By Dr. David L. Holmes, Chairman of Lifespan Services LLC, Princeton, NJ, USA and Archibald ‘Archie’ Brechin, Self-Advocate, Graduate Student, Rutgers University’s School of Social Work and Intern at the Global Autism Project

Foreword to this article; Throughout this article Archie Brechin, a self-advocate, will share with you vignettes from his life before he was better able to manage his anxiety and depression.

I’m in the kitchen in my apartment, it’s almost 11:30 at night and I have to be at work tomorrow by 9am sharp. I’m scurrying around the kitchen simultaneously trying to clean up, study Russian and get ready for tomorrow so I can go to bed at somewhat of a reasonable hour (hint it isn’t gonna happen) Instead I’m passing around the living room practically throwing a miniature conniption fit at the mess that I majestically created out of a fairly clean apartment just a couple of hours before. My thoughts are racing faster than a Japanese bullet train arrives from Tokyo to Kyoto. My thoughts are semi-logical mostly ridiculous and non-consequential and at times arbitrary. “Oh, my goodness, it’s already 11:30 pm and my kitchen is a bleeping mess. Gosh Darn it, why wasn’t I raised by tiger parents, If they were to be more demanding and shovel more expectations on me I would have been farther along in life. I should have taken more AP’s in high school.” “Oh no, I forgot to return my friend’s phone call and write Yu Xia a message, they probably think that I’m a selfish prick and yell at me. I’ll end up with no friends and spend the rest of my life alone. What, I’m 28 years old, most people have their life together by now and are doing amazingly in their careers, I’m still really figuring out what I want to do. They must think that I am a loser. Omg, the dishes are piling up in the sink and the apartment is filthy, what if my apartment manager comes and inspects the place tomorrow I’ll be evicted for sure.” “Wait, I should really read a little bit of the Tale of Genii, I haven’t done anything productive and intellectual today. If I don’t spend every waking moment engaged. I’m nothing I’m already such a pitiful creature for needing eight hours of sleep, this makes me even more of a loser”.

Finally, at 2:30 a.m. I collapse from exhaustion (and the belated effects of my sleeping medication and finally go to sleep). By 7 a.m. I awake utterly exhausted from last night’s ordeal. As I lay limply on my bed. I call in sick to work and slowly sink deeper into depression (and my mattress) feeling helpless and despondent and extreme anxiety robs me of another day in my life. I lay silently in bed and drift off again to sleep, not to emerge from my sleep until the next day. Up until very recently this was a typical anxiety-stricken day (or rather night) for me. My anxiety demons would attack me at any time of the day causing me to question every step I talk and everything I do. At times it was pervasive and all-consuming encompassing my entire world view. My amygdala was running like a hamster on a treadmill going ninety miles an hour. The apprehensive thoughts just kept inundating my soul until all my self-control suffocated under its breath.

Over the years the means of determining a diagnosis of Autism Spectrum between the United States and the rest of the world has been less than harmonious. However, more recently, the DSM-5, i.e., the Diagnostic and Statistical Manual of the American Psychiatric Association as well as the ICD-10, the International Statistical Classification of Diseases and Related Health Problems (World Health Organization), have become more synchronic. This new-found harmony enables researchers and clinicians across the globe to speak with greater clarity in terms of their understanding of what Autism Spectrum Disorder comprises. Autism Spectrum has increased significantly, according to the Centers for Disease Control (CDC), having demonstrated an increase of 150% since the year 2000. Their most recent findings in 2016 were that 1 in 59 eight-year olds are on the Autism Spectrum; with a special note that 1 in 34 eight-year olds in New Jersey are on the Autism Spectrum.  

It was an accident of fate that I spent the majority of my early years in Princeton, New Jersey, home of the Eden institute and other renowned autism centers. Having access to world class autism professionals (especially Dr. David Holmes) was an incredible lifeline for me and my family as we navigated together this complex condition and the challenges associated with it It is another accident of fate that I returned to the very state responsible for my early development to begin my professional journey as an international clinical social worker and Global Autism (and disability/mental health) rights advocate. I look forward to taking advantage of world class institutions such as Rutgers New Brunswick, ASAN, Global Autism Project and Eden institute [now Eden Autism Services] to further my academic and professional development. I also look forward to a lifetime of service on behalf of autistic children and adults domestically and internationally and other traditionally marginalized populations. As a staunch humanist I believe that shining a light on autism and its associated strengths and challenges opens up critical pathways towards a greater more nuanced understanding of the human condition. My mother and father’s strong voice, intimate knowledge and penchant for advocacy really made a world of difference and I cannot stress enough the importance of advocating on behalf of your child during the early years and teaching your children, who are capable, to self-advocate as they grow up and approach adulthood. Without crucial support from family, therapists, educators and an accepting community, none of this would have been possible.

