Higher depressive symptoms in early adolescents with Autism Spectrum Disorder by self- and parent-report compared to typically-developing peers

Type, content, and triggers for self-injurious thoughts and behaviors in autistic youth and their disclosure to caregivers

LAY ABSTRACT

Self-injurious thoughts and behaviors are high among autistic youth, yet research most often relies on caregiver reports and does not include youth perspectives. Relatedly, specific characteristics of self-injurious thoughts and behaviors (e.g. type of behavior, thought content, triggers), and choices to share these thoughts and behaviors with caregivers/parents (or not), have not been studied in autistic youth. With limited information on self-injurious thoughts and behaviors in autistic youth, clinicians and families supporting autistic youth in crisis continue to experience major challenges to best assess and support youth. Therefore, to begin to understand youth perspectives of self-injurious thoughts and behaviors, we administered a self-injurious thoughts and behaviors clinical interview (Columbia-Suicide Severity Rating Scale; C-SSRS) to 103 autistic youth without intellectual disability (10-17 years of age) at a clinic for outpatient mental health services. We added follow-up questions to the interview about suicide to better understand what youth think about when it comes to suicide, what triggers them to feel suicidal, and whether they let their caregiver know about what they are thinking and feeling. Results show that most autistic youth reported suicidal thoughts at some point in their life (n = 86; 83.5%), with thoughts of dying/suicide (n = 20; 23.3%) and death by cutting (n = 13; 15.1%) as common thought content. Half of youth experiencing suicidal thoughts (n = 43; 50.0%) did not share this with their caregiver. Nearly one in four youth had attempted suicide at some point in their life (n = 25; 24.3%), while some youth (n = 16; 15.5%) sought help from caregivers to prevent an attempt. Sadness/depression and bullying/teasing were the most common triggers of suicidal behaviors, while anger/frustration was the leading trigger for nonsuicidal self-injury. Findings can be used to improve current assessment tools and prevention approaches for autistic youth to create better support for autistic youth in crisis.

Extracurricular Activity Participation Among Autistic Children and Adolescents: Buffer for Internalizing Conditions and Foundation for Friendship?

PURPOSE

Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth.

METHODS

Secondary analysis was performed using data from the 2018-2019 National Survey of Children's Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted.

RESULTS

Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = .006) and adolescents (OR = 2.35, p = .001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = .048).

CONCLUSION

Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.

Prevalence, Symptom Profiles, and Correlates of Mixed Anxiety-Depression in Male and Female Autistic Youth

Relatively little attention has been given to mixed anxiety and depression in autistic youth, particularly how this differs between males and females. This study investigated sex-based differences in the prevalence and correlates of mixed anxiety and depression in a sample of 51 autistic males (M age = 10.16 yr, SD = 2.81 yr, and range = 6 yr to 17 yr) and 51 autistic females (M age = - 10.07 yr, SD = 2.76 yr, and range = 6 yr to 17 yr), matched for age, IQ, and autism severity. Self-reports on generalised anxiety disorder and major depressive disorder, morning salivary cortisol, ADOS-2 scores, and WASI-II full-scale scores were collected from these autistic youth, and data on the ASD-related symptoms of these youth were collected from their parents. The data were analysed for total anxiety-depression score levels, for the underlying components of this scale, and for the individual items used in the scale. The results indicate no significant sex differences for the prevalence of mixed anxiety and depression total scores or the underlying components of anxiety and depression or for the individual items of the mixed anxiety-depression scale. There were sex differences in the significant correlates of mixed anxiety and depression: morning cortisol and ASD-related difficulties in social interaction for females, and ASD-related behaviour for males. Males' feelings of being restless or edgy were correlated with their social interaction and repetitive and restricted behaviour. Females' difficulties in social interaction were correlated with their concerns about their abilities and their sleeping problems. Females' sleeping problems, their tendency to talk about dying, and feeling worthless, were correlated with their morning cortisol. These findings suggest that, while mixed anxiety and depression is experienced similarly by autistic males and females at the global, component, and individual item levels, specific aspects of the symptomatology of mixed anxiety and depression are differently associated with aspects of their ASD-related symptomatology and their levels of chronic physiological stress for males and females.

