For people with autism, and their family and friends, understanding related mental health conditions and emotional challenges can be both important and helpful. This article hopes to shed light on the complex relationship between autism and two of the most common mental health conditions: anxiety and depression. We will explore both depression and anxiety within the context of autism, drawing on key insights from public health information and research evidence.
What are Anxiety & Depression?
Depression and anxiety are common internalised mental health conditions that can affect anyone, regardless of age, gender, race or background.
“Internalised” refers to the fact that the main symptoms and experiences associated with anxiety and depression occur within the internal mental and emotional state of the person. Although these experiences can influence an individual’s external behaviours and interactions, the core struggles, thoughts and emotions are mostly experienced from within.
Anxiety and depression share commonalities in terms of their impact on mood, cognition (mental processes), and behaviour, often involving disruptions to sleep patterns, concentration, and negative perceptions about oneself and the future.
Signs of raised anxiety or depressed mood can also occur even if they are not considered to be severe enough to meet the threshold for a formal mental health diagnosis – these experiences can still have a detrimental impact on someone’s wellbeing.
Anxiety
Anxiety is described as a feeling of unease, such as worry or fear, which can be mild or severe. A clinical condition, like an anxiety disorder, is considered when the associated signs are experienced for a prolonged period of time and have a significant impact on someone’s life[i].
Some common signs that you, or someone you know, might be experiencing anxiety include:
- Restlessness and feelings of worry
- A fast, thumping or irregular heartbeat
- Faster breathing, sweating or hot flushes
- Nausea (feeling sick) or a churning feeling in the stomach
- Panic attacks – intense episodes of overwhelming fear/discomfort, accompanied by physical symptoms such as rapid heartbeat & shortness of breath
Depression
When a sad, or low, mood lasts for a long time, and interferes with everyday life, this might be a sign that someone is depressed or experiencing a depressive episode.
A depressive episode can be categorised as mild, moderate, or severe depending on the number and severity of symptoms that someone is experiencing, as well as the impact on the individual’s functioning i.e. how much their life is impacted.
Some common signs that you, or someone you know, might be experiencing depression include:
- Continual sadness over an extended period of time
- Loss of motivation & interest in activities that were once enjoyed
- Changes in sleep (such as insomnia or excessive sleep) and in appetite
- Moving or speaking more slowly than usual
- Feeling hopeless and helpless, and/or tearful
- Having thoughts of harming yourself or of suicide
Breathing techniques have long been recognised as a powerful tool for improving wellbeing and managing anxiety. Learn more about these benefits in our blog article: The Benefits of Breathing Techniques for People with Neurodiverse conditions
The connection between Autism, Anxiety & Depression
Research widely suggests that people with autism are at an increased chance of experiencing symptoms of depression and anxiety.
This is likely due to a combination of factors, including:
- Social challenges
Individuals may have difficulty understanding and interacting with others. This can lead to feelings of loneliness and social isolation, which can increase the risk of depression.
- Communication difficulties
Individuals may have difficulty communicating their thoughts and feelings, which can lead to feelings of isolation and frustration.
- Sensory sensitivities
Hypersensitivity to certain sounds, lights, or textures is very common in autism. This can make it difficult for individuals to cope with everyday situations and can lead to anxiety.
Understanding Anxiety in Autism
Although it is not part of the ASD diagnostic criteria, many individuals do experience high levels of anxiety. In fact, research estimates that 50% of individuals with autism will experience a level of anxiety that has a significant impact on their everyday lives[ii].
Everyday situations which might seem manageable to others, may trigger feelings of stress and anxiety in individuals with ASD, which may be contributed to by:
- Increased difficulties in recognising and understanding emotions – this can be the emotions both of others, and oneself (also known as alexithymia)
- Greater difficulty with uncertainty and change – this could be the result of an unexpectedly altered routine, a drastic life change like moving schools, or
- Trying to ‘fit in’ – a sense of being misunderstood and/or not accepted by other people can increase feelings of anxiety and incentivise the wish to avoid being seen as different
- Increased sensory sensitivities – greater sensitivity to sound, touch and other sensory stimuli can be overwhelming and anxiety provoking[iii]
- Performance anxiety – being unsure about whether one might get things wrong can lead to a lot of apprehension and possibly avoidance[iv], which causes further worry[v].
How Anxiety might show up
Symptoms of anxiety add a significant burden to many individuals on the autism spectrum and their loved ones. Experiencing high levels of anxiety can lead to exhaustion and meltdowns, or autistic fatigue and burnout[vi]. This can significantly affect someone’s quality of life, including their physical and mental health, work/school and social life.
The symptoms of depression and anxiety in ASD can be similar to those shown in the general population, but they may also present in unique ways[vii]. Therefore, there may be some important anxiety indicators that may not readily be recognised as anxiety in individuals with autism.
For example, people with autism may experience depression as an additional decrease in communication, & social interaction, or experience anxiety as increased sensitivity to sensory input.
When experiencing increasing anxiety, individuals with ASD may also become more insistent on routines and become more repetitive in their actions, as a possible way of managing uncertainty, fear of failure and sensory input,[viii].
Types of Anxiety Common in Autism
There are overlaps between ASD and certain types of anxiety conditions. Some common ones to be aware off are:
- Social Anxiety – This anxiety is heightened by the experience of engaging in social situations, which may be a result of difficulties navigating social norms and cues. Difficulties with ‘reading people’ and the emotions of those around them can contribute to this, by making their environment feel more unpredictable[ix].
- Generalised Anxiety Disorder (GAD) – This involves persistent, excessive and uncontrollable worry and fear about various aspects of life, such as being overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work.
- Obsessive Compulsive Disorder (OCD) – This is an anxiety condition where repetitive behaviours or mental acts are carried out to reduce the distress associated with obsessive and/or intrusive thoughts, which can significantly interfere with daily functioning and quality of life.
Understanding Depression in Autism
Individuals with ASD show higher rates of depression than the general population, with lifetime prevalence estimates as high as 48%[x], based on pooled data.
Studies have reported that depression in individuals with ASD is associated with stress[xi], emotion regulation[xii], and loneliness[xiii].
Communication difficulties and sensory sensitivities can also contribute to the feelings of hopelessness and sadness that often present during a depressive episode.
The connection between ASD and depression, however, may be more complicated than meets the eye. Whilst research shows difficulties in social communication to be associated with depression, this association seems to partially accounted for by environmental factors, such as bullying[xiv]. This example shows the complex psychosocial factors contributing to the mental health and daily living experiences of individuals with ASD.
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Or, for one-to-one expert support, schedule an appointment with one of our nutritionists:
How Depression might show up
Despite the high rates of depression, the consensus in research is that depression is likely often under- or misdiagnosed in individuals with ASD[xv], likely because depressive symptoms present differently than in neurotypical individuals. This might look like changes in autism symptoms, behavioural regression, hyperactivity, decreases in self-care, greater self-injurious behaviour, or increased frequency of agitation and tantrumsxiv.
Studies comparing symptoms between adolescents have found higher levels of internally directed symptoms in female participants than male participants, such as feelings of sadness, loneliness or low self-esteem[xvi]. Meanwhile, it seems male adolescents may be more likely to demonstrate anhedonia (inability to feel pleasure), social withdrawal, and changes in mood or energy[xvii].
Getting mental health support
Identifying signs of depression and anxiety early on can help with getting timely mental health support or treatment.
If you think you, or a loved one, are depressed or anxious to an extent which is detrimentally affecting your life, please talk with a doctor or a mental health professional as soon as possible.
There are numerous forms of treatment available for both depression and anxiety, including psychological and medicinal options, which should be overseen by a health professional.
- Samaritans – 116 123
- Phone 0800 107 0160 – free confidential support 24/7
- SaneLine: 0845 767 8000 – 6.00pm to 11.00pm (Offers multilingual support)
- Shout Crisis Text Line – text SHOUT to 85258 anytime
- NHS GP on call – 111
- Talk to someone you trust
Self-help guidance
Being open to understanding what experiences or actions might trigger difficult feelings for someone is also important when it comes to getting appropriate wellbeing and mental health support – and what this looks like will be different between individuals.
