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Anxiety Management in High-Functioning Autism: 25 Tips for Parents

Anxiety can't 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, etc.).

To manage the anxiety in Aspergers and High-Functioning Autistic (HFA) 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.

==> Preventing Meltdowns and Tantrums in HFA Children

6. Don’t dismiss his feelings. Telling your 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 youngster by preparing him for anxiety-producing situations by discussing antecedents, settings, triggers, and actions to take.

10. Help your youngster identify the source of the anxiety if he is old enough to understand this concept.

11. If he is old enough, teach your 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 youngster's exposure to upsetting news or stories. If she 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 her 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 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).

==> Discipline for Defiant Asperger's and HFA Teens

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 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.

Behavioral Manifestations of Anxiety in Kids on the Autism Spectrum:



==> Parenting Children and Teens with High-Functioning Autism

Summary of Anxiety Treatments for Children on the Autism Spectrum—

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) 

Resources for parents of children and teens on the autism spectrum:
 
 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

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Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

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Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

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Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

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Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here to read the full article...

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Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...
 
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A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

Click here for the full article...
By

Aspergers Q & A: "My step-son has had numerous meltdowns off and on for most of his life..."

Question

My step-son is about to turn 12. He has been diagnosed with Asperger's Syndrome. He currently lives with his mother and step-father and half sister. My husband and I live with our son and my two daughters. My step-son has had numerous meltdowns off and on for most of his life. He seems to pick one thing out of his life and fixate on it until he is so afraid of it that he has a meltdown. These fixation normally last for six months or more until all of a sudden, he is no longer afraid of it but finds a new thing to fear. Currently, he is fixated on being scared of coming to visit his dad and is constantly making up excuses not to visit. We have tried to explain to him that there is nothing to be afraid of. We love him very much. He told me that he is afraid that his dad will yell at him or get on to him. Now, I have been with my husband for 7 years and I have seen that the only thing he gets in trouble for is the normal everyday stuff that children get into trouble about. We treat him as we do the other three. From everything that I have read I feel that he should face his fears in order to get past it. But, me being just a step-mom, anything I say doesn't matter or is taken the wrong way. We are getting no help from his mother or any of the other family members who all feel that if he doesn't want to visit, then it must be something that we have done to cause. But, last year when he freaked out about going to school every morning, did they just let him quit? NO! I know this is a tough one. Any opinions would be greatly appreciated. This is not only affecting my husband emotionally, but also my son. He misses him terribly too!


Answer

What you are dealing with here is anxiety. Although little is known about what anxiety symptoms look like in kids with Aspergers, the following symptoms, which overlap with Anxiety Disorders, indicate anxiety:

• Avoidance of new situations
• Irritability
• Somatic complaints
• Withdrawal from social situations

Another set of anxiety symptoms may be seen and may be unique to kids with Aspergers:

• Becoming "silly"
• Becoming explosive easily (e.g., anger outbursts)
• Increased insistence on routines and sameness
• Increased preference for rules and rigidity
• Increased repetitive behavior
• Increased special interest

Cognitive behavioral therapy, a time-limited approach designed to change thoughts, emotions, and behaviors, has been shown to be successful in treating Anxiety Disorders in kids.

For kids with both anxiety symptoms and Aspergers, an innovative group therapy program using cognitive behavioral therapy has been developed. The program includes specific modifications for working with kids with Aspergers and Anxiety Disorder and consists of both a child component and a parent component.

Modifications designed to address the cognitive, social, and emotional difficulties include:

1. More education on emotions—Activities such as feeling dictionaries (i.e., a list of different words for anxiety) and emotional charades (i.e., guessing people's emotions depending on faces) are helpful in developing emotional self-awareness.

2. Greater parent involvement—To build on the attachment between youngster and caregiver, it is important to have moms and dads learn the techniques and coach kids to use them at home.

3. Games and fun physical activities are important to include in group therapy to promote social interactions.

4. Combining visual and verbal materials—Use of worksheets, written schedules of therapy activities, and drawings can be added to increase structure in therapy sessions.

5. Behavioral management—Addition of a reward and consequence system maintains structure and prevents anger outbursts.

6. "Individualizing" anxiety symptoms—Kids should be helped by the therapist to identify what their own anxiety symptoms look like as anxiety symptoms may present differently.

There is some early evidence to suggest that cognitive behavioral group therapy with specific modifications can be successful in treating anxiety symptoms in kids with Aspergers. In a study involving kids with both disorders, most benefited from their participation in the group therapy program and showed fewer anxiety symptoms after 12-weeks of consistent attendance. Future research is being done to get stronger evidence for the effectiveness of the group therapy program.

By

Aspergers Children & Mental Health Issues

Individuals with autism or Aspergers are particularly vulnerable to mental health problems such as anxiety and depression, especially in late adolescence and early adult life (Tantam & Prestwood, 1999). Ghaziuddin et al (1998) found that 65 per cent of their sample of patients with Aspergers presented with symptoms of psychiatric disorder. However, as mentioned by Howlin (1997), "the inability of individuals with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states, particularly for clinicians who have little knowledge or understanding of developmental disorders". Similarly, because of their impairment in non-verbal expression, they may not appear to be depressed (Tantam, 1991).This can mean that it is not until the illness is well developed that it is recognized, with possible consequences such as total withdrawal; increased obsessional behavior; refusal to leave the home, go to work or college etc.; and threatened, attempted or actual suicide. Aggression, paranoia or alcoholism may also occur.

In treating mental illness in the patient with autism or Aspergers, it is important that the psychiatrist or other health professional has knowledge of the individual with autism being assessed. As Howlin (1997) says, "It is crucial that the physician involved is fully informed about the individuals usual style of communication, both verbal and non-verbal". In particular it is recommended, if possible, that they speak to the parents or care-givers to ensure that the information received is reliable, e.g., any recent changes from the normal pattern of behavior, whilst at the same time respecting the right of the person with autism to be treated as an individual. Wing (1996) asserts that psychiatrists should be aware of autistic spectrum disorders as they appear in adolescents and adults, especially those who are more able, if diagnostic errors are to be avoided. Attwood (1998) also stresses the importance of the psychiatrist being knowledgeable in Aspergers. Tantam and Prestwood (1999), however, state that treatments for anxiety and depression that are also effective for individuals without autism are effective for individuals with autism. They go on to say that practitioners and psychiatrists with no special knowledge of autism or Aspergers can be of considerable assistance in treating these conditions. Typically, however, it is of great advantage if the psychiatrist has experience of autism/Aspergers.

