What Could Depression Look Like?

Traditional signs of depression may include the following:

• Sadness or tearfulness
• Limited interest in previously pleasurable activities
• Excessive tiredness or difficulty sleeping
• Change in appetite
• Feelings of guilt or worthlessness
• Play including violent themes such as death
• Physical complaints such as headache or stomachache
• Difficulty concentrating
• Withdrawal from peers or family members
• Recurrent thoughts of death or suicide

Additional signs of depression in children with ASD may include:

• Decrease in self-care or hygiene
• Loss of previously learned skills
• Increased stereotypic behavior (e.g., pacing, hand flapping) or decrease in focused interests
• Self-injurious behavior
• Increased compulsive behavior

Example: A school-aged child engages in violent play, draws dark images, and writes violent stories related to death. They spend more time in their room, say they have no friends and everything in life is bad, and their grades worsen. They engage in more ritualistic and compulsive behaviors. They previously had a strong interest in going outside but display less motivation and interest in going outside to play.

Suicide Risk and Warning Signs:

• A diagnosis of ASD is considered a risk factor for suicide. Some characteristics of autism can be misperceived as warning signs for suicide. There are important considerations to pay attention to when asking an autistic individual about suicidal ideation or when assessing an autistic individual for suicide risk. Questions related to suicide and the purpose of life may be misinterpreted by autistic youth.  For example, many autistic youth struggle with cognitive flexibility, social isolation, and feelings of not fitting in; therefore they may have difficulties answering questions related to suicide due to lifelong challenges. Careful consideration of the meaning of an autistic youth’s answers is important. 
  

• Acute Suicide Warning Signs Include:
  • Threatening to or talking about hurting or killing themselves;
  • Seeking out ways to kill/harm themselves (firearms, substances, etc.)
  • Talking, writing, or drawing about death or suicide

• The above description of depressive symptoms may also be warning signs. Other signs to consider related to suicide risk:
  • No reason for living; lack of purpose in life
  • Feeling of being stuck/trapped – no way out
  • Increased recklessness or engaging in risky activities
  • Giving away previously important possessions
  • Increased anger and/or seeking revenge 

• If you or anyone you know is experiencing suicidal thoughts or exhibits warning signs, contact the National Suicide Prevention Lifeline at  1-800-273-8255 for support from a trained counselor. If you or someone you care about is in immediate danger, call 911.

Resources

• National Suicide Prevention Lifeline: 1-800-273-8255 
• Colorado Crisis Services: 1-844-493-TALK (8255) or text “TALK” to 38255
• Mental Health Colorado 

Suicide Prevention for Autistic Youth

• Crisis Supports for the Autism Community: A Toolkit
• Autism Resource for Warning Signs of Suicide
• Warning Signs of Suicide for Autistic People: An autism-specific resource based on research and expert consensus
  

How To Help Your Child With Depression

Helping your child understand their sadness and depression is an important first step. Your child may not understand why they feel sad and/or have a hard time sharing these emotions.  For older children, providing education about the probable causes of depression (e.g., stress, genetics) and the role of brain chemistry (e.g., low levels of certain chemicals in the brain) may help to normalize their feelings and reduce self-blame. Psychotherapy, specifically Cognitive Behavior Therapy (CBT), is recommended to help your child understand the connection between thoughts, feelings, and behavior. CBT may also help to decrease your child’s negative self-talk.

• Similar to recommendations for other mental health conditions like anxiety, engaging in self-care can help manage depressive symptoms: 
  • Self-Care

• Regular exercise
• Good sleep hygiene
• Eating a well-balanced diet
• Encourage your child to engage in a range of hobbies or activities
  • Behavioral activation is a technique frequently used for depression. It involves increasing engagement in activities that your child finds pleasurable and/or feels successful. It also involves decreasing activities that maintain the feelings of depression (e.g., activities that increase self-doubt). Activities that may be helpful for increasing pleasure may include creative projects such as art and painting or relaxing activities such as baths and reading. Other ideas may increase a feeling of success or accomplishment such as finishing a puzzle, volunteering, or learning a new skill.
  • Start Small and Use Rewards
    • Making changes is hard work! It can be very helpful to use rewards to increase motivation. It is important to begin with small goals so that your child meets their goal and feels successful from the start. Talk with your child about what they want to earn when they meet their goal. Earning tokens, stickers, or marbles that they can then turn in for a special treat, or for more time doing a favorite activity can be helpful. For older children or adolescents, earning extra screen time, a trip to get ice cream,  a movie night, or even money may be motivating.
  • Build-in regular time at home to talk about your child’s feelings. Especially if your child is in therapy and beginning to learn to identify and express their feelings, it will be important to provide an open and comfortable environment for your child to talk about their feelings.
  • Help your child develop a list of their positive qualities. This may be helpful for your child to look at when they are feeling sad or experiencing low self-esteem.
  • Encourage your child to use positive self-talk. For example, instead of your child saying “I’m not good at anything,” they can list what they are good at such as “I’m good at riding my bike and being a caring friend.”