Identifying and monitoring when feelings of anxiety or depression occur can be useful in coming up with solutions to minimise distress. For example, being aware of increased stress or depleted energy levels following social interactions might remind someone to recharge or take some alone time to engage in activities they enjoy.
There are also other self-help and practical strategies that might support someone facing these difficulties such as:
- Making adaptations to the environment where possible e.g., lower harsh unnatural light, or try noise-cancelling headphones to reduce sensory overload.
- Experiment with self-soothing or relaxation activities e.g., use of sensory tools and stimming to manage anxiety levels, or other exercises such as meditation, mindfulness, yoga or physical activity.
- Daily structure and routine e.g., using a visual schedule or an organisation mobile app may help reduce uncertainty and more comfortably navigate days where there are changes to regular activities. More generally we can reduce the issue of uncertainty by ensuring that, where possible, individuals on the autism spectrum know what to expect.
Learn about the benefits of mindulness based cognitive therapy in our blog article:
This therapy can can offer valuable support to individuals in managing a range of mental health challenges, including stress, anxiety, and depression.
Important
This article is for insight and educational purposes. Identifying with any symptoms or experiences mentioned should not be taken as a substitute for a formal or clinical diagnosis of these complex conditions, nor the specific support required to support a particular individual. Please talk to a qualified health professional or GP if you are seeking mental health or specific ASD, ADHD, dyslexia or dyspraxia support. Every individual is unique, and a diagnosis alone is also not an adequate basis on which to determine all of an individual’s potential, abilities or needs.
Written by Hazel De Maeijer
MSc |GMBPsS | BSc (Hons)
References
[i] https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/
[ii] Simonoff, E. et al. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample.
[iii] Wigham, S. et al. (2015). The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder. J
[iv] Keen, D., Adams, D., Simpson, K., Den Houting, J. and Roberts, J., 2019. Anxiety-related symptomatology in young children on the autism spectrum.
[v] Rodgers, J. et al. (2016). Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD).
[vi] www.autism.org.uk/advice-and-guidance/topics/mental-health/autistic-fatigue
[vii] Kerns, C.M. et al (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder.
[viii] Joyce, C. et al (2017). Anxiety, intolerance of uncertainty and restricted and repetitive behaviour: Insights directly from young people with ASD.
[ix] https://www.autism.org.uk/advice-and-guidance/professional-practice/anxiety-autism
[x] Hudson, C. C., Hall, L., & Harkness, K. L. (2019). Prevalence of depressive disorders in individuals with autism spectrum disorder: A meta-analysis.
[xi] DeFilippis, M. (2018). Depression in children and adolescents with autism spectrum disorder..
[xii] Sáez-Suanes, G. P., García-Villamisar, D., del Pozo Armentia, A., & Dattilo, J. (2020). Emotion regulation as a mediator between depressive symptoms and autism spectrum disorder (ASD) in adults with ASD and intellectual disabilities.
[xiii] Schiltz, H. K., McVey, A. J., Dolan Wozniak, B., Haendel, A. D., Stanley, R., Arias, A., & Van Hecke, A. V. (2021). The role of loneliness as a mediator between autism features and mental health among autistic young adults.
[xiv] Rai, D., Culpin, I., Heuvelman, H., Magnusson, C. M. K., Carpenter, P., Jones, H. J., Emond, A. M., Zammit, S., Golding, J., & Pearson, R. M. (2018). Association of autistic traits with depression from childhood to age 18 years.
[xv] Magnuson KM, Constantino JN. Characterization of depression in children with autism spectrum disorders.
[xvi] Angel, L., Ailey, S.H., Delaney, K.R. and Mohr, L., 2023. Presentation of depressive symptoms in autism spectrum disorders..
[xvii] Rao U, Chen LA. Characteristics, correlates, and outcomes of childhood and adolescent depressive disorders.
Disclaimer: The views and opinions expressed in this blog post are those of the author and do not necessarily reflect the official policy or position of any professional organization or guidelines. The information provided is for educational and informational purposes only and is not intended as a substitute for professional advice, diagnosis, or treatment. Always seek the advice of your therapist or other qualified health provider with any questions you may have regarding a medical or mental health condition.