This post will concentrate on mental health in individuals with high-functioning autism or Aspergers although references will be made to autism per se where appropriate. Emphasis will be on depression, anxiety and obsessive compulsive disorder, but it is important to realize that individuals with Aspergers also experience other problems, such as impulsive behavior and mood swings. To date there has been little research in this area but, as Carpenter (2001) has found, these can sometimes be incapacitating. Treatment can include conventional mood stabilizing drugs, but helping the person to improve their self-awareness is also important.

Depression—

Depression is common in individuals with Aspergers with about 1 in 15 individuals with Aspergers experiencing such symptoms (Tantam, 1991). Individuals with Aspergers leaving home and going to college frequently report feelings of depression as demonstrated by the personal accounts that can be found at www.users.dircon.co.uk/~cns/index.html As one young person says, "I also had to deal with anger, frustration, and depression that I had been keeping inside since high school". A study by Kim et al (2000) also found depression to be more common in children aged 10-12 years with high-functioning autism/Aspergers than in the general population of children of the same age.

Depression in individuals with Aspergers may be related to a growing awareness of their disability or a sense of being different from their peer group and/or an inability to form relationships or take part in social activities successfully. Personal accounts by young individuals with Aspergers frequently refer to attempts to make friends but "I just did not know the rules of what you were or were not supposed to do" www.users.dircon.co.uk/~cns/jeanpaul.html Indeed, some individuals have even been accused of harassment in their attempts to socialize, something that can only add to their depression and anxiety; "I also did not know how to approach girls and ask them to go out with me. I would just walk up and talk to them, whether they wanted to talk to me or not. Some accused me of harassment, but I thought that was the way everybody did that." www.users.dircon.co.uk/~cns/jeanpaul.html

The difficulties individuals with Aspergers have with personal space can compound this sort of problem. For example, they may stand too close or too far from the person to whom they are speaking.

Other precipitating factors are also seen in many individuals without autism who are depressed and include loneliness, bereavement or other form of loss, sexual frustration, a constant feeling of failure, extreme anxiety levels etc.

Childhood experiences such as bullying or abuse may also result in depression, as can a history of misdiagnosis. Another possibility is that the person is biologically predisposed to depression (Attwood, 1998). However, there are, of course, many other factors that may trigger the depression and this list should not be taken as exhaustive.

Tantam and Prestwood (1999) describe the depression of someone with Aspergers as taking the same form as in individuals without the condition, although the content of the illness may be different. For example, the depression might show itself through an individual’s particular preoccupations and obsessions and care must be taken to ensure that the depression is not diagnosed as schizophrenia or some other psychotic disorder or just put down to autism. It is important to assess the individual’s depression in the context of their autism, i.e. their social disabilities, and any gradual or sudden changes in behavior, sleep patterns, anger or withdrawal should always be taken seriously.

Symptoms of depression can be psychological (poor concentration/memory, thoughts of death or suicide, tearfulness); physical (slowing down or agitation, tiredness/lack of energy, sleep problems, disturbed appetite (weight loss or gain)); or affects of mood and motivation (e.g., low mood, loss of interest or pleasure, hopelessness, helplessness, worthlessness, withdrawal or bizarre beliefs etc.) Individuals with depression can also experience periods of mania.

Lainhart and Folstein (1994) cite three approaches that need to be made in diagnosing depression in a person with autism. The first concerns a deterioration in cognition, language, behavior or activity. The complaint is rarely couched in terms of mood. Secondly, it is important to take the patients history to establish their baseline, patterns of activity and interests. It is this pattern with which the presenting patterns can be compared. Thirdly, an attempt should be made to assess the patient’s mental state, both directly and through the parent or care-giver, if present. Examples would include reports of crying, difficulties in separating from their parent/care-giver for an interview, increased/decreased activity, agitation or aggression. There may be evidence of new or increased self-injury or worsening autistic features, such as increased proportion of echolalia or the reappearance of hand-flapping.

Attwood (1998) also refers to the inability that some individuals with Aspergers have in expressing appropriate and subtle emotions. They may, for example, laugh or giggle in circumstances where other individuals would show embarrassment, discomfort, pain or sadness. He stresses that this unusual reaction, for example after a bereavement, does not mean the person is being callous or is mentally ill. They need understanding and tolerance of their idiosyncratic way of expressing their grief.

In treating depression, medications used in general practice may be prescribed (Carpenter, 1999). It is important to realize, however, that such agents do not make an impact on the primary social impairments that underlie autism. See Gringras (2000) for a discussion on the use of psychopharmacological prescribing for children with autism or Santosh and Baird (1999) for a analysis of psycho pharmacotherapy in children and adults with intellectual disability (including autism). As with any treatment for depression, adjustments may have to be made to find the appropriate drug and dosage for that particular person. Side effects should also be monitored and effort made to ensure the benefits of the treatment outweigh the penalties (Carpenter, 1999). It is also important to identify the cause for the depression and this may involve counseling (see below), social skills training, or meeting up with individuals with similar interests and values.

Anxiety—

Anxiety is a common problem in individuals with autism and Aspergers. Grandin (2000) writes that, at puberty, fear was her main emotion. Any change in her school schedule caused intense anxiety and the fear of a panic attack. Anxiety attacks started shortly after her first menstrual period. Muris et al (1998) found that 84.1% of children with pervasive developmental disorder met the full criteria of at least one anxiety disorder (phobia, panic disorder, separation anxiety disorder, avoidant disorder, overanxious disorder, and obsessive compulsive disorder). This does not necessarily go away as the child grows older. Attwood (1998) states that many young adults with Aspergers report intense feelings of anxiety, an anxiety that may reach a level where treatment is required. For some individuals, it is the treatment of their anxiety disorder that leads to a diagnosis of Aspergers.

Individuals with Aspergers are particularly prone to anxiety disorders as a consequence of the social demands made upon them. As Attwood (1998) explains, any social contact can generate anxiety as to how to start, maintain and end the activity and conversation. Changes to daily routine can exacerbate the anxiety, as can certain sensory experiences.

One way of coping with their anxiety levels is for persons with Aspergers to retreat into their particular interest. Their level of preoccupation can be used a measure of their degree of anxiety. The more anxious the person, the more intense the interest (Attwood, 1998). Anxiety can also increase the rigidity in thought processes and insistence upon routines. Thus, the more anxious the person, the greater the expression of Aspergers. When happy and relaxed, it may not be anything like as apparent.

One potentially good way of managing anxiety is to use behavioral techniques. For children, this may involve teachers or parents looking out for recognized symptoms, such as rocking or hand-flapping, as an indication that the child is anxious. Adults and older children can be taught to recognize these symptoms themselves, although some might need prompting. Specific events may also be known to trigger anxiety e.g., a stranger entering the room. When certain events (internal or external) are recognized as a sign of imminent or increasing anxiety, action can be taken for example, relaxation, distraction or physical activity.

