Find out which signs and behavioral changes to watch for in a child with ASD and when it’s appropriate to talk to a doctor about mental health.

Like all kids, those on the autism spectrum display a wide variety of behaviors and emotions. It can be tricky to know what’s normal and what needs to be addressed.

Parents need to trust their guts and observations. You know your child best, and negative and/or unusual behavior is always a red flag.

When behavior repeatedly seems out of the ordinary for a child, it’s appropriate to start with a visit to the pediatrician or a specialist. A pediatrician sees a wide range of kids, and can often more easily identify what is out of the ordinary.

It’s important to differentiate between irritability and being scared or nervous. Irritability is a hallmark of autism spectrum disorder (ASD), but if a child is truly afraid or extremely nervous, there is likely something else going on.

Rigidity is also typical of ASD, but if a small change in routine raises fear and really throws the child off it maybe anxiety driving the behavior.

  • Signs of a mental health disorder and changes to watch for:
  • Acting out with physical violence if that isn’t a typical response
  • Showing extreme anxiety (crying, shaking, screaming, running away) over minor changes in routine
  • Continually asking for reassurance about perceived dangers
  • Loss of enjoyment in activities that were previously satisfying
  • Pronounced fear or avoidance of social situations
  • Obsession with contamination, germs, or other perceived threats
  • Ritualistic activities such as repeated hand washing

Next steps

If there is concern that a child may need more support, the pediatrician may refer to a developmental pediatrician who can oversee testing for autism and other neurodevelopmental disorders.

Depending upon the circumstances and whether the child is already known to have ASD, the pediatrician may instead refer directly to a psychiatrist or psychologist to assess for mental health concerns.

Sometimes more intensive treatment for the mental health concern is warranted. I’ve had the incredible opportunity to start a unique program at Rogers Behavioral Health in Tampa, Florida, that addresses mental health issues in children and teens on the spectrum.

The program is now offered on an outpatient basis in Chicago, Philadelphia, San Francisco, and Tampa. Kids and teens participate in cognitive behavioral therapy and related techniques, including exposure therapy and behavioral activation.

Children between six and 18 with high-functioning autism and at least one other disorder may qualify for the program. Because kids are engaged in treatment up to six and a half hours a day, fie days a week, for an average of six weeks, we see significant improvement.

Families see results from the treatment

One Tennessee family was able to access the treatment in Tampa and found that it not only gave their teenage son greater understanding of his thoughts, feelings, and behaviors, but also introduced new parenting skills and approaches that have helped them know how best to interact with their son.

“He’s very smart and aware of being different. He wants so desperately to be what he calls ‘normal’. This treatment has been a life-changing experience for him and really, our whole family,” the mother shared.

Another mother said her son and family benefited from the new program in the Chicago area, especially from working in a group setting. “Over time he began to accept his ASD more as well as his anxiety and now knows he is not the only one.

It’s hard because those things don’t go away and he is still coming to terms with that, but he is more equipped to handle it. He is calmer, less aggressive, more self-aware and much happier…The house is more relaxed and has a different feel to it,” she says.

The stats

  1. One in 59 children has an autism spectrum disorder
  2. 70 percent of kids with ASD have at least one mental health disorder
  3. 41 to 50 percent have two or more conditions
  4. Anxiety affects about half of those who have a mental health condition

Dr. Joshua Nadeau focuses on the use of cognitive behavioral therapy (CBT) for the treatment of obsessive-compulsive and related disorders, as well as on the adaptation of evidence-based techniques to address the unique needs of youth and adults with autism spectrum disorder (ASD) and other neurodevelopmental disorders. Website: