Abstract
Autism spectrum disorder (ASD) has a high rate of psychiatric comorbidity. The prevalence of comorbid depression seems to correlate with higher functioning forms of ASD and increasing age. Adolescence is a time when youth struggle with identity and interpersonal relationships, and a diagnosis of ASD further complicates this process. Adolescents with ASD may be more aware of the social communication deficits that come with the diagnosis than children with ASD, and it is theorized that higher functioning adolescents may experience this more acutely. While this may be true, the lack of reliable rating and diagnostic scales for depression in individuals with ASD makes it difficult to accurately measure rates of depression among individuals with more severe verbal deficits. While some research has focused on the prevalence of comorbid depression in children and adolescents with ASD and on the associated risk factors, there is very little evidence guiding treatment, including no empirical studies on psychopharmacology for depression in this population. Available evidence exists only in psychosocial approaches to treatment at this time and is mostly limited to adult studies. Current evidence will be presented in this review, including prevalence rates of depression in youth with ASD, various risk and protective factors, the use of diagnostic rating scales, and treatment studies. The lack of evidence supporting various treatment approaches will be highlighted, including challenges specific to the treatment of depression in ASD, which are not addressed in the current treatment studies in typically developing youth with depression.
Highlights
Autism is a diagnosis that includes social communication deficits and restricted and repetitive behavior, interests, or activities, which are severe enough to significantly impair functioning [1].The prevalence of autism spectrum disorder (ASD) has increased significantly over the past few decades, affecting 1 in 59 children in the United States, based on recent Centers for Disease Control data [2]
There is a relative lack in validated instruments for measuring comorbid psychiatric illnesses in the ASD population; it is no surprise that prevalence estimates of depression vary widely, from 2% to 30% [3]
Depressive symptoms were measured using the Centre for Epidemiological Studies Depression Scale—Children’s Version (CES-DC), and the results showed significantly higher rates of depressive symptoms in the ASD group versus the comparison group
Summary
Autism is a diagnosis that includes social communication deficits and restricted and repetitive behavior, interests, or activities, which are severe enough to significantly impair functioning [1]. ASD frequently includes associated behavioral symptoms and comorbid psychiatric diagnoses, which can be as impairing as the core symptoms in some cases. It can be difficult to distinguish associated symptoms of ASD from comorbid psychiatric diagnoses (repetitive behaviors in ASD may be very similar to compulsions seen with obsessive-compulsive disorder, for example), making it hard to measure true comorbidity in youth with ASD. Identifying comorbid diagnoses in children and adolescents with ASD is important in guiding clinicians toward more appropriate and targeted treatment for these symptoms. Reviewing research on the prevalence rates and risk factors of depression in youth with ASD is important to help clinicians more accurately diagnose depression in this population and provide appropriate interventions. More research is needed examining efficacy and safety of treatment of depression in youth with ASD as current evidence is lacking in this area, and most treatment decisions are extrapolated from research in depressed youth with typical development [7]
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