Depression is common in autism and Asperger syndrome, but despite this, there has been little research into this issue. This review considers the current literature on the prevalence, presentation, treatment and assessment of depression in autism and Asperger syndrome. There are diagnostic difficulties when considering depression in autism and Asperger syndrome, as the characteristics of these disorders, such as social withdrawal and appetite and sleep disturbance, are also core symptoms of depression. Impaired verbal and non-verbal communication can mask the symptoms of depression. Symptoms associated with autism and Asperger syndrome such as obsessionality and self-injury may be increased during an episode of depression. There is a clear need to develop specific tools both for diagnostic purposes and for measurement of depression in autism and Asperger syndrome in order to help alleviate the distress caused by this treatable illness.
ABRAMSON, R.K. , WRIGHT, H.H. , CUCCARO, M.L. , LAWRENCE, L.G. , BABB, S. , PENCARINHA, D. , MARSTELLER, F. & HARRIS, E.C. (1992) ‘Biological Liability in Families with Autism’ , Journal of the American Academy of Child and Adolescent Psychiatry31: 370-371 .
2.
AMERICAN PSYCHIATRIC ASSOCIATION (1999) Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV). Washington, DC: APA .
3.
BARNHILL, G.P. (2001) ‘Social Attribution and Depression in Adolescents with Asperger Syndrome’ , Focus on Autism and Other Developmental Disabilities16: 46-53 .
4.
BECK, A.T. , WARD, C.H. , MENDELSON, M. & ERBAUGH, J. (1961) ‘An Inventory for Measuring Depression’ , Archives of General Psychiatry4: 561-571 .
5.
BIEBERICH, A.A. & MORGAN, S.B. (1998) ‘Brief Report: Affective Expression in Children with Autism or Down Syndrome’ , Journal of Autism and Developmental Disorders28: 333-338 .
6.
CAPPS, L. , YIRMIYA, N. & SIGMAN, M. (1992) ‘Understanding of Simple and Complex Emotions in Non-Retarded Children with Autism’ , Journal of Child Psychology & Psychiatry & Allied Disciplines33: 1169-1182 .
7.
CHUNG, S.Y. , LUK, S.L. & LEE, P.W.H. (1990) ‘A Follow-Up Study of Infantile Autism in Hong Kong’ , Journal of Autism and Developmental Disorders20: 221-232 .
8.
CLARKE, D. , BAXTER, M. , PERRY, D. & PRASHER, V. (1999) ‘The Diagnosis of Affective and Psychotic Disorders in Adults with Autism: Seven Case Reports’ , Autism3: 149-164 .
9.
CLARKE, D.J. , LITTLEJOHNS, C.S. , CORBETT, J.A. & JOSEPH, S. (1989) ‘Pervasive Developmental Disorders and Psychoses in Adult Life’ , British Journal of Psychiatry155: 692-699 .
10.
COOKE, L.B. & THOMPSON, C. (1998) ‘Seasonal Affective Disorder and Response to Light in Two Patients with Learning Disability’ , Journal of Affective Disorders48: 145-148 .
11.
GHAZIUDDIN, M. & GREDEN, J. (1998) ‘Depression in Children with Autism/Pervasive Developmental Disorders: A Case-Control Family History Study’ , Journal of Autism and Developmental Disorders28: 111-115 .
12.
GHAZIUDDIN, M. & TSAI, L. (1991) ‘Depression in Autistic Disorder’ , British Journal of Psychiatry159: 721-723 .
13.
GHAZIUDDIN, M. , TSAI, L. & GHAZIUDDIN, N. (1991) ‘Fluoxetine in Autism with Depression’ , Journal of the American Academy of Child & Adolescent Psychiatry30: 508-509 .
14.
GHAZIUDDIN, M. , TSAI, L. & GHAZIUDDIN, N. (1992) ‘Comorbidity of Autistic Disorder in Children and Adolescents’ , European Journal of Child and Adolescent Psychiatry1: 209-213 .
15.
