Why It May Be Difficult to Recognize Depression in People with Autism

 Author:  BeenThereMom-Parent to an adult son on the autism spectrum


In the “Mood Disorders” section in this blog, I was reading about the 2006 research report that said 25% of children with autism met the diagnostic criteria for depression.  The mean age in this study was nine years old.  I was reminded about the difficulty we had realizing that our son was actually depressed, not just withdrawn and non-social because of his autism.

One reason for the difficulty in recognizing depression in children, of course, is that their symptoms are usually different from those of adults. They may not verbally complain of feeling low and will often be irritable rather than sad. If you add to this other complications, such as developmental disability or autism, it’s not hard to see why it might be difficult to identify any kind of mood disorder.  An article by Christine Cadena on Yahoo Voices talks about the difficulties of diagnosing depression in children withhigh-functioning autism.

When my son, Jack, was a teenager, we noticed he was becoming rather surly and more quiet than usual. He decided that he was too fat, so he started obsessively counting calories and fat grams in everything he ate.  He’d always been very particular about his clothes, preferring colorful brand-name items in contrast to those of his older brother, who would wear nothing but black or gray.  His brother, Nate, had been in treatment for depression for several years by this time and at the age of 18, attempted suicide.  We didn’t know how to approach this with Jack – it had happened in the evening, after he had been sleeping and he never knew about our trip to the emergency room or that his aunt and uncle had come over and stayed in the house with him while we were gone.  So, I think we erred on the side of not talking about it enough, somehow hoping he wasn’t paying much attention or assuming he wouldn’t understand.  At this point, I don’t think we even knew Jack was autistic so were probably misinterpreting his lack of emotion as a sign that he was handling it.

The next thing we noticed was that he became tearful and would go into his bedroom and secure one of his belts around his neck, like he was trying to choke himself.  We thought that maybe he was just acting out what was going on with his brother and tried to talk with him.  But communicating what was going on in his head was extremely difficult for him, partly due to the damage to his frontal lobe and we didn’t realize just how badly he was feeling.  He’d have angry outbursts over things we couldn’t understand and I finally decided to take him to see the psychiatrist who was treating Nate; I don’t know how much experience he’d had with developmentally disabled teens (although I later learned he had a brother who was also disabled), but the first thing he did was weigh him – to my shock, he’d lost 25 pounds in a fairly short period of time!  That was about all we had to go on as to the severity of his depression.  The doctor put him on medication and found him a therapist, but it was obvious that this person didn’t know how to work with Jack, nor did the next several.  I finally found a therapist through his social worker who DID know how to work with him. 

Since one of the common traits of depression is withdrawal, it’s easy to see why it would be hard to miss in a person with autism.  Jack has a tendency to disappear into the woodwork, so to speak, even to this day, and it’s easy to forget he’s there if I’m preoccupied with something else.  When we try to ask him questions to get him talking, we’re lucky to get more than a one-word reply. On the other hand, if something strikes him as being particularly funny or interesting, he’s able to talk at length about it and will surprise you with how much thought he’s put into it.

Besides seeing a therapist, Jack has also been taking Wellbutrin, Concerta and Abilify for a number of years, which seem to keep him functioning at a good level most of the time.  Because of the weight gain caused by Abilify, we tried switching him over to Geodon, but for him, that didn’t work.  His mood rapidly deteriorated and he was missing work, not taking care of himself and called one night to tell us that he had tightened a belt around his neck and couldn’t get it off.  When his mood isn’t stable, it takes very little to set him off and he becomes paranoid about people having it in for him.  For example, he’ll start believing that people he works with are purposely trying to make his life “hell” and then he becomes defensive and combative.  Luckily, this has only happened a few times and the people he works for now are fairly educated about his disabilities and how to handle it when he does act inappropriately.  His job coach keeps close tabs on his progress at work and speaks with his supervisor often so that they can nip any small problems in the bud before they might become larger ones.

For Jack, I think a lot of his depression may be a result of his being intelligent enough to know that he isn’t like most other people in regard to mental abilities.  He dreams about being an airline pilot and owning a mansion in one of our wealthiest neighborhoods here, yet knows that isn’t going to happen.  I can only imagine how frustrating it must be.  Even in our families, he’s almost invisible to many of his cousins and isn’t close to his brother.  I worry about who will be watching out for him when we’re gone or no longer able to do so, although I know there are resources available for that.  I don’t know if I can expect his older brother to be responsible for him.  I guess we just do the best we can to set him up for success, like anyone else does for their children, regardless of abilities.

What I’ve learned from dealing with depression in my son is that if you have any suspicions at all that your child might have a mood disorder, don’t hesitate to get an evaluation from a mental health professional. Don’t be afraid of getting criticized for being an alarmist and try to find someone who has experience with children with special needs.  I believe there are more of them out there now than there once were and it’s worth it to keep looking until you find the right person.  Check with any of your child’s healthcare or social service providers, who may have knowledge of these kinds of professionals. If you feel that the provider your child is working with is not really connecting with your child or really understanding what your concerns are, it’s important to speak up and see if they are either willing to consult with someone else or refer you to a different provider.  I know from experience that you can waste a lot of precious time in tolerating less-than-adequate treatment.