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Armstrong, licensed marriage and family therapist and Senior Manager of Counseling at Cortica, for a conversation we've been wanting to have for a long time: mental health in autism. For Mental Health Awareness Month, we go beyond the surface to talk about why mental health is so often overlooked in autism care, and why that needs to change. One 2021 study found that nearly 78% of autistic youth also have a mental health condition, most commonly depression, anxiety, ADHD, or behavioral challenges. And those conditions can affect a person's quality of life sometimes even more profoundly than the features of autism itself.","I walk you through, alongside Aqila, why anxiety and depression are so common across the autistic lifespan: the biological factors like sleep and rumination, the mismatch with environment, social isolation, bullying, sensory overload, and the quiet exhaustion of masking. We break down how mental health distress can show up differently in autistic children, why irritability is so often misread as a \"bad child,\" and how what gets labeled as noncompliance or PDA (now increasingly understood as a persistent drive for autonomy) often points to underlying anxiety. We also talk about which therapies work, what to look for in a neuro-affirming practitioner, and how to support the whole family, including siblings carrying a silent burden and the caregivers who are often holding more than anyone realizes. (Research shows parents of autistic youth have higher rates of PTSD than the general public.)","This episode is for you if: you've ever wondered whether your child's behavior might be more than autism, you're a parent feeling stretched thin and unsure how to add one more thing to the schedule, you want to understand what neuro-affirming mental health support actually looks like, or you're a clinician, educator, or family member who wants to better support an autistic child or adult."],"durationMinutes":26,"episode":14,"publishedOn":"2026-05-11T16:00:00.000Z","releaseDate":"May 11, 2026","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/Mental-Health-in-Autism-Supporting-the-Whole-Family-e3ivv8e","summary":"In this episode, I'm joined by Aqila Armstrong, licensed marriage and family therapist and Senior Manager of Counseling at Cortica, for a conversation we've been wanting to have for a long time: mental health in autism.","title":"Mental Health in Autism: Supporting the Whole Family","topics":["Family Life"],"youtubeLink":"https://www.youtube.com/watch?v=ijQi4dBkc0o"},"more":{"nodes":[{"id":"69836c38-8fed-5650-89ea-661591ccf44a","applePodcastLink":"https://podcasts.apple.com/us/podcast/why-the-future-of-autism-care-is-holistic-with/id1852580651?i=1000799447093&uo=4","durationMinutes":23,"episode":22,"releaseDate":"Nov 2, 2026","slug":"why-the-future-of-autism-care-is-holistic-with-savannah-jaska-mt-bc-bcat-part-2","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/Why-The-Future-of-Autism-Care-is-Holistic-with-Savannah-Jaska--MT-BC--BCAT--Part-2-e3r6of3","title":"Why The Future of Autism Care is Holistic with Savannah Jaska, MT-BC, BCAT | Part 2","topics":["Therapies"],"youtubeLink":"https://www.youtube.com/watch?v=ajWRuFRot3o"},{"id":"feed6be5-2182-5cd7-9629-cc4579012544","applePodcastLink":"https://podcasts.apple.com/us/podcast/why-the-future-of-autism-care-is-holistic-with/id1852580651?i=1000797109260&uo=4","durationMinutes":27,"episode":21,"releaseDate":"Oct 19, 2026","slug":"why-the-future-of-autism-care-is-holistic-with-savannah-jaska-mt-bc-bcat-part-1","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/Why-The-Future-of-Autism-Care-is-Holistic-with-Savannah-Jaska--MT-BC--BCAT--Part-1-e3qikcr","title":"Why The Future of Autism Care is Holistic with Savannah Jaska, MT-BC, BCAT | Part 1","topics":["Therapies"],"youtubeLink":"https://www.youtube.com/watch?v=fFa5TRJbwEY"},{"id":"7b5395ac-6c06-584f-b606-ca95c6e221bb","applePodcastLink":"https://podcasts.apple.com/us/podcast/autism-in-the-news/id1852580651?i=1000793279007&uo=4","durationMinutes":15,"episode":20,"releaseDate":"Oct 5, 2026","slug":"autism-in-the-news","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/Autism-in-the-News-e3pl4t8","title":"Autism in the News","topics":["Research & News"],"youtubeLink":"https://www.youtube.com/watch?v=uq5EtoX1-iQ"},{"id":"a685616c-ce1d-5ec8-9fac-136769428dfd","applePodcastLink":"https://podcasts.apple.com/us/podcast/the-four-biological-subtypes-of-autism/id1852580651?i=1000777655337&uo=4","durationMinutes":20,"episode":19,"releaseDate":"Jul 21, 2026","slug":"the-four-biological-subtypes-of-autism","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/The-Four-Biological-Subtypes-of-Autism-e3mbac5","title":"The Four Biological Subtypes of Autism","topics":["Medical & Biology"],"youtubeLink":"https://www.youtube.com/watch?v=dTiUF1_1P80"},{"id":"1e792a56-4e5c-56dc-8416-0d1eda41a4a8","applePodcastLink":"https://podcasts.apple.com/us/podcast/the-girl-gap-why-autism-is-missed-in-girls/id1852580651?i=1000775670950&uo=4","durationMinutes":19,"episode":18,"releaseDate":"Jul 6, 2026","slug":"the-girl-gap-why-autism-is-missed-in-girls","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/The-Girl-Gap-Why-Autism-Is-Missed-in-Girls-e3lfrt9","title":"The Girl Gap: Why Autism Is Missed in Girls","topics":["Early Signs & Diagnosis"],"youtubeLink":"https://www.youtube.com/watch?v=L1NozziRfIU"},{"id":"b29137cb-2743-5ef6-8736-12ca6d885b8b","applePodcastLink":"https://podcasts.apple.com/us/podcast/how-much-aba-is-too-much-how-much-is-too-little-the/id1852580651?i=1000773754510&uo=4","durationMinutes":21,"episode":17,"releaseDate":"Jun 22, 2026","slug":"how-much-aba-is-too-much-how-much-is-too-little-the-truth-about-dosing-aba-for","spotifyLink":"https://podcasters.spotify.com/pod/show/suzanne-goh/episodes/How-Much-ABA-Is-Too-Much--How-Much-Is-Too-Little--The-Truth-About-Dosing-ABA-for-Your-Child-e3ku3kd","title":"How Much ABA Is Too Much? 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Today's episode is part of Mental Health Awareness Month, and we're going to talk about something that's incredibly important, but often not talked about enough in the world of autism. And that's mental health. When most people think about autism care, they think about therapies, speech therapy, occupational therapy, behavior therapy, and those are all incredibly important."},{"start":35,"text":"But there's another layer that is just as essential. And that's emotional well-being. Because autistic individuals are not just developing skills, they're navigating a world that can sometimes feel overwhelming, unpredictable, and even isolating. And alongside that, families like parents, siblings, caregivers, after all, navigating their own emotional journeys, too. So today we're going to talk about mental health in autism across the lifespan, from young children to adolescence to adults, and also what it means to support the mental health of the entire family."},{"start":74,"text":"Because one of the most important things I've learned over the years is this autism is never just one person's experience. It's a family's experience. And to help us explore this topic, I'm joined by someone who brings deep clinical expertise and a truly compassionate lens to this work. Aqila Armstrong, licensed marriage and family therapist and senior manager of counseling at Cortica. Aqila, works closely with children, adolescents, adults and families every day, supporting not just development, but emotional health, relationships, and resilience."},{"start":112,"text":"Aqila, thank you so much for being here today. Of course. Thank you so much for having me. It's a pleasure to talk with you about this really important topic. Well, to start things off, could you tell our listeners about yourself, who you are and why you do what you do? Yes, absolutely. So I am someone who has always been passionate about building communities, and I found myself getting into the world of psychology at an early age, and that has led me to this fruitful career where I really feel fortunate to be able to do what I love to do."},{"start":154,"text":"I get to live out my passion, and that's just helping people. And every day I get to experience or see someone grow. And that's what I love to be able to contribute to, not just individually one on one, but helping families to grow in their wellness. And also I get to impact teams, and that impact trickles down to the families they serve. And it's it's so lovely to be able to do that and to serve the community. I know you lead a team of really extraordinary counselors at Cortica."},{"start":193,"text":"Can you tell us more about Cortica’s counseling team and our counseling program? Absolutely. I think what I really love about leading our team of counselors is the passion that I get to see in them every day. It's really contagious. There's a passion similar to mine for helping people and also for helping people be seen. So I think when we work with our neurodiverse families, oftentimes their voices are not at the forefront in their families, in the community, and we get to support them in that way and empower them and advocate on their behalf and support them in advocating for themselves."},{"start":234,"text":"So a lot of our counselors have that deep passion as well as a variety of expertise. I think the wonderful thing is that we know more than we did ten years ago, or a couple decades ago when I first got into this field. And we know that mental health is very closely related to neurodivergent, specifically autism and ADHD, where a majority of autistic youth have at least one mental health condition. One study in 2021 found that nearly 78% of autistic youth had also a mental health condition."},{"start":276,"text":"And typically, or what's most common is depression, ADHD, anxiety in general behavioral challenges and our counseling services don't just focus on that neurodivergent child, but we get to support the family, the caregivers with whatever they bring. So it could be their own mental health. It could be trauma that they experience as a child that is impacting how they're functioning. So we can have we can provide those individual services to those caregivers as well in couples therapy, even, which can be a huge benefit in supporting the the whole family system."},{"start":318,"text":"You know, that really is one of the most important findings, I think, that has come out of autism research in the past 10 to 15 years is just how important mental health is and how common depression, anxiety, ADHD, these various mental health co-occurring conditions are with autism and how they can affect a person's quality of life, sometimes even more profoundly than those features of autism itself. So hugely important to recognize and then to be providing the right supports. Absolutely."