GHAZIUDDIN, M. , ALESSI, N. & GREDEN, J.F. (1995) ‘Life Events and Depression in Children with Pervasive Developmental Disorders’ , Journal of Autism and Developmental Disorders25: 495-502 .
16.
GHAZIUDDIN, M. , WEIDMER -MIKHAIL, E. & GHAZIUDDIN, N. (1998) ‘Comorbidity of Asperger Syndrome: A Preliminary Report’ , Journal of Intellectual Disability Research42: 279-283 .
17.
GILLBERG, C. (1985) ‘Asperger’s Syndrome and Recurrent Psychosis: A Case Study’ , Journal of Autism and Developmental Disorders15: 389-397 .
18.
GILLOTT, A. , FURNISS, F. & WALTER, A. (2001) ‘Anxiety in High-Functioning Children with Autism’ , Autism5: 277-286 .
19.
GREEN, J. , GILCHRIST, A. , BURTON, D. & COX, A. (2000) ‘Social and Psychiatric Functioning in Adolescents with Asperger Syndrome Compared with Conduct Disorder’ , Journal of Autism and Developmental Disorders30: 279-293 .
20.
GRODEN, J. , CANTELA, J. , PRINCE, S. & BERRYMAN, J. (1994) ‘The Impact of Stress and Anxiety on Individuals with Autism and Developmental Disabilities’, in E. SCHOPLER & G.B. MESIBOV (eds) Behavioural Issues in Autism. New York: Plenum .
21.
HAMILTON, M. (1960) ‘A Rating Scale for Depression’ , Journal of Neurology, Neurosurgery and Psychiatry23: 56-62 .
22.
HARE, D.J. (1997) ‘The Use of Cognitive-Behavioural Therapy with People with Asperger Syndrome’ , Autism1: 215-225 .
23.
HERJANIC, B. & CAMPBELL, J.W. (1977) ‘Differentiating Psychiatrically Disturbed Children on the Basis of a Structured Interview’ , Journal of Abnormal Child Psychology5: 127-135 .
24.
HIRSCHFELD, R.M.A. , KLERMAN, G.L. , LAVORI, P. , KELLER, M.B. , GRIFFITH, P. & CORYELL, W. (1989) ‘Premorbid Personality Assessments of First Onset of Major Depression’ , Archives of General Psychiatry46: 345-350 .
25.
HOBSON, R.P. (1986) ‘The Autistic Child’s Appraisal of Expressions of Emotion’ , Journal of Child Psychology and Psychiatry and Allied Disciplines27: 321-342 .
26.
HOLMES, N. , SHAH, A. & WING, L. (1982) ‘The Disability Assessment Schedule: A Brief Screening Device for Use with the Mentally Retarded’ , Psychological Medicine12: 879-890 .
27.
HOWLIN, P. (1997) ‘Psychiatric Disturbances in Adulthood’, in P. HOWLIN (ed.) Autism: Preparing for Adulthood, pp. 216-235. London: Routledge .
28.
KAZDIN, A.E. , MATSON, J.L. & SENATORE, V. (1983) ‘Assessment of Depression in Mentally Retarded Adults’ , American Journal of Psychiatry140: 1040-1043 .
29.
KENDLER, K.S. , NEALE, M.C. , KESSLER, R.C. , HEATH, A.C. & EAVES, L.J. (1993) ‘A Longitudinal Twin Study of Personality and Major Depression in Women’ , Archives of General Psychiatry50 (11): 853-862 .
30.
KIM, J.A. , SZATMARI, P. , BRYSON, S.E. , STREINER, D.L. & WILSON, F.J. (2000) ‘The Prevalence of Anxiety and Mood Problems among Children with Autism and Asperger Syndrome’ , Autism4: 117-132 .
31.
KOMOTO, J. , USUI, S. & HIRATA, J. (1984) ‘Infantile Autism and Affective Disorder’ , Journal of Autism and Developmental Disorders14: 81-84 .
32.
