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Anxiety & Depression

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Autism and Anxiety

Researchers at The University of Amsterdam reviewed thirty-one studies which concentrated on the occurrence of anxiety disorders among children ages 18 and under with ASD. This study showed that approximately 40% of children with autism also had an anxiety disorder, which involves chronic worrying, nervousness, and tension. (van Steensel et al., 2011)  This study and others also found that children with ASD will have more severe symptoms of phobias, obsessions, motor and/or vocal tics, social phobia or anxiety, and even compulsions. Even with no official diagnosis, many children and teenagers with autism suffer from anxiety in their everyday lives.

Anxiety disorders have been at the following rates in youth with ASD:

• Specific Phobia: 30%
• Obsessive-Compulsive Disorder: 17%
• Social Anxiety Disorder/Agoraphobia: 17%
• Generalized Anxiety Disorder: 15%
• Separation Anxiety Disorder: 9 %
• Panic Disorder: 2%

Researchers suspect that high cognitive functioning teenagers struggle with anxiety disorders more frequently due to their heightened awareness of their surroundings and the way people perceive them, especially as differences between themselves and the peers become more prominent after puberty (Alfano, et al., 2006). Comparatively, children with higher intellectual impairment may experience less anxiety because they either lack of content-rich emotional experiences or have more difficulty reporting instances of anxiety for formal diagnosis.

Causes and Symptoms

When a child feels overwhelmed by a task or situation, anxiety occurs, such as when a child with autism has anxiety during school while seeming fine at home. Gadow and his colleagues (2005) noted that teachers were more likely to report children as having anxiety than the parents were. Most likely because the school setting is overwhelming and exceptionally demanding for a child with autism. Furthermore, children with autism have difficulty with verbal communication, meaning outward manifestations of anxiety are typically the only sign that they are facing anxiety-inducing situations. Researchers suspect that these external, physical symptoms are more common in children with autism. Children may manifest their anxiety through the following behaviors:

  • Refusal or avoidance of feared situations
  • Temper tantrums
  • Crying
  • Hyperactivity
  • Inability to move or expressionless
  • Refusal to make eye contact
  • Clingy Behavior
  • Problems sleeping

In addition to the above manifestation of anxiety, children may have certain physical symptoms as well:

  • Faster heart rate
  • Rapid breathing
  • Sweating
  • Dizziness
  • Trembling
  • Muscular tensions
  • Abdominal pain
  • Headache

Suruchi Chandra, M.D., has recommended a whole-body approach to identify core imbalances underlying anxiety disorders, including gut-brain connection, immune system dysfunction, hormonal imbalances, mitochondrial dysfunction, and methylation defects. (Potential causes: infection, nutritional deficiency, heavy metals, chemical toxics, environmental stimulations, emotional neglect/ignorance, and physical trauma.). If your child is suffering from any of the above symptoms, watch closely to see when these symptoms arise, and what occurs before and after the behavior to accurately describe them to a medical professional.

Cognitive behavioral therapy (CBT)

Mainstream cognitive behavioral therapy is the most effective treatment for anxiety disorders. In CBT treatment programs, knowing your child’s anxiety triggers is vital to help anticipate and recover from stress or anxiety. Changes in routine, insufficient sleep, and social situations could be the most common triggers. CBT emphasizes working to change maladaptive thinking, such as minimizing positives, magnifying negatives, and overgeneralizing. Psychologists have demonstrated that CBT has helped high-functioning children with ASD replace maladaptive thoughts and behaviors with more adaptive and logic ones.

The psychologist may also employ exposure therapy to treat anxiety. It involves exposing individuals to his/her fears without any danger in order to overcome their anxiety. For example, a child suffering from separation anxiety may be asked to spend increasing amounts of time away from their parents, with the parents appearing occasionally to show that the child is safe.

Aside from cognitive behavioral therapy, Dr. June Groden suggests that relaxation programs can also help reduce the anxiety level a child experiences on a daily basis. Rather than having the child to challenge their fears, relaxation therapy encourages the child to think of relaxing and calming scenarios whenever they feel stressed or anxious. This allows the child to not only feel more in control of their own environment, but may also help them to calmly accept any new situation that may occur.

Autism and Depression

One of the most common concurrent disorders in individuals with autism is major depression. Those with this disorder may exhibit symptoms of angry outbursts, feelings of sadness, sleep disturbances, changes in appetite, sever self-injurious behaviors and suicidal attempts. According to recent studies, more than one third of all adults and adolescents with ASD could display an episode of major depressive disorder in their lifetime.

 Signs of Depression

An accurate and reliable depression diagnosis is important and should come from mental health professionals, including a psychiatrist, psychologist or mental health specialist with comprehensive knowledge and experience with ASD. Accurate diagnoses are difficult to receive for depression because of individuals with autism’s communication difficulties. Parents should keep a watchful eye for depression signs and consult a doctor when the child appears to have one or more of the following symptoms:

  • Low mood or irritable mood most of the time
  • Trouble sleeping, or sleeping too much
  • A big change in appetite
  • Trouble concentrating
  • Loss of energy
  • Loss of interest
  • Feeling worthless, helpless, and guilty
  • Feeling sad, anxious, or angry
  • Consistent aches and pains that do not ease with treatment
  • Suicidal thoughts or attempts

As a parent, if you think that your child may be depressed, potentially suicidal, or has exhibited three or more symptoms of depression, consult the child’s physician immediately. This may be difficult since individuals with autism spectrum disorders (ASD) show little to no facial emotion and have communication limitations. This is when the use of augmentative or alternative communication devices may help.

Depression is fueled by isolation, which makes a strong support system essential for an individual’s recovery. As a result, parents play the most vital role in treating depression in teens or adults with ASD. Most would agree that in this situation, a parent is not just a parent, but also the child’s coach, therapist and friend.

Depression Treatments

There has been limited research conducted in regards to treating depression in teens and adults with ASD, with most of the research involving the psychopharmacology of ASD and signs of irritability, such as aggression, tantrums, and self-injury, along with hyperactivity, repetitive interfering behavior, and inattention (Marcus et al., 20096); RUPP Autism Network, 20027; RUPP Autism Network, 20058; King et al., 20099).

There are many effective treatments that can help you overcome depression and reclaim your life. Medications may be used to relieve depression symptoms, but should not be considered a cure as they come with unwanted side effects. If you do decide to try medication, remember that medication works best when you also make healthy lifestyle changes.

Alternative and complementary treatments include various relaxation techniques, such as yoga, meditation, acupuncture, hypnosis, or massage therapy. Additionally, doctors may suggest changes in the child’s diet and nutritional supplements as these may also be causes of the chemical imbalances leading to the depression.

References

WebMd. “Depression Health Center”. (2015). “Alternative Treatments for Depression”.

Suruchi Chandra, M.D. (2015). “Addressing Anxiety & OCD in ASD”.

June Groden, Ph.D. (2015). “Stress & Anxiety Reduction”.

Autism Speaks.  (2015). “What’s the connection between autism depression?”.

Anna Merrill, Graduate Student. (2015). “Anxiety and Autism Spectrum Disorders”.

Massachusetts General Hospital for Children. (2015). “Depression and ASD”.