By Pat Matuszak
Sometimes one health condition can look like another. When my daughter and I saw red, itchy spots on her little girl’s legs, we guessed she’d walked through poison ivy. But we knew from experience they might also be caused by a common virus or a parasite-like ringworm. To get a reliable diagnosis, a doctor check seemed necessary.
While her mom started staging things for a trip to urgent care, I talked to my granddaughter about her day to distract from doctor-visit anxiety. She’d had a great time at a school picnic. They ran a sack race, and she told me how they used “real, old-fashioned potato sacks.”
A light bulb came on.
“Burlap bags?” I asked. “Were they brown and scratchy on your bare legs?”
So the mystery rash was solved by talking and listening.
Sometimes diagnosing mental health issues in individuals on the autism spectrum follows a similar course. Parents and therapists see certain symptoms and want to determine whether they’re the result of autism or a separate mental health issue. A visit with a knowledgeable clinician is usually scheduled, but getting as much information as possible from the patient is also helpful. The problem is, talking out a solution with someone with autism may be difficult or impossible.
If you have a loved one with autism, you know the wide variety of symptoms that may or may not appear in individuals who are “on the spectrum.” Communication difficulty is a big one. A person with autism may be able to speak very clearly but may be out of touch with their feelings. Or they may not be able to speak at all and yet be fully aware of feelings they cannot communicate.
This would create frustration and turmoil in anyone’s life. Imagine how much more difficult it is for someone already coping with autism spectrum complications.
Fear of change, anxiety about unfamiliar people and situations, difficulty filtering out background noise, feeling compelled to make repetitive movements and an overwhelming attraction to special interests (or fixations) are autism symptoms that may also be associated with mental health disorders. The frustration caused by these symptoms may be expressed across a wide range of reactions that vary from apathy to panic.1 But doctors don’t want mental health issues to go untreated because someone has autism.
After studying over 15,000 young adults — both with and without autism — Yona Lunsky, the study’s coauthor and a senior scientist at the Centre for Addiction and Mental Health in Toronto, concluded: “I think sometimes people will dismiss something as being part of autism when, in fact, it’s not.” Furthermore, Lunsky advises that “… symptoms and behaviors of depression and anxiety may look different in those with an autism diagnosis than in those without, and caregivers and providers need to understand that.”2
Lunsky cautions that there are people with autism who don’t have psychiatric issues, but the study found that those on the spectrum were five times more likely to have a psychiatric diagnosis than typically developing individuals.2 The question that arises is: How often are serious mental health issues being missed by doctors who believe their symptoms are part of autism?
It’s important to find the distinction between autism symptoms and mental health issues. For example, ritualized movements found in “stimming” are a common aspect of autism, so it’s important to connect with experienced therapists who understand the difference between autism and obsessive-compulsive disorder and can make a proper diagnosis. Different treatments and prescription drugs may work for one and not the other. Treatment has to be customized for each individual’s unique needs.
Patients on the spectrum may also experience more anxiety and should be treated for it as a separate issue rather than accepting it as part of autism. A Brigham Young University study by Mikel South found evidence that “instead of having an overactive fear response, people with autism have trouble finding a ‘safe space’ and, as a result, are afraid of everything.” More than half of the people he talks to who have autism are consumed with worry. “They worry about so much all of the time,” South tells Scientific American. “There’s nothing they’re not worrying about.”3
For many who are on the spectrum, Cognitive Behavioral Therapy (CBT) helps them deal with worry that has progressed to anxiety. CBT combines talk therapy with exposure to anxious situations to help patients develop appropriate and effective ways to cope. These sessions usually need to be ongoing because patients may have a difficult time applying what they practiced to new situations that weren’t practiced.
Helping individuals with autism communicate more effectively also helps them manage anxiety. Even when patients can only point to photos of objects and can’t speak, being understood about basic needs relieves some of their frustration.
While research is being done using drugs to treat anxiety, depression and hyperactivity, researchers caution that each patient may have a different reaction and tolerance. That’s why it’s important to work with expert clinicians who will monitor each patient carefully.3
“As a group, children and adults with autism spectrum disorder (ASD) have a higher rate of psychiatric disorders than that of the general population,” according to Autism Speaks, an online resource that publishes a wealth of information about the latest autism research findings.4 At the present time, emphasis is being placed on thorough diagnosis and developing tests that take autism into account so that other mental health issues aren’t missed. The goal is that patients on the spectrum won’t miss being treated for a disorder that is occurring alongside autism.
1 “Autism Spectrum Disorder.” Psychology Today, January 30, 2017.
2 Haelle, Tara. “Many Young Adults With Autism Also Have Mental Health Issues.” NPR, October 1, 2017.
3 Wright, Jessica. “Unmasking Anxiety in Autism.” Scientific American, October 9, 2017.
4 “Treatment for Associated Psychiatric Conditions.” Autism Speaks, Accessed December 8, 2017.
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