The choice of relaxation method depends very much on the individual and many of the relaxation products available commercially can be adapted for use for individuals with autism/Aspergers. Young children may respond to watching their favorite video. Older children and adults may prefer to listen to calming music. There is much music on the market, both from specialist outfits and regular music stores that is written specifically to bring about a feeling of tranquility. It is important the person does not have social demands, however slight, made upon them if they are to benefit. It is also important that they have access to a quiet room. Other techniques include massage (this should be administered carefully to avoid sensory defensiveness), aromatherapy, deep breathing and using positive thoughts. Howlin (1997) suggests the use of photographs, postcards or pictures of a pleasant or familiar scene. These need to be small enough to be carried about and should be laminated in order to protect them. Howlin also stresses the need to practice whichever method of relaxation is chosen at frequent and regular intervals in order for it to be of any practical use when anxieties actually arise.

An alternative option, particularly if the person is very agitated, is to undertake a physical activity (Attwood, 1998). Activities may include using the swing or trampoline, going for a long walk perhaps with the dog, or doing physical chores around the home.

Drug treatment may be effective for anxiety. Individuals may respond to buspirone, propranilol or clonazepam (Santosh and Baird, 1999) although Carpenter (2001) finds St. Johns Wort, benzodiazepines and selective serotonin reuptake inhibitors (SSRI) antidepressants to be more effective. As with all drug treatments it may take time to find the correct drug and dosage for any particular person. Such treatment must only be conducted through a qualified medical practitioner.

Whatever method is chosen to reduce anxiety, it is crucial to identify the cause of the anxiety. This should be done by careful monitoring of the precedents to an increase in anxiety and the source of the anxiety tackled.

Obsessive compulsive disorder—

Obsessive compulsive disorder (OCD) is described as a condition characterized by recurring, obsessive thoughts (obsessions) or compulsive actions (compulsions) (Thomsen, 1999). Thomsen goes on to say that obsessive thoughts are ideas, pictures of thoughts or impulses, which repeatedly enter the mind, whereas compulsive actions and rituals are behaviors which are repeated over and over again.

Baron-Cohen (1989) argues that the stereotypic obsessive action seen in children with autism differs from the child with OCD. As Thomsen (1999) explains, the child with autism does not have the ability to put things into perspective. Although terminology implies that certain behaviors in autism are similar to those seen in OCD, these behaviors fail to meet the definition of either obsessions or compulsions. They are not invasive, undesired or annoying, a prerequisite for a diagnosis of OCD. The reason for this is that individuals with (severe) autism are unable to contemplate or talk about their own mental states. However, OCD does appear often to coincide with Aspergers, although there is very little literature examining the relationship between the two (Thomsen, 1999).

Szatmari et al (1989) studied a group of 24 children. He discovered that 8% of the children with Aspergers and 10% of the children with high-functioning autism were diagnosed with OCD. This compared to 5 per cent of the control group of children without autism but with social problems. Thomsen el at (1994) found that in the children he studied, the OCD continued into adulthood.

Individuals with Aspergers can sometimes respond to conventional behavioral treatment to help reduce the symptoms of OCD. However, as with anyone, this will only be effective if the person wants to stop their obsessions. An alternative is use medication to reduce the anxiety around the obsessions, thus enabling the person to tolerate the frustration of not carrying out their obsession (Carpenter, 2001).

Schizophrenia—

There is no evidence that individuals with autistic conditions are any more likely than anyone else to develop schizophrenia (Wing, 1996).

It is also important to realize that individuals have been diagnosed as having schizophrenia when, in fact, they have Aspergers. This is because their odd behavior or speech pattern, or the persons strange accounts or interpretations of life, are seen as a sign of mental illness, such as schizophrenia. Obsessional thoughts can become quite bizarre during mood swings and these can be seen as evidence of schizophrenia rather than the mood disorder that actually are. However, should someone with Aspergers experience hallucinations or delusions that they find distressing, conventional antipsychotic medications can be prescribed? However, it is recommended that only the newer atypical antipsychotics are used, as individuals with Aspergers often have mild movement disorders (Carpenter, 2001). Cognitive behavior therapy and other psychological management methods may be effective.

Psychological Treatments—

A primary psychological treatment for mood disorders is cognitive behavioral therapy as it is effective in changing the way a person thinks and responds to feelings such as anxiety, sadness and anger, addressing any deficits and distortions in thinking (Attwood, 1999). Hare and Paine (1997) list ways in which the therapy can be adapted for use with individuals with Aspergers: having a clear structure e.g., protocols of turn-taking; adapting the length of sessions therapy might have to be very brief e.g., 10-15 minutes long; the therapy must be non-interpretative; the therapy must not be anxiety provoking as any arousal of emotion during therapy may be very counterproductive; group therapy should not be used. It is also important that the therapist has a working knowledge and understanding of Aspergers in a counseling setting i.e., the difficulty individuals have dealing things emotionally, finding it best to deal with things intellectually. The therapist and client can work towards explicit operational goals, the focus being on concrete and specific symptoms. Attwood (1999) gives a succinct overview of the components of the counseling process. Hare and Paine (1997) stress that such therapy is not a treatment or even an amelioration of the characteristics of Aspergers itself. It merely opens the psychotherapeutic door for individuals with such a diagnosis.

Catatonia—

Catatonia is a complex disorder covering a range of abnormalities of posture, movement, speech and behavior associated with over- as well as under-activity (Rogers, 1992; Bush et al, 1996; Lishman, 1998).

There is increasing research and clinical evidence that some individuals with autism spectrum disorders, including Aspergers, develop a complication characterized by catatonic and Parkinsonian features (Wing and Shah, 2000; Shah and Wing, 2001; Realmuto and August, 1991).

In individuals with autistic spectrum disorders, catatonia is shown by the onset of any of the following features:

a. difficulty in initiating completing and inhibiting actions
b. increased passivity and apparent lack of motivation
c. increased reliance on physical or verbal prompting by others
d. increased slowness affecting movements and/or verbal responses

Other manifestations and associated behaviors include Parkinsonian features including freezing, excitement and agitation, and a marked increase in repetitive and ritualistic behavior.

Behavioral and functional deterioration in adolescence is common among individuals with autistic spectrum disorders (Gillberg and Steffenburg, 1987). When there is deterioration or an onset of new behaviors, it is important to consider the possibility of catatonia as an underlying cause. Early recognition of problems and accurate diagnosis are important as it is easiest to manage and reverse the condition in the early stages. The condition of catatonia is distressing for the individual concerned and likely to exacerbate the difficulties with voluntary movement and cause additional behavioral disturbances.

