Co-occurring Conditions with Autism

For many autistic people, an autism diagnosis is a vital part of their story, but it is often not the whole story. It is very common for people on the autism spectrum to also have one or more other conditions, known as "co-occurring conditions". Recognising and understanding these is essential for providing effective, holistic support that addresses all aspects of a person's well-being.

This article explores some of the most common conditions that co-occur with autism-namely anxiety, depression, ADHD, and learning disabilities. We will discuss why they are so prevalent, how they might present, and key considerations for diagnosis and support, aimed at autistic people, their families, and healthcare professionals.

Why Are Co-occurring Conditions So Common in Autistic People?

What is it about being autistic that can make a person more susceptible to conditions like anxiety and depression? The reasons are complex and often rooted in the chronic stress that comes from navigating a world that is not always accommodating to autistic neurology.

• The Stress of a Neurotypical World

  The constant effort of processing a sensorily intense environment, trying to understand complex social cues, and navigating expectations that do not align with one's natural way of being is a significant source of chronic stress.

• Social Difficulties and Bullying

  Challenges with social interaction can lead to feelings of isolation, rejection, and low self-esteem. Furthermore, autistic people are at a much higher risk of being bullied at school and in the workplace, which can have a devastating impact on mental health.

• The Toll of Masking

  The exhausting effort of "masking" or camouflaging autistic traits to fit in can lead to a profound sense of burnout and a disconnect from one's authentic self, contributing significantly to anxiety and depression.

• Shared Neurological Roots

  Some conditions, like Attention-Deficit/Hyperactivity Disorder (ADHD), are also neurodevelopmental. It is thought that autism and ADHD may share some underlying genetic and neurological factors, which helps to explain why they so frequently occur together.

Anxiety Disorders

Anxiety is exceptionally common in the autistic population, with some studies suggesting up to 50% of autistic adults experience an anxiety disorder.

• How it Presents and its Impact

  In an autistic person, anxiety can be triggered by social situations, sensory overload, or a fear of unexpected changes to routine. It might not look like typical worry; instead, it can manifest as an increase in repetitive behaviours (stimming), a greater need for routine, physical symptoms like stomach aches, or what might be perceived as challenging behaviour. This constant state of high alert can make daily activities like going to school or work incredibly difficult and can lead to avoidance of new or unpredictable situations.

• How You Can Help

  Creating predictability is one of the most powerful ways to reduce anxiety. Use visual schedules or calendars to show what is happening next. Help the person identify and name their anxious feelings. Support them in creating a "safe space" or a sensory toolkit they can use when feeling overwhelmed. Practising simple grounding or breathing exercises together during calm moments can provide a valuable tool for them to use when stressed.

Depression

Autistic people are at a much higher risk of developing depression. Recognising it can be difficult because some symptoms can be confused with autistic traits.

• How it Presents and its Impact

  Symptoms like social withdrawal, low energy, a loss of interest in activities, and changes to sleeping patterns can all be signs of depression. In an autistic person, the key is to look for a change from their usual baseline behaviour. For example, a person who usually finds great joy in their special interest might suddenly become disengaged from it. Depression can rob a person of their motivation, negatively impact self-care, and deepen feelings of isolation and hopelessness.

• How You Can Help

  Be a patient and non-judgmental listener. Let them know you are there for them without applying pressure to "cheer up". Gently encourage engagement in low-demand, enjoyable activities, especially their special interests, which can be a source of comfort. Offer practical support with tasks that may have become overwhelming, like preparing a meal or tidying a room. Most importantly, support and encourage them to seek professional help from their GP.

ADHD (Attention-Deficit/Hyperactivity Disorder)

ADHD frequently co-occurs with autism, creating a complex and sometimes contradictory profile of traits.

• How it Presents and its Impact

  A person with both autism and ADHD might have the intense focus of an autistic special interest but also the distractibility of ADHD. They may crave the predictability of a routine but struggle with the impulsivity and organisational challenges of ADHD to maintain it. This can be very confusing and frustrating for the person themselves. At school or work, they may struggle with tasks that require sustained attention (a common ADHD challenge) while also being overwhelmed by the sensory environment (a common autistic challenge).

• How You Can Help

  Support their executive functioning. Provide clear, step-by-step instructions for tasks. Use visual aids like checklists and planners to help with organisation. Build short movement breaks into routines to help manage hyperactivity. Be patient and understanding about forgetfulness or time management difficulties. The key is to acknowledge that both sets of needs are valid, even if they sometimes seem to conflict.

Learning Disabilities (LD)

It is important to understand that autism is not a learning disability, but the two conditions can co-occur. A learning disability affects a person's cognitive functioning, making it harder to learn, understand, and use information.

• How it Presents and its Impact

  The presence of a learning disability alongside autism will mean a person is likely to need more significant support throughout their life. It can add considerable barriers to traditional academic learning and to developing skills for independent living. Their ability to communicate their needs may also be more limited.

• How You Can Help

  Use very simple, clear, and concrete language. Break down all information and tasks into very small, manageable parts. Use visual and hands-on teaching methods wherever possible. Patience and celebrating small steps of progress are absolutely vital. Working closely with educational and social care professionals to ensure support plans (like an EHCP) are appropriate is essential.

The Challenge of Diagnosis and Support

Diagnosing co-occurring conditions in an autistic person can be difficult due to this symptom overlap. A clinician needs a deep understanding of autism to differentiate between autistic traits and the symptoms of a separate condition. This is why a holistic approach is so important. Standard treatments may also need to be adapted; for example, talking therapies like CBT often need to be modified to be more concrete and visual for an autistic person.

Seeing the Whole Person

Understanding co-occurring conditions is not about collecting more labels. It is about building a complete and accurate picture of a person's unique profile of strengths and needs.

By seeing the whole person-acknowledging their autism and any other conditions they may have-we can provide support that is truly person-centred, effective, and compassionate, helping them to live their best possible life.