Child, Parent, and Systemic Correlates of Comorbid Anxiety and Depression in Adolescents and Adults with ASD

Background:   Symptoms of anxiety are one of the most common mental health problems in individuals with autism spectrum disorders (ASD), with the majority having some level of impairment attributed to anxiety (White et al., 2009). Although less common, depression is also noted as a major concern (Hedley et al., 2006). Little is known about how individual with ASD who experience comorbid anxiety and depression differ from those with only anxiety or those without any internalizing problems. Understanding the factors that differ among these groups can help us tailor interventions more effectively.

Objectives: This study examines child (age, gender, ASD symptom severity, intellectual ability, aggression), parent (age, gender, education, service and caregiver efficacy, and burden), and social and systemic factors (family distress, negative life events, history of emergency department and hospital use, current mental health care use) that differentiate people with ASD with a history of anxiety and depression from those with no history of internalizing symptoms and those with only a history of anxiety problems.

Methods: As part of an online survey, 330 parents (M = 48.9, SD = 7.4) of adolescents and adults with ASD (M = 18.4, SD= 5.8) completed brief measures of children’s problems with depression, anxiety, and aggression (Yes/No), severity of ASD symptoms (Social Communication Questionnaire; Rutter et al., 2003), level of intellectual functioning (parent report), family distress (Brief Family Distress Scale; Weiss & Lunsky, 2011), caregiver mastery and burden (Revised Caregiving Appraisal Scales; Lawton et al., 2000), history of emergency room visits and psychiatric hospitalizations, and negative life events in the last two months. The majority of parents were mothers (94%).

Results: Only 14% of the sample did not have a history of problems with anxiety or depression, compared to 50% with only anxiety and 35% with depression and anxiety. Only 1% were noted to have depression only, and as such were removed from analyses.  As expected, individuals with anxiety and anxiety/depression received more mental health services and were more likely to have a problem with aggression than those without internalizing symptoms. Parents of individuals with anxiety/depression reported lower rates of perceived service and caregiving efficacy than parents of individuals with no internalizing symptoms. Individuals with ASD and depression/anxiety had higher intellectual functioning, more negative life events, more family distress and were more likely to have visited the emergency department and have had a psychiatric hospital admission than individuals with only anxiety and those with no internalizing symptoms (all p’s < .001).  

Conclusions: The present findings describe the challenges faced by adolescents and adults with ASD and their parents, when children have comorbid anxiety and depression. Possibilities for intervention and future research will be discussed.