There is little information on the cause or effective treatment of catatonia. In a study of referrals to Elliot House who had autistic spectrum disorders, it was found that 17% of all those aged 15 and over, when seen, had catatonic and Parkinsonian features of sufficient degree to severely limit their mobility, use of speech and carrying out daily activities. It was more common in those with mild or severe learning disabilities (mental retardation), but did occur in some who were high functioning. The development of catatonia, in some cases, seemed to relate to stresses arising from inappropriate environments and methods of care and management. The majority of the cases had also been on various psychotropic drugs.

There is very little evidence about effective treatment and management of catatonia. No medical treatment was found to help those seen at Elliot House (Wing and Shah, 2000). There are isolated reports of individuals treated with anti-depressive medication and electro-convulsive therapy (ECT) (Realmuto and August, 1991; Zaw et al, 1999).

Given the scarcity of information in the literature and possible adverse side effects of medical treatments, it is important to recognize and diagnose catatonia as early as possible and apply environmental, cognitive and behavioral methods of the management of symptoms and underlying causes. Detailed psychological assessment of the individuals, their environment, lifestyle, circumstances, pattern of deterioration and catatonia are needed to design an individual program of management. General management methods on which to base an individual treatment program are discussed in Shah and Wing (2001).

Conclusion—

Individuals with Aspergers can experience a variety of mental health problems, notably anxiety and depression, but also impulsiveness and mood swings. They may be misdiagnosed as having a psychotic disorder and it is therefore important psychiatrists treating them are knowledgeable about autism and Aspergers. Conventional drug treatment can be used to treat depression, anxiety and other disorders. Behavioral treatments and therapies can also be effective. However, any treatment must be careful tailored to suit an individual and overseen by a qualified practitioner. However, any psychotropic medicine should be used with extreme caution and strictly monitored with individuals with autism due to their susceptibility to movement disorders, including catatonia.


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
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism



References—

• Attwood T. (1998) Aspergers syndrome: a guide for parents and professionals. London: Jessica Kingsley.
• Attwood T. (1999) Modifications to cognitive behaviour therapy to accommodate the unusual cognitive profile of people with Aspergers syndrome. Paper presented at autism99 internet conference ( http://www.autismconnect.org ).
• Baron-Cohen S. (1989 ) Do autistic children have obsessions and compulsions? British Journal of Clinical Psychology, Vol. 28 (99), 193-200.
• Bush G. et al (1996) Catatonia. I. Rating scale and standardising examination. Acta Psychiatrica Scandinavica, Vol. 93 , pp. 129-136
• Carpenter P. (1999) The use of medication to treat mental illness in adults with autism spectrum disorders . Paper presented at autism99 internet conference ( http://autismconnect.org ).
• Ghaziuddin E., Weidmer-Mikhail E. and Ghaziuddin N. (1998) Comorbidity of Asperger syndrome: a preliminary report. Journal of Intellectual Disability Research Vol. 42 (4), pp. 279-283.
• Gillberg C. and Steffenburg S. (1987) Outcome and prognostic factors in infantile autism and similar conditions: a population based study of 46 cases followed through puberty. Journal of Autism and Developmental Disorders, Vol. 17 (2), pp. 273-287.
• Hare D.J. and Paine C. (1997) Developing cognitive behavioural treatments for people with Aspergers syndrome. Clinical Psychology Forum, no. 110, pp. 5-8.
• Howlin P. (1997) Autism: preparing for adulthood. London: Routledge.
• Kim J. et al (2000) The prevalence of anxiety and mood problems amongst children with autism and Asperger syndrome. Autism, Vol. 4(2), pp. 117-132.
• Lainhart J.E. and Folstein S.E. (1994) Affective disorders in people with autism: a review of published cases. Journal of Autism and Developmental Disorders, Vol. 24 (5), pp. 587-601.
• Lishman W. A. (1998) Organic psychiatry: the psychological consequences of cerebral disorder pp. 349-356. Oxford: Blackwell.
• Muris P. et al (1998) Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, Vol. 12 (4), pp. 387-393.
• Realmuto G. and August G. (1991) Catatonia in autistic disorder; a sign of comorbidity or variable expressions? Journal of Autism and Developmental Disorders, Vol. 21 (4), pp. 517-528.
• Rogers D. (1992) Motor disorder in psychiatry: t owards a neurological psychiatry. Chichester: Wiley.
• Santosh P.J. and Baird G. (1999) Psychopharmacotherapy in children and adults with intellectual disability . The Lancet, Vol 354 , July 17, pp.233-242.
• Shah A. and Wing L. (2001) Understanding and managing catatonia in autism. A clinical perspective. To be published.
• Szatmari P., Bartoluci G. and Bremner R. (1989) Aspergers syndrome and autism: comparison of early history and outcome . Developmental Medicine and Child Neurology, Vol. 31 , pp. 709-720.
• Tantam D. (1991) Asperger syndrome in adulthood . In U. Frith (ed.) Autism and Asperger Syndrome, pp. 147-183 Cambridge University Press.
• Tantam D. and Prestwood S. (1999) A mind of one's own: a guide to the special difficulties and needs of the more able person with autism or Asperger syndrome.
• Thomsen P.H. (1994) Obsessive-compulsive disorder in children and adolescents. A 6-22 year follow-up study. Clinical descriptions of the course and continuity of obsessive-compulsive symptomatology . European Child and Adolescent Psychiatry, Vol. 3 , pp. 82-86.
• Thomsen P.H. (1999) From thoughts to obsessions: obsessive compulsive disorder in children and adolescents. London: Jessica Kingsley.
• Wing L. (1996) The autistic spectrum: a guide for parents and professionals. London: Constable.
• Wing L. and Shah A. (2000) Catatonia in autistic spectrum disorders. British Journal of Psychiatry, Vol. 176 , pp. 357-362.
• Zaw F. K. et al (1999) Catatonia, autism and ECT . Developmental Medicine and Child Neurology, Vol. 41 , pp. 843-845.
By

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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Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders?  Sign-up for Online Parent Coaching today.

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By

Reasons Why Your ASD Child Gets So Stressed-Out at School

Kids with and Asperger’s (AS) and High-Functioning Autism (HFA) commonly experience anxiety. Estimates report that as many as 80% of kids on the spectrum have anxiety disorders such as specific phobias, social anxiety disorder, panic disorder, or generalized anxiety disorder. Physical complaints with no apparent medical basis is often an indicator of anxiety (e.g., stress in a social situation, a demanding school setting, sensory sensitivities, etc.).

Factors that can make existing anxiety even worse can include an introverted temperament, having highly anxious parents, high levels of family stress or conflict, and a family history of anxiety.

