Interventions for Adolescent Students With Autism and Co-Occurring Mental Health Disorders

Abstract

School nurses are often the forward-facing health care practitioner for youth, simultaneously managing mental health and medical care for their students while also interacting with students’ families and navigating consequences of family dynamics, including health literacy, social support, and financial issues. Thus, it makes sense to train school nurses on how to best interact with and support adolescents diagnosed on the autism spectrum. Part one of this three-part series will include an overview of mental health diagnoses often co-occurring with autism, associated challenges for the autistic adolescent, and school nurse interventions that may be helpful. The second and third part of the series will address the medical health diagnoses, nursing interventions, and overall discussion on how to best care for autistic adolescents in the schools.

Keywords

autism spectrum disorder autism special needs interventions collaboration research mental health school nurse

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425787

Autism Speaks. (2025a). Notes for the school nurse: Common challenges related to autism. https://www.autismspeaks.org/blog/notes-school-nurse-common-challenges-related-autism#:~:text=Regardless%20of%20an%20autistic%20student's,need%2C%20illness%20or%20emergency%20occurs

Autism Speaks. (2025b). Social skills and autism. https://www.autismspeaks.org/social-skills-and-autism#:~:text=Social%20skills%20groups%20offer%20an,an%20effective%20social%20skills%20group.&text=*Excerpted%20from%20Social%20Skills%20Interventions,D

Aymerich

Pacho

Catalan

Yousaf

Pérez-Rodríguez

Hollocks

Parellada

Krebs

Clark

Salazar

Pablo

(2024). Prevalence and correlates of the concurrence of autism spectrum disorder and obsessive-compulsive disorder in children and adolescents: A systematic review and meta-analysis. Brain Science, 14(4), 379. https://doi.org/10.3390/brainsci14040379

Brookman-Frazee

Stadnick

Chlebowski

Baker-Ericzén

Ganger

(2018). Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism, 22(8), 938–952.

Cai

R. Y.

Richdale

A. L.

Uljarević

Dissanayake

Samson

A. C.

(2018). Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Research, 11(7), 962–978.

Chantiluke

Christakou

Murphy

C. M.

Giampietro

Daly

E. M.

Ecker

Brammer

Murphy

D. G.

; MRC AIMS Consortium. (2014). Disorder-specific functional abnormalities during temporal discounting in youth with attention deficit hyperactivity disorder (ADHD), autism and comorbid ADHD and Autism. Psychiatry Research: Neuroimaging, 223(2), 113–120.

Che

Y. M.

Zhou

H. Y.

(2025). Difficulties in emotion recognition from body movements in Autism Spectrum Disorder: A systematic review and meta-analysis. Review Journal of Autism and Developmental Disorders, 1–14. https://doi.org/10.1007/s40489-025-00524-y

10.

Clarke

E. B.

McCauley

J. B.

Lutz

Gotelli

Sheinkopf

S. J.

Lord

(2024). Understanding profound autism: Implications for stigma and supports. Frontiers in Psychiatry, 15, Article 1287096. https://doi.org/10.3389/fpsyt.2024.1287096

11.

Dell’Osso

Nardi

Bonelli

Amatori

Pereyra

Massimetti

Cremone

Pini

Carpita

(2024) Autistic traits as predictors of increased obsessive-compulsive disorder severity: The role of inflexibility and communication impairment. Brain Science, 14(1), 64. https://doi.org/10.3390/brainsci14010064

12.

Demetriou

E. A.

Lampit

Quintana

D. S.

Naismith

S. L.

Song

Y. J.

Pye

J. E.

Hickie

Guastella

A. J.

(2018). Autism spectrum disorders: A meta-analysis of executive function. Molecular Psychiatry, 23(5), 1198–1204. https://doi.org/10.1038/mp.2017.75

13.

Dwyer

(2022). Stigma, incommensurability, or both? Pathology-first, person-first, and identity-first language and the challenges of discourse in divided autism communities. Journal of Developmental & Behavioral Pediatrics, 43(2), 111–113. https://doi.org/10.1097/DBP.0000000000001014

14.

Gardiner

Iarocci

(2018). Everyday executive function predicts adaptive and internalizing behavior among children with and without autism spectrum disorder. Autism Research, 11(2), 284–295. https://doi.org/10.1002/aur.1877

15.

Hadland

Solomen

Guss

(2023). Affirming care for autism and gender diversity. Pediatrics, 152(2), e2023061813. https://doi.org/10.1542/peds.2023-061813

16.

Hours

Recasens

Baleyte

J. M.

(2022). ASD and ADHD comorbidity: What are we talking about? Frontiers in Psychiatry, 13, Article 837424.

17.

Johnson

van Zijl

Kuyler

(2023). Pain communication in children with autism spectrum disorder: A scoping review. Paediatric and Neonatal Pain, 5(4), 127–141.

18.

Joshi

Petty

Wozniak

Henin

Fried

Galdo

Kotarski

Walls

Biederman

(2010). The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: A large comparative study of a psychiatrically referred population. Journal of Autism and Developmental Disorders, 40(11), 1361–1370.

19.

Joshi

Wozniak

Petty

Martelon

M. K.

Fried

Bolfek

Kotte

Stevens

Furtak

S. L.

Bourgeois

Caruso

Caron

Biederman

. (2013). Psychiatric comorbidity and functioning in a clinically referred population of adults with autism spectrum disorders: a comparative study. Journal of autism and developmental disorders, 43(6), 1314–1325. https://doi.org/10.1007/s10803-012-1679-5

20.

Kahn

Sequeira

Reyes

Garrison

Orlich

Christakis

Aye

Conard

Dowshen

Kazak

Nahata

Nokoff

Voss

Richardson

(2023). Mental health of youth with autism spectrum disorder and gender dysphoria. Pediatrics, 1(6), 156. https://doi.org/10.1542/peds.2023-063289

21.

