by Adam Klapperich, DO

I was recently sent an Instagram reel where an adult had an autism reveal party. He had the results of his neuropsychologic testing contained in a pinata, and after breaking the pinata, results were shared with a group of friends. While fairly tasteless in general, this video did have me think about how far this person (who turns out does have autism spectrum disorder) must have come to have this sort of social support network. As we know, a key criteria of ASD is social difficulties. For children and adolescents, these social difficulties can lead to trouble forming friendships, social isolation, and bullying. These challenges, along with difficulties managing intense emotions, sensory sensitivities, and negative feedback from peers and adult caregivers, puts neurodivergent children at greater risk for depressive disorders.

Signs and symptoms of depression may look differently in neurodivergent children than typical presentations. You may see a higher degree of irritability, emotional outbursts, social withdrawal (even from typically enjoyable activities), and repetitive behaviors become more intense or rigid. Additionally, overlapping traits of ASD may mask depression symptoms.

Treatment recommendations remain therapy and medication, though therapy modalities may need special consideration based on level of verbal communication. Play therapy and art therapy may be better options. Social skills training may help reduce isolation. SSRI medication may be considered, though typically lower starting doses are used, and the child needs close monitoring for side effects.