Other factors that may contribute to heightened anxiety include the following:
- Family history is frequently a factor. Both Asperger’s and anxiety disorders run in families. Kids who have a family history of anxiety, often going back several generations, are at increased risk for developing an anxiety disorder.
- Kids with introverted temperaments may be more prone to anxiety. Introverted kids are more apt to internalize their distress rather than to act it out.
- Kids who are experiencing high levels of family stress or conflict may exhibit signs of anxiety.
- Kids with highly anxious moms and dads may exhibit high levels of anxiety themselves. The highly anxious parent who continually worries and frets about her “special needs” child or who is overly-protective can foster high levels of anxiety in her child.
There are several types of anxiety disorders, including:
- Generalized anxiety disorder: Involves excessive, unrealistic worry and tension, even if there is little or nothing to provoke the anxiety.
- Panic disorder: Children with this disorder have feelings of terror that strike suddenly and repeatedly with no warning. Symptoms include a feeling of "going crazy," a feeling of choking, a feeling of having a heart attack, chest pain, sweating, and unusually strong or irregular heartbeats.
- Social anxiety disorder: Involves overwhelming worry and self-consciousness about everyday social situations.
- Specific phobias: An intense fear of a specific object or situation (e.g., snakes, heights, flying, etc.). The level of fear is usually out of proportion to the situation and may cause the child to avoid common, everyday situations.
The behavioral and emotional symptoms listed below may signal an anxiety disorder in your AS or HFA child (or the propensity for developing one):
- avoidance of activities that require independence
- avoidance of social situations
- avoidance of stressful situations (e.g., tests and exams, interactions with others, etc.)
- avoidance, refusal or reluctance to participate in social activities that might result in social scrutiny
- being overly clingy
- complains about physical concerns and problems (e.g., headaches, stomachaches, etc.)
- constant thoughts and intense fears about the safety of parents
- constant worries or concerns about, school
- constant worry about everyday activities (e.g., what's going to happen next)
- extreme fear about a specific thing (e.g., dogs, insects, needles, etc.)
- extreme worries about sleeping away from home
- extremely slow to complete tasks in order to ensure they are done correctly
- fears of embarrassment or making mistakes
- fears of meeting or talking to people
- few friends outside the family
- highly dependent on a parent
- highly sensitive to other people watching them
- low self-esteem and lack of self-confidence
- many worries about things before they happen
- panic or tantrums at times of separation from parents
- physical symptoms (e.g., flushing) or an extremely quiet or shaky voice during social situations
- refusing to go to school
- reluctant to engage in activities without a significant other
- repetitive, unwanted thoughts (obsessions) or actions (compulsions)
- shows a high need for a great deal of reassurance
- signs of perfectionism
- trouble sleeping or nightmares
Fortunately, much progress has been made in the treatment of children with anxiety disorders. Although the exact treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders:
- Cognitive-behavioral therapy: A therapeutic approach in which the child learns to recognize and change thought patterns and behaviors that lead to troublesome feelings.
- Dietary and lifestyle changes
- Medication: Drugs used to reduce the symptoms of anxiety disorders include anxiety-reducing drugs and anti-depressants.
- Psychotherapy: Counseling that addresses the emotional response to anxiety. Trained mental health professionals help children by talking through strategies for understanding and dealing with their disorder.
- Relaxation therapy
How parents can help the highly-anxious Asperger’s or HFA child:
It’s nearly impossible to “cure” anxiety in AS and HFA kids. Some anxiety is genetic, and others are as a result of situations beyond the parent’s control. But parents can minimize the effect that anxiety has on their youngster’s development. Over time, moms and dads can help their child develop the coping strategies he or she needs to be able to handle day-to-day anxiety and stress. Here are some tips:
1. As a mother or father, it’s natural to want to be supportive of your “special needs” youngster. But you may be unintentionally reinforcing negative behaviors. For instance, if your youngster is anxious when you drop him off at school and he runs back to the car crying, it’s not a good idea to pick him up, hug him, cry too, and tell him ‘it will be okay’. This just reinforces that leaving him is a scary thing to do.
2. AS and HFA children who suffer with anxiety issues are often described as "going from 0-to-60 in a split second," which often results in a meltdown. In reality, however, the child’s emotions probably grew more gradually from calm to uneasy to anxious, but the parent (and the child) didn't notice the build-up. Teaching your child to identify this escalation is essential if he is to learn how to catch himself on the way up. A helpful tool to use is an emotional thermometer. When your youngster is calm, share the graphic with him, explaining how emotions often grow in intensity from calm to uneasy to anxious. Give him a copy of the thermometer and ask him to pay attention to where he is on it at different times of the day over the course of a few weeks, checking in with him as needed to discuss what he is noticing.
