Anxiety & depression in AuDHD (Part II)

Welcome to part 2 of Anxiety and depression in AuDHD! Here, we’ll focus on some ways we can improve outcomes for autistic people and AuDHDers (autism + ADHD) who experience anxiety and depression. 

Protective factors

What factors help lessen the frequency and risks of anxiety and depression?

Researchers have come up with various potential solutions to minimize the risk of anxiety and depression in autistic and AuDHD communities. These potential solutions are also called protective factors. In this article, I have organized these protective factors into three, specific levels: systems-level factors, individual-level factors, and group-level factors.

Systems-level factors

When referring to systems-level factors, I mean that these changes are not things we can enact on our own, but through the help of policy and widespread changes to practices by clinicians and care providers. One systems-level factor to help mitigate the effects of anxiety and depression on AuDHDers is widening access to diagnosis and mental health support. This can be done in a few ways.

One way is by ending the disconnect between treating mental health and supporting neurodevelopmental conditions.  As mentioned in Part 1 of this article, many autistics find that when seeking out treatment for anxiety and depression, practitioners do not understand autism and do not know how to help them.^[1]“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults (Maddox et al., 2020) Many autistics report that clinicians weren’t accommodating for overwhelming sensory issues (like harsh lighting, uncomfortable chairs) and wouldn’t offer enough solutions to their clients looking for help. 

It could be the case that practitioners might feel more confident in treating common mental health conditions like anxiety and depression, and may feel they do not have the tools to provide adequate support to autistic folks. However, while I’m not a clinician, I feel they have a responsibility to learn more about autistic folks as well as about different presentations of anxiety and depression. After all, the high prevalence of autistics with co-occurring mental health conditions suggests these providers are very likely to have autistic and AuDHD people in their office at one point. This would likely increase providers’ confidence in encountering different kinds of clients and make more autistic people feel comfortable reaching out for support.

Another systems-level way to mitigate anxiety and depression is by widening financial access to care, including diagnosis and treatment. Financial barriers to these procedures are a popular reason why autistics find difficulty accessing services.^[2]Depression in independent young adults on the autism spectrum: Demographic characteristics, service use, and barriers (Zheng et al., 2021) I have personally seen how not being able to afford consistent therapy and medications can perpetuate even more anxiety and overwhelm in my friends. 

Finally, creating more research on different cultural presentations of Autism and ADHD is necessary for autistics of various ethnic and cultural backgrounds to gain access to supportive care.^[3]“I wouldn’t know where to start”: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults (Maddox et al., 2020)^[4]Depression in independent young adults on the autism spectrum: Demographic characteristics, service use, and barriers (Zheng et al., 2021)^[5]When Autism and Depression Come Together: What We Know, How to Manage, and Key Resources (Zheng et al., 2021) | Anxiety & Depression Association of America Making it easier to receive earlier diagnoses for autism and ADHD can be helpful in preventing the functional challenges and emotional distress that arise with unsupported autism. This, in turn, would decrease the risk of developing anxiety and depression disorders earlier in life for autistics and AuDHDers.

Individual-level factors

By individual-level factor, I am referring to tools and avenues of support that we can find on our own. Likewise, an individual-level factor in decreasing anxiety and depression rates may look like having a person you trust to confide in. Research in depression studies suggests that the perception of social support, rather than the number of supports you have, is associated with fewer depression symptoms.^[6]When Autism and Depression Come Together: What We Know, How to Manage, and Key Resources (Zheng et al., 2021) | Anxiety & Depression Association of America

For autistics, we might not know what kinds of support we need and might have trouble voicing our needs for social support to others. Sometimes we might need physical support, while other times we might need someone to bring us out of our spiralling minds by providing a different perspective. When feeling low, it might feel emotionally exhausting having to reach out. But when no one knows what we are going through, it can also seem like there is no one around who can help, which is a horrible, distressing feeling.

Because of this, I’ve found that it can be helpful (during a time when you are not in crisis) to identify the actions and behaviours of people that make you feel most supported. When helpful behaviours are hard to identify or you are drawing a blank, try asking the people in your life what they have seen to be helpful for you. Finally, sharing these actions with the person(s) who make you feel safe can be a proactive step in seeking out support that is affirming of our communication styles.

Even just having one person you know you can rely on when needed, rather than having to talk all the time, is still very helpful in lessening feelings of loneliness and the effects of depression and improving our quality of life.^[7]Social support and links to quality of life among middle-aged and older autistic adults (Charlton et al., 2023)

Group-level factors

Finally, there are group-level factors that can minimize the risk of anxiety and depression through the supports we build as a community, either in school, work, or any community groups we are a part of.

One factor that can do this is the radical inclusion of people with all types of neurodivergent learning and communication. The encouragement of radical inclusion, especially in schools, would make it easier for everyone (not just autistic people) to navigate the world and its challenges. This could be done by clinicians and educators through workplace and classroom initiatives to challenge misconceptions about autism and ADHD.^[8]When Autism and Depression Come Together: What We Know, How to Manage, and Key Resources (Zheng et al., 2021) Likewise, these initiatives would make these spaces less stressful to be in, potentially reducing the risk for high anxiety in these spaces.

Another group-level factor in reducing anxiety and depression could be through peer support. Through the comment sections of blogs, online community forums, and support groups, the autistic and AuDHD community can find in-person or virtual spaces to share with people like ourselves about our experiences with anxiety and depression as well as the ways we cope. Seeking support from like-minded individuals with similar experiences may not only validate our feelings but also help us find new avenues of support. Sharing our experiences with others in a safe space may also increase our self-confidence and self-advocating skills in contexts with neurotypicals, where people are less likely to understand us.

In any situation, I feel it is important for neurotypicals to encourage different styles of communication and knowledge so that everyone—regardless of ability—feels welcome.

Summary

To lessen the impact of anxiety and depression on our daily lives, making diagnostic resources and personal support for autism and ADHD easier to access can be helpful. This can be done in the following ways:

• At the systems level, the impact of anxiety and depression can be lessened through more research into culture-specific presentations of neurodevelopmental conditions, as well as making treatment for mental health conditions more accessible.
• On an individual level, it’s important for autistics and AuDHDers to have someone they can rely on for support, as this can help minimize the effects of anxiety and depression.
• Finally, on a group level, creating more neurodiverse-inclusive spaces as well as finding peer support groups either in-person or online can create safer spaces where AuDHD people can be themselves and find support.