Signs of school anxiety in AS and HFA children include the following:

Behavioral Signs—
  • Abnormal failure or delay to complete everyday responsibilities
  • Change in eating habits
  • Change in sleeping habits
  • Frequent lying
  • Nail biting
  • Pacing
  • Significant change in school or work performance
  • Trouble getting along with classmates and/or teachers

Cognitive Signs—
  • Anxious thoughts or feelings
  • Chronic worrying
  • Impaired concentration
  • Impaired speech (e.g., mumbling or stuttering)
  • Reduced or impaired judgment
  • Repetitive or unwanted thoughts
  • Trouble with remembering things (e.g., homework assignments or deadlines)
  • Unusual desire for social isolation

Emotional Signs—
  • Feelings of being overwhelmed
  • Feelings of sadness and/or depression
  • Irritability
  • Less than normal patience
  • More frequent or extreme pessimistic attitude
  • Reduced or eliminated desire for activities once enjoyed or regularly done
  • Restlessness
  • Sense of isolation
  • Trouble coping with life’s issues

Physical Signs—
  • Chest pain with or without tachycardia
  • Clenched teeth 
  • Fatigue 
  • Flushed skin 
  • Getting sick more often than normal 
  • Headaches 
  • Heartburn or indigestion 
  • Involuntary twitching or shaking 
  • Irregular bowel movements 
  • Muscle aches 
  • Nausea 
  • Trouble sleeping 
  • Unusual changes in weight

Other signs include:
  • Shutdowns
  • Shadowing parents around the house
  • Severe tantrums when forced to go to school
  • Regressive behavior
  • Refusing to go to school
  • Nightmares
  • Meltdowns
  • Feeling unsafe staying in a room by themselves
  • Fear of being alone in the dark
  • Excessive worry about harm to themselves
  • Excessive shyness
  • Exaggerated, unrealistic fears of animals, monster, burglars
  • Clinging behavior



Let’s take a deeper look at all the things that can contribute to your AS or HFA child’s anxiety level:

1. There's a lot of pressure for students to learn more and more – and at younger ages than in past generations. For example, while a few decades ago, kindergarten was a time for learning letters, numbers, and basics, most kindergarteners today are expected to read. With test scores being heavily weighted and publicly known, schools are under great pressure to produce high test scores. That pressure gets passed on to the students, and no one feels that pressure more than a child on the autism spectrum.
 
==> How to Prevent Meltdowns and Tantrums in Children with Autism Spectrum Disorder

2. Just as it can be stressful to handle a heavy and challenging workload, some students experience stress from work that isn't difficult enough. Many children with AS and HFA have average to above-average IQs (sometimes into the “gifted” range), and can become easily bored and disengaged if the subject matter is not challenging enough. They may respond by acting-out or tuning-out in class, which leads to poor performance, masks the root of the problem, and perpetuates the difficulties.

3. Many of us have experienced test anxiety, regardless of whether or not we're prepared for exams. Unfortunately, greater levels of test anxiety hinder performance on exams. Due to the fact that the AS or HFA child already has an element of anxiety to contend with throughout the day, the added pressure of an exam may prove to be too much anxiety-overload, resulting in either a meltdown or shutdown.

4. With the overabundance of convenience food available these days - and the time constraints we all experience - the average youngster's diet has more sugar and less nutritious content than is recommended. This can lead to mood swings, lack of energy, and other negative effects that exacerbate the stress levels of “already-anxious” kids on the spectrum.

5. While most “typical” kids would say that their peers are one of their favorite aspects of school, peers can be a source of stress for students on the spectrum (e.g., due to being rejected, teased, and bullied). Concerns about not having any friends, not being in the same class with someone who actually is a friend, not being able to keep up with peers in one particular area or another (e.g., gym class), interpersonal conflicts, and peer pressure are a few of the very common ways kids with AS and HFA can be stressed by their social lives at school.

6. In an effort to give their “special needs” child an edge, or to provide the best possible developmental experiences, some parents enroll their child in too many extra-curricular activities. As the child becomes a teenager, school extracurricular activities become much more demanding. College admissions standards are also becoming increasingly competitive, making it difficult for a college-bound high school student to avoid over-scheduling himself. All of this adds up to stress-overload.

7. Many parents of children on the autism spectrum report that their child is not getting enough sleep to function well each day. As schedules get busier, even younger kids are finding themselves habitually sleep-deprived. This can affect health and cognitive functioning, both of which increase anxiety levels and impact school performance.

8. Noise pollution from school hallways, strange smells coming from the cafeteria, the buzz of florescent lighting, and other environmental stimuli have been shown to cause stress that impacts the AS or HFA child’s performance in school.

9. As you know, there are different styles of learning. Some students learn better by listening, others retain information more efficiently if they see the information written out, and still others prefer learning by doing. Students on the spectrum usually learn best through visual forms of instruction. If there's a mismatch in the child’s learning style and the teacher’s teaching style, this often leads to a stressful academic experience.

10. Due in part to the hectic schedules of parents, the sit-down family dinner has become the exception rather than the rule in many households. While there are other ways to connect as a family, many families find that they’re too busy to spend time together and have both the important discussions and the casual day recaps that can be so helpful for “special needs” kids in dealing with the stressful issues they face. Due to a lack of available family time, many parents are not as connected to their children - or knowledgeable about the issues they face - as they would like.
 
==> Parenting System that Reduces Defiant Behavior in Teens with Autism Spectrum Disorder

11. A good experience with a caring teacher can cause a lasting impression on an AS or HFA youngster's life – BUT so can a bad experience. While most teachers do their best to provide “special needs” students with a positive educational experience, some students are better suited for certain teaching styles and classroom types than others. If there is a mismatch between student and teacher, the student can form lasting negative feelings about school or his own abilities.

12. Many schools now have anti-bullying policies. Though bullying does still happen at many schools, help is generally more accessible than it was years ago. The bad news is that bullying has gone high-tech. Many kids use the Internet, cell phones and other media devices to bully HFA and AS kids, and this type of bullying often gets very aggressive. One reason is that bullies can be anonymous and enlist other bullies to make their target miserable. Another reason is that they don't have to face their targets, so it's easier to shed any empathy that they may otherwise feel.

What can be done to reduce school anxiety in AS and HFA children? Here are a few suggestions:

1. You may have tried to “reassure” your anxious child. But oftentimes, these reassurances sound “empty.” Saying something such as “It's going to be fine” is not likely to help a nervous AS or HFA youngster. When he begins to worry, you can use it as an opportunity to have more dialogue and find out what is making him so anxious. The more information you have, the better job you can do to help him feel more comfortable in the school environment. Thus, do a bit of an investigation to get to the root of the problem. For example, your child may become extremely anxious getting on the bus in the morning, during transitions, in the lunch room, during gym class, while taking a quiz or test …just to name a few. On a scale of 1 to 10 (with 10 being the highest level of anxiety), your child is not at a level 10 all day. Most likely, there are only one or two situations that launch him to that level. Address those situations first.