As mentioned previously, my paternal aunt Diane played an indispensable role in eventually making me eligible for the very early intervention services to which I currently attribute my ability to integrate into society and most importantly pursue my professional and personal ambitions. She first noticed something amiss or unusual about me at the tender age of two and a half. She observed me playing in the back yard and noticed that I wasn’t meeting certain developmental milestones (mostly in the linguistic and cognitive realms but she also noticed poor fine motor coordination). Telltale signs such as lack of eye contact, solitary and unnuanced play (lining up blocks) cued her into the possibility that I was on a divergent developmental trajectory and compelled her to contact my parents to voice her concerns. My parents in turn took me to a child psychiatrist who later diagnosed me with “autism spectrum disorder”, a diagnosis that opened up lots of doors to quality services and crucial social support. I also felt this odd cloak of protection surrounding me (like a guardian angel was watching over me like that old A&E TV series, “Touched by an Angel”). Although I was certainly bullied and ostracized by schoolyard strongmen at times, as all children are, it was never like the horror stories I have heard from other autistic self-advocates. Overall, I had a great childhood thanks to my incredibly warm and supportive parents. My adolescence and young adult hood however was very tumultuous. As I grew older existentialist anxieties started to manifest themselves psychiatricaly in chronic depression, self-deprecating thoughts, distorted cognition, nagging perfectionism and a host of other psychological shows that would continue into young adulthood.

Autism Spectrum has increased significantly, according to the Centers for Disease Control (CDC), having demonstrated an increase of 150% since the year 2000.  Their most recent findings in 2016 were that 1 in 59 eight year old’s are on the Autism Spectrum; with a special note that 1 in 34 eight year olds in New Jersey are on the Autism Spectrum.  The Centers for Disease Control has also noted that the average age of diagnosis is 42 months and that active treatment for the syndrome varies state by state.  Because the research on ASD points out that early identification and intensive treatment results in a better prognosis for children, the CDC challenges Primary Care Physicians and, these authors recommend, Pre-school Providers and Early Childhood Professionals to be much more vigilant in terms of identifying the markers for Autism Spectrum and to cease with the notions that “boys develop more slowly than girls”; “he’ll grow out of it”; or, “you are being overly cautious… relax”.  The Centers for Disease Control chides Primary Care Physicians and other diagnosticians and early childhood providers to “Learn the Signs; Act Early!”. (CDC5/8/18)  

Although it may be easier and more comforting to be in denial about your child’s atypical development as the prospect of them being “different” (not less) frightened many parents. Perhaps you may be thinking somewhat fatalistically “if she (or he) gets a diagnosis of autism or any other developmental/behavioral conditions his quality of life will suffer. She’ll be a victim of bullying at school. She’ll fall academically behind her peers. She’ll never go to prom, date, go to college, start a career etc. However, if you remember anything from this article remember these two things; a diagnosis of autism or any other neurodevelopmental/cognitive difference will not totally jeopardize your child’s future, but ineligibility for services resulting from a lack of an accurate diagnosis certainly will. I will reiterate the absolute worst thing that you can do is “wait until your child grows out of it” because chances are they never will, and you are left with a situation in which the child’s quality of life is compromised and they lack the requisite skills to effectively meet activities of daily living. Further, most people on the spectrum need some level of support throughout their lives to function effectively. Even prominent and highly-accomplished members of our community such as John Elder Robinson, Steven Shore, and Temple Grandin have often confided that without weekly visits to their therapists and psychiatrists they wouldn’t be able to function to their full capabilities.

Now, the senior author of this paper recently presented at the World Congress on Neuroscience in Bangkok, Thailand that when it comes to ASD Anxiety and Depression are sister symptoms of the many various symptoms associated with Autism Spectrum.  They often times operate hand in hand; with depression reflecting sadness, moodiness, melancholy, dysphoria, dismay, chronic grief and other expressions that reflect a general disinterest in life events with concomitant lethargy.  Anxiety, on the other hand, reflects fearfulness, worry, apprehension, the notion of impending doom, multiple phobias/fears.

