More often than not, kids with autism also have a mental health condition such as ADHD, anxiety or depression. This is referred to as a co-occurring condition or a comorbidity — and as many as 80% of people with autism also have a co-occurring mental health condition.
Because this is so common, awareness is important for parents of children with autism, say child and adolescent psychiatrist Melissa Hendriks, M.D., and pediatrician Tisa Johnson-Hooper, M.D., both with the Center for Autism and Developmental Disabilities (CADD) at Henry Ford Health.
Here, we share what you need to know about autism and mental health, and offer tips for getting your child the care they need for their mental health.
Mental health conditions may show up earlier in children with autism
Often, kids with autism are receiving ABA therapy or seeing a psychologist. Because they are spending time with care professionals, their behavioral health is on the radar, and symptoms may be spotted more quickly.
“ADHD is commonly identified in the early elementary years. For most children, this is around age 7, but it may be diagnosed earlier in children with autism,” says Dr. Hendriks.
Autism often coexists with mental health conditions
Symptoms of a mental health condition can often be attributed to a child’s autism diagnosis — but they shouldn’t be, necessarily. It’s important to be on the lookout for other possible causes of behaviors as early identification and intervention lead to better outcomes.
When parents notice changes in behavior, they should contact their child’s primary care provider, as it may signal ADHD, anxiety or depression.
“It’s the role of the primary care provider to screen for both physical and behavioral health,” says Dr. Johnson-Hooper. “While everybody may have risk for behavioral health conditions, kids with autism are at significant risk of co-occurring behavioral health diagnoses. The primary care provider and parent need to be intentional and screen this population throughout childhood.”
Professionals can determine the “why” behind behaviors in children with autism
Because of the complex nature of co-occurring autism and mental health conditions, an evaluation with a child and adolescent psychiatrist can help determine the underlying cause for any behaviors of concern.
Is a child having a hard time sitting through class because there is a sensory concern or an attentional concern and they can’t sit for more than 20 minutes? Or is there an intense interest in the back of the room that they want to check out and are highly motivated by?
“The reason for the behaviors is the first step when trying to determine whether a certain behavior is related to autism or ADHD, or both,” says Dr. Hendriks. All behavior is an attempt to communicate and it’s up to parents and health care professionals to figure out the “why” in order to address it.
Parents should be aware of mental health concerns and look for early signs
Watch your child for any behavior changes. Get feedback from key players, such as teachers, coaches, therapists and other family members. What are they noticing?
“If your child was always a good sleeper and suddenly is not sleeping well, or they were a good eater, but not now, or if they are typically in good spirits but now irritable, these could be signs that something else is going on,” says Dr. Hendriks.
Changes in behavior from home to school is also good information to gather because it can better help you determine what’s going on.
Physical complaints are important to note, too. “A lot of stomach aches, headaches, not feeling well at school, especially if it’s happening frequently but there’s no sign of a physical illness. This is another clue that something is going on that is bothering your child,” Dr. Hendriks says.
What to do if you are concerned about your child’s mental health
“Talk to your child, first and foremost,” suggests Dr. Hendriks. Then, start with a visit to your child’s pediatrician, especially if your child struggles with communication or with talking about social and emotional problems they might be experiencing. The pediatrician can help rule out any medical problems, then make a referral to a mental health professional — a child psychiatrist or a child psychologist, social worker or counselor — if appropriate.
Early diagnosis and treatment are important for the best outcomes, says Dr. Hendriks.
There’s no one-size-fits-all treatment, so anticipate an individualized approach
If your child is experiencing a co-occurring mental health condition, be prepared to work with health care providers to support their needs. You may have to try different approaches, based on what’s best for your child and appropriate for their age.
“I think it’s important to look at your environment,” says Dr. Johnson-Hooper. “How might your environment be modified to support your child regardless of the diagnosis? What behavioral interventions may be of benefit? It needs to be developmentally appropriate from early to mid to late childhood.”
Be sure to find out what supports are available at school, too. And know that you may need to focus on one issue at a time. “If the child has autism and severe ADHD, we may need to deal with that ADHD before we can make any improvement or impact on their social communication,” Dr. Johnson-Hooper says.
Above all, trust your instincts. You know your child best. If something isn’t a good fit, don’t be afraid to express your concern. “I would empower families to speak up when things don’t feel right, even if it’s just for it to be explained in another way. Be willing to pump the brakes until it feels right,” she says.
Consider your child’s lifestyle basics and how they impact mental health
Diet, sleep and exercise can have more influence than you might think, so be sure to get down to basics and focus on making the healthiest choices possible.
“If your child is sleep deprived, you’re going to see more behavioral concerns like hyperactivity and impulsivity,” says Dr. Johnson-Hooper, adding that an unhealthy diet will not help your child feel their best.
Address your own beliefs about mental health and reduce stigma
This varies from one culture to another, but historically, those with behavioral health diagnoses have been marginalized or ostracized. What are your own beliefs about mental health?
Don’t let fear and stigma stop you from getting your child the help they need. Instead, try to be open to what your child’s doctor and therapy team suggest, and ask as many questions as you can to get a better understanding.
“If you don’t know anything about mental health, you may not know how to even identify the concern and then address it appropriately because you don’t have anyone in your family, in your community, or elders to give you direction, support and encouragement. Stigma impacts early identification and compliance with intervention,” says Dr. Johnson-Hooper.
Ask your child’s doctor to share information about mental health organizations in metro Detroit that understand your culture and can provide culturally competent support. Speaking with someone with lived experience can help you better understand what a mental health diagnosis means — and how treatment and interventions can help.
Content sponsored by Henry Ford Health Center for Autism and Developmental Disabilities. Learn more at henryford.com/services/autism.