2. Try to find out if your child is refusing to go to school due to real anxiety issues, or some other reason. Answers to the following questions may help to determine the motivation behind school-refusal:
  • What specific tangible rewards does your child pursue outside of school that cause her to miss school?
  • What specific social situations at school are avoided?
  • What specific school-related stimuli are provoking her concern about going to school?
  • What specific problematic behaviors are present in the morning before school?
  • What is her degree of anxiety or misbehavior upon entering school?
  • What is her academic and social status? (This would include a review of academic records, formal evaluation reports, attendance records, and IEP or 504 plans.)
  • What family disruption or conflict has occurred as a result of her school-refusal?
  • What comorbid conditions (e.g., anxiety, depression, sensory sensitivities, etc.) occur with her school-refusal?
  • What are her specific forms of absenteeism, and how do these forms change daily?
  • Is her school-refusal relatively acute or chronic in nature? 
  • Is her refusal to attend school legitimate or understandable in some way (e.g., due to a school-based threat, bullying, inadequate school environment, etc.)?
  • Is she willing to attend school if you accompany her?
  • Is she willing to attend school if incentives are provided for attendance?
  • How did her school-refusal develop over time?
  • Have recent or traumatic home or school events influenced her school-refusal?
  • Are there any non-school situations where anxiety or attention-seeking behavior occurs?
  • Are symptoms of school-refusal evident on weekends and holidays?

3. Put a picture of you, the parent, in your youngster's notebook, or place a special note in his lunch box (e.g., “Mommy loves you”). These “little things” aren’t so little, and will help your child feel more comfortable at school (especially if he is coping with separation anxiety).
 
==> Launching Adult Children with Autism Spectrum Disorder: Guide for Parents Who Want to Promote Self-Reliance

4. Discuss the daily plans with your child so that everyone is informed and knows what to expect. Make sure your youngster is aware of everything, including who will be at the bus stop or who will be picking her up at school (this is especially important if you carpool).

5. Emphasize the positives of school. Frequently discuss how much fun school can be and all the new friends your child can meet. If your AS or HFA youngster has an older sibling in school, have that sister or brother talk to your “special needs” child about recess and all the fun that is had during the school day.

6. Meet with the school guidance counselor. This visit will make you and your child more relaxed about school. If you keep your youngster’s anxiety in the open with the counselor, he or she will likely check in on your child more often.

7. Lastly, if your youngster’s anxiety continues to grow, or you feel you can’t help her resolve her fears about school, it is time to see the doctor. Your doctor can consult with you and the entire family in order to decide if a therapist is needed.

Resources for parents of children and teens on the autism spectrum:
 
 
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COMMENTS:

•    Anonymous said… Even with the IEP it's still about conforming.
•    Anonymous said… Great article. My daughter has always shown signs of anxiety, but it ballooned once she started high school and resulted in severe depression, cognitive decline, and school refusal. It was not until age 16 that she was diagnosed with Asperger's. Her diagnosis came as both a surprise and a relief to us. She flew under the radar for so long, developing her own coping strategies along the way... but it finally became too much for her to handle. It has helped her and us to have a better understanding of her behaviour and sensory triggers. She is now back in school but on a reduced schedule of 2 in-school classes and 1 online class this semester. Our school has been very helpful and accommodating. She knows it will take her longer to complete high school with this schedule and she's fine with that. We still have our daily challenges but, with the right medication and removing the pressure to attend a full day of school, we've seen a positive change.
•    Anonymous said… I am done with school systems. After my son being bullied and called a loser by the school psychologist, that was the last straw. My ASD Spectrum son is 16. I dropped him out and homeschooling him. He'll take the Hi-Set (new GED) and go at his own pace until he's ready to take the Hi-Set.
•    Anonymous said… I am raising a child who is struggling in school.She doesn't have servers but has learning disabilities. You are right, it might look good on paper but the schools don't understand anxiety or learning pace.
•    Anonymous said… I am so sorry your son was bullied. No one deserves that.
•    Anonymous said… I can only speak from my own experience. The schools in our area really have nothing for Aspergers kids. My son is expected to be neurotypical and this has caused so much heartache for us. Inclusion without real support is rough. My hope is that there are schools out there who have more than what we've been given.
•    Anonymous said… Inclusion without support is not inclusion...it has been my experience that schools think they're being inclusive when really they are working towards integration...trying to make a neurodiverse student indistinguishable from their peers...the pressure to conform causes significant anxiety... this was one reason we recently moved schools...there are good schools out there striving for a truly inclusive culture... we are feeling positive about our new school....it's small and has a great part time program
•    Anonymous said… It is a real shame that schools don't work with kids with aspergers the way they should. Oh they go through the motions but they don't seem to do all that they can! It is very difficult for kids to sit in a classroom for a whole period and concentrate on the lesson....is that so hard to understand!
•    Anonymous said… my son gets stressed out at school feeling hes being bullied because other kids are trying to tell him what hes supose to do, then they ignor his requests knowing he will loose it and will get into trouble when they tell the teacher, all innocent, that he was yelling at them.
•    Anonymous said… my son is in first grade and I'm exhausted. We changed schools to give him something better. Looking ahead is hard. The thought of middle school worries me as well.
•    Anonymous said… We are in elementary school have problems with it too. I am very worried about middle school.
•    Anonymous said… You can ask for a IEP Which gives aspergers children a easier time. my son also has aspergers and makes his school day rough but he has learned to cope thank goodness also do you have any charter schools in your area they are also more prepared and willing to work with aspergers children.

Post your comment below…
By

Anxiety and Sleep Problems

Question

My 11 yr old daughter was diagnosed with Asperger's just about a year ago. She is very very high functioning, well we though until about 6 months ago, when her anxiety took over and she had a mental and physical breakdown. Her anxiety continues to plague her, although, she is better than she was.

Sleeping is a huge issue for her, always has been since she was 18 months old. The hard thing is, is that no calming techniques seem to help or better yet, she is not willing to even try some. Not to mention the fact that nothing is consistent, yet it’s all consistent. That something is always the matter, here or there. She is very smart, very stubborn, and very very pre pubescent. She was always quirky, and pretentious, but this anxiety is very difficult to maintain daily life without know what she can handle and what she can’t. No rhythm or reason. She is on anti anxiety meds, only at night... but sometimes do the opposite. They make her cranky and anxious, frustrated and sometimes they knock her right out. But nothing.... keeps her sleeping. We need to re visit the Neurologist and see if there is something other than anxiety causing such issues. But, for right now, life is different every day and night. It’s getting harder on me, because we have to tip toe around the house at night, to try not to wake her or she cries until I lay with her or she makes me stay on the couch until she falls asleep there. So, I am wiped out too. It’s to the point where I need to take a mild sedative to fall asleep because I am always in anticipation of her waking up.