Periodic anxiety and depressive episodes became pervasive forces in my life once I entered Middle school and increased in intensity as I aged further into adolescence and young adult hood. During some of these periods I was so anxious, nervous and lethargic that even leaving my house and performing acts of daily living became insurmountable tasks. I became increasingly disheartened that the more I gained awareness of my social environment and realized that the majority of my classmates (or so I thought) weren’t experiencing the same symptoms that began to think I was melodramatic or hypersensitive. This awareness (an epiphany that hit me like a bullet train) subsequently caused me to gaslight myself and I proceeded to compare myself to anyone and everyone. These comparisons were predominately academic “Why wasn’t I able to read the whole Mahabharata by the age of 11 like my classmate was?” “Why wasn’t I taking as many AP courses as my classmates.” “Why couldn’t I survive with just 4-5 hours of sleep?” “Why wasn’t I dating?” “I’m not involved in as many extracurricular activities.” Ironically these very comparisons, instead of motivating me, these comparisons just increased my anxiety which led me to fall more behind academically eventually withdrawing from my peer group. The anxiety driven comparisons were just endless, and, in the end, they did nothing for me but increase my anxiety and depression and later caused me to develop ulcerative colitis. At the time I wasn’t aware that the majority of my problems were manifestations of anxiety but in retrospect it was the common denominator of all my mental anguish, pandemonium, and executive dysfunction. Throughout all this my only refuge was my special interest in language learning. My Spanish and Chinese grammar textbooks provided a soothing sense of predictability, structure, and sense of mastery; needs which were not fulfilled by any of my other activities. Language learning for me was (and largely still is) a self-directed activity in which I set the pace for myself and found extrinsically rewarding. The content of my language books didn’t change, and I knew what unit is up next. For many autistic people, engaging in special interests are often a way of mitigating anxiety since they are activities that we have complete control over. However, there is a fine line between special interests and obsessions and once a person on the spectrum crosses that threshold the activity could actually exacerbate their anxiety and promote depression.

When Anxiety and Depression chronically occur in a person with ASD it can be significantly debilitating.   Triggers for both Anxiety and Depression result from a lack of predictability and consistency in a person with Autism’s environment.  This causes them to be chronically Anxious resulting in a general lethargy to engage in activities of daily living, i.e., Depression. “Being Depressed often makes us Anxious, and anxiety often makes us depressed”. [Irwin, N. B., 2017] individuals who have ASD may be particularly prone to Depression as they enter adolescence and adulthood.  It has been noted that Depression may be hard to diagnose in those who have ASD because of their unique communication challenges.  Diagnosticians however who are well trained in the symptoms associated with ASD will note general lethargy and disinterest in activities of daily living as reflective of a depressive state.  Individuals who have ASD may be particularly prone to Depression as they enter adolescence and adulthood.  It has been noted that Depression may be hard to diagnose in those who have ASD because of their unique communication challenges.  Diagnosticians however who are well trained in the symptoms associated with ASD will note general lethargy and disinterest in activities of daily living as reflective of a depressive state. [Autism Speaks]

Undoubtedly my worst depressive and anxious episode occurred upon graduating from High School back in 2008. A circumspect and apprehensive part of me is loath to share this experience with the general public. However, if I could help one person emerge unscathed from the grips of suicidal ideation and depression than sharing my story is worth it. For parents of autistic children and adults reading this, please take note and remain observant of your child’s mood and demeanor during major transitions. What may seem like perfunctory, expected, logical or even intuitive transitions from one stage of life to another can provoke major anxiety in individuals on the spectrum. Although many secondary skills teach these, plan for major transitions (i.e. high school to college, college to independent living, one group home to another etc.) ahead of time and explicitly lay out what will be expected of your children so that they know in advance what to expect/predict which lessens anxiety when change is coming. For people on the spectrum considering higher education, many universities have summer programs for high school students to attend and get a feel for what college is like. This will give you a chance to familiarize yourself with the campus and the academic and social expectations of college life. Just let the advisor or counselor know that you are autistic (have autism) and will need some extra supports or accommodations. A trigger warning for everyone who has experienced pervasive or periodic mental health issues or major depressive episodes, this paragraph includes visceral and graphic description of an individual in the grips of a major depression as well as references to suicidal ideation and self-mutilation; reader discretion is advised.

It was a monumental achievement for me; as it would be for any graduate and newly established adult. However, as a person on the spectrum, that day held a special significance that to this day I believe was not shared by my classmates. On that day I felt that I had totally mastered my environment. I learned all the necessary academic time management, self-regulatory, and social skills to successfully navigate my high school environment. I had come a long way since my first day as a high school freshman when I burst into tears at the family dinner table. Not only did I graduate that crisp May day, I also won numerous accolades and academic distinctions for my academic promise in history, language, and most importantly of all a special award given to an individual who has demonstrated “incredible academic and extracurricular potential”. I really felt as if I had mastered my environment and was at the zenith.

