Children on the Autism Spectrum and Social Phobia

The diagnosis of social phobia in Aspergers and high-functioning autistic (HFA) kids emphasizes the following:

1. A youngster with social phobia must show the capacity for age-appropriate social relationships with familiar people, and his/her anxiety must occur in peer contexts, not just with grown-ups.
2. Due to limitations of cognitive and perceptual skills, Aspergers and HFA kids with social phobia need not recognize that their fear in social situations is excessive or unreasonable.
3. The anxiety brought on by social situations may be evidenced by crying, tantrums, meltdowns, freezing, shutdowns, or shrinking from social situations with unfamiliar people.
4. There must be evidence of the social fears existing for a minimum of six months.

Developmental Pathways to Social Phobia—

1. Genetic factors: Taken as a whole, studies using twins to determine whether genetics play a significant part in the development of social phobia are inconclusive. Some twin studies have examined the heritability of shyness and social fears rather than the clinical disorder social phobia. Overall, these studies suggest that genetics play a modest to moderate role in the development of symptoms and temperamental traits associated with social phobia.

Studies examining the rates of social phobia in the offspring or in other first-degree relatives of socially phobic people show that social phobia rates in relatives are higher than in the relatives of people with other anxiety disorders or no disorder. Overall, these studies suggest that social phobia is at least moderately familial and possibly specific in its transmission. However, family studies cannot specifically sort-out the relative contributions of genetic influences and family environmental influences on the development of a disorder. Thus, the mechanisms behind this familial connection in social phobia still need clarification.

2. Normative developmental factors: Kids as young as 6 months through 3 years of age commonly show anxiety in the forms of stranger and separation anxiety. Some young kids, when confronted with a new social situation, throw tantrums, cling to a familiar person, avoid contact, refuse to take part in group play, and become overly vigilant. By late childhood and early adolescence, kid's fears of social evaluation of academic and social performance are forefront. Although at some point during their adolescence all youth will experience some level of anxiety about being judged in school or social situations, obviously not everyone goes on to develop pathological levels of social anxiety (i.e., social phobia).

3. Parenting/family environment factors: Research indicates that parent characteristics and family environment (through such mechanisms as modeling of avoidant responses and restricted exposure to social situations) are likely to have at least a moderate effect on the development of social phobia in kids and adolescents. It appears likely that if the parent's own anxiety is communicated to the youngster, a cycle is established in which parent and youngster reinforce each other's anxiety.

Controlling/overprotecting and less affectionate parenting styles have been found to be associated with social phobia in adult offspring, although the cause and effect relationship between these characteristics and social phobia is unclear. A major gap in this area is research that uses kids with social phobia or kids at high risk for social phobia, and this needs to be filled before the developmental impact of parental and family factors can be specified.

4. Physiological factors: Researchers have just begun to explore the physiology of social phobia, and studies have been primarily conducted with grown-ups. When facing phobic situations, socially phobic people commonly experience such symptoms as blushing, racing heart, sweating, and increased respiration, all of which are reactions associated with the autonomic nervous system (ANS). However, the few studies that have examined ANS functioning in socially phobic people have provided mixed results.

Other research has examined the function of the amygdala, a small region in the forebrain involved in the output of conditioned fear responses, e.g., freezing up behavior, blood pressure changes, stress hormone release, and the startle reflex. Hypersensitivity in the neural circuitry that centers on the amygdala may be responsible for behavioral inhibition in kids. The application of currently developing neuroimaging technologies to kids and adolescents may prove to be especially useful in elucidating the continuities and differences between social phobia in youngsters and in grown-ups.

5. Temperamental factors: A predisposition to timidity and nervousness has been believed to be a matter of inborn temperament. The majority of recent research in the role of temperamental factors in the development of social phobia focuses upon behavioral inhibition (BI). BI refers to a temperamental style that is characterized by reluctance to interact with and withdrawal from unfamiliar settings, people or objects. In infants, BI is typically manifest as irritability, in toddlers as shyness and fearfulness, and in school age kids as cautiousness, reticence and introversion. BI includes reactions that can be seen in behavior, such as interrupting of ongoing behavior, ceasing vocalization, comfort seeking from familiar persons, and retreat from and avoidance of unfamiliarity.

