Characterization of Depression in Children With Autism Spectrum Disorders

Abstract

Depressive syndromes represent a disabling comorbidity for many children with autism spectrum disorders (ASD), however the ascertainment of depression can be complicated by phenotypic overlap between the two conditions, by ways in which autistic symptomatology can mask cardinal features of depression, and by atypical manifestations of depression in children with ASD. These issues have contributed to wide variation in the estimation of prevalence rates of depression in individuals with ASD, and invoke the need for new approaches to the specific detection of depression and other neuropsychiatric comorbidities that aggregate in children affected by ASD. We review the scientific literature relevant to the occurrence of depression in ASD, and consider important parameters of risk, including psychosocial factors such as insight into affectation status, as well as biological factors such as the aggregation of depressive syndromes in certain families affected by autism, which has suggested possible overlap in genetic influences underlying the two conditions. Variability in the manifestations of depression across environmental contexts provides important clues to intervention, and underscores the potential importance of involving multiple informants in ascertaining depression in children and adolescents with ASD. A practical strategy for evaluating the presence of depression in youth with ASD is synthesized from the available data and discussed.

Depression and its measurement in verbal adolescents and adults with autism spectrum disorder

“…We were surprised to find that cognitive symptoms of depression (i.e., those associated with negative attributions about self and situation, including pessimism, sense of failure or punishment, guilt) were among the most frequently endorsed BDI-II items in our ASD sample (see also Gotham et al, 2014), and in fact were endorsed at higher rates in this sample than in previously published data from a similarly-aged general population sample (Dozois et al, 1998). This stands in contrast to the idea (derived from early reports) that these symptoms might be particularly difficult to express in ASD and therefore less useful markers of this comorbidity (Stewart et al, 2006; Magnuson & Constantino, 2011). Taken together, these findings support the value of self-report on depressive symptoms in the verbally fluent ASD population.…”

“…Other possible depressive symptoms more specific to or common in ASD might include irritability and agitation, increase in social withdrawal beyond an individual's baseline, a change in the character of obsessions (with fixations taking on a more morbid tone), and an increase in compulsive behavior (Ghaziuddin, 2005). Increased self-injury and regression of adaptive skills may be particularly significant symptoms of depression in less cognitively able individuals with ASD (Magnuson & Constantino, 2011). Overall, the presentation of depression in ASD depends on age, level of intelligence, and level of verbal skills.…”

Cornelia de Lange and Ehlers-Danlos: comorbidity of two rare syndromes

“…We can presume our patient improved under morphine and tramadol treatment because of severe acute pain he presented from his displaced screw, then the postoperative pain. The ascertainment of depression was complicated by absence of language on the one hand, and phenotypic overlap between autism and depression on the other (by ways in which autistic symptomatology can mask cardinal features of depression, and by atypical manifestations of depression in patients with autism) 21. We proposed antidepressant treatment assuming a depressive syndrome in our non-verbal patient based on irritability, labile mood, loss of restricted interests and a very ritualistic mode of functioning, as it may occur in autism with depression 22.…”

Clinician Perspectives of Adult High-Functioning Autism Support Groups’ Use of Neurodiversity Concept

“…The concept of neurodiversity can change the way an individual feels about him or herself and can also help thwart maladaptive perceptions leading to depression and anxiety in individuals [36]. The neurodiversity concept can help individuals understand their innate talents and the goals they can achieve.…”

“…By examining the thoughts of clinicians who work with persons with HFA, I took the first step in broadening the knowledge of the field regarding the potential implementation of this new therapeutic modality [8]. Persons on the autism spectrum are at-risk for societal stigma and being ostracized from their communities [36]. Neurodiversity can help clinicians turn maladaptive notions around and help retrain both individuals on the autism spectrum and persons within the community.…”