Although I have no recollection of ever expressing such sentiments, my father distinctly remembers me uttering to him almost under my breath, “So dad what do I do now?”. For my parents this casual phrase foreshadowed my eventual tragic decent from the zenith of my achievements to the nadir of my anguish. Although I knew that the transition from high school to college would be challenging, nothing could have possibly prepared me for the almost insurmountable psychological torment I would experience starting that fall. In retrospect, my lack of emotional maturity, sufficient academic planning, and inadequate self-advocacy skills led me toward a downward spiral the first semester of my freshman year in college. I started off the semester in a full load but due to mounting pressure I was in a panic/high anxiety mode.

My parents, doctors, academic advisors, disability coordinator and psychiatrists tried everything from medication management, psychotherapy, reduced course loads, accommodations, and tutors but nothing seemed to work. Despite everyone’s best intentions, my symptoms just exacerbated. Much to the ire of my parents (who I still lived with at the time) I would feign illness or fabricate myriad excuses to cancel sessions with my tutors, skip class, and avoid office hours with my professors. I would spend entire days if not weeks in bed paralyzed by my anxiety, lethargy, and apathy- depression.

Assignments that would have taken hours or even minutes to complete in high school ended up taking me days if not weeks those first two semesters. I practically lost my ability to speak English (let alone the Spanish and Mandarin I learned in high school). Inordinate amounts of junk food became my only friend (I’m talking whole boxes of insomnia cookies, bags of potato chips and the entire takeout menu from Panda West here!) as old high school and potential college friends gradually faded into the fog of my former life. Suicidal ideation metastasized to every corner of my psyche as the abyss of my depression grew wider and more cumbersome to surmount. It wasn’t until I was twice involuntarily committed to a psychiatric ward for suicide attempts that I finally received the help I needed.

Treatment for depression for those with ASD reflects a broad range of therapeutic interventions from Psychiatric supports, i.e., medications, to Cognitive Behavioral Therapy, holistic approaches. Behavioral Therapy [CBT] has shown promise for treating Depression in those with Level 1 Autism as talk therapy and graduated exposure to activities that are expected to bring an elevated positive mood; as such exposure alters cognition for the better. 

No matter if talk therapy is indicated for an individual with ASD or not, exposure to activities that appear to bring some degree of pleasure to the individual with ASD is indicated even if the individual himself is disinclined to engage. Currently, medication, often used by the Medical profession to treat Depression in Autism, it must be noted that no medications to date have been approved by the Food and Drug Administration [FDA] specifically for treating youth and adults with Autism and Depression.  In fact, research supports the notion that there are increased side effects from anti-depressants and ASD.  It has been mentioned that sleepiness, agitation, increased irritability, gastro-intestinal problems can be such side effects.  That said, if medications are attempted to be used then extreme care must be exercised starting with low doses of medication and altering various medications based upon their clinical success with the youth or adult with ASD. Note; medications such as Prozac, Luvox, Zoloft, Paxil, Celex are the more generally used medications for Depression, but again, caution is indicated as there have not been rigorous testing of such medications with those with ASD.

I am a huge promoter of the use of psychotropic medication as an intervention for major depression, anxiety and other mental health concerns associated with autism provided that it is used in conjunction with counseling and our psychotherapy However it is important to know that medication is neither a panacea for mental health conditions associated with autism nor should it be the only therapeutic service a person receives. For example, during my major depressive episode upon graduating from college, I was on a panoply of psychotropic medications which were adjusted through trial and error. Most of them at best did nothing and at worse exacerbated my condition. It wasn’t until I found that one miracle pill in a supportive environment that I really started making progress. I continue to take medication for depression and anxiety which has benefited me tremendously without unwarranted side effects. What medication initially did was make me more receptive to psychotherapy and challenging cognitive distortions while currently I take it to maintain neurochemical homeostasis.

