Dealing with the Dual Diagnosis: Autism and Other Mental Health Disorders

Categories: Interventions

I was ready to round up my frequently asked question series when a reader asked this extremely important question on my post about evaluating medical causes of behavior – she asked, “What about mental health disorders?” Although this isn’t technically a frequently asked question, it’s a tough one and an important one. I was immediately reminded of a post I wrote a few year back on Depression and Autism. I reread it this morning and it almost immediately took me back to that point in my teaching career. To say it was challenging is an understatement. I was completely physically and mentally exhausted working with this student who had that beyond difficult dual diagnosis. The rule governed and rigid aspects of his autism diagnosis were all completely apparent in the way his depression manifested. I cried a lot of tears that year (as did that student and his parents). But I think we really were able to work together as a team with the best interest of this young man.

I absolutely by no means an expert in the world of mental health disorders. So my advice will be have an annoying pattern to it – consult the experts, consult the experts, consult the experts. You need a team approach more than ever with these situations. And the will extend beyond the walls of your school. Reach out consistently to your student’s parents. They are your liaison and connection to the student’s outside doctors and psychologist who can be valuable resources for you. Get consent to communicate with you student’s outside physicians.

One area we can be very helpful in is sharing our data. Students with a mental health disorder may be a range of medications and doctors may be working to figure out the correct combination or dose of those medications. Providing our data can be helpful to show the effect these medications may be having on the student.

It is also helpful to thoroughly track the potential triggers for behaviors. The triggers may be an environmental event that causes in an increase in aggressive, disruptive, or maladaptive behaviors. When there is no clear trigger or the antecedents change frequently or are inconsistent – that could be a clear cue that the behavior is due to challenges related to the mental health disorder. Communicate this with doctors as well as frequency of the behaviors (how often behaviors occur each day and at what magnitude).

Give lots of breaks and have a lot of empathy. From my few years working with the student with autism and depression, I found that frequent access to breaks made a big difference for him. I also really tried to look at things from his perspective a lot. Not that I didn’t try to do that with all of my students, but for him, figuring out interventions and strategies that worked required a lot more creativity and thinking outside the box. I spent a lot of hours talking with the parents. Sometimes they just wanted to vent or cry. And I let them. I knew they needed an outlet and someone to talk to and I was happy they felt comfortable enough with me to open up.


  1. Excellent article.

  2. Keep up the good work! I wish there was a class that would educate teachers to help understand autism. That is the first step in helping these kids.
    My son is autistic, with aggression. He escalates in less than 5 seconds. Their brain thinks differently, he was not diagnosed until 5th grade. The doctors before he was diagnosed give meds for adhd, mood disorder, odd, anxiety, which gave my son psychosis. I thought he was getting worse, fast.
    Bless you for the patience and understanding. By listening to the parents. Thank you

  3. I just stumbled on this blog post. I work in a behavior support class and this year I have multiple students with dual diagnoses. It’s tough… so very tough because the EBD strategies that I know to be tried and true don’t work as effectively, and neither do interventions I use with my students on the spectrum. It’s relieving to know that I’m not the only one who has struggled with this.

  4. It can be so tricky! It’s hard finding that right balance!


Submit a Comment

Your email address will not be published. Required fields are marked *