BI also includes reactions that are physiological, such as stable high heart rate, acceleration of heart rate to mild stress, pupillary dilation, and increased salivary cortisol. Overall, evidence to date suggests that a behaviorally inhibited temperament may predispose a youngster to the development of high social anxiety, although BI has yet to be definitively identified as a necessary precursor to the development of the clinical syndrome social phobia.

Treatment of Social Phobia—

1. Cognitive Behavioral Treatment (CBT): Treatment from the cognitive-behavioral perspective assumes that social anxiety is a normal and expected emotion. Social anxiety becomes problematic when it exceeds expected developmental levels and results in significant distress and impairment at home, school, and in social contexts. Anxiety is assumed to be comprised of physiological, cognitive, and behavioral components.

Cognitive behavioral treatment involves specific psycho-education, skills training, exposure methods, and relapse prevention plans for addressing the nature of anxiety and its components. Psycho-education provides corrective information about anxiety and feared stimuli; somatic management techniques target autonomic arousal and related physiological responses; developmentally appropriate cognitive restructuring skills are focused on identifying maladaptive thoughts and teaching realistic, coping-focused thinking; exposure techniques involve graduated, systematic, and controlled exposure to feared situations and stimuli; and, relapse prevention methods focus on consolidating and generalizing treatment gains over the long term.

2. Social Effectiveness Therapy for Children (SET-C): This treatment is appropriate for youth ages 8 through 12 and involves 24 treatment sessions held over a 12-week period. Each youngster participates in one group social skills training session and one individual exposure session each week, with structured homework assignments serving to promote generalization of the within session experience to the youngster's real life.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

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Helping Kids on the Spectrum with Transitions: Moving to a New Home

The logistics of a move can - and will - influence your Aspergers or high functioning autistic (HFA) child's adjustment. For many "neurotypical" (i.e., non-autistic) kids, moving can be a positive experience, as it brings the opportunity to develop new friendships, pursue new interests, increase social confidence, and learn important lessons about adapting to change.

However, as parents of Aspergers and HFA children know, “change” is extremely difficult for them. Transitions of any kind, especially those that are unpredictable, are unsettling and can cause the youngster to become totally undone.

Knowing how to support your youngster through change in order to make a successful transition is crucial. Helping with transitions is especially important during childhood “life event” changes (e.g., attending a new school, death in the family, divorce, going to college, moving, etc.).

Here are some tips to help transition your child to a new home:

1. Access religious and community organizations. They can provide a ready structure of activities, contacts, and resources for the whole family. If the family was involved with similar groups before, participating in such activities in the new location can increase feelings of familiarity.

2. Adolescents with Aspergers and HFA will be able to understand the nuances of the decision to move, but may be resistant to change. At a time when they are establishing important relationships outside of the family, they may feel the move threatens their evolving identity. The move can be disruptive to the stability they have already established with a core group of friends or with an athletic or academic path they are pursuing.

3. Allow your youngster to accompany you when viewing potential new homes. Encourage him to ask questions of the Realtor related to areas of interest or importance for him. This will help quell his anxieties, and you may be surprised to hear him ask questions you hadn't thought to ask yourself.

4. Be patient, some kids on the autism spectrum will dive in, develop a support network of friends, and become involved with school and activities without missing a beat. Others may need more time and help to feel acclimated and at ease. Providing your youngster with new experiences in new places will help him in the future when he makes decisions for himself about where to live.

5. During a walk-through of a potential home, give your youngster the chance to speculate with you about room designations, potential location of furniture, changes in décor, etc.

6. For young kids on the spectrum, put their furniture on the moving van last so that it is first to unload. This will help orient them quickly to the new surroundings.