This senior author’s experience with treating Depression in individuals with ASD comes from decades of overseeing day and residential services at Eden Autism Services in Princeton, New Jersey.  We have found that the singular most effective treatment is cardiovascular exercise. It is recommended that, based upon the age and health of the individual, heart rates should be peak recommended rates for the individual as well as peak duration of exercise. Note; endorphin production during such activities is a powerful endocrine response that results in elevating mood.  Others have supported the notion that cardio will “raise our heart rate and get us moving and sweating for a sustained period of time and then ‘magical things’ happen to our mind and body.  We start to think more clearly, feel better about ourselves, raise our spirits and even build buffers against age related cognitive decline.  Our lungs and hearts get stronger too”. [Broadwin, E. 12/10/2017]

Throughout my childhood and adolescence, I hated athletics and sports. Don’t get me wrong I did Aikido, was on the soccer, baseball, and tennis team and even got into running at one point but it never became the centrifugal focus of my life the way it did for my peers. Quite honestly, I dreaded practices and matches and would rather be at home watching tv or playing video games. My laziness when it came to physical exertion only exacerbated as I got older. In high school, I would do the absolute minimum amount of physical activity required to fulfill my PE requirements and then spend the rest of the time in mostly sedentary activities. I had heard but I failed to make the correlation between physical health, psychological well-being and anxiety. I have heard that many (but not all) people on the spectrum do not enjoy physical activity because of poor dexterity and fine motor skills. However, I would advise parents to encourage their children (and adults) to pursue physical activates that they enjoy (or at least tolerate).

If your child is having a hard time making connections between physical activity and his overall biopsychosocial functioning inquire about your child’s goals and aspirations. Do they want to increase social skills, get better grades? Tapping into your child’s intrinsic motivation rather than vague and arbitrary social rewards (i.e. you’ll look great in that prom dress, or all the girls will be swooning over you, you’ll fit in more etc.) is more effective in getting your child to embrace physical activity as part of their daily routine. Moreover, deficits in impulse control made it harder for me to resist high glycemic starchy foods and sweets. Needless to say, I ate voraciously and didn’t compensate by increasing my physical activity all of which lead to gaining inordinate amounts of weight around my mid-section. All recipes for psychological disaster. In retrospect, given the latest research on this probably didn’t help my anxiety and overall sense of psychological stability. Nowadays I notice that by following a semi-regimented diet and exercise routine, I not only feel physically better but am much more effective at work and in daily life. My anxiety dissipates, I can concentrate more, I can think about and articulate concepts more clearly, and I grasp new concepts more quickly. I now attempt to incorporate more exercise into my life with the intention of losing weight and improving my cognitive abilities, manage my anxiety, and improve executive functioning.

Anxiety in those with ASD is a significant problem for many people on the Spectrum.  Research suggests that around 30 to 40% of those affected by Autism Spectrum Disorder have Anxiety. Triggers for Anxiety are stressors that can be as great as there are sensory challenges to the individual with Autism, including social fears, separation anxiety, loud noises, bright lights, unpredictability in schedules, lack of consistency in expectations, and the overwhelming demands that life in general presents to an individual with ASD.

Adolescents with Autism are particularly prone to Anxiety Disorders because of the onset of puberty as well as recognizing that they are different and not able to feel comfortable under social conditions. It is important to recognize that low levels of Anxiety/stress can be helpful in learning new skills. That said, most individuals with ASD have significant levels of Anxiety due to the significant stressors that they encounter in life, both at home, school, and community situations.  

The part of the last paragraph that really stuck a cord for me was the notion that lack of consistency of people’s expectations causes enormous anxiety for many autistic people. Growing up it always threw me for a loop when people displayed cognitive dissonance, spoke in numerous shades of nuance, didn’t follow through with their promises etc. As I grew older I developed (mostly out of necessity but partly because I wanted to challenge myself) an Arsenal of copping skills to help me deal with people’s fickleness and the constant flux of the State of the Universe. One of the classical psychological coping mechanisms I used was intellectualization. I started analyzing and rationalizing why people’s expectations change. I ended up fuzing Heroclitus famous quote “you never step in the same river twice” with a pseudo Darwinian explanation of natural selection (don’t worry it wasn’t as nefarious as it sounds). Later on after I started metting with Dr. Holmes he gave me an explanation that too this day i hold dear to me. He said and I paraphrase “Archie, one of the things you have to realize is that most people are improv actors, they just come up with things on the fly and adjust accordingly. Your mind works like a Shakespearean script. You have to memorize your lines and that’s why you like clear expectations.”

When individuals have chronic Anxiety with stressors/environmental triggers that evoke such feelings of uneasiness there is a release of norepinephrine which may increase the risk also of high blood pressure and heart disease. Anxiety in individuals on the Spectrum results in significant feelings of tension that can affect heart rate, muscle cramping, stomach aches and dry mouth. Under such conditions, one might observe a person with Autism engaging in significant self-stimulatory/self-soothing repetitive behaviors.  Oftentimes these behaviors can be destructive in nature with property damage and self-injury.  

