Aspergers and Anxiety: What Parents and Teachers Need To Know

The following is a transcript of the question-and-answer portion of Mark Hutten's seminar on "Aspergers and Anxiety: What Parents and Teachers Need To Know":

Question: Both of my boys have Aspergers, but one exhibits a lot of anxiety, whereas the other does not seem anxious at all. Is there a good explanation for that?

It’s very normal for different children to have different temperaments. Some children are more outgoing and seem to be impervious to feelings of anxiety, whereas other children may always seem to be anxious. But it’s very possible for the more anxious child to learn skills to help manage his anxiety better so he can participate in activities, do well in school, and not be held back due to anxiety-related issues, and so on.

Question: How common is anxiety in children with this syndrome?

Anxiety is extremely common. It’s estimated that up to 80% of people with Aspergers experience intense anxiety symptoms. It can take the form of obsessive-compulsive disorder, specific fears and phobias, and generalized anxieties. Also, 1 in 15 children with Aspergers meet the diagnostic criteria for depression, which can be both a cause and a result of anxiety. We don’t know exactly what causes the depression, but it’s likely a combination of the child’s realization of his difference from peers and the ostracizing that occurs from these peers. Bullying is an extremely common problem among children with Aspergers, and this often leads to an increased rate of both anxiety and depression.

Question: How should I go about choosing a child therapist for my 12-year-old Aspergers son?

In the field of child anxiety as it specifically relates to Aspergers, there are some therapists who have been specifically trained in implementing what we call ‘cognitive-behavioral therapy’ – or CBT. Cognitive-behavioral methods are essentially a set of skills that Aspergers children can learn to help them change their fearful thoughts, anxious behaviors, and to reduce their physical feelings of tension.

Cognitive-behavioral approaches to treating child anxiety have been found to have high levels of success. For example, a child who is experiencing panic attacks might learn how to identify anxious thoughts that trigger panic attacks, learn how to change his anxious feelings, and learn how to change anxiety-triggering behavior. In any event, ideally you will want to seek a Child and Adolescent Psychiatrist who specializes in CBT specific to the Aspergers condition.

Question: How long will it take before I see a change in my Aspergers son once he has started this cognitive-behavioral therapy?

That’ll depend on his unique set of symptoms. At one of our facilities in Indianapolis, children are typically treated within 7-12 sessions for difficulties like specific fears, panic disorder, generalized anxiety disorder, and obsessive compulsive disorder. In some cases, however, additional sessions are needed to help a child make the maximum progress. But even then, 15 sessions will usually be the max.

Question: I'm an anxious person also. Is it possible that I give this anxiety to my Aspergers daughter?

Although research has shown that anxiety may be heritable, there are many other ways that fears can be acquired. Your daughter may have a more anxious, inhibited temperament, which may make her more vulnerable to feeling anxious. Fears are often acquired through the media, through modeling from others, and so on. Fears might also occur after children have experienced some form of trauma. So, although you may feel you are anxious, it is not likely that you simply are ‘giving’ an anxiety disorder to your daughter. There are ways that you can interact with her, though, that may function to increase her anxiety, and it might be important to examine such factors with a therapist.

Question: What do anxiety symptoms look like in a child with Aspergers?

Not much is known about what anxiety symptoms actually look like in a child with Aspergers, but there are symptoms that overlap with Anxiety Disorders, for example: avoidance of new situations, irritability, somatic complaints, and withdrawal from social situations. Another set of anxiety symptoms may be unique to children with Aspergers, for example: becoming ‘silly’, becoming explosive, having anger outbursts or what we call ‘meltdowns’, increased insistence on routines and sameness, preference for rules and rigidity, repetitive behavior, and special interest.

Question: What is the difference between cognitive-behavioral treatment and other kinds of treatment for anxiety?

