Perspective

It is estimated that as many as 70% of those on the autism spectrum experience co-occurring mental health issues. While some mental health concerns are being identified in individuals as early as preschool, many are more likely to manifest themselves during adolescence and into adulthood. The most common co-occurring mental health issues include anxiety and depression. Others may include bi-polar disorder, oppositional defiant disorder, obsessive compulsive disorder, phobias, mood disorders, and disruptive mood dysregulation disorder, among others.

Managing the Intersection of Autism and Mental Health Issues

Supporting individuals and families living with co-occurring mental health diagnoses and autism presents many challenges, including:

• Clinical responses: Too few psychiatrists truly understand how autism and mental health intersect and how to properly treat mental health issues that co-occur with autism spectrum disorder (ASD). Often individuals are prescribed a cocktail of medications that may have unintended side effects. It is important to get references from friends and family members and your family physician, if you trust their recommendations, for reliable and trusted psychiatric care.
• A system that silos resources and services: In many states, developmental disability services are separate from those that support mental health, both in terms of access to funding and access to service provisions. An additional barrier to effective support is that community mental health centers often have neither the personnel nor the training to treat individuals on the autism spectrum. It is imperative that advocates continue to work toward a unified system and approach. Categories and labels should not drive need. Rather, each person should have access to a range of options based on their individual challenges.
• Educational support: School districts across many states grapple with having sufficiently trained support staff, including social workers and behavior consultants, who can accurately assess behaviors, develop positive behavior support plans that focus on building skills, and connect families with resources. As students on the spectrum are not the only ones at risk for mental health challenges, a school-wide approach benefits all students.
• Response to crisis: When extreme crises occur, the only options for parents are short-term solutions, such as calling the police or taking their child to the emergency room for immediate care. The more complex underlying issues that individuals with autism face often go untreated due to a lack of appropriate short- or long-term counseling, residential, and treatment options. Individuals on the autism spectrum are at greater risk of committing suicide. Adults report that crisis hotline staff often do not know how to communicate with them or how to respond in a timely manner to divert a crisis.

What Needs to Be Done?

Families need to better understand the intersection of mental health and autism in order to recognize when and why their loved one is struggling. They also need to know where to get help and what resources are available in their area. Beyond the family unit, we as a society need to systemically increase access to education, support, and counseling to help individuals with autism better manage their co-occurring mental health challenges.

For educators and service providers, it is essential that they are able to recognize the signs of possible mental health issues as well, and better address these challenges via behavioral supports and skill development (e.g., social skills, emotional regulation). Schools need to continue to focus on addressing the social emotional health of all students and reducing the stigma of mental illness so that everyone feels more comfortable interacting around these issues. Strategies such as building movement into the day, providing access to fidgets, allowing for breaks, addressing sensory challenges, and teaching alternative skills (e.g., self-management, emotional regulation) must be embedded across the day and environments. Staff need to model and maintain control over their own emotions so that individuals are not triggered. As such, staff need to address their own mental wellness as well.

Finding comprehensive solutions to meet the needs of persons with autism/autistic individuals with co-occurring mental health concerns will continue to be a challenge for all involved. States are beginning to recognize the problem and search for solutions so that people have better access to care. Still, there is more to be done to ensure that mental health help is available to all who need it.

Cathy Pratt, Ph.D., BCBA-D, is the director of the Indiana Resource Center for Autism and the Indiana School Mental Health Initiative at Indiana’s Institute on Disability and Community, Indiana University, Bloomington. Dr. Pratt is also a board-certified behavior analyst.

Betty Lou Rowe, M.Ed., is an educational consultant for the Indiana Resource Center for Autism and Indiana School Mental Health Initiative at the Indiana Institute on Disability and Community, Indiana University, Bloomington.