How Do I Know If My Child With Autism is Depressed?
According to research, approximately 20 percent of the population will experience depression at some point in their lives—this statistic increases to almost 60 percent in people with autism spectrum disorder (ASD). Mood disorders (including depression) do tend to be more common in those with developmental disabilities compared to the more general population. However, depression in individuals with autism, especially children, can be difficult to diagnose.
Why is it so difficult to diagnose depression?
Children with autism don’t always show a lot of emotion on their faces in the same way children without autism do. Leo Kanner, a psychiatrist and researcher in childhood autism, suggests that there is a disturbance in the ‘affective contact.’ This means that the ‘affect’ (the expression on their face and their body language) being used to describe an individual’s emotional state may not always entirely match their ‘mood’ (how they are feeling inside). This does not mean that a child is depressed. However, it does mean that the expression on his/her face may not always match the emotion. This can make it really hard to even suspect that the child has depression. Another hurdle that clinicians may come across during diagnosis is that some children with ASD may have limited or no speech capability.
As parents, you will be aware of changes in your child’s behavior. You may notice that your child is not acting like his/her usual self. Features of ASD can often be confused with symptoms of depression, so those changes might be the only evidence that there is something happening to your child. Even if you suspect there is something affecting the child, it can still be very hard to tell what it is exactly. Common symptoms of depression, such as not enjoying things and looking sad or downcast are often absent in children with ASD. It will also be hard to notice other psychological symptoms like low self-esteem, guilt, hopelessness, and suicidal thoughts.
So what signs of depression should you be looking out for with children with autism?
There are some symptoms which can be linked with depression more commonly noted in individuals on the autism spectrum.
- More severe or frequent repetitive/compulsive behavior
- Have or have more tantrums, aggressive behavior or showing signs of intense frustration
- Be more agitated than normal
- Begin hurting themselves (or more often) such as hair pulling or hand-biting
- Find it harder to do everyday things in different environments
- Seem to be obsessed with death or talk about suicide
- Becoming more withdrawn than usual
- Having trouble sleeping
While there does seem to be a link between ASD and mood disorders, researchers are yet to identify a specific link, although some think it might be genetic. A possible trigger might be the realization that he/she is different than friends and family. Children also may find it more difficult to cope with pressures and social interaction when they begin school. They may struggle to make friends, which could make them feel lonely.
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What should you do if you think your child is experiencing depressive symptoms?
Treatments for depression can range from psychological (such as talking to a psychologist) to medical (such as taking medication) regardless if the person has ASD. Please note that medication for children is not usually recommended unless it is given under specialist guidance. The best thing for you to do if you have any concerns is to visit your general practitioner as he/she can then refer you to a mental health support team or a specialist who can talk you through the different treatment options. Typical psychotherapy (talk therapy) may not be ideal for children with autism due to the added stress often felt with sharing feelings, but the behavioral components of most therapies will be useful. Most forms of therapy are adapted for children with ASD to make them more suitable for them including cognitive behavioral therapy. Behavioral activation has been particularly successful for people with ASD and depression.
If you have any questions or need some support and advice regarding your child and ASD or depression, you can find the relevant support here: http://www.autism.org.uk/services/helplines.aspx
Dr Andrés Fonseca is a consultant psychiatrist with nearly 20 years of clinical experience. He is co-founder and CEO of Thrive, a company that develops software to improve mental health combining computerized cognitive behavioral therapy and other eTherapy techniques with games and game dynamics to enhance engagement.
Sam Glass is working towards her MSc Honors degree in forensic psychology currently, whilst working alongside Andres at Thrive, who develop NHS approved apps for common mental health problems.
This article was featured in Issue 80 – Conquering Challenges With ASD