Autism

What is Autism?

Autism Spectrum Disorders and Mental Health

Having a child diagnosed with an autism spectrum disorder can be really hard on the whole family. Adding mental health problems to the mix can make things harder. There seems to be a huge connection between autism spectrum disorders (ASDs) and other mental health problems. The exact numbers are different from study to study, but researchers find that just under half to about three-quarters of children living with an ASD may also be diagnosed with another mental disorder. Other mental disorders can have a big impact on your child, but treatment does help.

Why is it hard to diagnose mental disorders?

Researchers know that these mental disorders are common, but they can be very hard to diagnose in children living with an ASD. Here are a few reasons why:

  • Symptoms of one disorder can look like another disorder
  • Symptoms of one disorder can hide symptoms of another disorder
  • It may be difficult to tell what your child is feeling
  • Your child may not be able to tell you how they feel
  • Other people may misread your child’s symptoms
  • Your child may not think that something is wrong
  • There are few guidelines and tests to help professionals diagnose other mental health problems in children living with an ASD

An important note on ASD studies

Many studies on mental health and ASD include “high functioning” children.   These are children that don’t have as many intellectual, social or communication problems. This means that there are very few research studies on the mental health of “lower functioning” children. This doesn’t mean that lower functioning children don’t have mental health problems. It also doesn’t mean that you can’t find help if you think your child might have mental health problems. But when you read this article, it’s important to know that it’s based on studies that may not include certain groups of children.

How do I know if my child has Autism?

Children and youth with ASD experience two types of symptoms: difficulties in social interactions and repetitive behaviours. These symptoms are present in different areas of life (e.g., school, home), cannot be explained by child’s or youth’s age (e.g., becoming more shy and self-aware during puberty), and cause a lot of distress. Difficulties in social interactions in ASD include:

  • Difficulties in conversations with others, not following the “rules” in conversations (such as taking turn speaking, answering questions, paying attention when someone shares their emotions, sharing thoughts and emotions)
  • Unusual facial expressions, eye contact, body position, or gestures during conversations as well as difficulties in understanding the gestures of others
  • Difficulties in building close relationships. Children and youth with ASD might not be interested in others and not know how to adjust their behaviour based on what others are doing.

Some common signs of an ASD are also signs of different mental health disorders. This can be confusing. It’s always a good idea to talk to your doctor if you notice a change in the way your child acts or feels or if you notice new behaviours or feelings.

This is especially true if the new behaviours you’re concerned about haven’t gotten any better under your child’s current ASD treatment program. Depending on the behaviours, your doctor may also want to see if a medical problem explains the behaviours. For example, “head banging” in non-verbal children living with an ASD might be a way to show pain from an ear infection, rather than a sign of an ASD.

Here are signs of the mental health disorders that most often go along with an ASD.

Anxiety disorders

Anxiety is a mental health problem that often goes along with autism. Anxiety disorders cause unreasonable and excessive fear or worry. Studies found rates of problem anxiety in young people living with ASD ranged from 11% to 84%. High-functioning children are more likely to also have an anxiety disorder.

Researchers aren’t sure why ASD and anxiety go together so often. There are a few different ideas how it might work. The brain changes that cause ASD may also cause anxiety.  There may be genes that link both ASD and anxiety, or anxiety may be caused by social skills problems found in ASD. ASD makes it hard for people to interact with others. In the past, researchers thought that those living with an ASD simply weren’t aware that they had social problems. But current research suggests that many young people living with an ASD are very aware of the difference, and want to interact with others. Young people living with an ASD may feel lonelier than other kids.  This can also lead to anxiety and depression.

There are a few different anxiety disorders. The anxiety disorders that go along with ASD the most are obsessive-compulsive disorder, generalized anxiety disorder, social anxiety disorder, specific phobia and separation anxiety disorder.

