DOI: 10.1177/25739581261473056 ISSN: 2573-9581
How Psychologists Identify Depressive Symptoms in Autistic Adults: DSM-5-TR Criteria and Autism-Informed Indicators
Emma Hinze, Dawn Adams, Nicole Dargue, Jessica Paynter
Background:
Autistic adults experience depression at higher rates than non-autistic adults, yet there is limited evidence describing how psychologists identify depressive symptoms in this group. Autism-related characteristics may influence how autistic adults express and describe depressive experiences, and how psychologists interpret them in relation to the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
(
DSM-5-TR
) criteria. This study examined how psychologists identify depressive symptoms in autistic adults, including how they interpret
DSM-5-TR
criteria and what additional indicators they consider.
Methods:
We conducted an exploratory qualitative study using semi-structured interviews with 20 psychologists experienced in providing psychological care to autistic adults, from October 2024 to January 2025. Using direct content analysis, we coded responses to
DSM-5-TR
depressive symptom criteria and used inductive coding to identify additional indicators.
Results:
Psychologists described
DSM-5-TR
criteria as a guiding framework but emphasized that their clinical usefulness depended on autism-informed interpretation in relation to baseline presentation, co-occurring conditions, and contextual factors. Psychologists often described depressed mood as hopelessness, anger, irritability, or somatic distress. They described anhedonia sometimes involving ongoing engagement in deep and focused interests despite diminished enjoyment or emotional connection. Psychologists described brief acute episodes of overwhelming hopelessness and suicidal ideation, which some termed “depression attacks,” as clinically important indicators of escalating distress. They frequently interpreted worthlessness in relation to repeated exclusion and invalidation. Psychologists described several
DSM-5-TR
indicators as diagnostically ambiguous because of overlap with autistic characteristics. Additional indicators included changes in autistic presentation, altered sensory sensitivities, increased need for routine, shifts in the thematic content of deep and focused interests, and self-injurious behavior requiring careful contextual interpretation.
Conclusion:
DSM-5-TR
criteria remain applicable to autistic adults, but identification often requires autism-informed interpretation, attention to baseline change, and consideration of additional indicators. Findings support the need for clearer clinical guidance, targeted clinician training, and development of assessment tools that better reflect autistic adults’ experiences.