Behavioral and Social Activation in Autism and Associations with Youth Depressive Symptoms from Youth and Caregiver Perspectives

Autistic youth are more likely to experience depression than their non-autistic peers, yet research on risk and protective factors to depression in this population is limited. Behavioral activation (i.e., prioritizing and engaging in meaningful activities), including social activities, is an important mechanism in the pathway to depression in non-autistic youth that is understudied in autism. Ratings of youth depressive symptoms and behavioral and social activation at one timepoint from 100 autistic youth without intellectual disability and 100 of their caregivers were analyzed. The study aims were to examine caregiver and youth ratings of youth internalizing symptoms and behavioral and social activation, inter-rater reliability on study variables, and associations between depressive symptoms and behavioral and social activation in autistic youth by rater. Results revealed significant differences in youth and caregiver ratings on all variables and inter-rater reliability ranged from poor to moderate. Across both raters, more severe anxiety symptoms and lower behavioral activation were associated with more severe depressive symptoms; social activation, specifically the number of friends youth have, was significant in caregiver ratings only. Findings can be leveraged to enhance risk stratification and intervention efforts for autistic youth experiencing depression.

Community-guided, autism-adapted group cognitive behavioral therapy for depression in autistic youth (CBT-DAY): Preliminary feasibility, acceptability, and efficacy

LAY ABSTRACT

Depression in youth is a significant public health problem worldwide, particularly for autistic youth who are over twice as likely to experience depression than their non-autistic peers. Although pathways to depression are complex, emotional reactivity and negative self-esteem are two risk factors for depression in autistic and non-autistic youth. Although autistic youth are more likely to experience depression than their non-autistic peers, psychotherapy options for autistic youth are very limited; community guidance in the development and testing of psychotherapy programs is a promising approach in autism. Therefore, in this study, we designed an autism-adapted CBT-DAY, in collaboration with autistic community members. Specifically, CBT-DAY combined neurodiversity-affirming and cognitive behavioral approaches to target emotional reactivity and self-esteem in youth to improve depressive symptom severity in a group setting across 12 weeks. We examined the preliminary feasibility, acceptability, and efficacy of CBT-DAY in a pilot non-randomized trial. In addition, we implemented a rigorous protocol for assessing, monitoring, and addressing potential harms in this intervention. Results from 24 autistic youth (11-17 years old) suggest that CBT-DAY may be feasible to use in an outpatient clinical setting and generally acceptable to youth and their caregivers. Participation in CBT-DAY may be associated with significant improvements in youth emotional reactivity and self-esteem, as well as depressive symptom severity per self-report only. Exploratory analyses showed that participation in CBT-DAY may also be associated with significant improvements in internalizing symptoms. Findings demonstrate the potential promise of neurodiversity-affirming and cognitive behavioral approaches to treating depressive symptoms in some autistic youth.

Predictors of Depressive Symptoms in Autistic Youth-A Longitudinal Study From the Province of Ontario Neurodevelopmental Disorders (POND) Network: Prédicteurs des symptômes dépressifs chez les jeunes autistes-une étude longitudinale du Réseau des troubles neurodéveloppementaux de la province de l'Ontario (réseau POND)

OBJECTIVE

The objective of this study was to identify longitudinal predictors of depressive symptoms in autistic children and youth.

METHODS

Participants were youth with a diagnosis of autism who were part of the Province of Ontario Neurodevelopmental Disorders Network longitudinal substudy. Depressive symptoms were assessed using the child behaviour checklist (CBCL) affective problems subscale. Univariate and multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between clinical and demographic characteristics at baseline (T1) and clinically elevated depressive symptoms (CEDS) approximately 4 years later (T2).