3. Breathing exercises that involve your youngster letting her belly expand as she inhales through her nose and deflate as she exhales through her mouth can help alleviate anxiety. The intake of oxygen and exhaling of carbon dioxide when she breathes deeply can lower her blood pressure and slow her heartbeat. When teaching this strategy to your child, tell her to pretend that she is blowing out candles on a cake or blowing up a make-believe balloon.
4. Calming music helps lower a youngster’s level of stress hormones, blood pressure and heart rate. When your youngster feels stressed, have him listen to soothing music (e.g., lullabies) using a pair of headphones. Create a playlist of spa-like music to play on an MP3 player.
5. Guided imagery teaches a youngster to calm her body and mind. This works best in a quiet, comfortable environment. Have your child close her eyes as you use a soothing voice to help her imagine that she’s in a relaxing situation (e.g., have her imagine that she’s filling bubbles with her negative emotions, which disappear into the air).
6. Kids pick up on social cues from their moms and dads. If the parent is an anxious person, her youngster is far more likely to be anxious as well. This is why it’s important that parents work on their own anxiety. They should try to minimize their fearful reactions to things when in front of their youngster – and try their best to relax and find composure in daily life.
7. Practice is key. Each day, at a time when your child is calm, ask him to role play what he looks like when he is fearful or anxious. Then ask him to practice self-soothing techniques. To make the practice most effective, have your child do the role-play in the area of the house he is most likely to go when he's actually upset (e.g., bedroom, beanbag chair, reading area, etc.). Then when he goes there in a moment of feeling uneasy, he'll be more able to use the correct technique in that space. Self-soothing training takes only a few minutes a day, but it's important that you focus on it daily with your child until you see him beginning to take hold of the strategies.
8. Social anxiety is easily the most common type of anxiety that affects kids on the autism spectrum. One of the main problems is that the AS or HFA youngster is unlikely to be adept at social skills. Parents should try to make sure that their youngster doesn’t have his fears reinforced. For example, you may be against violent video games or rap music, but the truth is that your youngster will want to converse with peers that will likely be talking about these subjects. The more your child knows about pop culture, the easier it will be for him to get into normal conversations, gain acceptance, and avoid having his social anxiety reinforced.
9. Teach your AS or HFA youngster to identify emotions by conducting a "body check." When you notice signs of anxiety first beginning, label it for your youngster and explain how you know (e.g., “Your voice is getting louder and your facial muscles are clenched, so I can see you're having some anxiety right now"). Over time, your youngster will learn to identify when he's anxious without your cues.
10. Think back to when you were a child. Most certainly, there were things that your parents did or said that helped calm you down. And most likely, there were those things that they did that raised your anxiety level. Vow to pass on the best – and leave the rest. In other words, some of the things that soothed you as a child may very well work with your child – so try them. Also, try to avoid doing the things that caused you be anxious as a child.
11. Try to find your child some very close friends. Studies have shown that having social support from close friends greatly reduces anxiety and improves confidence. As the AS or HFA youngster gets older, she will be able to leverage those friendships in such a way that she becomes less anxious in the process.
12. When your youngster feels anxious, oxygen-rich blood triggered by his fight-or-flight response often causes large muscle groups to feel tense. Practicing progressive muscle relaxation helps release the tension so he feels calmer. Guide your youngster by telling him to bring his shoulders up to his ears for five seconds – and then relax. Repeat the exercise five times.
Are you worried that your AS or HFA child may be exhibiting symptoms of anxiety? Observe his or her behavior and ask yourself the following questions:
- When did you begin to notice some of the signs of anxiety in your child?
- What factors or stressors do you think are contributing to the anxiety?
- What effect does anxiety have on your youngster and those around him or her?
- On a scale of 1 to 10, how severe do you think the problem is?
- Is it hard to manage?
- How long have these problems been of concern?
- How long do the symptoms of anxiety last?
- How frequently does your youngster exhibit symptoms of anxiety?
- How does it interfere with your youngster’s life?
By getting answers to these questions – and by utilizing the ideas listed above – parents should be able to greatly reduce the level of anxiety that their “special needs” child experiences.