CBT is focused on teaching children and parents specific skills for changing their fearful thoughts, anxious and tense physical feelings, and avoidant behaviors. Other types of therapy are more focused on using play therapy and/or talk therapy to produce change. There’s a lot of evidence suggesting that cognitive-behavioral techniques are quite successful in reducing anxiety in Aspergers children. Other forms of therapy have less empirical support.

Question: Will my child’s anxiety go away naturally or does he need treatment?

This is an excellent question, and one that is commonly asked by parents. Many childhood fears are part of normal developmental. Fears tend to rise and dissipate at predictable ages in a kid’s life. A child might develop a fear of the dark at age 4, which dissipates by the time he’s 6. Also, it’s normal for children to feel fearful of loud noises when they are very young. However, no matter how old your son is, if he is experiencing a fear that is beginning to interfere with aspects of his functioning, such as academic, social or family functioning …then these fears may warrant treatment.

Very often, successful short-term therapy can help to alleviate an Aspergers child’s fears and help him return to healthy functioning. If you’re unsure whether your son’s fear is normal, or whether it is interfering in his life, it may be a good idea to consult with a psychologist to determine whether he could benefit from treatment.

Question: You say that cognitive-behavioral treatment is the best treatment for anxiety symptoms in children with Aspergers. What does it consist of exactly?

CBT is a time-limited approach designed to change thoughts, emotions, and behaviors and has been shown to be successful in treating Anxiety Disorders in Aspergers children. It should consist of both a child component and a parent component. In using CBT, children should be helped to identify what their own anxiety symptoms look like.

Activities like feeling dictionaries (which is a list of different words for anxiety) and emotional charades (which is guessing people's emotions depending on faces) are helpful in developing this self-awareness. Worksheets, written schedules of activities, and drawings can be added to increase structure during therapy sessions. Games and fun physical activities are important to include in group therapy because they promote social interactions. A reward and consequence system should be used to maintain structure and prevent anger outbursts. Also, to build on the attachment between child and parent, it is important to have parents learn the techniques and coach children to use them at home.

Other useful techniques may include body brushing and massage, chewing gum or sucking on a candy cane to relieve pressure in the jaw, deep pressure activity like lying under a heavy blanket or cushions, physical energy burn like running and jumping on a trampoline, redirection and distraction, and whole-body activities like tug-of-war or rolling on the floor.

As a side note, know that kids with Aspergers tend to have perfectionist attitudes in many areas of their lives. This can be witnessed through their obsessive-compulsive behaviors, repetitive patterns of behavior, and their difficulty coping with change. Now …this self-imposed perfectionism can contribute to their anxiety and pressure to perform. So, since Aspergers kids usually place extreme and unrealistic demands on themselves, it’s important to not push the child too far in therapy. Small steps and taking it ‘one therapy session’ at a time will go a long way in effecting permanent positive change in the child. Go slow, have realistic therapeutic expectations, and monitor progress – these are the big 3 in CBT as far as I’m concerned.  

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Anonymous said...

Dear Mark,

I am writing to you for advice regarding the situation with my
aspergers son.

My son is sixteen and was diagnosed about two years ago after battling
for a diagnosis for two years.In the interim I became involved in a
relationship with an ex who wasn't the father of my son who turned out
to be abusive particularly to my aspergers son.

My son does not trust in my judgements anymore particularly in my
choice of partner however the undermindment of me as a parent has been
encouraged by the social services who have permitted my son to read all
reports written by social workers and have spoken inapproprately about
me to him.

My son has volunteered to go into care because of his anxieties, which
have never met his needs the most recent of which being where a
resident stole his property and then threatened him with his friend.My
son self harmed on three occasions,absconded and went missing for three
days.I have had to dig my heels in to prevent the professionals sending
him back to the home.He is now living with me on a temporary basis
until a more suitable placement is found.I am worried that he will yet
again be put into a place which is not suitable and which does not
consider his needs as an asp teenager.

Any advice about this would be welcome.



Mark said...

I don't usually turn these opportunities into a sales pitch - but in your best interest I should say that you really need to consider downloading the eBook entitled My Aspergers Teen. You may be pleasantly surprised at just how much headway you can make with him using the strategies there.

