As every parent knows, teenage life is full of challenges, from stress over academics to social relationships and physical changes due to puberty. This stage of life can be particularly challenging for those with autism spectrum disorder (ASD). A recent study found that teenagers and young adults with ASD are nearly three times more likely to develop depression than same-age peers without ASD.
What are typical symptoms of depression?
While occasional sadness is a normal part of life, persistent sadness can be a sign of depression. Other common signs and symptoms of depression can be grouped into thinking patterns, changes in behavior, and physical symptoms. Common thinking patterns seen in depression include guilt, hopelessness, worthlessness, excessive worrying, and thoughts of death or dying. Behavioral changes include social withdrawal, increased irritability, and decreased interest in preferred activities. Physical symptoms include appetite changes, sleep problems, and low energy.
If someone has ASD, recognizing their symptoms of depression can be challenging
There are several aspects of ASD that overlap with symptoms of depression, including difficulty identifying and accurately reporting mood, constricted range of facial expression, sleep problems, and social withdrawal. Because of this overlap, an assessment of depression should involve multiple observers (caregivers who understand a teenager’s ASD, teachers, healthcare providers). An assessment should also take into account whether there is a change in your teenager’s usual behavior and functioning. Symptoms of depression typically persist for at least two weeks and represent a clear change from their typical behavior.
Some features of depression that may be more prominent in teenagers with ASD include an increase in ASD-related behaviors, irritability, and self-injurious behaviors. Many teenagers with ASD have very specific interests. These interests can become less appealing to the teenager, or shift to become more morbid during depression; for example, someone who enjoys drawing cartoon characters may draw more unhappy characters. You may also notice more crying, aggressive behaviors, and a decline in self-care, like refusing to bathe or eat meals. Although many parents worry that puberty itself may cause worsened aggression, this is often not the case, and the possibility of depression should be taken seriously.
What should parents and caregivers do if they are concerned a teenager with ASD may be depressed?
If parents suspect their teenager with ASD is depressed, they should try asking about his/her mood. Some teenagers with ASD will be able to say how they are feeling, while others may have difficulty with this. It is common for teenagers with ASD to respond by saying they feel hungry, tired, or bored. If parents remain concerned about depression, a pediatrician or mental health clinician can conduct a more in-depth evaluation.
It can be helpful to prepare your teenager for an evaluation by telling him/her that the goal of the visit is to develop a treatment plan that will help him/her feel better. The assessment will include an evaluation of mood, a discussion of recent life changes or stressors, a review of past medical and mental health conditions, family history of mental illness, and a safety assessment. Since some people with depression many have thoughts of death or of wanting to kill themselves, it is very important for the evaluation to assess for these types of thoughts, so that the treatment team can work with your teenager and family to decrease the risk of self-harm and suicide.
Having ASD increases the risk of depression in teens, but effective treatments are available
Fortunately, there are many treatments available for depression. A comprehensive treatment approach for depression can address home, social, and educational stressors, and may include lifestyle changes, talk therapy, and medications. General lifestyle strategies that can enhance resilience and mental wellness include regular exercise, adequate sleep, good nutrition, and helping your teenager problem-solve stressful situations.
Because many teenagers with ASD dislike change, they may resist these lifestyle changes. Two types of talk therapies which have been demonstrated to be effective for treating depression in teenagers with ASD include cognitive behavioral therapy (CBT) and behavioral activation (BA). CBT focuses on helping change unhelpful thinking patterns and behaviors to improve mood; BA improves mood by helping a person plan enjoyable activities to increase opportunities for positive experiences.
Since teenagers with ASD who do not see themselves as depressed may be resistant to trying talk therapy, a therapist may begin by collaborating with the teen to identify relevant treatment goals. Medications can also be helpful; however, there are no published studies of antidepressants specifically for depression in ASD. It is important to start antidepressants at low doses and increase the dose slowly, since those with ASD may have more difficulty communicating side effects. That said, it is important to work with the prescriber to continue to gradually increase the dose of the medication if your teenager remains depressed and is not experiencing side effects. Common side effects of antidepressants include headaches, digestive problems, increased anxiety, and changes in sleep or energy. If the first antidepressant is not effective, then it is worth trying another type of antidepressant.
Although teenagers and young adults with ASD may be at higher risk for depression, it is a treatable condition with many treatment options to help build resilience, decrease the severity of symptoms, and restore quality of life.