It is common for someone with autism to also have a mood or anxiety disorder, including bipolar disorder.
Autism and bipolar disorder can share a lot of the same traits and symptoms. As a result, it can be tricky to pin down a diagnosis when both conditions co-occur.
Symptoms of each disorder can be more severe when bipolar disorder and autism occur together. The dual diagnosis can lead to more significant health concerns and problems with functionality.
Managing co-occurring autism and bipolar disorder often involves a combination of medications and behavioral interventions.
The Link Between Bipolar Disorder & Autism
Bipolar disorder and autism are both conditions that involve variations in the brain that may be heritable.
Autism is a neurodevelopmental spectrum disorder wherein a person will have issues with socialization and communication, and engage in repetitive and restrictive behaviors.
Bipolar disorder is a mood disorder characterized by extreme mood swings — periods of mania, depression, or both. Bipolar disorder involves significant shifts in mood, energy and activity levels, and ability to concentrate. It interferes with daily life functioning.
Just like with autism, there is no single known cause of bipolar disorder, but genetics and brain functioning and structure likely factor into its occurrence. Recent studies show links between certain overlapping genes that may be involved in both bipolar disorder and autism spectrum disorder (ASD). This means that bipolar disorder and autism may share a genetic link.
Both autism and bipolar disorder commonly co-occur with other disorders, including each other.
Difficulties Diagnosing Comorbidity
Historically, it has been difficult to diagnose comorbid autism and bipolar disorder. This is due in part to the fact that each disorder can have overlapping symptoms that can therefore mask the other disorder. In addition, autism is typically diagnosed in early childhood, while bipolar disorder traditionally manifests in late adolescence or early adulthood.
Overlapping symptoms for bipolar disorder and autism often escalate during the teenage years. They can include:
- Elevated moods.
- Irritability.
- Excessive talking.
- Sleep disturbances.
- Distractibility.
- Suicidal ideations.
- Self-harming behaviors.
- Being prone to accidents.
- Behavior issues and tantrums.
Just because a child exhibits these symptoms does not necessarily mean that they also have bipolar disorder. Bipolar disorder can be easily misdiagnosed in adolescent autistic children since many of the symptoms of the disorder can be similar to those found in autism. Specific evaluations and checklists should be used to determine true overlap.
When Bipolar Disorder & Autism Overlap
There is a wide range of information regarding rates of comorbid autism and bipolar disorder. Some studies report rates of close to 30% of people with autism who also have bipolar disorder. Others put the comorbid rates at 7% . Similarly, studies show that people with bipolar I disorder present with autistic traits nearly half the time.
Symptoms of bipolar disorder can often look a little different in someone with autism than they do in someone who has bipolar disorder alone. The depressive episodes can be more extreme with a greater risk for suicide, for instance.
Manic episodes will often not include the same level of psychosis that they can in people without autism, but they are still problematic. They commonly lead to injuries, accidents, violence, and difficulties functioning in everyday life.
A bipolar manic episode in someone with autism regularly includes:
- Nonstop, rapid, and loud talking.
- Sudden decrease in sleep.
- Increased repetitive and ritualistic behaviors.
- Excessive pacing.
- Increased impulsivity, risk-taking behaviors, and aggression.
- Agitation.
- Greater focus on obsessions.
- Inflated self-esteem and delusions of grandeur.
If you suspect overlapping bipolar disorder with autism, talk to your child’s doctor about your concerns.
Medications for Treating Bipolar Disorder With Autism
There is no medication specifically approved to treat autism, but there are several for managing bipolar disorder.
Some of these medications can interact differently in people with overlapping bipolar disorder and autism, so they should be taken with care. Antidepressants, for example, can make bipolar disorder worse in someone with autism, while mood stabilizers and second-generation antipsychotics are proven to be effective treatment methods.
Lithium is one of the gold-standard medications used to treat bipolar disorder, but it also has a high rate of potentially dangerous side effects. People with autism often have difficulties communicating effectively. This can make use of a medication like this problematic if people with autism are unable to let a caregiver or doctor know when they are experiencing them.
Instead, mood-stabilizing anti-seizure medications like valproic acid are often a better choice for managing comorbid bipolar disorder and autism. Atypical antipsychotic medications, such as aripiprazole and risperidone, can be used to help with irritability in children with autism. Often, low-dose antipsychotic medications can be combined with a mood stabilizer to manage symptoms.
The first line of treatment for bipolar disorder is managing potentially dangerous manic and depressive episodes that can be life-threatening. This means stabilizing moods. A combination of medications and therapies is often the best course of action to do this.
Ask your doctor about the pros and cons of potential medications that may be used in your treatment regime.
Behavioral Interventions
Medications can help with the extreme symptoms of bipolar disorder, but they aren’t enough on their own. They should be used in conjunction with therapies and behavioral interventions.
It is important to have an accurate diagnosis for comorbid bipolar disorder and autism, as treatments for each disorder need to be specific. Treatment for one of the disorders may not be as effective when they overlap.