This is her first year of Middle school was a complete disaster. Beyond disaster. So, for this coming year, I am going to look into alternative education methods that fit her strengths and giftings. So, that is it in a short nut shell. I could type for days, on details of our life with an Aspie, but this is what I feel to share so far. Thanks for listening.

Answer

Re: Anxiety—

While most people associate anxiety with an emotional response to stress, a major factor in stress and anxiety is the physical response to external stimulus. The stress response in the brain sends signals to the body to prepare us to handle a perceived danger or threat, and this induces a physical state of tension that can add to the emotional reaction to problem situations. As the body stores tension over time, a state of chronic anxiety can occur. Proper diet and regular exercise can help alleviate the physical tension associated with stress and help lower anxiety levels.

Eating a balanced diet consisting of whole grains, fruits, vegetables, and lean meats can help strengthen the body’s resistance to stress. These foods contain nutrients that are essential for healthy body function. Combining complex carbohydrates available from whole grains such as whole wheat bread or whole oats with protein helps to keep blood sugar levels steady, avoiding the stress of the sugar crashing cycle that can add to physical stress. Drinking plenty of water helps, too, as dehydration is just added stress to the body.

Avoiding stimulants such as caffeine also helps to reduce stress. Stimulants put the body in a constant state of heightened agitation and can facilitate a kind of false stress response when no stress is present. Refined sugar also creates stress as the body feels a rush of energy and then a crash in blood sugar. Processed foods should be avoided in favor of whole foods as they don’t contain the nutrients needed for strengthening the body’s ability to handle stress.

Exercise also helps to alleviate stress and anxiety. It does this in several ways. Engaging in physical activity increases the flow of oxygen through the body and stimulates the nervous system, and this can help to release the tension held in the body and induce a relaxed state of calm, making it easier to deal with stressful situations when they arise. Hormones such as endorphins are released during exercise, and these hormones help to alleviate pain and create a mental state of well-being. Exercise also helps to create a more positive self-image, provides a distraction from worries, and facilitates a sense of motivation and positive direction.

It doesn’t have to be overwhelming or exhausting to provide benefits against anxiety. Just 10 minutes of moderate exercise a day can create a more positive outlook. Choose an activity that you enjoy. Try becoming a member of a group to provide the added benefit of social interaction and fun. To see benefit, make sure to move at least 3 to 4 times a week, and remember to start small and build slowly based on your level of fitness. Overdoing it too soon can cause problems and make it hard to keep up the routine.

Adopting a more physically healthy lifestyle based on balance is the key to a healthy emotional outlook and reduction in problems such as anxiety. Wellness can be looked at as a lifestyle choice, and making good decisions about diet and exercise is one way to improve the quality of life.

Re: Sleep problems—

Here are some suggestions:

• Accept some awakenings. The experts stress that nighttime awakenings are perfectly normal -- much more normal, in fact, than the elusive solid eight hours people think they should be getting. Most people will roll over and go back to sleep, but those with insomnia become conditioned to feel anxious when they awake during the night. You need to accept that you will arouse some, so reassure yourself in the middle of the night that nothing catastrophic will happen if you are awake for a while.

• Acupuncture may help reduce her anxiety and induce deeper sleep.

• Cognitive behavioral therapy is often used in cases like this, and the experts agree that it could help. CBT aims to stop the behaviors that are perpetuating the insomnia. Typically, a therapist will work with a patient for four to eight weeks -- in sessions that last from 30 minutes to two hours -- to assess, diagnose, and treat the underlying problem, such as relationship worries. The therapist will teach the patient things like progressive-relaxation techniques and point out actions that are getting in the way of deep sleep, such as rehashing conversations that occurred earlier in the day.

• Distract her brain by trying a relaxation technique, like focusing on her breathing.

• Keep the glaring electric clock off the bedside table. Clock watching will only increase your anxiety about being awake.

• Make an appointment at a sleep clinic, which can be a smart step for people with a long history of sleep issues. Most often this involves office visits (which will not necessarily be overnight observations), during which the patient will undergo a physical examination and work with a doctor to assess and diagnose the cause of the sleep problems.

• Modulate her exposure to light, which could reset her internal clock gradually. Too much light at night will push her clock even later, so the key is to keep the lights dim the closer she gets to bedtime. Also maximize her light exposure first thing in the morning. If she can go outside in bright sunlight for some exercise, that would provide a double whammy of wakefulness.

• Pay even more attention to her evening routine and her sleep environment. Good sleep habits don't necessarily solve sleep problems, but they do create a foundation for improved sleep. Good habits include things such as keeping the bedroom cool and dark, using a fan or a white-noise machine to create a blanket of sound, and using the bed exclusively as a place for sleeping -- and not for watching television, for example.

• Take 0.3 milligram of an over-the-counter melatonin supplement about 20 minutes before bedtime since the production of melatonin (a naturally produced hormone that helps regulate circadian rhythms) drops off as we age.

• Try wearing earplugs.

• Use caution regarding over-the-counter sleep medications, since they contain some type of antihistamine, which can stay in the body for a long time. It takes about 18 hours for your body to clear out 50 percent of the active drug. For most of your waking hours, it will still be in your system, making you drowsy.

• Work on keeping her sleep environment quieter, such as using an air conditioner or a fan, as well as blackout shades to block street light.

Some parents enforce a strict bedtime and a regular bedtime routine as a way of calming their child for sleep. Another good trick is to use flannel sheets and to experiment with pajama fabrics until you find one that your child tolerates. Enclosing the child in a sleeping bag or under a bed tent can help. So does playing "white noise" in the background.

Your pediatrician may prescribe sleeping pills such as Sonata, Ambien, Desyrel or Serzone.