RESULTS

The mean age of participants (n = 75) at T1 was 9.8 years (SD = 2.7) and at T2 was 14.1 years (SD = 2.8). A total of 37% and 35% of participants had CEDS at T1 and T2, respectively. Additionally, 24% of participants had CEDS at both T1 and T2. T1 characteristics associated with T2 CEDS were: loneliness (OR = 3.0, 95% CI, 1.1 to 8.8), self-harm (OR = 4.0, 95% CI, 1.1 to 16.9), suicidal ideation (OR = 3.9, 95% CI, 1.0 to 16.5), more social and adaptive skills (OR = 0.3, 95% CI, 0.1 to 0.9), elevated restricted and repetitive behaviours (OR = 3.8, 95% CI, 1.3 to 11.6), psychotropic medication use (OR = 3.0, 95% CI, 1.1 to 8.4), attention-deficient/hyperactivity disorder (OR = 2.8, 95% CI, 1.1 to 7.8), and T1 CEDS (OR = 8.8, 95% CI, 3.1 to 27.0) (uncorrected for multiple comparisons). Associations persisted after adjusting for age and intelligence quotient (IQ) differences. Age, sex, IQ, teasing/bullying on the CBCL, family psychiatric history and family income were not associated with T2 CEDS.

CONCLUSION

Our results highlight both high prevalence and high potential for the persistence of depressive symptoms in autism and emphasize the importance of early support to address loneliness and social participation.

Trajectory of depressive symptoms over adolescence in autistic and neurotypical youth

BACKGROUND

Adolescence coincides with a dramatic rise in the onset of psychiatric conditions including depression. Depression symptoms may be particularly prevalent and impairing for youth with autism spectrum disorder (ASD). While prior research suggests adolescence is associated with worsening depression symptoms for typically developing (TD) and autistic youth, it is unclear if they follow a similar course.

METHOD

The study examined the trajectory of depressive symptoms in autistic and neurotypical youth over a 4-year longitudinal study using linear and logistic mixed effects models. In youth with clinically relevant depressive scores (t-score > 65), moderating factors (i.e., diagnosis, age, puberty, sex) were explored. During Year 1, the sample included 244 youth 10-to-13 years: 140 in the ASD group (36 females) and 104 in the TD group (46 females).

RESULTS

Autistic youth had elevated depression scores compared to TD peers (p < 0.001) and females were higher than males in both groups (p = 0.001). There was significant diagnosis by age (p < 0.001) and diagnosis by pubertal stage (p < 0.05) interactions. In the ASD group, elevated depressive scores presented in early adolescence and decreased during middle adolescence and puberty, whereas the TD group showed the opposite trend with an increase in depression symptoms with advancing development.

LIMITATIONS

Limitations include an unequal sex distribution (fewer females), non-representative autistic sample (e.g., cognition and race/ethnicity), and potential confound of the COVID-19 pandemic.

CONCLUSIONS

Autistic youth present with higher rates of depressive symptoms early in development; yet, approaching middle adolescence and puberty, the symptom trajectory in the autistic youth declines coinciding with an increase in the TD youth. While group trajectories are divergent, they lead to similar levels of depression in late adolescence with higher symptoms in females. Findings suggest a period of quiescence in depressive symptomology influenced by biopsychosocial factors impacting affective profiles.

Contrasting Views of Autism Spectrum Traits in Adults, Especially in Self-Reports vs. Informant-Reports for Women High in Autism Spectrum Traits

There is uncertainty among researchers and clinicians about how to best measure autism spectrum dimensional traits in adults. In a sample of adults with high levels of autism spectrum traits and without intellectual disability (probands, n = 103) and their family members (n = 96), we sought to compare self vs. informant reports of autism spectrum-related traits and possible effects of sex on discrepancies. Using correlational analysis, we found poor agreement between self- and informant-report measures for probands, yet moderate agreement for family members. We found reporting discrepancy was greatest for female probands, often self-reporting more autism-related behaviors. Our findings suggest that autism spectrum traits are often underrecognized by informants, making self-report data important to collect in clinical and research settings.

The importance of social relationships in depression in autistic adolescents: a narrative-review

Objective

The impact of social relationships on autistic adolescents has been recently studied. However, the link between social relationships and depression in autistic adolescents seem underrepresented in the scientific literature. Especially no specific assessment tool has been developed to evaluate depression in autistic adolescents. The aim of this narrative review is to raise the impact of social relationships on depression in autistic adolescents. We aim to propose lines of thought on the creation of a sensitive tool for identifying depression in this population.

Methods

We conducted two types of searches for articles and reviews on PubMed, Embase, and Cochrane. First, regarding social relationships, we searched the following terms: [("adolesc*" OR "youth") AND ("ASD" OR "autis*") AND ("social communication" OR "peer relationship") AND ("depress*")]. Secondly, regarding assessment tool, we searched the following terms: [("tool" OR "assess*") AND ("depress*") AND ("ASD" OR "Autis*)"].

Results

Social impact, verbal skills, and good social motivation are risk factors of depression in autistic adolescents. Social impairment during childhood is related to peer victimization and is a risk factor for depression. There is no specific tool to measure depression in autistic adolescents.

Conclusion

No specific tool based on social relationships was developed to evaluate depression in autistic adolescents. Depression in autistic adolescents needs to be assessed considering the social and pragmatic specificities of autism. Social communication and difficulties in peer relationships may be evaluated in specific assessment tools based on social relationships for depression in autistic adolescents.

Assessing suicidal thoughts and behaviors and nonsuicidal self-injury in autistic and non-autistic early adolescents using the Columbia Suicide Severity Rating Scale

LAY ABSTRACT

Autistic adolescents are more likely to experience suicidal thoughts and behaviors and nonsuicidal self-injury than non-autistic adolescents, per caregiver- and self-report on single-item questionnaires. Comprehensive, clinician-rated measures of suicide risk have not been used to measure suicidal thoughts and behaviors and nonsuicidal self-injury in autistic youth despite greater parent-child rating discrepancies among autistic youth than their non-autistic peers. The Columbia Suicide Severity Rating Scale is a widely used, clinician-rated measure of suicide risk that has not been tested with autistic youth. In this study, the Columbia Suicide Severity Rating Scale was employed to assess suicidal thoughts and behaviors and nonsuicidal self-injury in a community sample of 239 early adolescents (10:0-13:9 years old), of whom 138 youth were autistic and 101 were not autistic. Multiple analyses examined diagnostic (autistic vs non-autistic) and sex-based (male vs female) differences in suicidal thoughts and behaviors and nonsuicidal self-injury, as well as youth consistency in reporting across self- and clinician-rated measures. Findings show that a greater proportion of autistic youth reported lifetime suicidal thoughts and nonsuicidal self-injury than non-autistic youth; however, there were no sex-based differences. The majority of non-autistic youth were consistent in reporting suicidal thoughts on self- and clinician-rated measures; however, nearly one in five autistic youth disclosed suicidal thoughts on a self-report measure but not to a psychiatrist on the Columbia Suicide Severity Rating Scale. Findings suggest that autism diagnostic status, but not sex, confers significant risk for suicidal thoughts and behaviors and nonsuicidal self-injury in early adolescents and that the Columbia Suicide Severity Rating Scale may be a useful measure of suicide risk for some autistic youth, but it may not detect all autistic youth experiencing suicidal thoughts.

Suicidal Risk Behaviors in Adolescents With Rare Neurodevelopmental Disorders: The Role of Sex, Autistic Traits, and Mental Health Difficulties

OBJECTIVE

Autistic traits are associated with mental health difficulties and risk of suicidal risk behaviors among adolescents. Little is known about how autistic traits affect the mental health of adolescents with rare neurodevelopmental disorders (RNDs). The aim of this study was to investigate the relationship between autistic traits, mental health difficulties, and suicidal risk behaviors in adolescents with RNDs.

METHODS

Parents (N = 93) completed the Child Behavior Checklist, Social Communication Questionnaire, and Social Responsiveness Scale about their adolescent (Mage = 13.1, SD = 2.3, 62.4% females) with an RND (e.g., sex chromosome aneuploidies, Fragile X syndrome, 22q11.2 deletion syndrome). The data were analyzed with hierarchical logistic regression analysis.

RESULTS

The prevalence of suicidal risk behaviors (16.1%) was similar to that reported among autistic youth and was higher among boys than girls. More autistic traits were associated with suicidal risk behaviors in bivariate analysis. In multivariate analysis, more anxiety/depressive symptoms were associated with more suicidal risk behaviors and externalizing problems associated with suicidal risk behaviors beyond autistic traits and anxiety/depressive symptoms.

CONCLUSION

Adolescents with RNDs are at risk of suicidal risk behaviors, especially those with higher levels of autistic traits, anxiety/depressive symptoms, and externalizing problems. Assessment of autistic traits, mental health difficulties, and suicide risk may be indicated for adolescents with RNDs to determine if corresponding intervention is needed.

Community-guided measurement-based care for autistic youth and adults receiving psychotherapy: A conceptual overview and pilot implementation study of MBC-AUT

LAY ABSTRACT

Autistic youth and adults are more likely to experience psychiatric symptoms (e.g. depression, anxiety) and to use psychiatric services than non-autistic people, yet research on evidence-based approaches to enhance psychiatric care for autistic people is limited. Measurement-based care is an evidence-based approach to psychotherapy that improves outcomes for clients, clinicians, and organizations by routinely administering and evaluating measures to clients. Despite this, research on measurement-based care systems for autistic clients is sparse. To address this gap, we developed an autism-adapted measurement-based care (MBC-AUT) system for and with autistic people and pilot tested the system in an outpatient psychiatry clinic to investigate the preliminary feasibility, acceptability, benefits, and barriers to this system for clients and clinicians. Findings suggested that the MBC-AUT system was a feasible and acceptable system for the first 18 autistic youth, their caregivers, and autistic adults to use the system. In semi-structured interviews, clients and clinicians discussed the benefits of the MBC-AUT system to various therapeutic processes, as well as several important barriers to the use of the system. We offer potential solutions to address these barriers and to reduce client and clinician burden, and propose future directions for this line of research to increase access to more autistic people. As autistic clients continue to seek psychological services amid social landscapes of increasing complexity (e.g. COVID-19 pandemic), efforts to enhance the delivery of psychotherapy for this population are critical.

Mental health concerns in children with neurodevelopmental conditions attending a developmental assessment service

Children with neurodevelopmental conditions (NDCs) experience co-occurring mental health concerns. Little research has examined mental health symptoms in children attending developmental assessment services. This study profiled mental health symptoms in children with NDCs attending a hospital-based diagnostic service for their first diagnostic assessment. Participants were 232 children aged 1.96-17.51 years. Mental health concerns were assessed using the Child Behavior Checklist (CBCL), a caregiver-rated, questionnaire-based assessment of behavioural and emotional difficulties. Subclinical or clinically elevated internalising, externalising and total scores on the CBCL were reported in over one third of children. These increased prevalence rates remained after excluding items specifically relating to neurodevelopmental concerns. More school-aged females reported elevated internalising problems, relative to males (67 % vs 48 %). The number of diagnoses impacted symptoms, with children who received two or more DSM-5 diagnoses showing a greater rate of subclinical or clinically elevated scores, relative to children who received one DSM-5 diagnosis. Our findings demonstrate that children attending developmental assessment services have considerable mental health needs. It is critical that mental health concerns are identified and addressed in children when they first present to developmental assessment services, and that service providers are equipped to provide appropriate resources and pathways to ongoing care.

