Asperger’s, Depression and College Students

Depression is most common in adolescents and young adults with Asperger’s, and particularly in those with stronger intellectual and verbal skills. That means college students with Asperger’s are at a very high risk for depression. This is particularly true for freshmen, who are transitioning to the college experience. Although I’ve seen this in later years as well when students are dealing with more challenging classes, social issues, and upcoming graduation as triggers.

Let me tell you about one college student’s experience with depression:

Franklin went off to a good college based on his excellent academics in high school. However, he’d been provided with executive function scaffolding all through high school. His parents and a teacher had helped him organize his time and initiate his work. The school counselor and his parents had feedback from teachers if he was falling behind on assignments.

In college, he was on his own.

He was supposed to check in with the disability office, but he resisted being seen as needing help. Franklin had challenging classes and had taken on a very full load of five classes; he had always set his standards and expectations of himself very high. Franklin began falling behind in writing papers for his English literature class because writing was difficult and he wrote slowly. His effort was going into writing, so he fell behind on the reading. He tended to procrastinate as the pile of work grew. Franklin was embarrassed at being behind, so he stopped going to English. He also was stressed by feeling at a loss in terms of the 24/7 social demands.

As you might expect, all of this stress was a trigger for depression. In Franklin’s mind, one was either a success or a failure, and he was a complete failure.

He couldn’t concentrate and wasn’t sleeping well. Franklin began to feel hopeless and stopped attending all classes.  He withdrew, spiraling down into a hole and he felt it was impossible to climb out. Franklin had isolated himself from other students. He wasn’t aware that other freshmen had similar problems and resources were available to help.

The additional challenge with college is that there was no one to be aware of what was happening or check on Franklin’s increasing problems. His professors didn’t take attendance, and there was no immediate feedback on grades. Franklin could check online about his assignments but he avoided it. No one at the school nor his parents had any idea of what was happening until his grades came out. Franklin hid his grades from his parents until they insisted on seeing them during a school vacation.

At this point, Franklin was evaluated for depression and started medication. With support from his parents and the school, he was able to return to classes.

For some students who become too depressed, or who are too far behind to catch up, a medical leave of absence and a return to school next semester would be necessary.

It was possible for Franklin’s dean to help him work out a schedule with his professors for catching up with his work. He had tutors twice a week, and was supposed to go to the writing lab daily, but he began skipping appointments with tutors and didn’t always go to the lab. His anxiety had built up to a point where facing the work was just too stressful, even though he wanted to succeed. He continued to struggle with depression. He ended the year passing but on academic probation.

It was certainly possible to predict all of this given the amount of support Franklin had received in high school. There’s nothing magic about turning 18 and entering college that confers good executive functioning.

There are things that could have been done to prevent the situation:

• First, Franklin had to buy into the recognition that he needed the help he was getting, and that he would benefit from similar help starting in college.
• The disability office knew of Franklin’s challenges, but there was no external structure for his getting help as there had been before. He needed the structure of set appointments with a tutor as well as the writing lab.
• The disability office and tutors needed specific feedback about what had been helpful to Franklin in the past: how they’d help him initiate work, organize his papers with brain maps, and set up a daily schedule for work.
• There had to be a feedback loop if Franklin was falling behind or not attending his tutoring sessions.
• Franklin had to work on emotional regulation. He needed a therapist to identify when he was becoming anxious and to find strategies for self-calming.

It’s important to know that people who are 18 have complete control over their information. Unless he signed a release, Franklin’s parents would have no access to school reports or his grades. They would be unable to be part of his support team.

Franklin had been my client during his last year of high school. We met over the summer to prepare for the upcoming school year and by FaceTime when he was back at school. He also began to meditate every day, which helped him lower his overall anxiety.

For his second year, Franklin agreed to reduce his schedule from 5 to 4 classes, one being “easy” for him and only one writing class. With his psychiatrist, he decided to stay on medication while starting school again. He had been helped to find a tutor in the writing center with skills that were a good match for his learning style, and a second tutor for organizational help who checked in with him during the week.

Franklin met weekly with his dean as the person who got the feedback. They met regularly and as needed to encourage, check in, and problem solve. For example, Franklin got the flu and fell behind. His dean helped him contact his professors to catch up and make up work. His dean became a good mentor for choices in his major.

Not all college students want to agree to this kind of plan up front. It’s my belief that it’s easier to structure help and back off if it’s not needed than to bring in help when difficulties are already occurring.

Ideally, cooperation is voluntary, and a student will sign a release form so parents can be involved and be willing to set up a structure. I’ve sometimes recommended making these actions a prerequisite for paying for college – if the student goes, it’s to be successful. It’s possible to reduce the support later on if the family decides it is not needed.

Franklin’s academic stress was greatly reduced with his lighter schedule and support, and depression wasn’t an issue. We worked on expanding his social life to connect more with a roommate and another student who shared his interests, so he felt less isolated. With the right help, depressive triggers can be managed.

Asperger’s freshmen can do well if there’s realistic expectations and understanding of what college demands and reasonable plans put in place in the beginning of the transition.

by Marcia Eckerd, Ph.D.