Supporting the Psychological Health of Individuals on the Autism Spectrum
Mental Health challenges in the workplace for individuals with ASD
By: Dr. David Worling, R. Psych.
Part 1: Introduction and Overview
Autism Spectrum Disorders (ASD) encompass a wide range of challenges that broadly fall into three categories that include: social communication, social interaction, and restricted range of interests/stereotyped behaviours. The term ‘spectrum’ is meant to highlight the significant variation among and between individuals with ASD that may include those with significant intellectual delay through to those with very high IQ’s. Likewise, given the wide range of symptom presentations within the three diagnostic categories, the degree to which individuals are impacted may range from very mild to very severe. Recent shifts in diagnostic approaches, in combination with a growing awareness of the broader ASD symptom presentation, have led to a significant increase in the diagnostic rates. More specifically, current estimates from the Centres for Disease Control place the number of affected individuals at 1 in 68 or approximately 1.5% of the population.
Traditionally, many of the ASD-specific interventions have tended to focus on communication (e.g., acquisition of speech, conversation skills, etc.) and/or social skills (e.g., use of eye contact, greetings, making friends, etc.). Although it has long been acknowledged that individuals with ASD have a number of associated mental health challenges, there has been an increase in the attention to these challenges given the significant rise in the incidence rates. The mental health needs of adults on the spectrum, however, are complex and are often overlooked given the unique profile associated with ASD. Additionally, features that are commonly found in ASD, like strong reactions to sounds/smells or changes in routine are seen to be ‘part of the package’ of ASD and not necessarily seen to be mental health challenges. The literature on ASD and co-occurring mental health issues has been increasingly well documented and points to a considerable proportion of individuals with ASD having significant ongoing mental health challenges. Buck et. al., (2014) studied a community sample of adults with ASD and found that fully 69% of the sample met diagnostic criteria for a psychiatric disorder (e.g., depression, anxiety, etc.). If one broadens the scope of the search to include children and behaviour concerns (e.g., sleep disturbance, AD/HD, etc.), Joshi et. al., (2010) found that 95% of their sample of youth with ASD had at least one co-occurring psychiatric diagnosis and that a surprising 74% had 5 or more co-occurring diagnoses!
Historically, the bulk of research and accompanying funding has traditionally been paid to the study of ASD in children, however, with the significant rise in Autism Spectrum rates globally, there has been an accompanying increase in attention paid to adults, in general, and employment more specifically. Despite the recent focus on the issues of ASD and employment, there has been considerably less attention paid to the mental health challenges associated with adult ASD.
In many respects, the mental health concerns in individuals with ASD are no different from other individuals as they often include common diagnoses like anxiety and depression. As we move through this series, however, we will highlight the unique nature that ASD can have on the expression and severity of many mental health conditions.
Introduction to the Series
This series will explore the mental health challenges associated with adult ASD in general, and in the workplace more specifically. The information included in this series will be drawn from the available peer-reviewed literature in combination with observations from clinical experience.
Having an awareness of the more common mental health conditions, and how they can co-occur within the Autism Spectrum is helpful in understanding the complex nature of ASD.
Part II: Anxiety and ASD