Depressive Symptoms in Children with Autism Spectrum Disorder

Background: The detection of depression in children with autism spectrum disorder (ASD) can be problematic, even for experienced child mental health clinicians. An awareness of the presentation of depressive features in ASD is therefore important.

Objectives: This study describes the prevalence of parent-reported depressive symptoms in children with high functioning ASD, and the associations with autistic features, non-affective comorbidity, and competencies.

Methods: This is a retrospective study of 90 children (76 boys,14 girls; age range 5-16 years; mean age 9.9 years) referred to an autism assessment clinic and subsequently diagnosed as having a high functioning ASD. Data derived from the CBCL, ADI-R, and ADOS were analysed. 

Results: Thirty four children (38%) had a CBCL Affective Problems score in the clinical range, with 94% having significantly impaired competencies. In addition,there were high levels of comorbidity, with 88% having an additional DSM-oriented Scale score in the clinical range.

For the whole sample, Affective Problems were significantly correlated with higher levels of anxiety, more ADOS social affect impairments, and reduced activity competence (p<.01).

When compared with the rest of the sample, Affective Problems cases were particularly discriminated by higher levels of 'tiredness' (47% vs 2%),'self-harm' (53% vs 7%),'lack of enjoyment' (68% vs 21%),'depression' (71% vs 25%),'suicidal talk' (47% vs 9%), and 'sleep problems' (65% vs 27%) (p<.0001). In addition,the group had significantly higher ADI-R social and communication symptoms (p<.01), and more ADOS social affect impairments (p<.05).

Conclusions: Clinically significant levels of impairing depressive symptoms were common in this clinical sample of children with ASD. Although individual affective symptoms discriminated children with depression, the clinical picture was complicated by the frequent coexistence of non-affective symptoms. In addition, depressive symptoms may affect parental-reporting and clinical observations of autistic behaviours, further complicating accurate diagnostic assesment.

This study emphasises the need to enquire about the specific features of depression when assessing children with suspected ASD, and to be particularly alert to the presence of suicidal thoughts and self-harm. This approach is essential for the early detection and treatment of depressive disorders.