How to Be Normal: Trapped with Autism and Depression

An Autism diagnosis for many goes hand in hand with a Depression diagnosis.

light and dark sides of autism
Autism is a lifelong disorder with many adverse effects on behaviour and socialisation that makes depression and social isolation very likely. Photo via Snyman.Carla artwork on instagram.

How can a person be and act ‘normal’ when they have two disorders which are commonly known for causing social isolation (Autism and Depression) ?

Which both have diagnostic qualities for preventing social interaction and for decreasing overall happiness.

Yeah, they probably cannot.

AUTISTIC DEPRESSION

Neurotypicals (common term for Autistic people within the community) are prone to depression and many other mental health problems such as anxiety disorders and obsessive compulsive disorders (OCD), especially in their teen and young adulthood years.

It is hard enough for ‘normal’ adults to discuss mental health issues and seek help but for neurotypicals it is almost impossible; many have trouble communicating their thoughts and feelings, let alone disturbances, anxiety and/or distress in their lives and minds and it is very common for disorders such as depression to not be diagnosed until the effects are very evident (e.g. attempted suicide). 

WHY IS DEPRESSION SO COMMON WITH PEOPLE ON AUTISTIC SPECTRUM

A neurotypical adult faces many difficulties across three broad areas called the triad of impairments.

Meaning that experienced problems will be felt to varying degrees when it comes to social communication, social understanding and imagination.

The neurotypical person has troubles already in initiation of appropriate social interaction with other peoples around them, also with establishment and maintenance of relationships and anticipation of future events socially.

Depression for neurotypicals is thus a common and almost expected understandable reaction when faced with social isolation, relationship issues and problems that are daily challenges.

SIGNS AND SYMPTOMS OF DEPRESSION IN AUTISTIC PEOPLE CAN OFTEN BE MISINTERPRETED OR MISUNDERSTOOD

It is common for anyone to feel sad, but when feeling sad lasts for more than a few weeks and interferes with daily functioning, it becomes depression and atleast 20% of the population will experience a period of depression.

The problem when it comes to depressed people on the autism spectrum though is that an even larger percentage of those with the disorder experience it.

To the ordinary neurotypical depression symptoms might be found as change daunting and anxiety-provoking; they always feel worried enough of being blamed because of social awkwardness and not feeling validated and being generally unsure how to describe symptoms to others.

Autism, anxiety and depression is a terrible mix that can often be mistaken for each other.

Neurotypicals also find difficulty in labelling their feelings so communicate symptoms or concerns is infinitely harder.

Depression’s signs and symptoms often include mood changes such as flat emotional reactions or irritability or extremeness of feelings like sadness which are often seen in neurotypicals and can thus be misinterpreted by others (e.g. children on the spectrum might not really understand emotions and not thus be able to express them or some even have extreme outbursts which are treated as merely tantrums). 

Thinking patterns also change with many neurotypicals experiencing a sense of hopelessness and/or pessimism which cannot always be expressed well in spoken word or facial expressions by the autistic person.

Behavioural changes of depression can also be mistaken with common traits of Autism such as reduced attention (many neurotypicals have OCD) or physical appearance withdrawal (many autistic people do not care about looks).

Physical symptoms such as sleep disturbance, appetite changes and/or tiredness might be some of the only really helpful diagnostic material for neurotypicals as many do keep daily routines and habits that remain unchanged.

The most important consideration of depression is the severity of it and the time period within which it lasts; and for neurotypicals it can take longer to recognize and thus become more severe as time passes.

So recognition by self, family, friends etc. is vital in order for psychological support or any other forms of treatment by professionals to be received.

PERSONAL STRATEGIES FOR COPING WITH DEPRESSION

Thought challenging Self-Talk could be a useful technique for neurotypicals in modifying inaccurate and/or upsetting thoughts that come with autistic depression.

What is required is practicing replacing horrible thoughts with constructive explanations.

For example instead of negatively thinking, “I’ll never understand people,” the neurotypical can replace their thoughts with any constructive explanation such as, “I need to study up more about reading people’s body language, and then I’ll be able to better understand them next time.”

TREATMENT APPROACHES FOR AUTISTIC DEPRESSION

The most important step to getting help and treatment for the autistic person is through telling someone they trust.

Then a referral to a specialist service.

Autistic people with very severe forms of depression will probably require other forms of interventions such as hospitalization or medication.

But the problem is many specialized services in the Autism sector are scarce, with limited facilities (e.g. Lethabo Le Kutso) and options and treatment available in SA, for both children and especially adults with autism. 

But if hospitalization or other treatment is found and a neurotypical’s state of mind has been somewhat improved they can more than likely further benefit from psychological support to further reduce symptoms and provide ongoing management of the depression and the autism together.

Psychological therapy and support is specially crafted for autistic people with depression and can be used as this form of treatment is usually most effective with any mild to severe forms of depression.

Antidepressant medication for anyone with autistic depression needs to be monitored as mood changes and other side effects could be more lethal than helpful.

SUICIDE AND CONCLUSION

“Given the many difficulties faced by adults on the autism spectrum, feeling suicidal can occur when problems mount up. It is crucial to look for support or see a doctor during this periods as appropriate support will normally allow the person to get through these deep depressive episodes.”

One anonymous person using the alias of Claire S. has described in the given quote her feelings of having autism and depression;

“I have had depression a lot and then not a lot in the past and present. I am generally a very cheerful and happy person by nature (have everything I need and have a comfortable home and good marks and good friends and good family) but when I am confronted with a messy room, do not feel like I am fitting in with classmates or can’t do something, am criticized or my parents or anyone else argues and fights with me, I feel extremely depressed to the point of considering suicide almost immediately.”

There is thus no such thing as normality, only coping.

Reference List:

  1. Autism Speaks. McDougle, C. 2019. What’s the connection between autism and depression? 5 September 2018. [Online]. Available at: https://www.autismspeaks.org/expert-opinion/whats-connection-between-autism-and-depression [Accessed 28 May 2019].
  2. Greenberg, R. 2018. Bullying Linked to Depression in Youth With Autism. Psychiatric News, 53(16): 18-20. [Online]. DOI: 10.1176/appi.pn.2018.8a8. Available at: https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2018.8a8 [Accessed 28 May 2019].
  3. Health 24. 2000-2019. 30% of people with this disorder have kept it a secret. Health 24, 17 November 2017. [Online]. Available at: https://www.health24.com/Medical/Depression/Living-with-depression/30-of-people-with-this-disorder-have-kept-it-a-secret-20171010-2 [Accessed 27 May 2019].
  4. Instagram. 2019. Asperger’s verses and curses. [Online]. Available at: https://www.instagram.com/p/Buje_-Zhh5i/ [Accessed 30 May 2019].
  5. Lethabo Le Kutso, n.d. Day care, Residence & Vocational Stimulation for Adults with Autism, n.d. [Online]. Available at: http://www.autism-llk.org.za/ [Accessed 28 May 2019].
  6. National Autistic Society. 2018. Mental Health and Autism, n.d. [Online]. Available at: https://www.autism.org.uk/about/health/mental-health.aspx [Accessed 28 May 2019].
  7. Synapse. 2008. Depression & Autism Spectrum Disorders, n.d. [Online]. Available at: https://www.autism-help.org/adults-aspergers-depression.htm [Accessed 28 May 2019].
  8. WordPress. 2011. Autism. [Online]. Available at: https://williamoconnor.files.wordpress.com/2011/07/autism.jpg [Accessed 30 May 2019].