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Anxiety and Depression in Children with Autism: How to Recognize the Signs and Get Help

MAY 4, 2023

Many children experience feelings of sadness or worry at one time or another. But sometimes, these feelings may point to a more serious issue. How can you tell when there is a reason for concern? Anxiety and depression tend to be more common in children with autism.[i] Research suggests more than 70 percent of young people with autism have mental health conditions, including anxiety and depression.[ii] If your child has a mental health condition, know that you are not alone and there are supports to help you. Some families with children experiencing severe anxiety or depression may also benefit from our Urgent Response Services.

How can I tell if my child has anxiety or depression?

Symptoms of anxiety and depression may look very different from one child to another. These are some signs to look out for:

  • Behavioural changes: This can include emotional outbursts, task avoidance, increasing anger or aggression, violent behaviour, or self-injury.
  • Stress response to change: Intense levels of distress related to a change of routine or a change in your child’s environment could be a sign of anxiety.
  • Becoming withdrawn: This can include withdrawing from friends, family, or situations. If your child doesn’t want to do something they usually enjoy (like a favourite activity), this may be a sign of anxiety or depression.
  • Physical symptoms: If physical symptoms appear frequently, especially when there’s a change in your child’s routine, this may indicate a deeper issue. Regular stomach aches, nausea or headaches are common physical manifestations of anxiety.

How can I support my child?

If your child has anxiety or depression, here are some ways you can help them.

  • Stay calm: Sudden behavioural changes in your child may catch you off guard. Keep in mind that your child may have difficulty expressing their feelings. Try your best to remain a calm presence around your child when they experience strong emotions.
  • Try a weighted blanket: Deep pressure can have a calming effect on the nervous system. This is why some occupational therapists use them to help relieve anxiety in children with autism.
  • Use social stories: A social story can help prepare your child for a change in their routine, or something new (like a new situation) that may cause anxiety. The social story, a technique developed by Carol Gray, uses visuals to show your child what they can expect. This can help address your child’s worries ahead of time. When you develop a social story, be sure to use “I” statements and your child’s name. The idea is to write the story from their perspective.
  • Experiment with relaxation techniques: Teach your child how to self-soothe. Slowly counting to ten, practicing deep breathing, or using visualization are all great ways to calm down. An example of visualization can be going for a walk together and identifying ten things you see in the park. The idea is to equip your child with tools they can use to soothe themselves when they experience feelings of anxiety, stress, or depression.
  • Make a sensory kit: This is a portable box, bag, or bin filled with sensory tools and toys to help calm your child’s nervous system. This can help relax your child when they experience big emotions. Put items in the sensory kit that you know are soothing for your child. The kit may include fidget toys, stress balls, noise-reduction headphones, or a notepad and pencil, among other items.
  • Focus on your child’s strengths: It may be hard to focus on your child’s strengths when you are managing their challenging behaviour. But this is when it’s more important than ever, both for your child and for yourself. Show your child you’re excited about the things that interest them. This is a great way to support a child coping with anxiety or depression. Embracing your child’s uniqueness and focusing on their strengths may also help relieve your own stress.
  • Know when to call 911: You may encounter situations where your child’s behavioural changes escalate, and they become aggressive or violent. If this happens, the first step is to follow your family safety plan to ensure everyone in the household is safe. If things escalate to a point where your child or another household member’s safety is at risk, it’s time to call 911 or another crisis hotline.

When should I seek treatment?

Your child may benefit from individual or group therapy if:

  • Feelings of anxiety or depression persist for a very long time
  • They express feelings of hopelessness
  • Their anxiety or depression leads to reckless or risky behaviour

Therapy can help your child by:

  • Teaching them coping methods
  • Improving social and communication skills (in a group therapy setting)
  • Normalizing your child’s feelings and experiences (in a group therapy setting)
  • Providing professional support to deal with complex issues (one-on-one therapy is best in these situations.)

When should my child see a doctor?

If your child exhibits any of the following symptoms due to anxiety or depression, it is time to see a doctor:

  • Weight loss
  • Lack of appetite
  • Insomnia

How Surrey Place can help

If you are a caregiver with a child who exhibits high-risk behaviours that require an urgent response, like violent thinking, aggression, or property destruction, you may be eligible for Surrey Place’s Urgent Response Services. This program can be accessed through the Ontario Autism Program (OAP), which provides funding and services for children and youth under 18 with autism, and their families and caregivers.

Surrey Place offers a variety of services for mental health support. This includes child and teen counselling for youth with autism who are coping with a mental health issue like anxiety or depression (please note this service is not covered under the OAP funding).

For support for a child with autism spectrum disorder whose needs are not urgent, please visit Surrey Place’s Autism Services page.

About Urgent Response Services

This resource was written with support from staff in Urgent Response Services. Urgent Response Services are part of the Ontario Autism Program. They were created to support children or youth with an emerging urgent need. Surrey Place leads Urgent Response Services for Toronto Region in partnership with 2-Spirited People of the 1st Nations, Community Living Toronto, Family Service Toronto, Geneva Centre, Holland Bloorview, Kerry’s Place, Lumenus, SAAAC, SMILE Canada and Strides Toronto.