Obsessive-compulsive disorder or OCD is made up of two different parts: obsessions and compulsions. Obsessions are thoughts, ideas or urges that are distressing. Your child can’t control obsessions. They may seem very strange or have to do with things your child wouldn’t normally think about doing. Obsessions cause a lot of anxiety.

Compulsions are things that your child keeps doing to lessen their feelings of anxiety. For example, if your child has obsessions about getting very sick they might wash their hands a lot. Compulsions take up a lot of time and affect the way your child lives. Your child may avoid things or situations that trigger obsessions or compulsions. Children living with OCD may not see that their obsessions or compulsions are unreasonable. OCD affects about 37% of children living with an ASD.

OCD shares some signs with ASDs. For example, it can be hard to tell the difference between compulsions in OCD and repetitive behaviours in ASD (repetitive behaviours can include body movements as well as the need for sameness or routine and very narrow, specific interests). The difference between the two is how they make your child feel. Repetitive behaviours in ASD may give comfort or pleasure, but compulsions in OCD don’t. Researchers say that it can be hard to assess this kind of information in children living with an ASD. Your child may be diagnosed with OCD if they have a lot more compulsions than you’d normally see with ASD, but there’s no magic number to look for either.

Generalized anxiety disorder or GAD makes your child feel very worried about everyday things for a long time. Your child may feel like they can’t control or stop their worry, and it affects their life in a big way. This can affect your child’s concentration and memory. Even if you can’t always tell when your child worries, there are lots of physical signs of GAD, too. Common signs include headaches, stomach aches, sore muscles, irritability, restlessness and fatigue. But in any situation where your child shows physical signs, it’s important to talk to your doctor. Your doctor can make sure there isn’t a medical problem causing your child’s signs.

Phobia (sometimes also called simple or specific phobia) is the fear of a certain thing or situation that lasts for a long time.  This fear causes a lot of distress. It also changes the way your child lives their life because they work hard to avoid what they fear. They may also worry a lot about the thing they fear. The most common phobias in children living with an ASD are shots (injections), crowds and loud noises. Young children may not see that their fear is unreasonable. Phobias affect about 44% of children living with an ASD.

Separation anxiety disorder makes your child feel very anxious when they leave home or caregivers like parents or siblings. Of course, it’s normal for children to feel some anxiety when they’re separated from their caregivers or away from home. With separation anxiety disorder, though, they feel much more anxious or scared than you’d expect. It lasts for a long time and affects their life. Separation anxiety disorder may also make your child feel scared that something terrible will happen.  They may refuse to go to school, feel very scared of being home alone or have nightmares about being separated. It affects about 12% of children living with an ASD.

Attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder affects the way your child acts or behaves. It’s made up of two  different groups of symptoms: hyperactivity (over-activity) and inattention (difficulty paying attention)

Certain signs of ADHD, like hyperactivity and not paying attention, are common in ASD. The difference between the two is the way they affect your child. Having many signs of ADHD can make it harder for children living with an ASD to go about their daily life. The guidelines that health professionals use to diagnose mental health disorders say that children living with an ASD shouldn’t also be diagnosed with ADHD. Many researchers think that a child can have both disorders at the same time. One thing researchers do agree on is that treating troubling signs may improve your child’s quality of life.

Depression

Depression is a mental health disorder that affects your child’s mood for a long time. With depression, they might feel very sad, guilty, irritable or hopeless.  Your child may have a hard time concentrating and may not enjoy things they used to like. Depression can also make them feel very tired and affect the way they sleep. It affects about 24% of children living with an ASD.

Like anxiety disorders, there may be a link between social skills and mood problems. Studies find that children living with ASD are more likely to have signs of depression when they feel like they have social skills problems.

Schizophrenia

Schizophrenia is a mental health disorder that affects the way your child thinks. Signs of schizophrenia include hallucinations (sensing something that isn’t there), delusions (strongly believing in something that can’t possibly be true), disorganized thoughts and disorganized speech. Other signs include having a hard time expressing emotions, enjoying things or speaking.

