It has been said that you can’t understand a mind except in the context of the world it lives in. Often an inability to shift your frame of reference may not allow you to understand why an autistic individual thinks or behaves the way they do. For many autistic individuals their behaviors may be colored by a mood disorder. I have a friend whom I would describe first and foremost as a gifted writer. I would not dare to question him as to the autism literature because it is quite evident that he has encyclopedic knowledge on the subject. Yet he puts himself down whenever praise is bestowed upon him. He grieves for the person he could have been without autism in a way that expresses self-guilt. I worry about him, as he lives in another state and his ruminations, pessimism, and feelings of worthlessness/helplessness, make me believe he is depressed. He attributes difficulties in concentration and remembering details to autism, but I have to wonder whether these difficulties are really confounded by depression. It does not help that being an adult he is apparently socially isolated and some of his emails and other postings (late at night and early morning hours) suggest a disorganized sleep pattern.

In neurotypicals aging is a risk factor for major depression. This causal link may become a vicious cycle as depression may accelerate the aging process. It should be clarified that the aging process itself does not cause depression; rather there are many circumstances associated with aging that can promote mood changes (e.g., chronic medical conditions, diminished eyesight/hearing, limited finances, social isolation). I do believe that the natural history of major depression in older neurotypical adults is faced at a younger age in autistic individuals. Marsha Mailick in her presidential address at IMFAR this last year (http://bit.ly/YBU8jx ) described cognitive changes that occurred in high functioning autistic patients immediately after their high school years. These changes occurred after autistic individuals broke their social contacts with schoolmates, could not proceed to college, and were still ill prepared to find a job.

In the case of individuals with an autism spectrum disorder it is easy to see why the risk factors for depression may occur sooner than expected. For many this occurrence is a revelation that they lack control over their own lives. In other autistic individuals depression is an expression of perceived lack of accomplishments when compared with neurotypicals. This realization is one of the reasons why I believe Theory of Mind is misguided in autism (see http://bit.ly/1Fj7YI5 and http://bit.ly/1xTC6cf ). Abnormalities of Theory of Mind would demand equal deficits in both the awareness for others as well as that of our own consciousness or state of being.

Many of the problems faced by neurotypicals when they are in their 60’s are experienced by autistic individuals in their teenage years. Among these factors are a perceived lack of purpose, limited finances, poor eating habits, and lack of exercise. Confounding these factors stress reduces the ability of the immune system to respond to injurious elements thus fostering illness and deteriorating health- themselves risk factors for depression. What can we do in this regard? Are there preemptive steps to avoid depression?

I have always found that in raising children they don’t actually need to be “in control” all of the time. In order for them to be psychologically healthy what they really need is to attain a “sense of control”. Many autistic individuals may develop rituals as a way of gaining this sense of control, of reassuring themselves that life goes on in a familiar way. This is why I would promote approaching the behavior of an autistic individual with open (rather than closed) questions. Open questions provide choices to the person, and the ability to provide a decision by contrasting at least two possibilities. You always need to stress the sense that things can always get better and that they do have an element of predictive control over their environment.  I would list some preventive strategies for mood disorders, that can be implemented by parents, as follows:

1) Teach your children that they are loved unconditionally.
2) Enlist family and social support in raising your child.
3) Teach your child, by self-example, to let go of past mistakes and/or negative experiences. In this regard we can grow along with our children.
4) Instill a sense of spirituality
5) Find an outlet for frustrations.  Sometimes hobbies are good outlets to vent frustrations.
6) Institute healthy dietary habits
7) Emphasize physical fitness
8) Teach socialization skills, manners, and taking turns
9) Recognize mood disorder symptoms and be ready to ask for help
10) Provide autobiographical material of people with ASD that were/are high achievers

Postscript:

Anxiety disorders are quite common in autism, especially those that are higher functioning. Clinicians believe this skewed ratio of comorbidity towards those that are higher functioning is due to the fact that they can express themselves better. These individuals may suffer from palpitations, shortness of breath, muscle tension, impaired concentration, and an inability to seat still and calm. Still, during an anxiety crisis the person’s character and personality traits may remain intact, he/she can still have hope for something better, and he/she can still enjoy life.

Among mood disorders in autism depression is less prevalent than anxiety. Still, I believe it is the bigger daemon. Major depression can destroy you. Winston Churchill called this his “black dog”, although “ruthless beast” may have been a better descriptive terminology.

Depression takes away the strength to imagine a more cheerful tomorrow. There is no joy from being with your loved ones, visiting your parents or going out for a walk in the park. Your pattern of thoughts is altered and anything in your environment is taken as an excuse to further bring you down.  This is the beast we all have to watch for in order to squash it as soon as it raises its ugly head.