LAINHART, J.E. (1999) ‘Psychiatric Problems in Individuals with Autism, Their Parents and Siblings’ , International Review of Psychiatry11: 278-298 .
33.
LARSEN, F.W. & MOURIDSEN, S.E. (1997) ‘The Outcome in Children with Childhood Autism and Asperger Syndrome Originally Diagnosed as Psychotic: A 30 Year Follow-Up Study of Subjects Hospitalised as Children’ , European Child and Adolescent Psychiatry6: 181-190 .
34.
LONG, K. , WOOD, H. & HOLMES, N. (2000) ‘Presentation, Assessment and Treatment of Depression in a Young Woman with Learning Disability and Autism’ , British Journal of Learning Disabilities28: 102-108 .
35.
O ’BRIEN, G. , PEARSON, J. , BERNEY, T. & BARNARD, L. (2001) ‘Measuring Behaviour in Developmental Disability: A Review of Existing Schedules’ , Developmental Medicine and Child Neurology: Supplement, 43.
36.
PERRY, D.W. , MARSTON, G.M. , HINDER, S.A.J. , MUNDEN, A.C. & ROY, A. (2001) ‘The Phenomenology of Depressive Illness in People with a Learning Disability and Autism’ , Autism5: 265-275 .
37.
PUIG -ANTICH, J. , ORVASCHEL, H. , TABRIZI, M.A. & CHAMBERS, W. (1980) Schedule for Affective Disorders and Schizophrenia for School-Age Children: Epidemiological Version (Kiddie-SADS-E) (3rd edn). New York: New York State Psychiatric Institute and Yale University School of Medicine .
38.
REISS, S. (1990) Reiss Scales for Children’s Dual Diagnosis (Mental Retardation and Psychopathology). Worthington, OH: International Diagnostic Systems Inc.
39.
ROYAL COLLEGE OF PSYCHIATRISTS (2001) DC-LD: Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation. Occasional Paper Royal College of General Practitioners, 48.
40.
RUMSEY, J.M. , RAPOPORT, J.L. & SCEERY, W.R. (1985) ‘Autistic Children as Adults: Psychiatric, Social and Behavioral Outcomes’ , Journal of the American Academy of Child and Adolescent Psychiatry24: 465-473 .
41.
SOVNER, R. (1988a) ‘Anticonvulsant Drug Therapy of Neuropsychiatric Disorders in Mentally Retarded Persons’, in S. MCELROY & H.G. POPE JR (eds) Use of Anticonvulsants in Psychiatry, pp. 169-181. Clinton, NJ: Oxford Health Care .
42.
SOVNER, R. (1988b) ‘Behavioural Psychopharmacology: A New Psychiatric Subspecialty’, in J. STARK , F.J. MENOLASCINO , M. ALBARIELLI & V.C. GRAY (eds) Mental Retardation and Mental Health: Classification, Diagnosis, Treatment, Services, pp. 229-242. New York: Springer .
43.
TANTAM, D. (1991) ‘Asperger Syndrome in Adulthood’, in U. FRITH (ed.) Autism and Asperger Syndrome, pp. 147-183. Cambridge: Cambridge University Press .
44.
TSIOURIS, J.A. , COHEN, I.L. , PATTI, P.J. & KOROSH, W.M. (2003) ‘Treatment of Previously Undiagnosed Psychiatric Disorders in Persons with Developmental Disabilities Decreased or Eliminated Self-Injurious Behavior’ , Journal of Clinical Psychiatry64 (9): 1081-1090 .
45.
WING, L. (1981) ‘Asperger’s Syndrome: A Clinical Account’ , Psychological Medicine11: 115-129 .
46.
WORLD HEALTH ORGANIZATION (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization .
47.
YIRMIYA, N. , KASARI, C. , SIGMAN, M. & MUNDY, P. (1989) ‘Facial Expressions of Affect in Autistic, Mentally Retarded and Normal Children’ , Journal of Child Psychology & Psychiatry & Allied Disciplines30: 725-735 .