},{"start":353,"text":"I was just reading a study today that it was looking at parents of autistic youth, and they specifically looked in Denmark, Australia and Italy. And these parents were found to have a higher rate of PTSD compared to the general public. That's a huge, significant condition that impacts people, and that is related to having a child on the spectrum. So we want to look at supporting families with that kind of experience, and that's what mental health does."},{"start":390,"text":"A lot of the research has been really highlighting cognitive behavioral therapy. But there are some other therapies that have also been shown to be effective in working with autistic youth in their families. Yeah. And I want to dive in a lot deeper into therapies in just a moment. But if we think about why, you know, the why behind this, why are anxiety, depression, stress so common for autistic children, adolescents and adults? And what contributes to that?"},{"start":425,"text":"There are several factors which impact all of us actually, that contribute to stress, anxiety, and depression. They at a high level, they include physiological biological factors like sleep eating. Also psychological factors specifically for autistic youth, patterns of rumination which could be which is basically repetitive thoughts or worry, as well as social environment and also day to day stressors. So for the child, it could be school demands or demands at home, as well as interactions, day to day interactions with family and others in the in the community."},{"start":473,"text":"And then for adults work demands to so specific for autistic youth. I think it really comes down to a mismatch with the environment. I've seen that so much, specifically working with youth in the schools and just collaborating with parents, and how they could be functioning so differently in different settings. Right? We meet one on one with youth and some of the behavioral concerns or emotional dysregulation that are reported by others we don't see. And that's just because environments different."},{"start":508,"text":"So in children, specifically autistic youth, social isolation is a huge factor. They experience this more so than other youth their age, as well as bullying disproportionately affected by bullying. Sensory overload, which comes with their condition and just having that difficulty with unpredictability. So that's something that's unique to autistic youth that could really impact or influence their development of anxiety, stress and depression. And then in adolescence, all of that still remains the same."},{"start":545,"text":"But it can be amplified because there's more school demands, there's more social pressures sometimes, or just social input. They also tend to mask meaning, hiding their differences so that they can fit in, being able to fit in and be a part of a peer group and participate in the community becomes more expected in adolescence. So that's something that our autistic youth could be burdened by. And we know that that exhaustion that comes from hiding differences can lead to anxiety and depression."},{"start":584,"text":"And then with adults, we see the burnout just continue with ongoing masking, more workplace demands if they're involved in work or more school, if they also enrolled in school at that time as young adults and sometimes older adults, and then just filling out of sync with expectations from those around them, loved ones and in their career overall. So the factors that contribute to anxiety, stress and depression are basically the same, but how they look may change, and sometimes it can be amplified going through the lifespan."},{"start":627,"text":"Yeah. Now you touched on this, but the the way that mental health challenges show up, well, they don't always look the way that people expect them to look, especially in autism. And so in your experience, what are some of the more common ways that anxiety or depression might show up in young children? If we're thinking about young children, maybe even preschool age or school age? What are some of the signs that parents maybe should be looking for? I think the one of the primary signs that stand out to me is irritability and frustration."},{"start":666,"text":"It's often misinterpreted as I hate to say this, but it's so common a bad child or an angry child or that's just a part of their autism, when in reality there could be an emotional distress that's going on, or environmental situations impacting how they're showing up. And so that looks like irritability and frustration sometimes. So those mood changes really we're looking for differences though if there's a significant or sudden change, that's how we know it could be connected to mental health and not just the neurodevelopmental condition."},{"start":710,"text":"Also significant changes in sleep or appetite. So again, looking for patterns of change that might occur in their functioning. There's been a lot of interest recently in was sometimes called demand avoidance. Yes. Sometimes goes under the name PDA or pathological demand avoidance. Also now increasingly thought of as persistent drive for autonomy. So there's been an effort to try to understand what in the past might have been labeled as noncompliance. Yes."},{"start":748,"text":"And to better understand what role anxiety or depression might have in kind of leading to that type of behavior. So how do you think about that? And is that a common. Have you found that that's a common sort of behavioral sort of manifestation of underlying anxiety or depression? That is a great question. I think we we're still early in our knowledge about PDA. Our team likes to call it persistence for autonomy or drive autonomy. But I think what we've seen anecdotally when I have team discussions is the connection with anxiety, for sure."},{"start":790,"text":"And we we find this out because we we assess, we pay attention to the child and we learn their neurodevelopmental profile, meaning we learn how they make communicate differently what their sensory needs are. We learn how they tend to learn differently than others, right? How their brain best receives information, for example, with visuals or written or more audio."},{"start":828,"text":"And by learning this full picture of the child, we may discover that there is anxiety that shows up in a specific way, and then that anxiety manifests as those PDA symptoms. Yeah. Well, there's so much, as you say, there's so much we can do. There's so many ways that we can support and help and strategies we can use. And that's one of the most rewarding things I think about. The work we do is saying we see transformative change. Things can really get so much better for the child, for the family, and pretty quickly, you know, so there's there's a lot, a lot that we can do."},{"start":870,"text":"So let's pivot now a little bit to talk about therapies. How do you think about the overall approach to supporting mental health in autism? I remember being trained being an intern in this field and it seemed like you needed to specialize in in something and have a focus. But what I've learned in my career, 18 plus years now in the field is people are unique and diverse within themselves. They come from unique cultural backgrounds and traditions and rituals that we are trying to just fit in as professionals to help support them, to make things just a little better and sometimes a lot better."},{"start":921,"text":"So with that said, we are all different and we're trying to integrate in each other as a world to create some type of joy and improvement. And with that said, you have to be flexible and we have to utilize different approaches and be able to pivot when when the situation calls for us to pivot. So I, I pride myself on being trained in a variety of therapies. The more traditional insight oriented therapies all the way through, the more modern therapies like CBT and Act and DBT and all all of those more modern therapies are evidence based practice."},{"start":965,"text":"But what I've also learned is altogether more insight oriented. And the more tangible cognitive behavioral based therapies are about self-awareness and change. Well, I want to take a moment because you mentioned just now many different sort of textbook or different approaches to mental health, to psychotherapy that kind of have a label, have a name to it. And I think our listeners probably have heard of some or, you know, some some of these in the past and are curious to know more things like cognitive behavioral therapy, things like psychodynamic psychotherapy."},{"start":1018,"text":"And and I know each of these has a very long history and a lot of theory and, and strategies as part of it. But what I hear you saying, which I think is so important for families to hear, is that there isn't sort of a one single approach that is proven to be effective for, you know, for anxiety and autism, for depression and autism. It's not that kind of like that 1 to 1 matching like off the shelf, you know, you can pick it's something much more."},{"start":1057,"text":"Maybe nuanced and more complex. So if if there's a mom or a dad out there thinking about how to begin to approach supporting their child or their teens mental health, how would you guide them in seeking out, you know, a professional who will work well with their child? And a great question and really important one. And I do want to say that if we do follow the research, CBT stand strong as an effective practice for people in general and for autistic youth."},{"start":1102,"text":"So that is one that has been proven in the research to be effective. And we know that even in the research and with practice that we often have to modify it. And so that's where that client centered let me pull from other therapies to fit the needs of this unique client in front of me. Come in. So when we're looking for who can best support my child, we're looking for practitioners that identify as neuro affirming. So neuro affirming means they're going to consider your child's neurodevelopmental differences."},{"start":1140,"text":"And they're going to take a strengths based approach. And then honestly consulting you really don't know who's going to be a good fit until you kind of try it out and talk with them a little bit. But someone who is passionate about working with neurodivergent individuals is helpful, and someone who's going to be flexible. How do you think about if if we broad interview a little bit more to include the family? We know parents and caregivers are under a lot of stress."