7. Upon arrival to the new home, try to get the youngster’s room in order before the rest of the house.

8. Have your child pack a bag of essential, favorite, "can't live without" things to keep with them at all times.

9. If possible, have your child invite a friend from his old neighborhood for a visit. This can help the youngster make decisions about what is new and fun, and also helps him get a much-needed dose of validation from an old friend.

10. If you are building a new home, it will be beneficial to you and your youngster to document the building process with your child manning the camera.

11. It can be tempting to literally "clean house" and discard old toys and unused articles. But this should be done gingerly. The loss of material things will most likely overwhelm some Aspergers kids. Better to help them sort out the bulk of their things once they've moved in when they can feel more in control of their new environment.

12. Know that your youngster may experience resistance, denial, and emotional upset when you break the news of the move to another house. Be wary of your youngster's potential to dip into a depressed state at this time as well.

13. Moving day will be very emotional for you all, but maintaining a positive attitude about a new beginning and a fresh start will be of great value.

14. Once the initial shock and heartbreak of the news subsides, share with your youngster thoughts about all the impending unknowns that face you and your family.

15. Once you've narrowed your choices of location to a select few, plan to document the final decision-making visits by taking photos or videos. Not only will this be an aid to your youngster, it will be as equally helpful to you as well in recalling certain details.

16. Partner with your youngster in as many facets of the moving process as possible.

17. Preschoolers with Aspergers and HFA are not able to understand the meaning of the move or complex explanations. They are affected more by the reactions and availability of their parents. Little children do best when things are predictable, so keeping to a routine with familiar things and people eases the transition for them. Avoid making other changes at the same time as the move (e.g., toilet training, transfer to a new bed, etc.) so as not to overwhelm and confuse a young Aspie.

18. Scheduling some trips away from the new home may actually help establish the new base. It becomes the place to "come home to" and enhances the sense of a familiar place.

19. School-age kids on the autism spectrum are likely to be concerned about fitting in with new friends and dealing with different academic demands. Their general personality and social style may influence their ease in adjustment. They may also be better able to tolerate the “new kid jitters” if a brother or sister will be at the same school.

20. Some Aspergers and HFA kids will actually thrive in the new environment depending on the circumstances of the move, an accepting peer group, and a supportive mentoring adult network.

21. Stay in contact with the school and other areas in which your youngster is involved to monitor his progress in making the transition. Kids who are still sullen or angry at the parents about the move at home may have anger management issues at school as well.

22. The Internet and cell phone text messaging are a mixed blessing for kids who have recently moved. Contact with old friends helps a youngster stay connected to a support system and provides an outlet for talking about the new home and experiences. But, when a youngster spends long periods of time chatting with friends "back home," it can decrease the motivation to become involved with the new community and interfere with the adjustment to new friends.

23. Timing the move is important. Moms and dads should carefully consider their options. Certain moves may be inevitable (e.g., when a parent loses a job, when finances are strained, etc.) or impossible to predict (e.g., when a parent dies). But when circumstances allow for flexibility, it is often better to postpone or avoid a move at certain transitional times (e.g., when the Aspergers adolescent is a junior in high school, immediately following a divorce, etc.). When timing is not ideal, options may be possible to ease the strain (e.g., having a high school student remain in town with a friend or relative to finish out the year).

24. When moms and dads are sensitive to the impact of moving on their "special needs" youngster, they can make moving a positive experience, enhancing the child's emotional growth, adaptability, self-confidence and social skills.

25. If your youngster is the oldest sibling, let him assist you in breaking the news to younger siblings, cousins, neighbors, or other family members. This type of “grown-up” responsibility can empower him to shift his perspective of the move to a more selfless position. Think of some of the other responsibilities you can share with your youngster to make the move more palatable and less threatening. Some of the things he or she can do include:

• Begin to inventory household and personal belongings
• Determine data involving the geographic location of the move, mileage to and from the destination, and other pertinent logistics
• Fill out change-of-address cards
• Help arrange showings of your current home
• Help you to schedule dates and times to meet with Realtors to view prospective homes
• Identify all utility companies that require notification of the move
• Plan a garage sale or designate items for drop-off donation
• Scan the Internet to locate Realtors, new home listings, and other related information
• Start to prioritize packing and labeling moving boxes

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

Mourning the Loss of a Loved One: Helping Children on the Spectrum through the Grieving Process

As a parent, consider the range of emotions you have experienced after the loss of a loved one (e.g., grief, guilt, shock, loneliness, compassion, etc.), and think of how that might reflect in your ASD or high-functioning autistic (HFA) youngster during his first loss. 

