Written by: Dr. Rick Manista
No one wants their child to be sad. We can see them not engaging with peers, not doing well in school, or even not eating the same foods. This can be more complicated with a diagnosis of Autism. It becomes hard to separate the diagnoses and identify what is the main need for the child. Factors of social communication, sensory processing and mood can look similar, understanding the differences helps us create a plan to best support the child’s needs.
Autism Spectrum Disorders (ASD) relate to a wide range of symptoms. The most important is the brain’s inability to perceive social situations and communicate (Gargaro et al, 2011). Often this is the inability to read social cues. This causes children to think in literal “black and white” terms. Abstract thought and imaginary play are very challenging for a child with an Autism diagnosis. While typically developing children can learn social skills through observation, children with Autism cannot learn that way and require social situations to be taught didactically and often repetitively. Because of this, children on the Autism Spectrum miss developmentally milestones.
Children with Autism can have sensory issues as well. This occurs when the brain has difficulty processing information from the five senses (Hofmann & Bitran, 2007). Children may be sensory seeking where they fidget often, gets distracted or constantly touches objects. Children may also be sensory avoiding where they would refuse to go to loud areas, refuse to wear certain clothes based on the material and refuse to try new food of different textures. This may cause them to become overly excitable, angry, silly or nervous in a given situation. In these situations, a sensory diet created by an occupational therapist can help.
Depression is diagnosed by a constant low mood and loss of interest in activities. Often children with depression experience sadness and hopelessness, but in some cases children have anger outbursts. This becomes diagnosed when the behavior interferes with school, family and social activities. Other symptoms may include changes in sleep patterns, changes in appetite, physical complaints (such as stomach or headaches) and inability to concentrate. Children typically show different symptoms in different settings. Depression can be caused by a combination of factors including life events, genetics, physical health or environment. Often treatment consists of counseling and sometimes an antidepressant.
How Autism and Depression Differ
Depression can often be misdiagnosed in children with Autism. Symptoms of Autism include having a flat affect and not interested in social interactions. Although this may look like depression, these symptoms are common with Autism Spectrum Disorders. Children with Autism avoid social situations because they have no interest in them. Often they prefer repetitive, concrete tasks. Depressed children avoid situations because of underlying feelings of sadness.
Autistic children also avoid situations because of sensory overload. This causes them to have changes in sleep patterns. This can also cause them to stay away from certain foods because of the textures. Depressed children would have trouble with these activities because of their mood.
One main area to differentiate Autism and depression is with social skills. Children with Autism would show more progression in social skills, changing behavior such as social interaction, interpersonal skills, self-regulation and perspective taking (Garcia-Winner & Crooke, 2015). Children with depression would not progress in such a setting, but would progress with counseling and medication. On the other hand, Autistic children would not progress from typical counseling approaches alone.
While children with Autism may appear depressed, their behavior is a result of social difficulties that can be helped through social skills. Children with depression suffer from underlying sadness that can be helped with counseling and medication. Understanding both diagnoses can help us differentiate and identify wait the main need is.
Garcia-Winner, M., & Crooke, P. (2015, September 18). Updates on the social thinking's cascade of social attention: A conceptual framework to explore a system's approach to social communication. Retrieved October 15, 2018, from https://www.socialthinking.com/Articles?name=Updates on Social Thinkings Cascade of Social Attention
Gargaro, B. A., Rinehart, N. J., Bradshaw, J. L., Tonge, B. J., & Sheppard, D. M. (2011). Autism and ADHD: how far have we come in the comorbidity debate?. Neuroscience & Biobehavioral Reviews, 35(5), 1081-1088.
Hofmann, S. G., & Bitran, S. (2007). Sensory-processing sensitivity in social anxiety disorder: relationship to harm avoidance and diagnostic subtypes. Journal of anxiety disorders, 21(7), 944-954.
Dr. Liz Matheis
Dr Liz Matheis and her team specialize in assisting children and their families with Anxiety, Autism, AD/HD, Learning Disabilities and Behavioral Struggles