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Reasons Depression May Present Differently in Autistic People

By Emma Hinze, Professor Tony Attwood and Dr. Michelle Garnett

Autistic people might experience and express their emotional states uniquely, influenced by factors such as alexithymia, which affects around 50% of the autistic population (Kinnaird et al., 2019). Alexithymia is a subclinical condition characterised by difficulty in identifying and describing feelings and emotions, which makes it difficult for the person to identify and disclose their low mood and depression. Also, an autistic person’s tendency toward literal interpretation and unique abstract thinking patterns can lead to different expressions of depressive symptoms (Nicolaidis et al., 2020) and communication styles that might differ from non-autistic expectations (Legault et al., 2019). For example, an autistic individual might articulate their feelings metaphorically, saying they feel “like a phone running out of battery” to convey chronic fatigue and lack of energy, showcasing their individual way of communicating emotional states. Sensory sensitives may also influence how autistic people experience and express their depressive symptoms. These differences in how autistic people experience and interact with the world may lead to a greater range of depression presentations in autistic than in non-autistic people.


The Shortcomings of Current Diagnostic Tools

The tools commonly used to diagnose depression were primarily designed with non-autistic populations in mind, which means they often fail to capture the nuances of how depression presents in autistic individuals. For example, studies have shown that the Patient Health Questionnaire-9 (PHQ-9) is not very good at correctly identifying autistic people who have depression (Pilunthanakul et al., 2021). This misalignment highlights the urgent need for diagnostic instruments that are sensitive to the unique ways autistic people experience and express depression.


The Gap Between Self-Reported and Informant-Reported Symptoms

The discrepancies between how autistic individuals report their depressive symptoms and how these symptoms are perceived by caregivers or clinicians pose another challenge. Research indicates a significant gap between self-reported prevalence rates of depression among autistic individuals (25.9%) and those reported by caregivers (10.4%) (Hudson et al., 2018). This disparity suggests that caregivers may not fully recognise or understand the depth of their struggles with depression, underscoring the importance of increasing education and awareness of depression in autistic people but also developing more accurate assessment methods that consider both self-reported and informant-reported symptoms.


Moving Forward

Addressing the challenges of diagnosing and treating depression in autistic individuals requires a multifaceted approach. This includes developing and implementing diagnostic tools that are sensitive to the unique presentations of depression in autism, as well as fostering a deeper understanding among healthcare professionals and caregivers of the complex interplay between autism and depression. Through concerted effort and dedicated research, we can improve the quality of life for autistic individuals facing depression.


Where to from here:

Our online course Exploring Depression and Beating the Blues offers a ten-stage programme to treating autistic adolescents and adults who are suffering from depression. The programme was designed by Tony and Michelle and is based on their deep understanding of how to treat autistic individuals who suffer depression, as well as current research. Exploring Depression can be delivered as an individual or group therapy programme or can be utilised as a self-help guide at home, with the assistance of a carer or family member. The course is designed to be beneficial for clinicians, parents and partners but would also be useful for an autistic teenager or adult. Reasons an autistic person can become depressed are described, each of the stages of the programme is presented, and strategies for how to implement each stage are shared.



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