The difference may be that while you outwardly show a variety of feelings associated with loss, you may not see similar emotions in your "special needs" youngster.

Just like you, comprehending the loss of a loved one – even a beloved pet – may take time for your youngster to completely process. Just because he doesn’t grieve in “typical” ways (e.g., openly sobbing, wanting to be with family members, talking to close friends, etc.) doesn't mean he is emotionless or unaffected. In fact, the opposite could be true.

Tips for helping HFA children through the grieving process:

1. An HFA youngster's capacity to understand death — and your approach to discussing it — will vary according to the youngster's age.

2. As children mature into teenagers, they start to understand that every human being eventually dies, regardless of grades, behavior, wishes, or anything they try to do. As your HFA teenager's understanding about death evolves, questions may naturally come up about mortality and vulnerability. These young people also tend to search more for meaning in the death of someone close to them. A teenager who asks why someone had to die probably isn't looking for literal answers, but starting to explore the idea of the meaning of life. They also tend to experience some guilt, particularly if one of their friends died. Whatever your teen is experiencing, the best thing you can do is to encourage the expression and sharing of grief.

3. Children from the ages of about 6 to 10 start to grasp the finality of death, even if they don't understand that it will happen to every living thing one day. A 9-year-old might think, for example, that by behaving or making a wish, grandma won't die. Often, children this age personify death and think of it as the "boogeyman" or a ghost or a skeleton. They deal best with death when given accurate, simple, clear, and honest explanations about what happened.

4. Don't be quick to scold if your youngster's emotions seem inappropriate (e.g., laughing during a solemn discussion). He may be on the verge of meltdown and is distracting himself by playing a mind movie.

5. Don't be surprised if your youngster reports that he has seen, talked with, smelled, or otherwise interacted with the loved one who has recently passed. Remember that your youngster may be very sensitive to many things, seen and unseen. Instead, validate what your youngster tells you by listening carefully, requesting further information, asking clarifying questions, and providing assurances.

6. Don't get angry if your youngster catches you off-guard with seemingly insensitive questions (e.g., about the mechanics of embalming, cremation, burial, body decomposition, etc.). These are honest inquiries designed to contribute to your youngster's understanding and comfort level.

7. Encourage questions. This can be hard because you may not have all of the answers. But it's important to create an atmosphere of comfort and openness, and send the message that there's no one right or wrong way to feel.

8. Follow your youngster's lead. It’s not helpful to exclude him from participating in any of the subsequent formalities (i.e., the funeral or other rituals) if he expresses a desire to attend.

9. If possible, assign your youngster a responsibility. This may help him to maintain focus during what may be a chaotic and upsetting time (especially helpful for preteens and teens).

10. If you need help, many resources — from books to counselors to community organizations — can provide guidance. Your efforts will go a long way in helping your youngster get through this difficult time — and through the inevitable losses and tough times that come later in life.

11. If you think your own grief might prevent you from helping your "special needs" youngster during this difficult time, ask a friend or family member to care for - and focus on - your youngster during the funeral service. Choose someone you both like and trust who won't mind leaving the funeral if your youngster needs to go.

12. Many moms and dads worry about letting their children witness their own grief, pain, and tears about a death. Don't! Allowing your youngster to see your pain shows that crying is a natural reaction to emotional pain and loss. And it can make children more comfortable sharing their feelings. But, it's also important to convey that - no matter how sad you may feel - you'll still be able to care for your family and make your youngster feel safe.

13. Moms and dads can't always shield children from sadness and losses. But helping them learn to cope with them builds emotional resources they can rely on throughout life.

