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A 19-year-old male with a known diagnosis of autism spectrum disorder (ASD), level 1 (requiring support), is referred to the PMHNP by his primary care provider for evaluation of worsening social withdrawal, decreased interest in his special interests (coding and building electronics), irritability, and a 15-pound weight loss over two months. His mother reports that he has stopped attending his community college classes and spends most of his time in his room with the lights off. He was previously functioning well academically and had a small but consistent peer group through a coding club. When interviewed, he speaks in a monotone voice, makes minimal eye contact, and states he "doesn't see the point of anything anymore." The PMHNP considers the diagnostic assessment. Which of the following best reflects evidence-based practice?
Explanation
Co-occurring psychiatric conditions, particularly depression, are highly prevalent in ASD (20-40%). The critical diagnostic indicator is change from baseline functioning, especially loss of special interests, which are typically highly reinforcing in ASD. Assessment may require modification because autistic individuals often express depression through irritability, routine changes, and altered engagement with special interests rather than verbalized sadness.
Key Takeaway
In ASD, loss of special interests and change from baseline functioning are key indicators of co-occurring depression; diagnostic overshadowing and alexithymia complicate recognition of psychiatric comorbidities in this population.