It is estimated that up to 80% of Aspergers (high functioning autistic) kids also experience intense anxiety symptoms. Anxiety Disorders (e.g., Obsessive Compulsive Disorder, Social Anxiety, Generalized Anxiety Disorder) commonly co-occur with Aspergers. When anxiety symptoms are untreated, they can further interfere with a youngster’s quality of life. Kids with both Aspergers and Anxiety Disorders experience a more limited social world than kids with only one disorder. They may have difficulty (a) adapting at home and in school, (b) making friends and joining in social activities, and (c) breaking their usual rituals to try something new.
Although little is known about what anxiety symptoms look like in Aspergers kids, the following symptoms, which overlap with Anxiety Disorders, indicate anxiety:
• Withdrawal from social situations
• Somatic complaints
• Avoidance of new situations
Another set of anxiety symptoms may be seen and may be unique to Aspergers kids:
• Becoming "silly"
• Becoming explosive easily (e.g., anger outbursts)
• Increased insistence on routines and sameness
• Increased preference for rules and rigidity
• Increased repetitive behavior
• Increased special interest
Social anxiety is a condition in which the child has an excessive and unreasonable fear of social situations. Anxiety (intense nervousness) and self-consciousness arise from a fear of being closely watched, judged, and criticized by others. The fear may be made worse by a lack of social skills.
Aspergers children with social anxiety may be afraid of a specific situation. However, most kids with social anxiety fear more than one social situation. Other situations that commonly provoke anxiety include:
• Answering questions
• Asking questions
• Attending family get-togethers (e.g., Christmas)
• Attending parties
• Being called on in class
• Being teased or criticized
• Being the center of attention
• Being watched while doing something
• Eating or drinking in front of others
• Giving reports in groups
• Going to school
• Interacting with people
• Making phone calls
• Making small talk
• Meeting new people
• Performing on stage
• Public speaking
• Taking exams
• Talking on the telephone
• Talking with “important” people or authority figures
• Using public bathrooms
• Writing or working in front of others
Psychological symptoms of social anxiety include:
- Avoidance of social situations to a degree that limits activities or disrupts life
- Clinging to the parent
- Excessive self-consciousness and anxiety in everyday social situations
- Extreme fear of being watched or judged by others, especially people you don’t know
- Fear that others will notice that you’re nervous
- Fear that you’ll act in ways that that will be embarrassing or humiliating
- Having a meltdowns
- Intense worry for days, weeks, or even months before an upcoming social situation
- Refusing to go to school
- Throwing a tantrum
Physical symptoms of social anxiety include:
• Clammy hands
• Dizziness, feeling faint
• Dry mouth
• Muscle tension
• Pounding heart or tight chest
• Rapid breathing
• Trembling voice
• Sweating or hot flashes
• Upset stomach, nausea
Cognitive behavioral therapy, a time-limited approach designed to change thoughts, emotions, and behaviors, has been shown to be successful in treating social anxiety in Aspergers children. Cognitive-behavioral therapy for social anxiety typically involves:
- Challenging negative, unhelpful thoughts that trigger and fuel social anxiety, replacing them with more balanced views.
- Facing the social situations you fear in a gradual, systematic way, rather than avoiding them.
- Learning how to control the physical symptoms of anxiety through relaxation techniques and breathing exercises.
Modifications designed to address the cognitive, social, and emotional difficulties include:
1. "Individualizing" anxiety symptoms—Kids should be helped by the therapist to identify what their own anxiety symptoms look like as anxiety symptoms may present differently.
2. Behavioral management—Addition of a reward and consequence system maintains structure and prevents anger outbursts.
3. Combining visual and verbal materials—Use of worksheets, written schedules of therapy activities, and drawings can be added to increase structure in therapy sessions.
4. Games and fun physical activities are important to include in group therapy to promote social interactions.
5. Greater parent involvement—To build on the attachment between parent and child, it is important to have moms and dads learn the techniques and coach kids to use them at home.
6. More education on emotions—Activities such as feeling dictionaries (i.e., a list of different words for anxiety) and emotional charades (i.e., guessing people's emotions depending on faces) are helpful in developing emotional self-awareness.
Three types of medication are also used in the treatment of social anxiety:
• Antidepressants – Antidepressants can be helpful when social anxiety disorder is severe and debilitating. Three specific antidepressants—Paxil, Effexor, and Zoloft—have been approved by the U.S. Food and Drug Administration for the treatment of social phobia.
• Benzodiazepines – Benzodiazepines are fast-acting anti-anxiety medications. However, they are sedating and addictive, so they are typically prescribed only when other medications for social phobia have not worked.
• Beta blockers – Beta blockers are used for relieving performance anxiety. They work by blocking the flow of adrenaline that occurs when you’re anxious. While beta blockers don’t affect the emotional symptoms of anxiety, they can control physical symptoms such as shaking hands or voice, sweating, and rapid heartbeat.
Practicing breathing exercises can help the Aspergers child decrease the physical symptoms of anxiety and stay calm. Parents and teachers can coach the child on the following techniques:
- Sit comfortably with the back straight and the shoulders relaxed. Put one hand on the chest and the other on the stomach.
- Inhale slowly and deeply through the nose for 4 seconds. The hand on the stomach should rise, while the hand on the chest should move very little.
- Hold the breath for 2 seconds.
- Exhale slowly through the mouth for 6 seconds, pushing out as much air as possible. The hand on the stomach should move in when exhaling, but the other hand should move very little.
- Continue to breathe in through the nose and out through the mouth. Focus on keeping a slow and steady breathing pattern of 4-in, 2-hold, and 6-out.
My Aspergers Child: Preventing Meltdowns