},{"start":1175,"text":"What do you see most commonly in terms of parent mental health and what support can benefit them? You said we see stress. We see overwhelm and anxiety with our caregivers. And sometimes just by having someone that sees their child and is excited to work with their child, just relieve the stress a little bit more. They, like their child, often encounter people who have a negative perspective or don't engage with them because of how their child's difference is present."},{"start":1213,"text":"So just being able to be accepted and welcomed, I think helps the caregiver. And going a little deeper, being able to talk to them about how they're doing and recommend or ensure they get their own support as well their own mental health support. So oftentimes we may be doing an evaluation for a child, and we end up referring the caregivers for their own individual therapy, for the family therapy, as well as for couples therapy, which may or may not be provided by the evaluating therapist, and anything specific to siblings and the experience of siblings."},{"start":1255,"text":"Well it's important to consider the siblings, even the ones that seem to be doing well, you know, functioning, getting good grades, have a social network just to check in on that. That's a part of our assessment, right? How is that sibling getting along with their neurodivergent brother or sister? Is there any rupture in that relationship. Is it is it a caretaking relationship? Because that can indicate sort of a silent burden that the sibling has, where they can sometimes act as a secondary parent just because of the role in the family?"},{"start":1300,"text":"Or do they completely avoid their sibling? And then that can indicate that there's an opportunity for repair or emotion or therapeutic intervention as well. So what would you say to parent who is already feeling overwhelmed, trying to keep up with the child's therapies and may not think that they have the time for something like counseling? First thing I would say is I get it and it's hard. It's hard to make time for all the things that is required of them."},{"start":1335,"text":"Honestly, I'm impressed seeing all that they do, so I understand how it can sort of tip the cup over just by adding one more thing, and I would ask them to consider what are the priorities right now. And sometimes that conversation is best had with a mental health professional. An evaluation is not a commitment in the schedule yet, so check it out. The evaluation of waiting therapist might say, you're right, there's a lot right now."},{"start":1372,"text":"Focus on your child's ABA services and speech. And then, you know, come see us for counseling. Once this type of progress has been made. Or I can I can work with you right now. Can you make time in your day away from the kids? So there are ways to figure it out and prioritize so that they can try to get the support they need. And sometimes that therapist may refer community resources that could be just a little bit supportive, so we can explore those options, or just having a brief moment to talk about what what could be helpful, how to build their coping skills as well, and in managing all that they manage."},{"start":1417,"text":"So I think I would really encourage them to if there is even a little bit of concern, I would encourage them to at least get an evaluation, because getting help early could prevent some really long term stressors down the road. That's such great advice. And I, I find with the families I've worked with that sometimes getting mental health support, counseling services for oneself as a parent unleashes more energy, more optimism, more hope."},{"start":1452,"text":"That then translates into more that they have available for their child and their whole family, so that they have more to give and they can give from a place of better health and well-being. So. So I think that's something to keep in mind too. Absolutely. Well, thank you, Aqila. I mean, this has been such a rich conversation. Is there anything else as we wrap up that's sort of a key piece of advice or a key takeaway that you'd like our listeners to, to take with them? Yes, I when I think about supporting mental health and working with caregivers and their child, I always want to emphasize relationship first."},{"start":1498,"text":"Unfortunately, when families come to us, it's because they are dealing with situations, behaviors that are really distressing. And so we're focused on that. We're focused on what's wrong, and then we forget about what's right, and we forget about the connection that we need to have. So I would just kind of leave that with our listeners is make sure you pay attention to the person, see them for who they are, gifts in all, and connect."},{"start":1535,"text":"Build that relationship by connecting with those gifts. Well said. Thank you. Akila, thank you so much for being here and for the incredible work you do every day supporting families. And to all of our listeners, thank you for being here. Thank you for showing up and for caring so deeply. If this episode resonated with you, please share it with another parent, caregiver, or professional who might benefit from hearing this conversation. And as always, take good care of yourself and your family. Until next time, I'm Dr. Suzanne Goh And this has been magnificent minds."}]}},
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