Studies show that more than three-quarters of children with autism spectrum disorder (ASD) also have a mental health condition — nearly 78%. Autism and mental health conditions commonly overlap and occur in the same person simultaneously, called co-occurring or comorbid conditions.
Children with autism are more likely to also have a mental health condition, with studies showing the following being the most common:
- Attention-deficit hyperactivity disorder (ADHD) — 28%
- Anxiety disorders — 20%
- Sleep-wake disorders — 13%
- Disruptive, impulse-control, and conduct disorders — 12%
- Depressive disorders — 11%
- Obsessive-compulsive disorder (OCD) — 9%
- Bipolar disorder — 5%
- Schizophrenia spectrum disorders — 4%
Symptoms of a mental health condition can often be similar to those of autism and therefore are commonly overlooked. It is important to treat both conditions simultaneously with an integrated approach as they are often complexly intertwined. Each condition can complicate the other, and a comprehensive treatment plan can help manage both for happier and healthier outcomes.
The Importance of Managing Mental Health in Children With Autism
Children with ASD have a higher risk of mental health conditions than children without autism, and each condition can make symptoms of the other worse. Children and people with autism often have difficulties making sense of and fitting into the world around them, which can increase feelings of anxiety and depression and lead to worsening mental health. Mental health conditions can amplify autistic behaviors as well and complicate treatment methods.
Young people with autism also have a higher risk for a mental health crisis, including self-harming, aggressive, and suicidal thoughts and behaviors. In this way, it is important to treat autism and the mental health condition to help manage both conditions at the same time. Working to manage mental health concerns such as anxiety and depression, for instance, can help to decrease potentially harmful behaviors to the self or others.
Why Mental Health Conditions Are Often Missed in Children With ASD
Symptoms of autism and mental health conditions can often overlap, making it more difficult to diagnose a mental health concern in a child with ASD. Behavioral challenges, sleep issues, mood swings, repetitive behaviors, rigidity, sensory dysregulation, and fixation on specific topics or objects can be symptoms of autism and a mental health condition. When both are present simultaneously, it can often be seen as a more severe form of ASD instead of indicating the presence of a mental health condition as well.
Autism can impact communication skills and make it more challenging for a child with autism to verbalize exactly how they are feeling, contributing to missing a potential mental health condition. Children with autism often have issues expressing their emotions, experience language delays, have trouble interpreting social cues, and lack social understanding. This can make it more difficult to diagnose a mental health disorder.
Common Mental Health Conditions in People With Autism
Diagnosis of a mental health condition in a person with autism is important to help improve treatment options and care plans for better management of both disorders. Some of the most common mental health conditions in people with autism include the following:
ADHD (attention-deficit hyperactivity disorder)
ADHD and autism commonly co-occur as more than half of those diagnosed with ASD also have signs of ADHD. Around a quarter of those with ADHD also have signs of low-level ASD. ADHD is the most common mental health condition to co-occur with autism.
These conditions are neurodevelopmental disorders impacting brain development and the central nervous system. This involves the brain’s executive functioning, responsible for impulse control, decision-making, organizational skills, time management, and focusing abilities.
People with autism and ADHD often experience hyperactivity, inattention, and impulsivity.
Autism and anxiety involve similar regions of the brain, and about 40% of people with ASD have comorbid anxiety. Anxiety symptoms and autism symptoms are often similar and can include repetitive behaviors, fear of social situations, atypical phobias, separation anxiety, fear of change, uncertainty, hypersensitivity, especially to stimuli, and fear of being unable to engage in fixated areas of interest. These symptoms can be exacerbated in someone with both disorders.
Anxiety in someone with ASD can be both typical and atypical, including fear and anxiousness and also nonfunctional behaviors such as head banging and physical symptoms such as muscle tension, gastrointestinal issues, racing heart, and sweating.
