I hope this post heading scared the crap out of you because the combination of these two words is terrifying. This is something I have been dealing with in my class for that past year. It’s unbelievably challenging and have probably been the source of some of my Facebook statuses regarding consuming red wine on a weeknight. I have been stressed. I have cried. I have felt helpless and alone. And I am not the one struggling with the counteractive dual-diagnosis. I cannot even imagine what is going on in the head of my students. My heart breaks for him.

I am not a mental health expert. Depression is not my area of expertise and that is part of the issue in this situation. As a BCBA, I feel confident in all of my decisions in the world of autism. Even if those decision are wrong I know they are based in data, ABA, and experience. Not so much with depression. And I feel like a lot of my “tough love” decisions that are majorly effective with my students with autism are not the right call with this guy. I don’t want to push him too hard.

Depression and autism is such a challenging dual diagnosis because traditionally the autism diagnosis coincides with rigidity, perseverating, and rule governed behavior. However when you spend all of your time perseverating on what makes you feel depression, create rules that you will never feel happy, and are rigid enough to be stuck in those ways – you are digging yourself deeper and deeper into a huge hole of despair.

I wanted to share what tips I have found dealing with this dual diagnosis:

  • Monitor the Medical Aspect: There are countless combinations of depression drugs. Stay on top of medication changes, doctor appointments, and drug potential side effects. If you are a teacher – request permission of the parents to get in contact with the students’ psychologist and psychiatrist and keep in contact with them. Send information of specific behaviors, frequency, and magnitude.
  • Allow Extra Breaks: Sometimes your student may just need a break to regroup and refocus. It’s okay – allow them that opportunity. Even if it feels like you are missing out on work, it will be better for you in the long run.

Break Card

  • Use Visuals: Sometimes engaging in any social responses might be too overwhelming for this student when they are dealing with depression or anger issues. Provide visuals – even written visuals – that they can use to communicate during these times. Using rate scales will help put emotions into some context. Anding visuals or color coding will help clarify the rating scale.

TAH

  • Help Create New Rules: Like I said, children with autism are role governed creatures. And while that is usually an awesome quality, when the rule is keeping them stuck in their depressed ways – help create new rules. Spell them out and be detailed. Remind them of when the rule is kept, “See Shari, we are having fun when we play Jenga. Playing games with Ms. Smith is fun.”

On top of everything – have empathy. Depression is incredibly difficult for individuals without autism – so imagine the struggles of having both. Take a deep breath, give yourself a break when needed, and try your best.

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