Friendship and Anxiety/Depression Symptoms in Boys With and Without Autism Spectrum Disorder

The transition to adolescence may be a challenging time for individuals with autism spectrum disorder (ASD). This developmental period is marked by increased social demands and increasing anxiety and depression symptoms for many individuals with autism. As both of these factors may compound social difficulties and impact friendship experiences, this study explored the relations among autism symptom severity, internalizing symptoms, and friendship experiences in boys with and without ASD (with IQ > 75). Results showed that internalizing symptoms predicted quantity of close friendships in the ASD group. Given the observed relationship between internalizing symptoms and friendship experiences, social skills intervention programs should address possible internalizing symptoms associated with establishing/maintaining social relationships and perceived friendship quality.

Age differences and brain maturation provide insight into heterogeneous results in autism spectrum disorder

Studies comparing individuals with autism spectrum disorder (ASD) to typically developing (TD) individuals have yielded inconsistent results. These inconsistencies reflect, in part, atypical trajectories of development in children and young adults with ASD compared to TD peers. These different trajectories alter group differences between children with and without ASD as they age. This paper first summarizes the disparate trajectories evident in our studies and, upon further investigation, laboratories using the same recruiting source. These studies indicated that cognition improves into adulthood typically, and is associated with the maturation of striatal, frontal, and temporal lobes, but these age-related improvements did not emerge in the young adults with ASD. This pattern - of improvement into adulthood in the TD group but not in the group with ASD - occurred in both social and non-social tasks. However, the difference between TD and ASD trajectories was most robust on a social task, face recognition. While tempting to ascribe this uneven deficit to the social differences in ASD, it may also reflect the prolonged typical development of social cognitive tasks such as face recognition into adulthood. This paper then reviews the evidence on age-related and developmental changes from other studies on ASD. The broader literature also suggests that individuals with ASD do not exhibit the typical improvements during adolescence on skills important for navigating the transition to adulthood. These skills include execution function, social cognition and communication, and emotional recognition and self-awareness. Relatedly, neuroimaging studies indicate arrested or atypical brain maturation in striatal, frontal, and temporal regions during adolescence in ASD. This review not only highlights the importance of a developmental framework and explicit consideration of age and/or stage when studying ASD, but also the potential importance of adolescence on outcomes in ASD.

Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression

Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

Anxiety in Autism Spectrum Disorder: Clinical Characteristics and the Role of the Family

BACKGROUND

Anxiety Disorder (AD) is among the most common psychiatric comorbidity in children and adolescents with Autism Spectrum Disorder (ASD). Likewise, parental psychological distress (PPD) was linked to anxiety symptoms in children and adolescents with ASD. The aim of this study was to characterise, in a sample of children and adolescents with ASD, anxiety symptoms, the functional impairment associated and the presence of PPD.

METHODS

Participants were divided into three groups based on their diagnosis: children and adolescents with a diagnosis of ASD + AD, others with a diagnosis of AD but without a diagnosis of ASD, and others with a diagnosis of ASD but without a diagnosis of AD.

RESULTS

Group ASD + AD showed lower global functioning than Group ASD and Group AD. Generalised Anxiety Disorder, Separation Anxiety Disorder and Specific Phobias were more frequent in Group ASD + AD. Our findings also showed higher depressive symptoms in Group ASD + AD, both in the child and parent reports. Finally, parents of the Group ASD + AD revealed higher levels of PPD.

CONCLUSIONS

Our findings suggest that early assessment of AD with functional impairment associated with the role of PPD could define individualised treatments and consequently mean a better prognosis in children and adolescents with ASD and AD.

Friendship quality among autistic and non-autistic (pre-) adolescents: Protective or risk factor for mental health?

