Julie Froelich Tracy’s son John was a high functioning autistic child. He had poor motor skills, sensory issues, and odd mannerisms — not unlike many other children on the spectrum. Yet, he was bright and talkative. He was good at sharing with other children and was a member of his local 4-H.

His behaviour began to shift once he hit puberty.

John started having difficulty making and maintaining friendships. He grew withdrawn because of ongoing bullying. He began to have mood swings and uncontrollable anger. He lashed out over small things and often became violent. Afterwards, he was always repentant and alarmed over his lack of self-control. Julie began to lose hope that her son’s aggression would go away on its own.

John was formally diagnosed with Autism when he was in middle school. However, he received an additional diagnosis of bipolar disorder when he was 20 years old — after numerous hospital visits, medications, and police confrontations.

In another case, Kyle was misdiagnosed with social anxiety. In first grade, he received the correct diagnosis of Asberger’s. However, over time, diagnoses of anxiety disorder, ADHD, a learning disability, and depression followed. For his mother, Jodi, this was difficult — but not a negative thing. “Once you understand the clinical diagnosis, then you can actually provide them with the services they need.” She said in an article for NPR.

Kyle spent an extra year doing grade 12 so that he could prepare himself for the next stage of life. He had the support of social workers, social skills coaches, and a school board psychologist — but the transition was still difficult. He said that in high school he was given a lot of “leeway” and that he never failed a class. In his first semester of college — he failed two. “[the amount of work in other classes] prevent me from even thinking about work in the easy classes.”

However, Kyle is thankful to have received his diagnosis early on. He says that is allowed him to get the support he needed to even transition to college at all.

Many people with autism also have another form of mental illness and the illness is often left untreated because it is considered a part of the autism. This was the experience that John’s family had. When he began to show massive mood swings and severe aggression, they just thought his autism was getting worse.

Studies show that young adults on the spectrum are far more likely to have a psychiatric condition like anxiety, depression, or ADHD. Over the past 15 years, studies have been conducted that show the 70% of people on the spectrum qualify for what is known as a comorbid mental health disorder (Comorbid meaning when two disorders or illnesses occur in the same person. Comorbidity also implies that these illnesses affect each other).

One reason it’s difficult to detect these mental illnesses is because autism is not fully understood, and looks so different from person to person. There is still so much left to learn about autism and it’s hard to tell when a person needs an additional diagnosis. However, when a person has all the symptoms of a mental disorder in addition to their autism, another diagnosis can be extremely helpful.

Often the onset of these mental illnesses occurs when a young adult experiences fast developmental changes and shifts in social environments — including new expectations and pressures. The timing of this change can mislead parents into believing that their child’s evolving behaviour is due to “growing up”. Which in turn leads them to hope the problem will resolve itself, rather than spur them into active intervention.

In middle school, an autistic child can start to stick out for their lack of social graces. This often warrants bullying, which can spiral the child into depression, frustration, and hopelessness. This same thing is what took John from being the quirky younger brother of a popular athlete to the angry and irritable teen he was before his bipolar diagnosis. He mothers states “We thought it was just adolescence and that we would get through it. But what we were really seeing was cycles of rage in a person who was becoming severely mentally ill.”

The Centre for Addiction and Mental Health in Toronto conducted a study of young adults in Ontario, aged 18-24. The study found that those on the spectrum were five times as likely to suffer from an additional mental illness than those developing typically: and two times as likely than those with a different developmental disability.

The biggest misconception about mental health in autistic people is that it is just part of their autism. With that assumption comes the equally incorrect thought that it can’t be treated or changed. However, certain doctors and psychologists are looking to reframe this thought. In their paper “Assessment of Autism Spectrum Disorders” Psychologists  Leslie Deprey and Sally Ozonoff write: “although differential diagnosis is difficult, it is essential, as treatment of the [autism] symptoms alone will usually not result in improvement in the other behavioral or emotional problems that exist. Undertreatment or partial treatment can result in significant functional impairment.”

It is so important for young adults on the spectrum to find treatments for additional mental illnesses. Many of these disorders emerge at the 18-25 age range; right when they are emerging into college or the working environment. Without proper treatment and support their condition may escalate and lead to injury of the individual or others around them.

About her son John, Julie says “Others should not be fooled into thinking these things pass. They can get worse and worse without treatment.”

In cases of additional mental disorders — or even suspected ones — more than one doctor should be involved. Always include a psychiatrist in addition to a primary care physician. Working with a comprehensive team is far better than individuals or families struggling alone.