Behavioral interventions for comorbid bipolar disorder and autism can include:
- Cognitive behavioral therapy (CBT). This type of therapy focuses on understanding how your thoughts and emotions are connected to your actions. CBT helps you to develop a better awareness of yourself. It also improves self-esteem and can help you to develop coping and emotional regulation skills.
- Family therapies. These therapies can help entire families learn how to support each other and a family member who has comorbid bipolar disorder and autism.
- Education. Learning about each disorder and what to expect can help to lessen the severity of symptoms by decreasing the unease that comes with uncertainty.
- Applied behavior analysis (ABA). This therapy can be modified to fit the individual. ABA works to reinforce positive behaviors while helping to decrease negative ones.
No two treatment plans will look exactly alike, as each person is different. Intervention team members will work closely with each other, and with parents and caregivers, to come up with a treatment plan that will be most effective for the individual.
Helping Children With Co-Occurring Disorders
Typically, bipolar disorder presents later in adolescence, but in children with autism, it often has an earlier onset. Early interventions for autism and the mood disorder can improve the symptoms of both.
Interventions for autism can start with babies or young toddlers. They include a variety of methods to increase communication and social skills, develop healthy coping mechanisms for managing stress, and improve abilities to manage emotions.
The best thing that you as a parent can do for your child is to be aware of behavior and mood changes, notice variations in sleeping and eating patterns, and share your concerns with your child’s doctor to ensure that a proper diagnosis is made as soon as possible. The right diagnosis early on can mean more specific treatment and a better long-term outcome.
Managing Bipolar Disorder & Autism in Adults
In autistic adolescents and adults, bipolar disorder can lead to extreme behaviors that can put the safety of the individual and those around them at risk. It can also cause further social isolation, withdrawal, and difficulties maintaining friendships. Comorbid bipolar disorder and autism can greatly interfere with a person’s ability to perform daily tasks and therefore function within society.
Education, medication, therapies, and support groups can help. Awareness is key for managing symptoms of both disorders. When a person is more able to understand why they might be feeling the way they do and are reacting in kind, they are also more apt to be able to regulate themselves and control these behaviors.
Support and social skills groups can provide healthy social outlets. They can teach methods for managing daily life, creating positive habits, and learning and practicing coping mechanisms.
Organizations & Support Resources
There are many resources and organizations designed to help people who have been impacted by both autism and bipolar disorder. Suicide and crisis lines are important to have on hand for safety purposes, educational sites can provide a wealth of information, and many organizations host local support groups.
Here are some resources that can provide helpful information and support:
- National Suicide Prevention Lifeline: This crisis line offers support 24/7 that is confidential and free to individuals in need and their loved ones.
- SAMHSA National Helpline: This is a 24-hour confidential and free helpline run by the Substance Abuse and Mental Health Services Administration (SAMHSA). They can provide referrals and information to families seeking help for mental health concerns.
- Depression and Bipolar Support Alliance: This national organization hosts more than 200 local chapters where people can find information and support on bipolar disorder and related mental health concerns. They also offer 24/7 online support and many other online resources.
- National Alliance on Mental Illness (NAMI): With both an online presence and local support groups, NAMI also hosts confidential and free crisis counseling as well as online resources.
- Autism Speaks: This is a resource for individuals impacted by autism. They provide online information and education as well as details on local support groups.
References
Bipolar Disorder. (January 2020). National Institute of Mental Health (NIMH).
Exome Sequencing of Familial Bipolar Disorder. (2016). JAMA Psychiatry.
Bipolar Disorder Has a Genetic Link to Autism Study Shows. (May 2015). University of Iowa Health Care.
Autism and Bipolar Disorder: Is There a Connection? (May 2014). Autism Speaks.
Longitudinal Course of Bipolar Disorder in Youth With High-Functioning Autism Spectrum Disorder. (October 2016). Journal of the American Academy of Child and Adolescent Psychiatry.
Autistic and Schizotypal Traits and Global Functioning in Bipolar I Disorder. (January 2017). Journal of Affective Disorders.
Subthreshold Autism Spectrum in Bipolar Disorder: Prevalence and Clinical Correlates. (November 2019). Psychiatry Research.
Features of Comorbid Autism Spectrum and Pediatric Bipolar Disorders. (April 2018). Psychiatry Advisor.
Comorbidity of Asperger’s Syndrome and Bipolar Disorder. (November 2008). Clinical Practice & Epidemiology in Mental Health.
Clinical Research: Autism, Bipolar Disorder May Often Overlap. (September 2013). Spectrum News.
National Suicide Prevention Lifeline. Substance Abuse and Mental Health Services Administration (SAMHSA).
National Helpline. (April 2020). Substance Abuse and Mental Health Services Administration (SAMHSA).
About DBSA. Depression and Bipolar Support Alliance.
About NAMI. National Alliance on Mental Illness (NAMI).
Help and Information. (2020). Autism Speaks.
