Anxiety cannot be measured or observed except through its behavioral manifestation, either verbal or nonverbal (e.g., crying, complaining of a stomachache or headache, crawling under the table, becoming argumentative, calling others unkind names, etc.). To manage the anxiety in Aspergers (high functioning autistic) kids, moms and dads are encouraged to do any – or all – of the following:
1. Avoid over-scheduling. Soccer, karate, baseball, music lessons, play-dates the list of extracurricular activities children can take on is endless. But too many activities can easily lead to stress and anxiety in kids. Just as grownups need some downtime after work and on weekends, kids also need some quiet time alone to decompress.
2. Be flexible and try to maintain a normal routine.
3. Consult a counselor or your pediatrician. If you suspect that a change in the family such as a new sibling, a move, divorce, or a death of a family member is behind your youngster's stress and anxiety, seek advice from an expert such as your youngster's school counselor, your pediatrician, or a child therapist.
4. Create an anxiety hierarchy, and put the events in order from easy to hard.
5. Develop, practice, and rehearse new behaviors prior to exposure to the real anxiety-producing situation.
6. Don’t dismiss his feelings. Telling your Aspergers youngster “not to worry about his fears” may only make him feel like he’s doing something wrong by feeling anxious. Let him know that it’s okay to feel bad about something, and encourage him to share his emotions and thoughts.
7. Don’t punish mistakes or lack of progress.
8. Get him/her outside. Exercise can boost mood, so get him moving. Even if it’s just for a walk around the block, fresh air and physical activity may be just what he needs to lift his spirits and give him a new perspective on things.
9. Gradually shift “anxiety control” to your Aspergers youngster by preparing him for anxiety-producing situations by discussing antecedents, settings, triggers, and actions to take.
10. Help your Aspergers youngster identify the source of the anxiety if he is old enough to understand this concept.
11. If he is old enough, teach your Aspergers youngster increasing independence in anticipating and coping with anxiety in a variety of situations.
12. Implement new behaviors in the actual situations where anxiety occurs.
13. Keep your youngster healthy. Make sure he’s eating right and getting enough sleep. Not getting enough rest or eating nutritious meals at regular intervals can contribute to your youngster’s stress. If he feels good, he’ll be better equipped to work through whatever is bothering him.
14. Limit your Aspergers youngster's exposure to upsetting news or stories. If your youngster sees or hears upsetting images or accounts of natural disasters such as earthquakes or tsunamis or sees disturbing accounts of violence or terrorism on the news, talk to your youngster about what's going on. Reassure her that she and the people she loves are not in danger. Talk about the aide that people who are victims of disasters or violence receive from humanitarian groups, and discuss ways that she may help, such as by working with her school to raise money for the victims.
15. Listen carefully to your Aspergers youngster. You know how enormously comforting it can be just to have someone listen when something’s bothering you. Do the same thing for your youngster. If he doesn’t feel like talking, let him know you are there for him. Just be by his side and remind him that you love him and support him.
16. Make a list of numerous anxiety-producing situations, from easy ones to those that are more difficult (this is called “anxiety mapping”).
17. Modify expectations during stressful periods.
18. Offer comfort and distraction. Try to do something she enjoys, like playing a favorite game or cuddling in your lap and having you read to her, just as you did when she was younger. When the chips are down, even a 10-year-old will appreciate a good dose of parent TLC.
19. Plan for transitions (e.g., allow extra time in the morning if getting to school is difficult).
20. Prevent anxiety by “external control” (i.e., structuring the environment to make it predictable, consistent, and safe).
21. Use psychological, environmental and psychopharmacological treatments as needed (see below).
22. Recognize and praise small accomplishments.
23. Set a calm example. You can set the tone for how stress and anxiety in kids is handled in your house. It's virtually impossible to block out stress from our lives in today's high-tech, 24-hour-news-cycle world, but you can do something about how you handle your own stress. And the more you are able to keep things calm and peaceful at home, the less likely it is that anxiety in kids will be a problem in your household.
24. Stay calm when your Aspergers youngster becomes anxious about a situation or event.
25. Stick to routines. Balance any changes by trying to maintain as much of her regular routine as possible. Try to stick to her regular bedtime and mealtimes, if possible.
Summary of Anxiety Treatments for Aspergers Children—
1. Psychological Treatments:
- Behavioral Therapies: Focus on using techniques such as guided imagery, relaxation training, progressive desensitization, flooding as means to reduce anxiety responses or eliminate specific phobias.
- Cognitive-Behavioral Therapy: Addresses underlying “automatic” thoughts and feelings that result from thoughts, as well as specific techniques to reduce or replace maladaptive behavior patterns.
- Psychotherapy: Centers on resolution of conflicts and stresses, as well as the developmental aspects of an anxiety disorders solely through talk therapy.
2. Environmental Treatments:
- Reduction of stressors. Identify and remove or reduce stressful tasks or situations at home, school and work.
- Good sleep habits. Getting adequate, restful sleep improves response to interventions to treat anxiety disorders.
- Avoidance or minimization of stimulants. No caffeine, minimize use of asthma medications if possible (bronchodilators, theophylline), avoid use of nasal decongestants, some cough medications, and diet pills.
3. Psychopharmacological Treatments (used as a last resort only):
- Antihistamines: Older medications used for mild to moderate anxiety for many years. These, like the benzodiazepines, work fairly quickly (Atarax, Vistaril).
- Benzodiazepines: Long-acting are best (Klonopin, Ativan, Valium, Librium, Serax) to quickly reduce the symptoms of an anxiety disorder. However, if used long term the result may be that tolerance develops.
- Buspirone (BuSpar): A new serotonergic combination agonist/antagonist. Is nonaddicting, but may take 2 to 4 weeks for full effect.
- Combination Serotonin/Norepinephrine Agents: New medications such as Effexor, Serzone, and Remeron, also with excellent tolerability and effectiveness. Takes 4 to 6 weeks for full response.
- Major Tranquilizers (also called neuroleptics): Medications that act on a variety of neurotransmitter systems (acetylcholine, dopamine, histamine, adrenergic). Most are somewhat sedating, and have been used in situations where anxiety is severe enough to cause disorganization of thoughts and abnormal physical and mental sensations, such as the sense that things around you aren't real (derealization) or that you are disconnected with your body (derealization). Commonly used neuroleptics include: Zyprexa, Risperdal, Seroquel, Mellaril, Thorazine, Stelazine, Moban, Navane, Prolixin, and Haldol.
- Serotonergic Agents: Newer antidepressants act as antianxiety agents as well, with excellent tolerability and effectiveness. Takes 4 to 6 weeks for full response (Luvox, Prozac, Zoloft, Paxil).
- Tricyclic Antidepressants (TCAs): Older antidepressants with more side effects typically than the serotonergic agents, but also effective. Takes 4 to 6 weeks for full response (Tofranil, Elavil, Pamelor, Sinequan)