As many individuals with ASD have difficulties, as with Depression, communicating how they feel, the clinician and parent should look for sweating, acting out, i.e., crying, covering eyes, covering ears, meltdowns, darting, screaming, self-injury, property destruction, and, assaulting others as these symptoms will especially be prominent amongst those with ASD when anxiety is at play. 
 
Treatment for Anxiety in those with Autism as with Depression takes on many different approaches.  Cognitive Behavior Therapy [CBT] again, has demonstrated some degree of success for individuals with ASD and has particularly been helpful for individuals who are at the level 1 and possibly level 2 diagnosis of ASD.  When using Cognitive Behavior Therapy the therapist should be challenging negative, compromising thoughts with role playing, e.g., modeling of courageous behavior and step by step exposure to feared situations; graduated desensitization to triggers to lessen the impact of the trigger/stressor.

The lead author has found creating more Prosthetic Environments, not unlike wheelchairs for the physically disabled, can be a significant help in reducing stressors for Anxiety and Depression. Note; a Prosthetic Environment (Holmes, D.L., 1998) is an environment that is predictable and consistent for the individual with Autism.  When one creates such an environment both within the school setting, the place of employment, the home as well as the community, to the extent possible, then one reduces a major stressor that triggers Anxiety and Depression, i.e., unpredictability which triggers a feeling of being “out of control/panic”.

I experienced many such “Prosthetic Environments” throughout my life that have made a tremendous difference in my quality of life and gave me access to the tools and resources I needed to successfully integrate both academically and socially with my peers and maximize my potential. These environments helped me eventually swim independently in a world in which I would have otherwise drowned. When I was a young child and adolescent such an environment included Autism/Disability awareness (and eventually acceptance) among administrators, educators and the general student body, access to school psychologists and social workers, extended time and distraction free environment for testing, and teaching aids. As I aged into young adulthood these environments took the form of residential treatment centers, group homes, outpatient programs, therapist offices all of which provided me with the structure, security, and supports that I needed at various times in my life to enhance my quality of life and achieve my goals. As I grew older and integrated more into the community. I gradually phased out of more stringent and conspicuous Prosthetic Environments to more subtle and nuanced ones. As a parent or service provider to an autistic individual, the worst thing you can do is just throw them off at the deep end of the pool and expect them to swim. For many people on the spectrum, these Prosthetic Environments provide the social infrastructure and supports necessary for them to learn skills that other people might have just picked up through osmosis/vicariously, i.e., the hidden curriculum.

As far as medication is concerned the FDA has not approved any medications specific to Autism Spectrum Disorder for Anxiety/Generalized Anxiety Disorder [GAD]. That said, some drugs however are used more commonly to help individuals with Autism and they are Selective Serotonin Uptake Inhibitors (SSRI’s) such as Prozac and Zoloft.  Again, with the cautions presented when using medications for Depression any of these SSRI’s must be utilized under the care of a physician or otherwise authorized prescriber of medications who understands the unique needs associated with Autism Spectrum Disorder and watches carefully to control for egregious/unintended side effects. 

Honestly in my experience medication only goes so far in terms of managing anxiety and depression. As I stated previously being prescribed the right medication opend the door for me to learn and grow emotionally as well as better manage my anxiety, however it was high quality counseling interventions such as CBT, DBT, and group therapy that really gave me a arsenal of tools as to how to manage my anxiety and subsequent depression episodes. Needless to say If you expect medicine to be a panacea for your mental health conditions, I am afraid you will be gravely disappointment.

Further, as with Depression, we have found that cardio-vascular exercise, i.e., exercise that has a significant duration as well as intensity based upon the health and age of the individual has proven effective in reducing the impact of Anxiety and as it has a calming effect on the individual as well as the aforementioned increase in endorphins which brings to the individual a greater sense of calmness. Finally, as our children with Autism Spectrum Disorder age we have found that the sister challenges of Depression and Anxiety often become more defining of the individual than the Autism itself. 

We know that our children are resistant to change because change results in lack of predictability so the symptom of “insistence on sameness” is really reflective of their need to know “what’s next”.  It also reflects an emerging Obsessive Compulsive Disorder [OCD] which finds strength in children with Autism as well as youth and adults because it gives them a sense of being in control; even if it’s debilitating control.

*The views expressed in this blog post are those of the author and not necessarily those of the Global Autism Project.*