Women With Autism And Depression
December 28, 2020 by Dr. Tasha Oswald
Welcome back to our two-part blog series on autism and depression. Women on the autism spectrum frequently experience depression. This is largely due to the loneliness that comes from feeling like they dont fit in or belong with other girls or women their age. After a while, they internalize this pain and begin to think that theres something wrong with them and thats why they dont fit in.
Women who are on the autism spectrum often are misdiagnosed or diagnosed later in life because they are so good at masking their autism traits. Often, autism traits and meltdowns look similar to the symptoms of other mental health disorders like depression, anxiety, ADHD, and Oppositional defiant disorder . So the underlying autism is missed or passed off as other mental health issues. Many women with autism state that theyve been prescribed psychiatric medication for these concerns only to find them ultimately unhelpful, which leads to further confusion and disappointment. Many women share that this misdiagnosis simply solidified the fact that no one really understood how they felt. This led them to feel very alone which ultimately led to depression.
Common symptoms of depression in women include:
- Persistent feelings of sadness or hopelessness
- Negativity or pessimism
- Physical discomfort: pain, digestive issues, and headaches
- Thoughts of death, self-harm, or suicide attempts*
The Value Of Treatment
She is doing more things at home, such as making her lunch for the next day.
Treating anxiety or any psychiatric condition is important, perhaps especially so in people with autism. Anxiety could spill over into other aspects of a person’s life. For example, people with autism often have unusually low “adaptive skills,” the so-called skills of daily living, regardless of their IQ scores. Even those with average to above-average intelligence, and autism, may struggle with basic skills such as showering, riding a bus, crossing the street, shopping, or preparing a meal,18 according to a study of 417 teenagers in the Simons Simplex Collection autism project.
Poor adaptive skills may affect someone’s ability to live and work independently in adulthood. It is not clear why everyday living skills would lag far behind intelligence. However, one study of 52 young adults with autism suggested a link to anxiety and depression. The men and women in the study had an average IQ of 110. Those with the lowest adaptive skills also had higher levels of anxiety, depression, or attention deficit-hyperactivity disorder, according to the researchers, who were based in Washington, DC.19
Major Depressive Disorder In Autism Spectrum Disorder: A Double Whammy
Ahmed Naguy, MBBch, MSca,*
Prim Care Companion CNS Disord 2021 23:20br02895
To cite: Naguy A. Major depressive disorder in autism spectrum disorder: a double whammy. Prim Care Companion CNS Disord. 2021 23:20br02895.To share: https://doi.org/10.4088/PCC.20br02895
aDepartment of Child/Adolescent Psychiatry, Al-Manara CAP Centre, Kuwait Centre for Mental Health, Shuwaikh, Sulibikhat, Kuwait*Corresponding author: Ahmed Naguy, MBBch, MSc, Department of Child/Adolescent Psychiatry, Al-Manara CAP Centre, Kuwait Centre for Mental Health, Jamal Abdul-Nassir St, Shuwaikh, Sulibikhat 21315 Kuwait .
In contrast to long-upheld clinical lore, major depressive disorder is commonplace in the autism spectrum disorder population, with lifetime rates 4-fold greater than in the general population and variable prevalence rates ranging from 7%40%.1,2 MDD takes a toll on patients with ASD by negatively impacting adaptive functioning and quality of life, adding to caregiver distress, increasing service utilization, and heightening comorbidities and associated suicidality and self-injurious behaviors. Elevated rates of MDD in ASD have been tied to increasing age and average to above-average IQ, using structured clinical interviews and reliance on self-reports.
Assessment and diagnosis of MDD in ASD is quite challenging. Many factors are at play. Diagnostic overshadowing, overlapping phenomenology, and lack of validated psychometric instruments are all contributory.
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Alexithymia Traits And Depression
Besides autism traits as a potential factor for depression in ASD, comorbid factors may account for heightened depressive symptoms. An increasingly discussed psychopathological construct, alexithymia, often co-occurs with ASD and is especially interesting in the context of depression in ASD. This condition was first described by Sifneos and is also referred to as emotional blindness. In the general population, the estimated prevalence of alexithymia is 1020%,,,,. In their recent meta-analysis, Kinnaird et al. reported a markedly increased prevalence of alexithymia in ASD of 50%. Alexithymia measures usually comprise three different traits: Difficulties in Identifying Feelings , Difficulties Describing Feelings , and Externally-Oriented Thinking . Alexithymia has frequently been linked to depression,,,,,. Regarding the distinct alexithymia subdomains, a meta-analysis of studies found medium-sized effects of difficulties identifying and describing feelings but only a weak relationship of externally-oriented thinking with self-reported depression.
Difficulty With Verbal Communication
A child with HFA will typically have no problems understanding language. Learning individual words, grammar rules, and vocabulary may not be an issue for them.
The use of language to communicate, however, can be problematic. Someone with HFA may have difficulty understanding sarcasm, metaphors, or idioms. This is known as “pragmatic” language.
In addition, some people with HFA may struggle to speak when under stress or overwhelmed.
