Education and Counseling for Individuals Affected by Autism Spectrum Disorders


Help for Anxious Children on the Autism Spectrum

Anxiety is a common problem in children with Asperger’s (AS) and High-Functioning Autism (HFA). In fact, in some cases fear is their main emotion. One study revealed that 84.1% of kids on the autism spectrum met the full criteria of at least one anxiety disorder (i.e., phobia, panic disorder, separation anxiety disorder, avoidant disorder, overanxious disorder, and obsessive compulsive disorder). This does not necessarily go away as the youngster grows up. Many teens and young adults with AS and HFA report intense feelings of anxiety that may reach a level where treatment is required. For some children, it is the treatment of their anxiety disorder that leads to a diagnosis of AS or HFA.

Children with AS and HFA are particularly prone to anxiety as a consequence of the social demands made on them. Any social contact can generate anxiety as to how to start, maintain and end a conversation or an activity. Also, changes to daily routine can exacerbate the anxiety, as can sensory sensitivities.

One way these children cope with their anxiety is to retreat into their special interest (e.g., video games, collecting baseball cards, tracking train schedules, etc.). Their level of preoccupation with the special interest can be used as a measure of their degree of anxiety. The more anxious the child, the more intense the interest. Anxiety can also increase their rigidity in thought processes and insistence on routines. In addition, the more anxious these children are, the more they experience other related symptoms. For example, anxiety often leads to depression and obsessive-compulsive behaviors.

One of the best ways to treat anxiety in AS and HFA children is through the use of behavioral techniques. This may involve parents (and teachers) looking out for recognized symptoms (e.g., meltdowns, shutdowns, rocking, hand-flapping, etc.) as an indication that the youngster is anxious. These kids can be taught to recognize these symptoms themselves (although some might need prompting).

Specific events may also trigger anxiety (e.g., recess and other unstructured school activities, itchy clothing, routine changes, a stranger entering the room, etc.). When certain events (internal or external) are recognized as a sign of imminent anxiety, action can be taken (e.g., relaxation, distraction, physical activity, etc.).

The choice of relaxation method depends very much on the unique needs of the child. Many of the relaxation products available commercially can be adapted for use for children with AS and HFA. Some kids may respond to watching their favorite video, while others may prefer to listen to calming music. Also, many benefit from having access to a quiet room.

Other techniques include:
  • aromatherapy
  • deep breathing
  • massage
  • physical activities (e.g., using a swing or trampoline, going for a long walk perhaps with the dog, doing physical chores around the house, etc.)
  • the use of photographs, postcards or pictures of a pleasant or familiar scene (these need to be small enough to be carried around and should be laminated in order to protect them)
  • using positive thoughts

It’s best to practice whatever method of relaxation is chosen at frequent and regular intervals in order for it to be of any practical use when anxieties occur.

Drug treatment may be effective for anxiety. Many AS and HFA children have responded well to:
  • benzodiazepines
  • buspirone
  • clonazepam
  • propranolol
  • selective serotonin reuptake inhibitors (SSRI) antidepressants 
  • St. Johns Wort

As with all drug treatments, it will take time to find the correct drug and dosage for any particular child – and must only be conducted through a qualified medical practitioner.

Whatever method is chosen to reduce anxiety, it is vital to identify the cause of the anxiety. This should be done by careful monitoring of the antecedents to an increase in anxiety and the source of the anxiety tackled. For example, many children with AS and HFA have difficulty with noisy, crowded environments. Thus, the newly arrived middle school student who becomes agitated or aggressive in the hallway during passing periods may need an accommodation of leaving class a minute or two early to avoid the congestion and over-stimulation that provokes anxiety and subsequent dysfunctional coping mechanisms.

Key issues to address when discussing this strategy are:
  • Will the antecedent strategy need to be permanent, or is it a temporary "fix" which allows the child to increase skills needed to manage the anxiety in the future?
  • What can be done to modify the anxiety-producing situation if it can’t be eliminated entirely?
  • What can be done to eliminate the problem (i.e., the antecedent condition)?

The importance of using antecedent strategies should not be underestimated. Kids with AS and HFA often have to manage a great amount of personal stress. Striking a balance of short and long term accommodations through manipulating antecedents to anxiety and problem behavior is often crucial in setting the stage for later skill development.

Teaching Social Skills and Emotion Management

1 comment:

DC Romika said...

My recently diagnosed 13 y.o. daughter with HFA experiences anxiety about some very necessary things, like drinking water (she saw her brother guzzle water and vomit and now associates water intake with vomiting), eating (if she starts to become anxious while eating a particular food, that food becomes a trigger in itself) and sleeping -- haven't quite figured out what frightens her about sleep, but it often results in her staying up until she just can't keep her eyes open any longer. Then of course, she's tired and can't focus and that contributes to her other anxieties in school and such. She's on an SSRI, and has been working with a CBT therapist for several years. I wish it were as simple as avoiding or modifying things that caused her anxiety but eating, drinking and sleeping are everyday necessities. Any thoughts on approaches that might help? thanks.

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