From risk to resilience: a narrative overview of modifiable factors influencing depression in children with autism spectrum disorder (part I)

Abstract

Background Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition frequently associated with internalizing disorders, particularly depression, which significantly impacts functioning and quality of life (QoL) in children and adolescents. Objective This paper represents the first part of a two-part structured narrative overview examining internalizing psychopathology in children and adolescents with ASD. Given the high co-occurrence and shared neurobiological, psychological, and environmental mechanisms linking depression and anxiety, the multidisciplinary research team elected to develop two complementary overviews to allow a more comprehensive and clinically meaningful synthesis of the evidence. The present review specifically aims to identify and synthesize current evidence on modifiable risk and protective factors influencing depression in children and adolescents with ASD. Methods A structured narrative overview was conducted, integrating evidence from systematic reviews, meta-analyses, and robust clinical studies. Studies were selected based on relevance and methodological quality, and findings were synthesized across biological, psychosocial, and lifestyle domains. Results Growing body of evidence indicates that depression in ASD is influenced by a complex interplay of genetic vulnerability, sensory and emotional dysregulation, social stressors, and environmental factors. At the same time, modifiable protective factors—including physical activity, psychosocial interventions, digital health approaches, and family-centered care—show potential in enhancing resilience and emotional well-being. However, the evidence base remains heterogeneous and often limited by methodological constraints. Conclusions A multidisciplinary and prevention-oriented approach that simultaneously addresses risk and strengthens protective pathways may optimize mental health outcomes and improve QoL in children and adolescents with ASD.