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Cognitivebehavioral Therapy Treatment Of Anxiety
In 1993, a task force appointed by the Society for Clinical Psychology developed a set of criteria for establishing empirically validated treatments . Current guidelines require ESTs to demonstrate superiority to a placebo in at least two well-designed and controlled studies, equivalence to a well-established treatment in several independent and well-designed and controlled studies and/or efficacy in many single-subject controlled studies . Additionally, studies that support an EST must clearly delineate various treatment procedures to allow for independent replication.
Among clinical trials that investigate the efficacy of psychotherapy for treating anxiety in typically developing youths and adults , cognitivebehavioral therapy has consistently been shown to be superior to the respective control conditions and, as a result, has been categorized as a well-established treatment for anxiety in children and adults . A number of randomized clinical trials have also investigated the efficacy of CBT for treating OCD in pediatric and adult populations , with such trials indicating the superiority of CBT to control conditions. CBT generally includes psychoeducation, cognitive restructuring, somatic management, exposure with response prevention, problem solving and relapse prevention , although the specific combination of components may be modified to match a patient’s developmental or cognitive level.
Cbt Treatment Of Anxiety In Asd
Although CBT is considered a first-line treatment for anxiety disorders , only recently have efforts focused on adapting treatment to meet the unique needs of youths with ASDs. As a result, a limited number of studies have examined the application of CBT for youths with ASDs and anxiety . With the exception of two single-subject case studies , no studies of CBT for anxiety in adults with ASDs have been published.
Most treatment studies for youths with comorbid ASDs and anxiety symptoms employ a CBT approach to address deficits associated with ASD symptomology . The protocols include core CBT components with varied modifications, such as increased caregiver involvement and tailoring of materials or discussion to the cognitive ability of the child in question. For example, CBT protocols have been augmented with the inclusion of increased caregiver involvement, an emphasis on personalizing treatment around a child’s interests, skill-building protocol to help shape social skills in children with ASDs and parent- and teacher-managed contingency systems .
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Differences With Social And Emotional Reciprocity
Autistic people with differences in social and emotional reciprocity may, for example, struggle to initiate or respond to communication, finding it difficult to participate in its typical back-and-forth nature. They may also face challenges in speaking about non-preferred topics.
People used to think it was an inability to empathize that lead to this. However, newer research has changed how we think about autism and empathy. It is almost the opposite, where autistic people may even be hyper empathetic.
It is just that their experiences and neurotypes are different. There is not a lack of empathy, simply another way of understanding and processing it. For example, autistic people may isolate themselves, but it is not because they prefer to be alone. Instead, it could be because they may feel they are annoying or causing trouble for others.
Video: Anxiety Melanie Mcconnell
Presenter: Melanie McConnell, PhD, RPsych in Neuropsychiatry, BC Childrens Hospital Clinical Instructor in Psychiatry Clinical Investigator, Child and Family Research Institute Clinical Instructor, UBC Developmental Disorders Program
Children and youth with ASD are at an increased risk for developing anxiety, which often exacerbates core autism symptoms. The anxiety can interfere with social development, life skills, academic achievement and relationships. Anxiety symptoms are often incorrectly attributed to ASD, and this diagnostic overshadowing is a barrier to accessing treatment.
- Chalfant . Managing Anxiety in People with Autism
- Davis & White . Handbook of Autism and Anxiety
- Reaven, Blakley-Smith, & Nichols . Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders
- Vasa et al. . Assessment and Treatment of Anxiety in Youth with Autism Spectrum Disorders. Pediatrics, 137 .
Additional Resources
- Anxiety Treatment Made Specifically for Children With Autism Works Better Than Other Treatment Programs
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The Application Of Adlerian Psychotherapy For An Adult With High Functioning Autism And Depression
Hom Yi Lee1,2
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1Department of Speech Language Pathology and Audiology, Chung Shan Medical University, Taiwan?2Department of Pediatrics, Chung Shan Medical University Hospital, Taiwan
Correspondence: Hom-Yi Lee, Professor, Department of Speech Language Pathology and Audiology, Chung Shan Medical University No. 110, Sec.1, Jianguo N. Rd., Taichung City 40201, Taiwan
Received: September 25, 2017 | Published: November 7, 2017
Citation: Hom-Yi L The Application of Adlerian Psychotherapy for an Adult With High Functioning Autism and Depression. J Psychol Clin Psychiatry 8: 00483. DOI: 10.15406/jpcpy.2017.08.00483
Challenges Faced By Children With High Functioning Autism
Sensory processing affects many individuals who have autism. Even for someone with high functioning autism, loud noise, large crowds, bright lights, strong tastes, or odors, as well as being touched, can be overwhelming or painful. It may be difficult for someone with sensory issues to go to restaurants, theaters, or shopping malls.
Children and adults with high-functioning autism may have a difficult time reading verbal and non-verbal social cues They may not know:
- How to greet others properly
- When to let someone else speak and when to listen
- When and how to control their tone of voice and volume level
- When or how to start or end a conversation
High functioning autism frequently co-occurs with anxiety, depression, or other mood disorders. Individuals with such challenges are more likely than the general population to struggle with and receive a diagnosis for mood-related issues.