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

•    Anonymous said… How can anxiety be managed in hfa children please?
•    Anonymous said… I also recommend melatonin - completely natural (no script needed) and works very well for my daughter, who is now 16. For the anxiety, she started on Zoloft a year ago and it helps her keep it at a manageable level. That plus cognitive behavioural therapy has been a winning combo. My daughter has improved dramatically in the past year.
•    Anonymous said… I do not have any advise. I will pray for all of you as you journey this rocky road. My Grandson Tyler is an aspie. His Dad, my son, has just written a book, Love That Boy, that may help you not feel so alone.
•    Anonymous said… I hear and feel you. My soon to be 16 year old daughter began severe anxiety and depression right about that age. Sleep has always been an issue;however, we had done several things with her in her early years that have luckily carried over into her teen years that do help. Melatonin helped for a while, but I have found that meditation helps the most. What is happening is that she can't stop the multitude of thoughts that come into her head and leaves her body in a state of fight or flight. Spray a little lavender near her pillow (calming), have her soak in a hot bath before bed (you can add lavender essential oil to the bath too), if she will allow it - lay down next to her and take turns telling each other what silly things pop up in your head while falling asleep. This helps to keep the anxious thoughts at bay. If she is really wound up, try just holding her feet. It sounds strange, but there is a hugely calming effect that this has. On the bright side, my daughter has decided to not depend on anti-anxiety/depression meds anymore and is doing great! Every day is a new day, with new challenges and hopefully some victories as well. Stay strong. She will get through this.
•    Anonymous said… I'd like to know if anyone has successfully gone "back" to school and graduated after experiencing all of the above^^^^symptoms? And if so, what worked for you?
•    Anonymous said… I'm experiencing something simile with my 10 year old daughter who is going through the diagnosis process. It especially comforting to me to read these comment as Esmes symptoms are starting to present themselves more severely now. Never been good at sleep since day1, now she is starting to say she won't go to school on a daily basis, cries all the time, tremendous anger outbursts. It's mentally exhausting for her and us. It's helpful for us as parents knowing this is not exclusive to Esme as everyone knows, we are having to find out a lot of this info by ourselves as the diagnosis process is so slow
•    Anonymous said… Melatonin has worked wonders with our kids. We have also been subscribed Clonodine with success though I am not sure there is much of a difference between them.
•    Anonymous said… Melatonin to help her sleep could work. No sleep, even if she denies being tired, will make her very overtired and emotional and then it won't matter what you do. Sleep is #1
•    Anonymous said… My 7 year old daughter has epilepsy and we thought adhd, but now the neuro is saying he thinks it could be aspergers, we are screening her for it now.... she is a sweet girl but gets bad rage fits all the time and it's not the medicine, she had them before the medicine. If she does have this she is very high functioning, I just can't be sure. But school, sleep every day its a struggle with her when she is not happy. When she doesn't get her way watch out and I don't mean regular kid meltdowns, she doesnt seem to care about punishment or time outs or anything. Rewards barely work on her. I find myself pleading and begging her all the time to stop with the behavior. Once it is over, she is back to her normal self and exhausted. The neuro says it has nothing to do with her epileptic spike. We are going to take her to a psychiatrist soon as well. We recently got IEP for her because of her slow slow pace. She is smart, but can't always focus and can't always complete her work.
•    Anonymous said… My daughter has the same issues. Cannabis oil isn't legal in Oklahoma yet. I wish it was.
•    Anonymous said… My six year old son is the same way, except for instead of anxiety and depression, he experiences anxiety and aggression. He has been a horrible sleeper since day one. We have tried several different meds to help his behavior, different counsellors, sports, and nothing takes his aggression towards our family away. He's fine with everyone else. Ugh. It's a daily struggle I wouldn't wish on anyone.
•    Anonymous said… My son is 13 and had struggled and struggles with all the above! He has good times and bad times that seem to come in waves. I have found a few helpful things....Anxiety medication has really helped calm his Anxiety and that in turn helps his friendships, his OCD And calms his mind so his ticks are not as bad as normal. I also have a weighted blanket, and use Melatonin to help him sleep. If all else fails I lay beside him, just having me with him helps soothes! I've even had late night walks, swinging time on the swing set or having him run laps around the yard to calm him at night. Hope this has given a few ideas to those that are struggling like I am. Each day is a new day! Never know what version of your child your going to see...such a stressful thing! Love and patience above all!!
•    Anonymous said… Not for under 18 though
•    Anonymous said… Our 10 year old use to wake up 1-3 times a night for almost eight years. Melatonin and a weighted blanket has finally straightened out his sleeplessness.
•    Anonymous said… Please check into the safe and effective cbd cannabis oil treatment. It is a miracle waiting for her.
•    Anonymous said… Saphris works wonders for high functioning Aspergers..taken at night sleep for 10 hrs straight
•    Anonymous said… Sounds like my 10 year old boy, our challenges are really more about the anxiety bought about through his Aspy needs for structure, routine etc than the other Aspy challenges. We had not slept through the night for the years and had tried everything from weighted blankets, meditation, counselling, bed routines (multiple), and sleeping medications to little success. In December his Paedetritian put him on a half tablet of anti anxiety medication (Prozac) due to his anxiousness around school and unexpected activities associated with being the youngest of four, He is a different boy. Within a month he was sleeping through the night and he s now sleeping through the night and in his own bed. I am not sure if this will be your answer but stay hopeful and keep trying things. Something will work. Good luck and God bless
•    Anonymous said… This is our 16 year old daughter
•    Anonymous said… This post mirrors my now 18 yr old daughter, eventually had to pull her out of school and do virtual classes. Helped the anxiety tremendously. Last year we were introduced to essential oils and were given a blend to help support her anxiety and she loves it. I have a fb page Essential Oils For All Your Needs, not trying to market it here, but it's got a lot of information on safe oil use and different blends to read about. I wish we knew of these oils years earlier so there wouldn't have been so many years of suffering. Great advice on here-Good luck to your family!
•    Anonymous said… We experienced something similar with our 16 year old son. There is a program called getting your teen out of defence mode that we are finding very helpful. It's put out by a group called asperger experts.
•    Anonymous said… We had the same breakdowns but our little one is 5. The neurologist put her on resperidol and epival when she had her mental break down and it was a god send. We added prozac for her anxiety and she is doing wonderfully and now sleeps through the night.
•    Anonymous said… We use melatonin for sleep. I didn't have high hopes for it originally since a lot of other oils and natural sleep aides didn't work. To my surprise my usual night owl was asleep in under 15 min.
•    Anonymous said… Welcome...to my world. We have a 14 year old daughter. Her high functioning autism comes along with its friends anxiety and depression. The trio are making life so miserable. Getting her to go into a school building is a never ending battle. Academically, she is fine. Well ahead of her grade....she still struggles to go in. Everyday. She hates being there. We even switched from a public school to a private, autism aware, school--thinking that might help. Nope. Sleep has been a thorn in her side from day one. It's been a rough road for her (and I) for at least 6 years. Seems to only be getting worse through the teen years. Hugs back to you mom. I know it's not easy.
•    Anonymous said… What are some of the medications being used. I am thinking it's time for a change and want some ideas.

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