Studies show that people with ASD are more than four times more likely to experience depression. This could be due to overlapping genetic and environmental factors, and autism itself can be a risk factor for depression. Autism can create a disconnect between an individual, the people around them, and the outside world, enhancing depressive symptoms. With autism, depression does not always present the same way without ASD, so it can also be overlooked.
Symptoms of comorbid depression and ASD can include social withdrawal, aggression, self-harming behaviors, eating issues and weight fluctuations, sleep disturbances, irritability, low self-esteem, emotional outbursts, lack of motivation, low energy levels, obsessive behaviors, and a lack of interest in things that were once enjoyable.
OCD (obsessive-compulsive disorder)
Autism and OCD involve similar brain regions and often have a genetic component. People with OCD quadruple the risk of being diagnosed with autism, and people with autism are two times as likely to also develop OCD. Both ASD and OCD include repetitive and obsessive behaviors. When these two disorders co-occur, it can be difficult for someone to express themselves clearly. This can cause unusual responses to sensory experiences, more tantrums and behavioral issues, and difficulties functioning in daily life.
There are differences between OCD and ASD symptoms, however. For instance, with ASD, people often engage in repetitive behaviors that do not have to be performed the same way. With OCD, however, these behaviors are often more ritualistic and must be done the same way each time. Comorbid OCD with ASD can make symptoms of each worse and impact everyday life.
Both schizophrenia and autism can share similar symptoms such as difficulties relating socially, concentration difficulties, troubles with motor functions, unusual thinking patterns, information processing difficulties, and relationship and social communication issues. People with ASD are three and half times more likely than the general population to also have schizophrenia.
The combination of schizophrenia and autism can interfere with daily life functioning and increase the rate of medical issues and create more health problems.
Bipolar disorder and autism likely share overlapping genes involving genetic variations in the brain. Bipolar disorder is characterized by extreme mood swings — high and low — while ASD generally includes communication and socialization issues along with restrictive and repetitive behaviors.
Bipolar disorder combined with ASD can significantly impact daily life functioning and lead to elevated moods, distractibility, excessive talking, sleep issues, irritability, behavioral issues, self-harming behaviors, and suicidal ideations that often escalate during the teen years.
Conduct, disruptive, and impulse control disorders
Disruptive, impulse control, and conduct disorders include a group of linked disorders that have difficulties with self-control and controlling impulses and aggressive behaviors. These are also often symptoms of autism, and these disorders can overlap and co-occur with ASD. When this happens, the symptoms of each disorder are amplified, and behavioral and disruptive issues are common.
Sleep disturbances and circadian sleep alterations are common in people with autism. Autism can contribute to sleep issues, and sleep disorders can contribute to autism. Genetics and alterations in brain development can contribute to the onset of each disorder. Both disorders can make the other worse. For example, children who have not had enough sleep are more likely to experience more severe autism symptoms, behavioral issues, mood swings, and focus and attention problems.
Treatment for co-occurring autism and a mental health condition should help manage both disorders simultaneously in a dual diagnosis fashion. This often involves a care team working together with a comprehensive care plan. Treatment for comorbid disorders will depend on the condition(s) being treated and will be individual for each person.
In general, treatment options can include:
- Medications. Depending on the disorder, there are many medications that can help manage specific symptoms.
- Cognitive behavioral therapy (CBT). This behavioral intervention teaches the individual to better understand their emotions and how they relate to subsequent actions and behaviors.
- Social skills training. With these interventions, people with autism can learn behaviors to support daily life function and communication and social interaction skills.
- Family therapies. Families can help learn how to support a family member with comorbid ASD and a mental health condition as well as how to support each other.
- Education. Learning about each disorder can help to better understand the symptoms, what to expect, and treatment methods.
- Occupational therapy (OT). This treatment strives to help an individual be more self-reliant and self-sufficient.
- Applied behavior analysis (ABA). This aims to reinforce positive behaviors while helping to decrease negative ones.
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