Symptoms of depression can vary across the lifespan based on development and can look very different for children and adolescents compared to adults. For instance, children experiencing depression can present as primarily irritable rather than sad/depressed and may engage in disruptive behavior or complain of physical discomforts instead of describing a loss of interest in activities they typically enjoy. Adolescents experiencing depression are more likely to sleep excessively (i.e., persistent sleepiness even after long periods of sleep). Male teens are more likely to describe feeling a loss of interest in activities they previously enjoyed and may be observed withdrawing socially and experiencing changes in mood/energy. Female teens more typically experience changes in appetite/weight, increased crying, and feelings of guilt/low self-esteem. Presentation differences in adults and children/teens with depression may be partially related to early development that led to limitations in understanding and communicating emotional experiences. Additionally, peer approval can play an integral role in establishing self-worth for kids and teens and peer victimization is correlated with symptoms of depression.
It may be assumed that children/adolescents with Autism Spectrum Disorder (ASD) are protected from the development of symptoms of depression. However, a growing body of research indicates that this population carries a significant increased vulnerability for developing depression. In fact, depression is more common among teens with ASD (as high as 35%) than teens without ASD (about 5% in the general population). Children and adolescents with ASD are often bullied, teased, or excluded in the school environment. Additionally, individuals with ASD may perceive the classroom as chaotic and may find that difficulties initiating and maintaining friendships can result in loneliness. This may be particularly true for children with ASD who have higher cognitive and social functioning as they may be more likely to develop lower self-worth based on self-perceived social difficulties. However, recognizing symptoms of depression for children and teens with ASD can be difficult because some of the sights of depression can look like typical characteristics of ASD (e.g., decreased emotional expression, social withdrawal). Additionally, impairments in communication associated with ASD can also make identifying symptoms of depression particularly challenging as kids and teens may have more difficulty expressing emotional distress.
Traditional signs and symptoms of depression for children, adolescents, and adults:
• Feeling down/sad most of the day nearly every day (increased tearfulness)
• Irritability (more commonly observed for children with depression)
• Loss of interest/pleasure in activities previously enjoyed
• Inability to fall asleep or stay asleep AND/OR oversleeping beyond developmental expectations
• Observable physical restlessness AND/OR observable slowed movements
• Fatigue/Loss of energy
• Social Withdrawal
• Weight loss/weight gain not associated with dieting or developmentally expected weight gain
• Increased feelings of worthlessness AND/OR inappropriate feelings of guilt
• Physical complaints and diminished emotional expression (more commonly observed for children with depression)
• Difficulty concentrating AND/OR increased difficulty making decisions
• Recurrent thoughts about death/thoughts about suicide
• Play characterized by themes of suicide/death (more commonly observed for children with depression)
Additional symptoms of depression that may be present for children with ASD:
• Aggression, irritability, agitation
• Intense/Severe mood swings
• Hyperactivity (abnormally active/disruptive behavior)
• Decreased ability to complete daily living needs (e.g., brushing teeth, showering, following school/safety rules)
• Return to previous developmental functioning/ regression to previously learned skills
• Increased compulsiveness
• Fluctuation in ASD symptoms including EITHER/BOTH increased stereotypic behavior and decreased interest in preoccupations/ restricted interests
• Self-injurious behavior reflecting emotional distress (examples include but not limited to: cutting, scratching, head-hitting, head-banging, and hand-biting)
• Catatonia (state of unresponsiveness/abnormal movements associated with mental state)
• Overall significant changes from typical behavior
It is important that parents and teachers identify observed changes in behaviors that may indicate symptoms of depression for typically developing kids and teens, as well as for kids and teens with ASD. If you are noticing any of these changes in behaviors, check in with the child/teen about how they are feeling. Using visual representations like a 5 point scale can be helpful for individuals with difficulty communicating. Also remember to talk to a professional if you have concerns about possible depression for a child/teen with ASD.
Author: Michelle Meleka, M.A.
Hedges, S., White, T., & Smith, L. (2014, May). Depression in adolescents with ASD (Autism at-a-Glance Brief). Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, CSESA Development Team.
Magnuson, K. M., & Constantino, J. N. (2011, May). Characterization of depression in children with autism spectrum disorders. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154372/developing children/adolescents and those observed for children/adolescents with ASD: