Imagine living in a world where unpredictability causes distress, and routine changes are overwhelming. Imagine a place where everyday noises and lights are intense enough to the point of discomfort, yet for others, they are barely noticeable. Imagine navigating this world as someone with autism, in a society designed with neurotypical expectations in mind. How might that leave you feeling? Misunderstood…? Maybe even isolated...?
Hello, everyone! My name is Isabella Molnar, and I am a Master’s Student at King’s College London. With Autism Awareness Day being on April 2nd, I have chosen to write about mental health in autism. We often talk about difficulties individuals with autism might experience, but not always consider the impact on their mental health. With my writing, I want this article to be a starting point in increasing interest and raising awareness of the importance of mental health in autism, so feel free to delve deeper and explore further resources.
Mental Health in Autism: What’s the Current Situation?
Starting with a brief explanation: Autism, also referred to as autism spectrum disorder, is a neurodevelopmental disorder that impacts approximately 1% of children and adults. Autistic individuals may perceive and interact with the world differently compared to their neurotypical peers. This difference can manifest as challenges in social communication and interaction, exhibiting restrictive or repetitive behaviours and interests, as well as being either hypo- or hypersensitive to sensory input.
Beyond these unique experiences and challenges, individuals with autism face mental health difficulties at a significantly higher rate than the general population. In fact, research suggests that between 70% and 80% of children and adults with autism experience at least one mental health problem in their lifetime, including conditions such as depression, OCD, bipolar disorder and schizophrenia, phobias, and social anxiety. Among these, anxiety stands out as the most common issue, with around 50% of autistic individuals experiencing anxiety that significantly impacts their lives. Alarmingly, as many as 35% of individuals on the autism spectrum have experienced suicidal thoughts, and up to 25% have either attempted suicide or exhibited suicidal behaviours.
But Why Do Autistic People Have Increased Mental Health Difficulties?
As discussed, mental health challenges are a significant burden in the lives of autistic individuals, more so than in the general population. This begs the question: what are the unique causes that put autistic people at such an increased risk?
Firstly, research has proposed that a core struggle for autistic individuals is fitting in with neurotypical peers. Difficulties with understanding and engaging in typical social interaction can lead to feelings of isolation, loneliness, and social anxiety. Moreover, misinterpretations of social cues and struggles with verbal and non-verbal communication can exacerbate these feelings. Due to fear of social rejection and negative attention, individuals with autism often mask or camouflage their autistic characteristics, in order to conform to societal norms. This can include suppressing stimming behaviours, forcing eye contact, or mimicking social cues. Whilst these strategies might be adaptive in the short-term, research has shown that this is simply exhausting, and can lead to identity confusion, anxiety, depression, suicidal thoughts, and the so-called "autistic burnout".
Furthermore, people with autism are often subject to discrimination and stigmatisation, including deprivation of education and opportunities to engage in their communities, which lead to further feelings of isolation. It places these individuals in a situation of either being themselves or being accepted. Besides, this population also experiences an unjust deprivation of health care, specifically in terms of mental health treatment. Health care providers often have inadequate knowledge on mental health in autism, leading to a scarcity of suitable and adaptive treatments.
Thirdly, sensory differences in autistic individuals can significantly impact their mental health due to the way they process sensory inputs – either with heightened sensitivity or under-responsiveness. For instance, everyday sounds and lights might be overwhelming, leading to sensory overload, which manifests as stress, anxiety, and physical discomfort. Such continuous sensory challenges often result in social withdrawal and meltdowns.
Lastly, a concept called ‘Intolerance of Uncertainty’ also significantly affects the mental health of autistic individuals and refers to difficulties managing the uncertainty or unpredictability of future events. The need for predictability and routine is often significantly stronger than in the neurotypical population, and deviations from expected outcomes or routines can cause distress. The intolerance of uncertainty can manifest in various aspects of life, including daily schedules, social interactions, and even minor changes in the environment. For an autistic individual, the world can seem unpredictable and confusing, leading to a constant state of vigilance and anxiety as they try to anticipate and prepare for potential changes.
And What Can We Do To Help?
In order to improve the mental wellbeing in individuals with autism, it necessitates access to adequate and needs-specific, personalised treatments by overcoming barriers to accessing mental health services. Besides, schools, universities, and work environments should contribute to creating an environment tailored to not only neurotypical, but also to individuals with autism, through providing noise cancelling headphones, sensory toys, as well as sticking to provided schedules. In order for these strategies to be effective however, they should be implemented as early as possible. Therefore, early diagnosis of autism and comorbid psychiatric conditions is of utmost importance, specifically when considering the barriers to diagnosis in terms the female autistic phenotype.
However, I believe that the current mental health crisis in autism is also partly due to the predominant medical view placing problems associated with autism solely within the individual, holding the assumption that the individual must be treated. As I've discussed in this article, interventions can be helpful in order to improve mental wellbeing and overall quality of life, nonetheless, according to the double empathy problem, challenges faced by autistic individuals often occur at the intersection of interactions between autistic and neurotypical people. Thus, the struggle to integrate into society stems not from their own social communication challenges, but rather from a mutual misunderstanding between autistic and neurotypical individuals.
This calls for action for neurotypicals to increase empathy, acceptance, and understanding for differences. Essentially, we all contribute to the society we live in, and it is crucial that we strive to create a world where autistic individuals feel recognised and embraced!