Studies find that rates of schizophrenia in people living with an ASD are about the same as the general population—about 1%. Researchers note that there may be a lot of overlap between signs of schizophrenia and an ASD, particularly among higher-functioning people living with an ASD. The relationship between the signs of an ASD and the signs of schizophrenia isn’t clear. There are a lot of different theories. But it’s important to find help from someone with a lot of experience diagnosing developmental health disorders.

 

What can be done?

Raising a child living with an ASD may seem overwhelming at times. It’s important to remember that there is help and there is hope. With early treatment and supports, many children living with an ASD can overcome problems and lead happy, productive lives. The same is true if your child is living with both an ASD and another mental disorder. No matter how confusing the research seems, the bottom line is that treatments and supports for other mental disorders do help. Here are just a few treatment options:

Modified cognitive-behavioural therapy

Cognitive-behavioural therapy or CBT is a type of talk therapy that helps your child understand the way their thoughts, feelings and behaviours work together. CBT is a helpful treatment for many different mental disorders. It takes a lot of communication skills and “big picture” thinking to finish treatment. This can be hard for children living with an ASD. Researchers and clinicians are finding ways to modify or change traditional CBT so that children living with ASD can benefit from this therapy. For example, clinicians can use worksheets and lists or activities like art to help your child. In studies, children living with ASD showed as many improvements as children without an ASD when they received modified CBT.

Changes are different for everyone because they’re based on your child’s particular strengths and interests. It’s important that at least one parent is involved in your child’s CBT treatment.

Social skills training

Social skills training is often used to help children living with Asperger’s disorder overcome social skills problems. This type of training may also help lessen anxiety because it may improve their relationships and social interactions with others. As there may be a link between social skills (as your child sees them) and depression, social skills training may also help with depression. Social skills training may help boost your child’s self-esteem and help them build useful skills.

Medication

There is no medication for treatment of an ASD itself, but some medications can help with some problems that may go along with an ASD. These problems include depression, anxiety disorders, ADHD, irritability and sleep problems. Researchers warn that it may hard to see the effects of the medication or see the side effects of the medication in children living with ASD. To learn more about medications used to treat certain problems associated with autism, click here.

It’s important to note that most of these medications aren’t approved by Health Canada for use by children. And some may not be approved by Health Canada for certain problems. Your doctor can prescribe a medication for a reason other than what it was approved for if they feel it will help your child. It’s important to have an honest discussion with your doctor so you understand the possible risks and benefits of medication.

Where to from here?

In addition to talking to your family doctor and contacting the Kelty Mental Health Resource Centre, check out the resources below for more information about autism:

Autism Spectrum Disorder Quick Reference Sheet
A list of the top websites, books, videos, toolkits and support services.

Autism Spectrum Disorder (BC Ministry of Children and Family Development)
Provides information on autism assessment, funding programs, and resources for parents & service providers.

BC Children's Hospital

This is an agency of Provincial Health Services Authority, providing provincial tertiary mental health services to the citizens of British Columbia. Programs include: Adult Tertiary Psychiatry, Geriatric Psychiatry, Forensic Psychiatric Services, Child & Adolescent Mental Health, Women’s Reproductive Mental Health, as well as the Provincial Specialized Eating Disorders Program for children and youth located at the BC Children’s Hospital.

Provincial Health Services Authority

Provincial Health Services Authority (PHSA) is one of six health authorities – the other five health authorities serve geographic regions of BC.

Ministry of Health

British Columbia Ministry of Health

RBC Children's Mental Health Project

RBC Children’s Mental Health Project is RBC's cornerstone “health and wellness” pillar; RBC Children’s Mental Heath Project is a multi-year philanthropic commitment to support community-based and hospital programs that reduce stigma, provide early intervention and increase public awareness about children’s mental health issues.

BC Children's Hospital Foundation

Through a wide range of fundraising events and opportunities, The BC Children's Hospital Foundation is united with its donors by a single, simple passion - to improve the health and the lives of the young people who enter BC Children's Hospital every day.