For many individuals on the autism spectrum, navigating life often involves managing more than just the core characteristics of autism. Co-occurring conditions — also known as comorbidities — are extremely common. These overlapping conditions can complicate diagnosis and care, especially for those supporting individuals with intellectual and developmental disabilities (IDD).
Recognizing and responding to these layered needs is essential for direct support professionals (DSPs), clinicians, and caregivers seeking to provide comprehensive, person-centered care.
Common Co-Occurring Conditions in Autistic Individuals:
ADHD – Attention-deficit/hyperactivity disorder (ADHD) frequently occurs alongside autism. Research suggests that nearly 50% of autistic children also meet the criteria for ADHD. Though the underlying connection is still under investigation, both conditions influence attention regulation, impulse control, and social behavior. Together, they can significantly shape an individual’s daily functioning and require tailored support strategies.
Anxiety Disorders – Anxiety is among the most prevalent co-occurring conditions for autistic individuals, with estimates suggesting up to 84% are affected. This intense emotional experience may not always present in ways typical for neurotypical populations — often emerging through increased rigidity, shutdowns, or repetitive behaviors.
Factors contributing to anxiety may include:
- Challenges in expressive communication leading to unmet needs and heightened frustration.
- Heightened sensory sensitivities, which can make everyday environments feel overwhelming.
- Social misunderstandings, which may lead to exclusion or isolation.
- Frustration with executive functioning or motor planning, impacting the ability to complete tasks.
- A detail-focused cognitive style, making it difficult to adapt to unexpected changes.
Depression – An estimated 1-in-4 autistic individuals experience depression. While some researchers point to difficulty in social relationships as a contributing factor, others highlight the role of cognitive patterns — such as rumination or a heightened awareness of unmet social or emotional needs — that can deepen depressive symptoms. Like anxiety, depression in autistic individuals may be underrecognized due to differences in emotional expression.
Sleep Disorders – Problems with sleep are twice as prevalent in autistic children as in neurotypical peers. Common issues include insomnia, irregular sleep patterns, night waking, and difficulty achieving restful sleep. These difficulties may stem from anxiety, GI discomfort, or even neurological differences in circadian regulation.
Treatment Considerations for Co-Occurring Conditions in Autism
Cognitive Behavioral Therapy (CBT) – CBT has been adapted with promising results for autistic individuals dealing with anxiety or depression. When tailored appropriately, it helps individuals recognize and reframe distressing thought patterns. It can also be integrated into existing therapeutic frameworks, such as applied behavior analysis, and may involve creative strategies like role-playing to support engagement, especially in children.
CBT’s strengths include:
- Long-term usefulness in managing symptoms
- Flexibility in addressing various mental health concerns
- Minimal side effects compared to pharmacological interventions
Medication Management – In some cases, medications — such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed to manage symptoms of anxiety or depression. These medications, while widely used, must be carefully managed, especially in youth. Onset of effectiveness can take several weeks, and potential side effects or interactions (e.g., dietary restrictions) require close monitoring.
Any medication plan should include regular check-ins to ensure safety, effectiveness, and overall well-being, especially during the early stages of treatment.
Integrating Insight with Compassion
Understanding the interplay between autism and co-occurring conditions like anxiety, depression, and others is critical to delivering effective, respectful care. By acknowledging how these challenges interact and manifest uniquely in autistic individuals, providers and caregivers can better support holistic wellness — and help create a more inclusive, empathetic world.
Jordan Baker is Content Marketing Manager at Relias. Learn how Relias can provide your organization with more than just education.