14. Remember that the questions you get may sound much deeper than they actually are. For example, a 5-year-old who asks where someone who died is now probably isn't asking whether there's an afterlife. Rather, children might be satisfied hearing that someone who died is now in the cemetery. This may also be a time to share your beliefs about an afterlife or heaven if that is part of your belief system.

15. Remember that honesty is the best policy. You may be pressured by well-meaning friends or relatives to offer some alternate explanation for the loss of a loved one (e.g., “Grandpa is resting in the ground now”). At some point, your sugar-coated explanation may be exposed, and the cover-up (despite your good intentions) might upset the trust between you and your youngster.

16. Remember that learning how to deal with grief is like coping with other physical, mental, and emotional tasks — it's a process.

17. Until children are about 5 or 6 years old, their view of the world is very literal. So explain death in basic and concrete terms. If the loved one was ill or elderly, for example, you might explain that the person's body wasn't working anymore and the doctors couldn't fix it. If someone dies suddenly, like in an accident, you might explain what happened — that because of this very sad event, the person's body stopped working. You may have to explain that "dying" or "dead" means that the body stopped working.

18. Watch for any signs that children need help coping with a loss. If a youngster's behavior changes radically — for example, a gregarious and easygoing youngster becomes angry, withdrawn, or extremely anxious; or goes from having straight A's to D's in school — then be sure to seek help.

19. What do you tell an HFA youngster about the funeral? You may want to explain that the body of the person who died is going to be in a casket, and that the person won't be able to talk or see or hear anything. Explain that others may speak about the person who died and that some mourners may be crying.

20. Younger children often have a hard time understanding that all people and living things eventually die, and that it is final and they won't come back. So, even after you've explained this, children may continue to ask where the loved one is or when the person is returning. As frustrating as this can be, continue to calmly reiterate that the person has died and can't come back. 

Note: The child who is having serious problems with grief and loss may show one or more of these signs:

• acting much younger than his age for an extended period of time
• an extended period of depression in which the youngster loses interest in daily activities and events
• excessively imitating the dead person
• inability to sleep
• loss of appetite
• prolonged fear of being alone
• refusal to attend school
• repeated statements of wanting to join the dead person
• sharp drop in school performance
• withdrawal from friends

If these signs persist, professional help may be needed. A qualified mental health professional can help the youngster accept the death and assist the others in helping him or her through the mourning process.

More resources for parents of children and teens with High-Functioning Autism:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism 

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

COMMENTS:

•    Anonymous said... I had to handle this with my son through the loss if two grand fathers and a dog all in two years. It was traumatic for him but he has handled himself well. I agree with all the suggestions. For my son, I had him pick a few special pictures to have in his room, had him help put together scrapbooks for him so he can revisit them whenever he feels the need. And we are a family that talks about of feelings so we talk about all of them often but happy and sad times.
•    Anonymous said... pretty much be honest with them and let them ask questions in a safe loving environment. My son was there they whole time my Dad was sick and dying. I think it helped that he knew what was happening and that Papa was not in pain and loved greatly. I never pushed him to do anything he didn't want to do. He did, however, disappear at the funeral. I got SO scared but found him hiding behind a couch-the noise/people were just too much for him (he also had sensory processing disorder). We still talk about Papa often and how he misses him. But I assure him that he is watching over us and hopefully one day we will all be together. Let them know their feelings are normal and they can talk about things anytime.
•    Anonymous said... This looks to be a marvelous opportunity for all family members involved. Fortunately, I am very interested in the many complexities of the psychy and it's challenges to those diagnosed with any mental "dis-eases" causing various stresses and difficulties growing up & continuing on through adulthood, if this is the case (and usually is). I only wish I were closer to my grandson, so I could be there in the moments, and not just be "out there somewhere"! He is growing up so fast, and I'm not even a part of his life. It all makes me want to cry. I am going to follow this group and try to learn as much as I can, hoping in the process, I can seriously reach out to him. I really have to get a handle on this issue and the part I want to play, literally/emotionally, in his life from now on.

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