Anxiety and Autism
- Hi there, It's Dr. Jenni Silva, Clinical Psychologist from Brilliant Minds Psychology. Anxiety and Autism... Let's get started.. We work a lot at the clinic with children, teens and adults with autism, anxiety and both! It has long been recognised that anxiety is common in children with ASD with Kanner (1943) first describing the child with autism as anxious and uneasy in the presence of others. Since this time, the presence of anxiety disorders in children with High Functioning-ASD has gained growing recognition, with the prevalence of anxiety in children with ASD approximately 45% when compared to 2.5% to 5% of typically developing children and adolescents (Chalfant et al., 2007; Joshi et al., 2010; Merikangas et al., 2010; Rapee, Schniering, & Hudson, 2009; Reaven, Blakeley-Smith, Culhane-Shelburne, & Hepburn, 2012; White et al., 2012; White, Oswald, Ollendick, & Scahill, 2009). Anxiety may exacerbate the core social difficulties of ASD such as difficulty with reciprocity, turn taking, compromise etc. That said, anxiety can clearly impact on everyday life activities such as going to school, following instructions, work, interactions with adults, parents, siblings, peers, shopping or social events. It is important that you keep a behaviour diary if your child is experiencing anxiety to understand the triggers. Here are a few things that can trigger anxiety for some people with autism:
- Uncertainity & changes in routine
- Changes in insistence to routine (eg., can't use same cup, or not going to school the same way)
- Change of teacher (teacher is away) and uncertaintly about who the replacement teacher will be.
- Starting a new school, new school year or new term
- Carnivals such as swimming and sport due to noise and unpredictability.
- Sensory sensitivities - loud noises
- Making mistakes and not knowing what to do
- Not enough time to finish task
- Not able to finish preferred task
- Social situations, difficulty managing and emotionally regulating when things don't go as per his/her plan.
- Some individuals on the spectrum have intense special interests and it can be very difficult and anxiety causing to be away from this at times.
- Planning ahead, giving notice by using visuals or a timer and making things predictable can be helpful to help manage anxiety.
- Clear Expectations: making it clear what is expected and when it is happening can really help reduce anxiety for individuals on the autism spectrum.
- Give enough time to process and 'brain breaks' (e.g., a chance to do their thing) are also important.
- Cognitive Behavior Therapy (CBT) - learning thinking, relaxation and other tools to help with emotional regulation.
- Understanding triggers and keeping behaviour diary of triggers.
- Allowing more time to complete tasks, remember many individuals on the spectrum require more time to process information.
- Transition into class early - if anxiety about getting to school.
- Quiet area in the room or school for chill out / down time.
- Validation of emotion e.g., "It's really tough when big worry turns up"
Types of Anxiety
There are many different ways anxiety presents, some types of anxiety disorders include: Generalised anxiety disorder - this presents as lots of worry, worrying about everything, separation anxiety such as not wanting to be away from a primary care giver, social anxiety which is a tendency to feel anxious in social situations, selective mutism, panic disorder, specific phobias and obsessive compulsive disorder including skin picking and hair pulling.
Some times Anxiety can look like Anger
Children with autism and anxiety can also show other behaviours such as defiance, aggression, increased fixations or obsessions, and increased rigidity. Sometimes people think the child is 'misbehaving' but it is often underlying anxiety. The behaviour at times can also look like anger. For many children, feeling overwhelmed by their environment, not given enough time to complete a task, or having to do a task that is based on someone elses agenda may increase anxiety.
When a child is anxious, sometimes other behaviours increase such as talking to self and repetitive behaviours such as flapping, stimming etc.
Is it Autism or Anxiety?
When it comes to social skill development in children, social delays or difficulty making friendships and maintaining friendships could also be related to anxiety and or also ADHD. There tends to be a certain degree of overlap with anxiety and autism spectrum conditions. As highlighted above a large number of children with ASD also have high levels of anxiety. A child with anxiety may be less likely to join in and make friends, this could or may also be true for a child on the autism spectrum. However, when assessing for an autism spectrum condition assessment goes beyond this. Screening for anxiety is essential as it would be a component of the intervention plan if present. When it comes to the autism spectrum we know that early intervention is related to best outcomes for children.
Autism Early Warning Signs
If your child is experiencing anxiety but you also think there are other behavours that anxiety does not explain ... keep reading. Early autism warning signs to look for include an absence of social smiling (i.e., does not return your smile), lack of shared enjoyment, preference for solitary play, or if play with others as he/she gets older may be only based on his or her agenda or have an immature quality, poor eye contact, absence of following the parent gaze, lack or limited gestures (lack of nodding, or shaking head for 'no', and poor pointing), poor listening response - for example you call your child's name and they don't seem to respond,, repetitive motor movements (e.g., tapping, flapping, spinning, tapping,), difficulty with transitions and changes in routine, insistence to routine and a need for sameness for example demanding to sit in the same place or to use the same cup. Your child may show an intense special interest in rocks, animals, for girls animals and horses is very common to see, or an unsual attachment to objects (such as a stick that they repeatedly spin and twirl), sensory sensitivies (e.g., loud noise, food, textures) or sensory seeking behaviour such as licking others and objects.
Check out the autism in girls post coming soon... for more information on how autism presents in girls
Well, that's it from me! Dr. Jenni Silva Clinical PsychologistBrilliant Minds Psychology
Date: 6th April 2019
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