References

“Autism Spectrum Disorder and Anxiety/Depression.” Anxiety & Depression Association of America. Available at: https://adaa.org/understanding-anxiety/autism-anxiety-depression. Accessed on February 6, 2023.“

The deep emotional ties between depression and autism.” Spectrum. Available at: https://www.spectrumnews.org/features/deep-dive/the-deep-emotional-ties-between-depression-and-autism/. Accessed on February 6, 2023.

“Do weighted blankets improve sleep for children with autism?” NAPA Center. Available at: https://napacenter.org/weighted-blanket-autism/. Accessed on February 7, 2023.

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By 2 months

Has your baby had their hearing screened? YES NO

By 6 months

Does the child?

Startle in response to loud noises? YES NO
Turn to where a sound is coming from? YES NO
Make different cries for different needs (hungry, tired)? YES NO
Watch your face as you talk? YES NO
Smile/laugh in response to your smiles and laughs? YES NO
Imitate coughs or other sounds such as ah, eh, buh YES NO

By 9 months

Does the child?

Respond to their name? YES NO
Respond to the telephone ringing or a knock at the door? YES NO
Understand being told no? YES NO
Get what they want through using gestures (reaching to be picked up)? YES NO
Play social games with you (Peek-a-Boo)? YES NO
Enjoy being around people? YES NO
Babble and repeat sounds such as babababa or duhduhduh? YES NO

By 12 months

Does the child?

Follow simple one-step directions (sit down)? YES NO
Look across the room to a toy when adult points at it? YES NO
Consistently use three to five words? YES NO
Use gestures to communicate (waves hi/bye, shakes head for no)? YES NO
Get your attention using sounds, gestures and pointing while looking at your eyes? YES NO
Bring you toys to show you? YES NO
Perform for social attention and praise? YES NO
Combine lots of sounds together as though talking (abada baduh abee)? YES NO
Show an interest in simple picture books? YES NO

By 18 months

Does the child?

Understand the meaning of in and out, off and on? YES NO
Point to more than 2 body parts when asked? YES NO
Use at least 20 words consistently? YES NO
Respond with words or gestures to simple questions (Where's teddy? What's that?)? YES NO
Demonstrate some pretend play with toys (gives teddy bear a drink, pretends a bowl is a hat)? YES NO
Make at least four different consonant sounds (p ,b, m, n, d, g, w, h)? YES NO
Enjoy being read to and sharing simple books with you? YES NO
Point to pictures using one finger? YES NO

By 2 years

Does the child?

Follow two-step directions (Go find your teddy bear and show it to Grandma.)? YES NO
Use 100 to 150 words? YES NO
Use at least two pronouns (you, me, mine)? YES NO
Consistently combine two to four words in short phrases (Daddy hat. Truck go down.)? YES NO
Enjoy being around other children? YES NO
Begin to offer toys to other children and imitate other children's actions and words? YES NO
Use words that are understood by others 50 to 60 per cent of the time? YES NO
Form words or sounds easily and without effort? YES NO
Hold books the right way up and turn the pages? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 30 months

Does the child?

Understand the concepts of size (big/little) and quantity (a little/a lot, more)? YES NO
Use some adult grammar (two cookies, bird flying, I jumped)? YES NO
Use over 350 words? YES NO
Use action words such as run, spill, fall? YES NO
Participate in some turn-taking activities with peers, using both words and toys? YES NO
Demonstrate concern when another child is hurt or sad? YES NO
Combine several actions in play (puts blocks in the train and drives the train, drops the blocks off.)? YES NO
Put sounds at the beginning of most words? YES NO
Use words with two or more syllables or beats (ba-na-na, com-pu-ter, a-pple)? YES NO
Recognize familiar logos and signs involving print (Stop sign)? YES NO
Remember and understand familiar stories? YES NO

By 3 years

Does the child?

Understand who, what, where and why questions? YES NO
Create long sentences using five to eight words? YES NO
Talk about past events (trip to grandparents house, day at child care)? YES NO
Tell simple stories? YES NO
Show affection for favourite playmates? YES NO
Engage in multi-step pretend play (pretending to cook a meal, repair a car)? YES NO
Talk in a way that most people outside of the family understand what she/he is saying most of the time? YES NO
Have an understanding of the function of print (menus, lists, signs)? YES NO
Show interest in, and awareness of, rhyming words? YES NO
Read to stuffed animals or toys? YES NO
Scribble with crayons? YES NO

By 4 years

Does the child?

Follow directions involving three or more steps (First get some paper, then draw a picture and give it to Mommy)? YES NO
Use adult type grammar? YES NO
Tell stories with a beginning, middle and end? YES NO
Talk to try and solve problems with adults and with other children? YES NO
Show increasingly complex imaginary play? YES NO
Talk in a way that is understood by strangers almost all the time? YES NO
Generate simple rhymes (cat-bat)? YES NO
Match some letters with their sounds (letter b says buh, letter t says tuh)? YES NO