Treating Co-Occurring Mental Health Conditions in Adults With Autism

The need for mental health services for individuals with autism spectrum disorders (ASD) has grown over the past decade as the prevalence of ASD has dramatically risen to 1 in 68.1 As autism is a lifelong condition, this need does not end in childhood. Familiarity with mental health issues for adult providers has never been more essential as an estimated 50,000 individuals with ASD enter adulthood in the U.S. annually.2

For many adults with ASD, the primary barrier to success is often a co-occuring mental health condition. Depression, anxiety, and other affective disorders lead the way. No one on the autism spectrum is safe from this risk. Individuals with “high-functioning” ASD (normal or above normal IQ) are even more susceptible to affective disorders possibly due to increased self-awareness and sometimes greater demands placed upon them.

For many young adults, the systems that provided support in the teen years either disappear or deteriorate. Public school support ends between the age of 18 and 21, and with the current dismal track record of vocational success, it is not surprising that depression and anxiety are so prevalent.

Also, the relationship with parents, usually the primary support for individuals with ASD, becomes even more strained as the parents “burn-out” and the expectation is for the individual to become more responsible for their own actions. Young adults with ASD, even high-functioning, usually have not developed the skills to live independently by their early 20s.

In addition to depression and anxiety, numerous other major mental health conditions have been reported at a higher prevalence in the ASD population including attention-deficit/hyperactivity disorder, bipolar disorder, obsessive-compulsive disorder, tic disorder, psychosis, and catatonia. All of these conditions have overlap with core ASD deficits making it difficult to see where the autism ends and the associated mental health condition begins.

In lower functioning and non-verbal adults with ASD, diagnosing the specific mental health condition becomes even more challenging, as mood disruption can manifest with the “least common denominator” of worsening disruptive, aggressive, or self-injurious behavior. Typically, core deficits and disruptive behaviors improve gradually over time.

New or worsening mental health co-morbidity should be considered in adults that regress in adaptive skills or develop worsening of disruptive behaviors. Further complicating the picture of behavioral regression are other medical or neurological conditions that can be common in this population including seizures, sleep disorder, and metabolic conditions, and the difficulty recognizing and communicating symptoms related to these medical and neurological conditions.

The prominence of mental health conditions in adults with ASD is currently overwhelming the capacity of mental health and medical providers experienced in working with this population. There is a clear need for more mental health counseling, behavioral therapy, vocational counseling, and speech therapy, in addition to the need for oversight of medication management.