taking
- Any additional questions
Treatments for Depression
There are a range of treatments that include
psychotherapy, medications, and even exercise. Treatments/interventions for
depression should be comprehensive and implemented under the guidance of a
qualified professional (e.g. psychiatrist, psychologist, mental health
practitioner).
See the resources listed below for more information on
treatments.
Suicide
If staff or parents think the teen is in immediate
danger of self-harm or attempting suicide, they should call 911 or the local
emergency number immediately. Or, if parents think they can do it safely, they
can drive their teen to the nearest hospital emergency department. They have
trained crisis management staff prepared to help in this situation.
Resources
Autism Speaks (www.autismspeaks.org)
http://www.autismspeaks.org/what-autism/treatment/treatment-associated-psychiatric-conditions
http://www.autismspeaks.org/blog/2013/05/13/whats-connection-between-autism-and-depression
http://www.autismspeaks.org/blog/2013/05/13/8-critical-measures-counter-suicide
American Psychological Association
https://apa.org/topics/depress/index.aspx
American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/aacap/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/The_Depressed_Child_04.aspx
National Institute of Mental Health
http://www.nimh.nih.gov/health/topics/depression/index.shtml
Citation
Hedges, S., White, T., & Smith, L. (2014, May).
Depression in adolescents with ASD (Autism at-a-Glance Brief). Chapel Hill: The
University of North Carolina, Frank Porter Graham Child Development Institute,
CSESA Development Team.
Autism at-a-Glance is a series of practitioner and
family-friendly documents created by the Center on Secondary Education for
Students with ASD (CSESA) designed for high school staff members supporting
students on the autism spectrum, as well as family members of adolescents with
ASD. The purpose of the Autism at-a-Glance series is to provide a current
summary of topics relevant to high school students with ASD as well as
practical tips and resources for school and community personnel and family
members.
This article was designed to support high school staff
and family members in understanding and recognizing symptoms of depression, and
how those symptoms may present in adolescents on the autism spectrum. | 