Please consider this option - I'm sure it is the best option at this point, otherwise I would simply give you a quick answer via email now. But that would be a Band-Aid, and you really need something more substantial than that.


Anonymous said...

This is the most interesting paper I read this year!!

Thank you,

Anonymous said...

My daughter's Special Ed teacher commented that my daughter was by far the most anxious student she had ever seen. :(

Last winter her anxieties became very severe (adding a phobia of throwing up) and she wouldn't interact or eat. She would just curl up in a blanket in front of the computer and watch movies. We started seeing a counselor and this year has been much better!

She is still anxious and still has the phobia, but she is learning what to do with her worries. She has found a way to "test" her tummy aches to see if they are anxiety or a real illness coming on. I am so proud of her!

Last year we would just talk about how every tummy "feeling" did not mean she was going to be sick. Then we would move on and do something else - we would make up silly names for the cat we wanted to get, we would draw, we would read Calvin and Hobbs, or if I was busy - she would be allowed to watch a cartoon - something to take her mind off of her worry.

One night after battling an intense time of worry, she so wisely said, "I think I'm always going to be afraid, but it won't be so strong." I'm afraid she is right about always battling fear, but she is learning that she can "change the channel" in her brain if she works hard at it and does it over and over and over.


Anonymous said...

Thanks! I loved the article.I have that problem with my son.
Have agood day.

Anonymous said...

I have a son who has aspergers. Here in North Dakota we have had an early spring thaw which brought out the bee's early. I dread when there is bee's. Ryan, my son, has a horrible fear of these critters and totally panics if any are near him. Last summer he wouldn't even go outside to play. If he see's one he screams and crys in panic and runs inside. All and all i've been trying to handle this the best way i can here at home with explainind to him about bee's, there importance, and the fact they are not looking for him...etc...all black and white explanations which always seem to work, but not in this case. School is still in session and i know its just a matter of time until he see's one there and i am sure his reaction will be the same. How can i get him over this huge hurdle of "bee" fear?
In closing i was soooo happy to see that this web'site is available. I have been just diagnosed with adult adhd(everthing makes sense now!), i have a 20 year old daughter with the same and a 16 year old son with add. My life is very interesting to say the least!

Anonymous said...

Dear Mr. Hutten,

I have been receiving your newsletters for a few months now and they have been so helpful. Can you lead me in a direction on how I can help my aspie (girl) with her fear of going outside and bugs (specifically bees and wasps). She refuses to go outside and if she does and sees a bug the outing will end. It's very hard for us (actually mostly impossible) as a family to travel and do things outside because of this. I just don't know how to help her.

Do you have any suggestions or resources I might be able to use?


Mark said...


Here are some tips Gabrielle:

1. How about singing a song, or make up a poem, or say a prayer about bugs. Singing a song like "Shoo Fly, Don't Bother Me" or making up a poem or prayer about bugs going away can help to empower your daughter and make her feel in control of a situation where bugs are present.

2. Also, I would recommend renting the movie "It's a Bugs Life." This cute movie starring bugs may help your daughter to lose her fear of bugs because she will see bugs being funny and silly.

3. Another idea: purchase or make a bug exploration kit. A fishing net, a magnifying glass, a container with a cover that has holes in it and a pair of plastic tweezers make the perfect bug exploration kit. Don't force your daughter to use it, but model how to use it in front of her.

4. Model for your daughter that bugs aren't scary. Let her see you respond positively to bugs. For example, the next time you see a spider in the house, say, "Oh, that little spider is lost. Let's help him find his way home" …and relocate it outdoors.

5. Lastly, acknowledge your daughter’s fear without condoning associated undesirable behaviors. For example, tell her that "I know that you are scared of bugs, but when we are scared of bugs, we do not scream and have a tantrum." Then provide an alternate way to respond by saying something like, "We walk away from bugs if we are afraid."

Good luck,


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