Review article
Depression and mood disorders among persons with Autism Spectrum Disorders

https://doi.org/10.1016/j.ridd.2014.04.020Get rights and content

Highlights

  • The study of comorbid psychopathology among persons with Autism Spectrum Disorders (ASD) is now well recognized.

  • Depression commonly occurs with ASD.

  • When depression occurs with ASD, anxiety is also frequently present.

  • Few treatments are available that have been specifically tested with ASD and depression.

Abstract

In the past decade, Autism Spectrum Disorders (ASD) have both risen in prevalence and become a critical area of research in the field of developmental disabilities. As the body of knowledge about ASD has grown, the overlap of ASD with other problems has also become a rapidly emerging area of study. One of the most studied of these topics is comorbid psychopathology, with depression and mood disorders emerging as one of the more troublesome of these co-occurring conditions. A great deal of research is still needed to determine how best to assess and treat these disorders within the context of ASD. This manuscript reviews current trends and topics relative to this area of study.

Section snippets

Assessment

Conventional wisdom is that ASD should be identified as early as possible (Matson et al., 2009c, Matson et al., 2008b, Matson et al., 2009f, Narzisi et al., 2013). Similarly, given the high prevalence rates of comorbid conditions such as challenging behaviours and comorbid psychopathology, they should be assessed earlier rather than later (Matson, Gonzalez, & Rivet, 2008). In addition to being assessed early, an individual with ASD should also be evaluated periodically as the individual ages (

Depression and mood disorders

The research on depression and mood disorders can be categorized into at least five general topics. These issues include mood and depression, suicidal ideation, comorbidity, the relationship of anxiety and mood, and research on treatment. A review of each topic follows.

Researchers generally recognize that depression is more common among persons with ASD relative to the general population. One such study was described by Mazzone et al. (2013), who evaluated 20 children and adolescents between 7

Suicidal ideation

Suicidal thoughts, which of course are related to depression and mood disturbances, have also been studied. A particularly impressive study was published by Mayes, Gorman, Hillwig-Garcia and Syed (2013). They evaluated 791 children with autism, 1–16 years of age. These children were compared to 186 typically developing children. The dependent variable was suicidal ideation. Mothers reported that 14% of the ASD group evinced suicidal ideation. This rate was 28 times greater than what was

Comorbid psychopathologies

A number of papers have been published looking at how psychopathology in general relates to ASD. Often, mood and depression issues are embedded in a broader comorbidity. For example, La Malfa et al. (2007) evaluated 90 adults with intellectual disability plus the co-occurrence of ASD and various forms of psychopathology. Their overall finding was that mental health issues were common in this group, and the co-occurrence of autism and mood disorders was high. In a second paper, Stahlberg,

Factors associated with mood disorders

While considerably more research is needed regarding mood disorders as they relate to ASD, some efforts have been made in this regard. For example, Ingersoll and Hambrick (2011) studied the effects of ASD on depressive symptoms on parental behaviour. Compared to the general population of parents, caregivers of children with ASD reported higher levels of stress and depression. More severe symptoms of ASD were predictors of more stress and depression among parents. Meltzer (2011) reported similar

Depression and anxiety

To date, one of the largest areas of studies on comorbidity with ASD and depression also involves anxiety. Kim et al. (2000) report on this co-occurring phenomenon among 9–14 year olds with Asperger Syndrome and High Functioning Autism. Fifty-nine children with an ASD were compared to a community sample of 1751 children. Greater rates of anxiety and depression were noted in the ASD sample.

Pine, Guyer, Goldwin, Towbin, and Leibenluft (2008) also studied these comorbidities. They tested 352

Treatment

Treatment research is lagging relative to describing and assessing comorbidity among persons with ASD. This situation is understandable at present since the problem must be accurately identified before treatment can proceed. Most intervention to date has been extrapolated from the research on persons without ASD, but more research is urgently needed to improve and target assessment and treatment for those with ASD, as symptoms may present differently among persons with ASD, or they may be

Conclusions

Comorbid psychopathology among persons with ASD has begun to receive attention from the scientific community. This fact is extremely important if the best quality care for persons with ASD is to be realized. The recognition of these comorbidities has been one of the most significant developments in the field of ASD. These developments have markedly changed how the disorder is conceptualized. For example, there will be a need to subtype the ASD syndrome, add more axes, or employ severity and

References (58)

  • S.V. LoVullo et al.

    Comorbid psychopathology in adults with autism spectrum disorders and intellectual disabilities

    Research in Developmental Disabilities

    (2009)
  • T. Lugnegård et al.

    Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome

    Research in Developmental Disabilities

    (2011)
  • B.M. MacNeil et al.

    Anxiety in children and adolescents with autism spectrum disorders

    Research in Autism Spectrum Disorders

    (2009)
  • A. Mannion et al.

    An investigation of comorbid psychological disorders, sleep problems, gastrointestinal symptoms and epilepsy in children and adolescents with autism spectrum disorder

    Research in Autism Spectrum Disorders

    (2013)
  • J.L. Matson et al.

    Norms and cut off scores for the autism spectrum disorders diagnosis for adults (ASD-DA) with intellectual disability

    Research in Autism Spectrum Disorders

    (2007)
  • J.L. Matson et al.

    The effect of autism spectrum disorders on adaptive independent living skills in adults with severe intellectual disability

    Research in Developmental Disabilities

    (2009)
  • J.L. Matson et al.

    Cutoffs, norms, and patterns of comorbid difficulties in children with an ASD on the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 2)

    Research in Autism Spectrum Disorders

    (2009)
  • J.L. Matson et al.

    Reliability of the autism spectrum disorder-behavior problems for children (ASD-BPC)

    Research in Autism Spectrum Disorders

    (2008)
  • J.L. Matson et al.

    Comorbid psychopathology in infants and toddlers with autism and pervasive developmental disorders-not otherwise specified (PDD-NOS)

    Research in Autism Spectrum Disorders

    (2010)
  • J.L. Matson et al.

    The increasing prevalence of autism spectrum disorders

    Research in Autism Spectrum Disorders

    (2011)
  • J.L. Matson et al.

    Trends and topics in autism spectrum disorders research

    Research in Autism Spectrum Disorders

    (2009)
  • J.L. Matson et al.

    Validity of the autism spectrum disorder-comorbid for children (ASD-CC)

    Research in Autism Spectrum Disorders

    (2009)
  • J.L. Matson et al.

    The behavioral function of feeding problems as assessed by the questions about behavioral function (QABF)

    Research in Developmental Disabilities

    (2005)
  • J.L. Matson et al.

    Examination of adaptive behavior differences in adults with autism spectrum disorders and intellectual disability

    Research in Developmental Disabilities

    (2009)
  • J.L. Matson et al.

    Characteristics of depression as assessed by the diagnostic assessment for the severely handicapped-II (DASH-II)

    Research in Developmental Disabilities

    (1999)
  • J.L. Matson et al.

    Validity of the mania subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II)

    Research in Developmental Disabilities

    (1997)
  • J.L. Matson et al.

    Psychometric testing methods for children's social skills

    Research in Developmental Disabilities

    (2009)
  • J.L. Matson et al.

    Early identification and diagnosis in autism spectrum disorders in young children and infants: How early is too early?

    Research in Autism Spectrum Disorders

    (2008)
  • J.L. Matson et al.

    Sensitivity and specificity of the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT): Validity and cutoff scores for autism and PDD-NOS in toddlers

    Research in Autism Spectrum Disorders

    (2009)
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