LAY ABSTRACT

Autistic young people are often misunderstood by non-autistic young people, and this can lead to difficulties in their friendships. We know that friendship is very important for our mental health. For non-autistic young people, having good friendships is linked to better mental health and having problems in friendship can cause mental health problems. This study aimed to compare the positive and negative features of friendship that autistic non-autistic young people experience. The study also aimed to understand if having positive or negative friendship features is related to signs of mental health problems (anxiety and depression). 306 young people aged 9-16 took part in this study. These were 86 autistic boys, 18 autistic girls, 91 non-autistic boys and 111 non-autistic girls. The findings of this study showed that autistic young people have less positive friendship features than non-autistic young people. For all young people in the study, having more positive friendship features was related to fewer signs of depression, while having more negative friendship features was related to more signs of depression. Just for autistic girls, having more positive friendship features was related to more signs of anxiety. These findings show that support is needed to help autistic young people have more positive friendships. For example, by teaching non-autistic young people how to be supportive friends to their autistic peers.

Correlates of suicidality in young people with depressive disorders: A systematic review

OBJECTIVE

Depression is one of the most prevalent and disabling mental health conditions among young people worldwide. The health and economic burdens associated with depressive illness are substantial. Suicide and depression are closely intertwined, yet a diagnosis of depression itself lacks predictive specificity for suicidal behaviour. To better inform suicide prevention and early intervention strategies for young people, improved identification of modifiable intervention targets is needed. The objective of this review was to identify clinical, psychosocial and biological correlates of suicidality in young people diagnosed with a broad range of unipolar and bipolar depressive disorders.

METHOD

Systematic searches were conducted across MEDLINE, Embase and PsycINFO to identify studies of young people aged 15-25 years diagnosed with unipolar or bipolar depressive disorders. An assessment of suicidality was required for inclusion. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Synthesis Without Meta-analysis guidelines.

RESULTS

We integrated findings from 71 studies including approximately 24,670 young people with clinically diagnosed depression. We identified 26 clinical, psychosocial and biological correlates of suicidality. Depression characteristics (type and severity), psychiatric comorbidity (particularly anxiety and substance use disorders) and neurological characteristics emerged as having the most evidence for being associated with suicidal outcomes. Our ability to pool data and conduct meaningful quantitative synthesis was hampered by substantial heterogeneity across studies and incomplete reporting; thus, meta-analysis was not possible.

CONCLUSION

Findings of this review reinforce the notion that suicidality is a complex phenomenon arising from the interplay of multiple contributing factors. Our findings question the utility of considering a diagnosis of depression as a specific risk factor for suicidality in young people. Suicidality itself is transdiagnostic; adoption of a transdiagnostic approach to investigating its aetiology and treatment is perhaps warranted. Future research investigating specific symptoms, or symptom networks, might help to further our understanding of suicidality among young people experiencing mental illness.

Predictors of Suicidal Thoughts in Children with Autism Spectrum Disorder and Anxiety or Obsessive-Compulsive Disorder: The Unique Contribution of Externalizing Behaviors

Children with autism spectrum disorder (ASD) are at elevated risk of suicidal ideation, particularly those with comorbid anxiety disorders and/or obsessive-compulsive disorder (OCD). We investigated the risk factors associated with suicidal ideation in 166 children with ASD and comorbid anxiety disorders/OCD, and the unique contribution of externalizing behaviors. Suicidal ideation was reported in the child sample by 13% of parents. Controlling for child age, sex, and IQ, perceived loneliness positively predicted the likelihood of suicidal ideation. In addition, externalizing behaviors positively predicted suicidal ideation, controlling for all other factors. Reliance on parental report to detect suicidal ideation in youth with ASD is a limitation of this study. Nonetheless, these findings highlight the importance of assessing and addressing suicidal ideation in children with ASD and comorbid anxiety disorders/OCD, and more importantly in those with elevated externalizing behaviors and perceptions of loneliness.

