The answer directly comes from Christopher McDougle, MD, director of Massachusetts General Hospital’s Lurie Center for Autism, and a member of the Autism Speaks Autism Treatment Network.
This is a vital issue. Depression, as well as mood disorders, are more common among those who suffer from disabilities that are developmental than generally speaking.
However, diagnosing depression in people with autism poses a problem that goes back to Leo Kanner’s initial definition of “infantile autism” in 1943.
Kanner identified disruption of “affective contact” in people who have autism. Clinicians employ”the word “affect” to define how an individual’s mood appears to other people. Also is the person looking stressed or depressed? This could differ in “mood.” Mood refers to how someone really feels inside.
The mood and the affect aren’t always in sync. A person’s expression could appear to be sluggish and show no reaction. Yet, they may claim that he is feeling good. The term “clinical” refers to the condition as an “incongruence of mood and affect.”
Addressing a challenging diagnosis
A lot of people with autistic spectrum disorders (ASD) exhibit a lack of facial expressions. It’s not necessarily a sign that they’re depressed! This means that the way they feel doesn’t necessarily correspond to what they’re feeling.
But it makes it harder to identify depression in people with autism. Furthermore, many people who suffer from ASD suffer from a lack of or limited speech. Therefore, they might not be able to tell us what they feel.
As you might imagine, this makes it difficult to pinpoint depression among those suffering from ASD. It is possible to inquire about other symptoms that can indicate depression. They could be changes in appetite or sleep patterns – either decreased or increased. There could be a noticeable loss of energy or the ability to enjoy things that used to be fun. It could be accompanied by an overall decline in interest and motivation.
We can track the changes in weight or the amount of time spent sleeping. However, it’s hard to diagnose depression with confidence for those who might not be able to express the emotions they are experiencing in the form of words or in their appearance.
Another obstacle when it comes to diagnosing depression in people who have autism concerns the overlapping symptoms. The signs of depression are the appearance of a depressed or flat affect (facial expression) as well as a decrease in appetite, insomnia, low energy decreased motivation, social withdrawal, and a diminished desire to interact with other people. It is clear that many of the same signs may be related to autism rather than depression.
Autism Depression, ADHD and suicidal Tendencies
In discussing the treatment and diagnosis for depression, it’s essential to consider potential suicidal thoughts. At the medical schools, psychiatrists are taught to determine the likelihood of suicide in each person we assess for depression. This is also true for the assessment of those suffering from ASD.
In a new study released in the Journal of research in Autism Spectrum Disorders, Angela Gorman and colleagues identified a variety of risk factors that are associated with thoughts of suicide as well as attempts to commit suicide in children who suffer from ASD. (The study was funded partially by a contribution by Autism Speaks.)
Through parent interviews, researchers questioned 791 children diagnosed with autism, 186 generally developing children, and 35 children that aren’t autistic but have been diagnosed with depression.
The proportion of children who were rated from their families as “sometimes” or “very often” thinking about or even attempting suicide was 28 times more common for children with autism than for those who have normal development. It was 3 times lower for children with autism than children who were not autistic with depression. It was also found to be the most significant single predictor of suicidal ideas or attempts among children who have autism. Suicidal tendencies are not common for children younger than 10 years old. (Editor’s note read “Eight crucial measures to Prevent Suicide,” a blog post written by Autism Speaks Board member Sallie Bernard. )
These findings highlight how vital it is for healthcare professionals to evaluate the risk of suicide in the evaluation of individuals or adults suffering from ASD. We are indeed challenged in determining the correct diagnosis of suicide risk and depression for people with ASD. It is essential to make use of all information we have available to us to make this determination. This includes direct interactions with and observations of our patients. It is important to communicate with parents as well as teachers and job coaches, as well as personnel from the group home, and others.
The Urgent Demand of Further Research and Clinical Guidance
It is urgently needed to conduct more research in order to create better tools and methods to identify anxiety and mood problems in people with ASD. This is crucial for those with significant difficulties communicating. Utilizing augmentative and alternative communication devices can help.
Furthermore, we urgently require research that helps in the development of effective medication and treatment for depression afflicted by ASD. At present, we do not have one published research study that is a systematic clinical trial of an antidepressant drug for treating depression in people with autism. Most likely, the difficulty of correctly diagnosing depression in individuals who suffer from ASD is a factor in the slow advancement. It is imperative to increase the efforts we put into this crucial health care field.