Executive functioning is a problem for most people with high functioning autism. Executive functioning refers to the abilities people have that enable them to organize and arrange their daily activities. This might make it difficult to manage a family or to adjust to modest changes in school or job schedules.
6. Difficulty communicating verbally
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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.
Autoimmune And Allergic Disorders And Depression
Autoimmune disorders are strongly linked to depression. Patients suffering from autoimmune disorders such as multiple sclerosis, lupus and rheumatoid arthritis have much higher rates of depression compared to the general population. Autoimmune conditions are highly prevalent in families of individuals with autism.
Coeliac disease is an autoimmune disorder in which the body triggers an immune reaction to gluten, a protein found in wheat, barley and rye. This immune reaction damages the bodys own tissue, notably the lining of the intestine, often resulting in decreased absorption of nutrients. Other possible consequences of undiagnosed and untreated coeliac disease can include weight loss, bloating, anaemia and diarrhoea.
More than half of CD sufferers have signs and symptoms unrelated to the gastrointestinal system, including:
- probiotics, prebiotics and microbiota transplant therapy
- reducing stress: aerobic exercise, yoga, meditation, mindfulness and breathing exercise
Psychiatric conditions, such as schizophrenia, depression, bipolar disorderare neurometabolic diseases that share several common mechanistic biopathologies. These include glucose hypometabolism, neurotransmitter imbalances, oxidative stress and inflammation. There is strong evidence that ketogenic diets can address these four fundamental diseases, and now complementary clinical evidence that ketogenic diets can improve the patients symptoms.
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What Are The Different Stages Of Autism Spectrum Disorder
- Level 1: Individuals who may need minimal support in the development and maintenance of appropriate daily living, self-care, behavior management and social skills. Maladaptive behaviors for those with a level-1 diagnosis may be minimal and non-disruptive to their daily routine or others.
- Level 2: Individuals who may need more support to develop communication, social, play, daily living, self-care and behavior management skills. Maladaptive behaviors for those with a level-2 diagnosis may be more severe and interfere with their and others daily routine.
- âLevel 3: Individuals who need extensive support to develop communication, social, play, daily living, self-care and behavior management skills. Maladaptive behaviors for those with a level-3 diagnosis may be severe to include increased aggression or self-injurious behaviors. Skill deficits for a level-3 diagnosis will also be greatly increased.
Looking For Treatment Providers
If you suspect an anxiety disorder in yourself, or your child with autism, how do you find treatment? You can start by talking with your primary health care provider, who may refer you to a specialist. Dr. Vasa recommended taking children to a psychiatrist or psychologist, with experience or training in autism, if possible. But she noted that can be difficult due to a shortage of those providers in many parts of the United States. “We need to increase the number of mental health providers trained in working with individuals on the spectrum,” she said. She and others are working to increase training in autism and intellectual disability for physicians.
Similarly, many U.S. communities do not have therapists trained in CBT for children or adults with autism.
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How Can You Support Your Teenager With Autism Spectrum Disorder If They Are Depressed
- Robyn Thom, MD, Contributor
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 . 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.
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Therapies That Dont Involve Medication
In addition, some health care providers have proposed some non-drug therapies for symptoms of depression in autism. Research into these therapies is limited.6
In Cognitive Behavioral Therapy, or CBT, a therapist helps a patient challenge the way he thinks about problems and adopt a pattern that is more helpful. CBT is a proven treatment for depression and anxiety in typically-developing children and adults.10 According to clinical psychologists Tony Attwood and Michelle Garnett, CBT therapy involves the following ideas:
- our perceptions or thoughts about events, people and situations determine our behaviors,
- the consequences of our behavior affect how often we repeat them, and
- our thoughts and behaviors can be monitored and changed over time.13
Therapists have tried to adapt CBT for people with autism in recent years, particularly for anxiety. A small Australian study showed that a CBT program called “think well, feel well and be well” helped reduce symptoms of depression and stress in people diagnosed with Asperger’s Syndrome and “high functioning autism” ages 15 to 25. In this group program, participants were taught that how they look at a situation, whether as a threat or a challenge, affects their emotions and thoughts.11 This study used “high functioning autism” to refer to people who can speak and do not have intellectual disability.
Tips For Preventing & Minimizing Depression With Autism
When an autistic child is feeling stressed or anxious, this often comes out in temper tantrums or outward signs of aggression or self-harm. The same can be true for depression, but depressive symptoms may be less obvious.
Autistic children often prefer to be left alone and would rather play by themselves than with others. This does not necessarily mean that they are depressed. However, socialization and healthy relationships are important to a childâs mental health. Itâs important to foster connections between autistic children and others, to prevent potential onset of depression.
Therapies for both autism and depression can teach healthy ways to express oneself and better techniques for socializing, communicating, and sustaining relationships. At home, parents and other family members can reinforce what is learned in therapy sessions and provide opportunities to practice new skills in a safe space.
There are additional measures you can take as a parent to minimize the chances of depression in children with autism.
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