Parental Depression Symptoms and Internalizing Mental Health Problems in Autistic Children

Autistic youth are at risk for internalizing mental health problems such as depression and anxiety. Similarly, parents of autistic youth report higher levels of depression than parents of typically developing children. The goal of this study was to examine bidirectional associations between parent depression symptoms and the internalizing problems of autistic youth in 188 families across four time points (T1-T4; spaced 12 months apart). A cross-lagged panel model revealed that mother (T1 and T2) and father (T1) depression symptoms positively predicted the youth's internalizing problems 12 months later. The youth's internalizing problems at T3 positively predicted maternal depression symptoms at T4. Future research should explore genetic and environmental pathways that link parent depression and internalizing problems in autistic youth.

Diagnostic- and sex-based differences in depression symptoms in autistic and neurotypical early adolescents

LAY ABSTRACT

Depression is more common in autistic adolescents than their neurotypical peers, but the effects of diagnosis and sex on the severity and types of depressive symptoms remain unclear. The study explored diagnostic- and sex-based differences in depressive symptoms in 212 autistic and neurotypical early adolescents. Results show that autism spectrum disorder and female may pose elevated risks, and depressive symptoms related to interpersonal problems and negative self-esteem are more frequent in autism spectrum disorder. Autistic males and females endorsed similar severity and type of depressive symptoms, but unique differences emerged when compared to sex-matched neurotypical peers. Exploratory analyses in a clinical subsample of early adolescents with elevated depressive symptoms (Children's Depression Inventory, Second Edition, Total T-score ⩾60) revealed more endorsement of beliefs of worthlessness in autistic early adolescents. Findings suggest initial intervention targets for treating depression in autistic early adolescents.

Physiological, psychosocial, and environmental factors in depression among autistic girls

Autism Spectrum Disorder and depression are often co-occurring in young people. However, despite the association between these two disorders, and the fact that females have a higher prevalence of depression than males in the general population, there is little reported evidence regarding the correlates of depression in young autistic females. Several physiological (age, menarche, HPA-axis responses), psychological (social anxiety), and environmental or genetic (mothers' depression) factors were tested for their contribution to depression severity in a sample of 53 autistic girls aged 6 yr to 17 yr. Depression scores were collected from the girls' self-ratings and also from the ratings their mothers gave them. Regression results indicated that girls' social anxiety, age, and mothers' depression were common significant contributors to both sets of depression scores, but with different effects. Autistic girls' self-reports of their depression were significantly associated with their HPA-axis responses but not with their menarche status. Implications for research and clinical settings are discussed.

Depression symptoms in adolescents with autism spectrum disorder: A contextual approach to mental health comorbidities

INTRODUCTION

Although research on mental health comorbidities in autism spectrum disorder (ASD) has increased in recent years, little has been done to evaluate potential individual × environment interactions associated with these comorbidities. The current study explored whether ASD-related characteristics (social-communication impairment) and environmental factors (peer and family contexts) had additive or interactive effects on the depression symptoms of youth with ASD.

METHOD

In a cross-sectional sample of adolescents with ASD (N = 176; 13-17 years old; 72.7% male), primary caregivers and adolescents responded to a series of surveys online pertaining to adolescents' mental health (Revised Child Anxiety and Depression Scale), family functioning (Self-Report of Family Inventory), and experiences of peer victimization (Peer Experiences Questionnaire-Revised).

RESULTS

There were statistically significant interactions between social-communication skills and the environment in both family (△R² = 0.02) and peer (△R² = 0.02) contexts. For youth with better social-communication skills, there was a positive association between peer victimization and depression symptoms and a negative association between family competence and depression symptoms.

CONCLUSION

Findings support social-push interactive models in which better social-communication skills are associated with fewer depression symptoms in the context of less-stressful peer and family environments, highlight the utility of ecologically informed approaches to the mental health of youth with ASD, and suggest several areas for future study.