Does Autism Mask Some Mental Health Issues?

Takeaway: Children with autism are usually quite solitary and emotionally withdrawn, making it harder to spot mental health issues. And they’re especially vulnerable to conditions like obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression. If you’re concerned about your child’s mental health, it’s worth finding a team of specialists who can support you and put together a comprehensive care plan for your child.

Autistic children have brains that have developed differently. And this gives them a unique set of strengths and weaknesses.

Autism is a developmental difference, and a child with autism often has remarkable skills — like the ability to hyperfocus on a topic or excel at maths or music. But she’ll also have some challenges. For example, she might struggle to read people’s emotions, which means it’s harder to make friends and get along with others. Or she might dislike loud noises, bright lights, and large crowds — so an over-stimulating environment might cause her to have a meltdown. Or she might love her daily routine so much that it agitates her to eat a different breakfast or take an unusual route to school. These types of traits show up differently in each child, so we think of the autism ‘spectrum’ rather than any one type of autism. Learn more about autism spectrum disorder (ASD).

Autism isn’t a mental health issue, but children with autism do often struggle with their mental health.

Studies have shown that there’s a strong connection between autism and some types of mental health issues like anxiety, depression, and aggression.

The trouble is that autism can mask mental health issues.

It’s not only the mental health issue that’s challenging (after all, non-autistic children have these too.) Rather, it’s that since autistic children engage with the world differently, it’s harder to recognise when they’re not doing okay. For example, you can tell something is wrong if your child becomes withdrawn and stops making eye contact. But for many autistic children, this behaviour is normal. And if they find it difficult to talk about their emotions (which is very likely), it becomes even harder to spot the problem.

So, what are some mental health concerns your child might be vulnerable to?

Here are some red flags to look out for:

1. Obsessive and repetitive behaviour

Most autistic children love routine and repetitive behaviour, so how do you decide if/when this is a problem? For example, if your child prefers to put her clothes on in a particular order, is that her regular need for routine? Or is it something more? As a rule of thumb, keep an eye out for two things: (1) How much control does your child have over a particular behaviour (I.e., can she stop it if needed?), and (2) Has the new behaviour developed recently? Let’s take our ‘dressing up’ example. If your child puts her clothes on in the ‘wrong’ order, does she insist on undressing and redoing the routine until she gets it ‘right’? Or if she’s always liked dressing in that order, has become significantly more particular about it in the last few months? With extreme cases of repetitive behaviour (e.g., Obsessive-Compulsive Disorder [OCD]), there are obsessions (recurring and intrusive thoughts) that lead to compulsions (repetitive behaviour). So, for example, an obsession with dirt might lead to a compulsion to keep washing her hands. Really, you’ll need a skilled professional to make these distinctions, but it’s worth knowing what to look for.

2. Attention problems and hyperactivity

Some children with autism could have ADHD (attention-deficit/hyperactivity disorder). ADHD is an umbrella term that describes three related behaviour patterns.

1. Problems focusing (e.g., getting distracted in class)
2. Hyperactivity (e.g., constantly fidgeting while doing homework)
3. Impulsive behaviour (e.g., interrupting a lesson to ask off-topic questions)

Most children show these traits from time to time, though, so try not to jump to conclusions too early. (Learn more about ADHD.)

3. Anxiety

Children with autism often have to deal with anxiety because their differences make ‘fitting in’ so much harder. For example, their heightened senses mean that a noisy classroom is often unbearable. Or their need for order gets in the way of playing with a particularly chaotic classmate. Or their challenge reading emotions can make socialising highly stressful. So, as parents, how can we recognise and track higher-than-usual levels of anxiety? A useful strategy is to pay attention to physical signs like an elevated heartbeat, tightening muscles, stomach problems, etc. And we can try and connect these stress responses with the situations that triggered them. That way, we can help our children prepare for these triggers in the future.

4. Depression

Psychologists differentiate between ‘affect’ and ‘mood’. ‘Mood’ is how someone feels on the inside, whereas ‘affect’ is how they appear on the outside. With non-autistic children, mood and affect usually overlap during a depression. But that’s often not the case with autism. For example, your child might seem ‘emotionally blunted’ on the outside (showing minimal facial expressions and no specific emotions) but feel fine on the inside. So what are some clues to look for, instead? There are objective measures like reduced appetite, disturbed sleep, low energy and motivation, etc. And we can dig a bit deeper to uncover things like sadness, a damaged sense of self-worth, and a loss of hope. This might seem like a big ask but becomes manageable if we bring in an experienced therapist to help. And this is essential because the longer and more severe a depression, the greater the chances of a child becoming suicidal.

For milder versions of these conditions, your family dynamics can make a big difference.

All children live within a larger family ‘system’. So, the healthier the system, the healthier the child. Children with autism already deal with high stress and anxiety levels, so a stressed and anxious parent makes matters worse. In contrast, when you’re warm and nurturing, you give your child the strength and courage to work through anxiety and stress, which in turn will make her more independent and resilient.

For more serious mental health issues, you’ll need a team of healthcare specialists to help.

Children with autism have unique needs, so traditional approaches to mental health often don’t work. They may (1) Develop a serious psychological condition that remains undetected and untreated, and (2) Not have access to the people and tools who can help manage the condition. That’s why you’ll need a trusted team of specialists who can address autism and any co-existing mental health concerns.

Are you concerned that your child might be struggling with some of the issues we’ve discussed? If so, it’s worth reaching out for support.

The Ed Psych Practice offers consultation, advice, and problem solving for parents, nurseries, schools, and colleges, in London. We have psychologists and therapists who can help assess your child and offer guidance and support.

• Phone: +44 (0) 78 3344 7356
• E-mail: Office@TheEdPsych.com

Want to see how else you can help your child? You might enjoy some of our other posts.

• 7 Steps to Better Emotional Regulation In Secondary-Age Children
• Why Children Need to Learn to Manage Their Emotions
• Has Your Toddler Reached the Right Developmental Milestones?
• Why Auditory Delays Are So Easy to Miss
• What Are the Signs of ADHD? And What Can You Do About Them?
• How Speech Therapy Can Solve ‘Swallowing’ Issues (Dysphagia)
• Is Your Child’s ‘Working Memory’ Holding Her Back?
• Why Do Some Children Take Longer to Process Things?
• The Inner World of Social, Emotional, and Mental Health (SEMH) Needs
• Can Children Practice Mindfulness? And Does It Work?

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