Help for Depressed Teens on the Autism Spectrum

"The older my teenage son gets, the more depressed he seems to be. I think something may be going on at school that he is hiding from us (perhaps not getting the acceptance from his 'friends' that he wants to like him - IDK). Any suggestions? Anyone else have a teen with ASD who seems depressed 24/7?"

Teens with Asperger’s (AS) and High-Functioning Autism (HFA) are particularly vulnerable to mental health problems (e.g., depression, anxiety). One study found that 65% of their sample of patients with AS presented with symptoms of a psychiatric disorder. However, the inability of AS and HFA teens to communicate feelings of distress can also mean that it is often very difficult to diagnose depression.

Likewise, because of their impairment in non-verbal expression, they may not appear to be depressed. This can mean that it is not until depression is well developed that it is recognized (e.g., in the form of aggression, alcoholism/drug abuse, increased obsessional behavior, paranoia, refusal to go to school/work/college, refusal to leave home, threatened/attempted/actual suicide, and total withdrawal).

In addition, teens with AS or HFA leaving home and going to college frequently report feelings of depression. As one young man said, "I had to deal with anger, frustration, and depression that I had been keeping inside since high school."

Depression in these young people is often related to a growing awareness of their disorder, a sense of being different from their friends, and an inability to form relationships or take part in social activities successfully. Personal accounts by AS and HFA teens frequently refer to attempts to make friends, but with little success. One teen stated, "I just did not know the rules of what you were and were not supposed to do."

Some of these “special needs” teenagers have even been accused of harassment in their attempts to socialize, which only adds to their depression and anxiety. Rodney, a 19-year-old with AS had this to say: "I did not know how to approach girls and ask them to go out with me. I would just walk up and talk to them, whether they wanted to talk to me or not. Some accused me of harassment, but I thought that was the way everybody did it." The difficulties AS and HFA teens have with personal space can compound this sort of problem (e.g., they may stand too close or too far from the person they are talking to).

==> Discipline for Defiant Aspergers and High-Functioning Autistic Teens

Negative childhood experiences (e.g., peer-rejection, teasing, bullying, etc.) can also result in depression, as can a history of misdiagnosis. Another possibility is that the teenager is biologically predisposed to depression.

The depression in teens on the autism spectrum resembles that of teens without the disorder, although the content may be different. For instance, it may show itself through the AS or HFA teen’s particular preoccupations and obsessions.

If parents believe their autistic teen is suffering from depression, an attempt should be made to assess his or her mental state. Symptoms to look for would include:
  • aggression
  • agitation
  • changes in appetite (e.g., decreased appetite, weight loss, increased cravings for food, weight gain)
  • crying
  • disruptive or risky behavior
  • exaggerated self-blame or self-criticism
  • extreme sensitivity to rejection or failure
  • feelings of sadness
  • feelings of worthlessness
  • fixation on past failures
  • frequent absences from school
  • frequent complaints of unexplained body aches and headaches
  • frequent thoughts of death, dying or suicide
  • frequent visits to the school nurse
  • guilt
  • increased time spent with special interests to the point of addiction (e.g., spending most of the day playing video games)
  • increased/decreased activity
  • insomnia or sleeping too much
  • irritability, frustration or feelings of anger, even over small matters
  • isolation
  • loss of interest in, or conflict with, family and friends
  • loss of interest or pleasure in normal activities
  • neglected appearance (e.g., mismatched clothes and unkempt hair)
  • ongoing sense that life and the future are grim and bleak
  • poor school performance
  • restlessness (e.g., pacing, hand-wringing, an inability to sit still)
  • self-harm (e.g., cutting, burning, or excessive piercing or tattooing)
  • slowed thinking, speaking or body movements
  • the need for excessive reassurance 
  • tiredness and loss of energy
  • trouble thinking, concentrating, making decisions and remembering things
  • use of alcohol or drugs
  • worsening of autistic traits (e.g., increased proportion of echolalia, the reappearance of stimming, etc.)

It can be difficult to tell the difference between depression and the normal ups-and-downs that are just part of adolescence. Talk with your teenager. Try to determine whether he or she seems capable of managing uncomfortable emotions, or if life seems overwhelming. If depression symptoms continue or begin to interfere in his or her daily functioning, talk to a mental health professional trained to work with autistic teens. Your family physician is a good place to start, or your child’s school may recommend someone.

You are your adolescent's best advocate. Here are some important tips parents can use that may help lessen the symptoms of depression in their autistic teens:

1. AS and HFA adolescents may be reluctant to seek support when life seems overwhelming. Encourage your teen to talk to a family member or other trusted adult whenever needed.

2. As long as your teen’s “special interest” (e.g., playing video games) doesn’t interfere with his normal day-to-day functioning (e.g., doing homework, completing chores, taking care of personal hygiene, having a modicum of a social life, etc.), allow him full access to this particular interest. It is most likely a great depression and anxiety reducer.

3. Create an environment where your teen can share concerns while you listen.

4. Do your part to make sure your adolescent eats regular, healthy meals.

5. Education about depression can empower your adolescent and motivate her to stick to a treatment plan.

==> Discipline for Defiant Aspergers and High-Functioning Autistic Teens

6. Encourage your adolescent to carefully choose obligations and commitments, and set reasonable goals. Let him know that it's OK to do less when he feels down.

7. Even if your adolescent is feeling well, make sure she continues to take medications as prescribed.

8. Even light physical activity can help reduce depression symptoms.

9. Help your adolescent plan activities by making lists or using a planner to stay organized.

10. It can benefit you and other family members to learn about your adolescent's depression and understand that it's a treatable condition.

11. Journaling may help improve mood by allowing your adolescent to express and work through pain, anger, fear or other emotions.

12. Make sure your adolescent attends appointments, even if she doesn't feel like going.

13. Many AS and HFA adolescents judge themselves when they aren't able to live up to unrealistic standards (e.g., academically, in athletics, or in appearance). Let your teen know that it's OK not to be perfect.

14. Participation in sports, school activities, or a job can help keep your adolescent focused on positive things, rather than negative feelings or behaviors.

15. Positive relationships can help boost your adolescent's confidence and stay connected with others. Encourage him to avoid relationships with peers whose attitudes or behaviors could make depression worse.

16. Sleeping well is important for all adolescents, especially those with depression. If your adolescent is having trouble sleeping, ask your physician for advice.

17. Talk to your adolescent about the changes you're observing and emphasize your unconditional support.

18. Talking with other AS or HFA adolescents facing similar challenges can help your adolescent cope. Local support groups for depression are available in many communities. Also, support groups for teens with autism spectrum disorders and depression are offered online.

19. Work with your adolescent's therapist to learn what might trigger depression symptoms. Make a plan so that you and your adolescent know what to do if symptoms get worse. Also, ask family members or friends to help watch for warning signs.

20. Your adolescent may feel like alcohol or drugs lessen depression symptoms, but in the long run, they worsen symptoms and make depression harder to treat.

If all efforts to reduce your AS or HFA teen’s depression fail to produce effective results, medication may be a good last resort. However, they do not make an impact on the primary social impairments that underlie autism spectrum disorders. As with any treatment for depression, adjustments may have to be made to find the appropriate drug and dosage for that particular teenager.

Side effects should also be monitored and effort made to ensure that the advantages of treatment outweigh the disadvantages. Also, it is important to identify the cause of the depression, which may necessitate counseling, social skills training, or meeting up with peers with similar interests and values.

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