Kenny

Remington

Pellicano

(2024). Everyday executive function issues from the perspectives of autistic adolescents and their parents: Theoretical and empirical implications. Autism. 28(9), 2204–2217. https://doi.org/10.1177/13623613231224093

22.

Kildahl

Helverschou

Rysstad

Wigaard

Hellerud

Ludvigsen

Howlin

(2021). Pathological demand avoidance in children and adolescents: A systematic review. Autism, 25(8), 2162–2176. https://doi.org/10.1177/13623613211034382.

23.

Lai

M. C.

Kassee

Besney

Bonato

Hull

Mandy

Szatmari

Ameis

S. H.

(2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819–829.

24.

McMaughan

Imanpour

Mulcahy

Jones

Criss

(2023). Mental health–related hospitalizations among adolescents and emerging adults with Autism in the United States: A retrospective, cross-sectional analysis of national hospital discharge data. Autism, 27(6), 1702–1715.

25.

Morris

I. F.

Sykes

J. R.

Paulus

E. R.

Dameh

Razzaque

Esch

L. V.

Gruenig

Zelazo

P. D.

(2025). Beyond self-regulation: Autistic experiences and perceptions of stimming. Neurodiversity, 3, 27546330241311096.

26.

Morris

Greenblatt

Saini

(2019). Healthcare providers’ experiences with autism: A scoping review. Journal of Autism and Developmental Disorders, 49(6), 2374–2388.

27.

Newson

Le Marechal

David

(2003). Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders. Archives of Disease in Childhood, 88, 595–600. https://doi.org/10.1136/adc.88.7.595

28.

Passarini

Parisi

Guerrera

Lazzaro

Costanzo

Menghini

Vicari

Fucà

(2025). Exploring the association between sleep disturbances and repetitive behaviors in autistic children and adolescents: A systematic review. Sleep Medicine. 133, Article 106609. https://doi.org/10.1016/j.sleep.2025.106609

29.

Plumb

(2025). Conversation guide: How to talk to your autistic teenager. ReachOut. https://parents.au.reachout.com/mental-health-and-wellbeing/autism-and-teenagers/

30.

Rising Above ABA. (2024). Benefits of social skills groups for autistic kids. https://www.risingaboveaba.com/autism-blog/benefits-of-social-skills-groups-for-autistic-kids

31.

Rosenthal

Wallace

Lawson

Wills

Dixon

Yerys

Kenworthy

(2013). Impairments in real-world executive function increase from childhood to adolescence in autism spectrum disorders. Neuropsychology, 27(1), 8–13. https://doi.org/10.1037/a0031299

32.

Schuck

R. K.

Chetcuti

Dwyer

Milosavljevic

Bury

S. M.

Hedley

Begeer

Vivanti

Uljarevic

(2025). Preferences for identity-first and person-first language: A systematic review of research with autistic adults/adults with Autism. Journal of Autism and Developmental Disorders, 1–15. Advance online publication. https://doi.org/10.1007/s10803-024-06586-0

33.

Smith

Horton

Fitzgibbons

(2023). Preferences for person-first language and identity-first language in autistic communities. Journal of Critical Study of Communication and Disability, 1(2), 106–140. https://doi.org/10.48416/jcscd_2023_vol1iss2_7

34.

Sterrett

Clarke

Nofer

Piven

Lord

(2024). Toward a functional classification for autism in adulthood. Autism Research, 17(10), 2105–2119.

35.

Taboas

Doepke

Zimmerman

(2023). Preferences for identity-first versus person-first language in a US sample of autism stakeholders. Autism, 27(2), 565–570. https://doi.org/10.1177/13623613221130845

36.

Valicenti-McDermott

Schlusse

l D.

Hurley

Rivelis

Bernstein

Cardin

(2023). Comorbidities in school-age children and adolescents with Autism in an ethnically diverse population: Brief report. Journal of Child and Adolescent Psychopharmacology, 33(5), 190–194. https://doi.org/10.1089/cap.2023.0006

37.

Vargas

Paoletti

De Stasio

Berenguer

(2025). Sleep disturbances in autistic children and adolescents: A systematic review and meta-analysis of randomized controlled trials. Autism, 29(7), 1661–1673.

38.

Verkooijen

M.H.

Ketelaar

van Woerden

Staal

W.G.

Tendolkar

Zinkstok

J.R.

(2026). Impact of peer-support programs for individuals with autism: A systematic review. Autism, 30(2), 300–315. https://doi.org/10.1177/13623613251374971

39.

Wachtel

L. E.

Escher

Halladay

Lutz

Satriale

G. M.

Westover

Lopez-Arvizu

(2024). Profound autism: An imperative diagnosis. Pediatric Clinics of North America, 71(2), 301–313. https://doi.org/10.1016/j.pcl.2023.10.006

40.

Wiggins

L. D.

Tinker

S. C.

Overwyk

Powell

Thompson-Paul

Fitzgerald

Rosenberg

S. A.

Rosenberg

C. R.

Maenner

M. J.

(2026). Individual profound autism criteria and unmet needs among autistic adolescents and their caregivers. JAMA Pediatrics. Advance online publication. https://doi.org/10.1001/jamapediatrics.2024.6151

41.

Yerys

B. E.

Wallace

G. L.

Sokoloff

J. L.

Shook

D. A.

James

J. D.

Kenworthy

(2009). Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Research, 2(6), 322–333.

42.

Zajic

M. C.

Gudknecht

(2024). Person- and identity-first language in autism research: A systematic analysis of abstracts from 11 autism journals. Autism, 28(10), 2445–2461. https://doi.org/10.1177/13623613241245678