Anxiety: children and teenagers with autism spectrum disorder

Anxiety: children and teenagers with autism spectrum disorder

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Anxiety or autism spectrum disorder?

Children with autism spectrum disorder (ASD) feel many of the same worries and fears as other children.

But when children and teenagers with ASD get worried or anxious, the way they show their anxiety can look a lot like common characteristics of ASD - stimming, obsessive and ritualistic behaviour and resistance to changes in routine.

Reducing a child's anxiety might reduce the behaviour associated with the core characteristics of ASD, but it won't get rid of these characteristics or behaviour.

How anxiety affects children and teenagers with autism spectrum disorder

The world can be a confusing place for children and teenagers with autism spectrum disorder (ASD).

They might find social or unfamiliar situations overwhelming and hard to understand. They often have difficulty working out what another person might be thinking or feeling, or how that person might react. As a result, people and situations can seem unpredictable, which can make children feel stressed and anxious.

On top of that, children and teenagers with ASD, especially younger children, might have trouble telling you that they're feeling anxious. Instead, you might notice an increase in challenging behaviour.

For example, your anxious child might:

  • insist even more on routine and sameness
  • have more trouble sleeping
  • have meltdowns or temper tantrums
  • avoid or withdraw from social situations
  • rely more on obsessions and rituals, like lining up or spinning objects
  • stim by rocking, spinning or flapping hands
  • do things to hurt herself, like head-banging, scratching skin or hand-biting.

Reducing anxiety and managing anxiety for your child with autism spectrum disorder

Anxiety is a natural part of life and something that everyone experiences at some stage.

You'll never be able to get rid of everything that causes anxiety or stress for your child with autism spectrum disorder (ASD). Even if you could, it wouldn't be helpful for him. But there are some things you can do to help ease your child's worries, and encourage him to manage his own anxiety levels.

Find out what makes your child anxious
Because children and teenagers with ASD can have trouble with understanding and communicating emotions, you might need to read your child's signals and work out what makes her feel anxious or stressed.

Some of the common triggers for anxiety in children with ASD include:

  • changes in routine - for example, a weekly piano lesson gets cancelled because the teacher is sick
  • changes in environment - for example, furniture in your home gets moved, there's new play equipment at the local park, or you move house
  • unfamiliar social situations - for example, a birthday party at an unfamiliar house
  • sensory sensitivities - for example, sensitivities to particular noises, bright lights, specific flavours or food textures
  • fear of a particular situation, activity or object - for example, sleeping in their own bed, going to the toilet, balloons or vacuum cleaners.

Once you've worked out some of the things that make your child feel anxious, it can help to make a list of them, so that you can find ways to help your child manage these situations.

Give your child lots of opportunities to practise dealing with these things and situations in safe environments.

It helps if other people who look after your child - for example, child care workers, teachers and family members - also know what makes your child feel anxious and what they can do to help him with managing anxiety in these situations.

Help your child recognise anxious feelings
Your child might need to be taught what anxiety is and what it feels like in her body. For example, when she feels anxious her palms get sweaty, her heart beats faster, and her hands flap.

You could try drawing an outline of a person's body. Inside the outline, help your child draw or write what happens in each part of his body when he feels scared or worried.

Use relaxation and calming strategies
Your child might also need to learn what she can do to calm down. You can help your child come up with a toolbox of ways to help herself calm down when she starts feeling anxious or stressed. These might be:

  • counting slowly to 10
  • taking five deep breaths
  • running around the yard five times
  • doing 50 jumps on the trampoline
  • looking at a collection of favourite or special things
  • reading a favourite book
  • closing eyes for a few moments
  • going to a quiet part of the house.

Get your child to practise these strategies when he's calm. Once he knows the strategies well, you can gently guide him to try them when he feels anxious.

Use visual techniques
Children and teenagers with ASD are often visual learners. This means that visual timetables, Social Stories™, picture schedules or photographs of themselves in certain situations can help them know what to expect.

For example, if your child gets anxious when you drop her off at school, you could take some photos of what you'll be doing while you're not together. You could include photos of you driving home, grocery shopping, gardening and so on, as well as a clear picture of you coming back to pick her up. You could also have photos of what your child will be doing - walking in the school gate, sitting in the classroom, playing sport, eating lunch and so on.

If your child gets anxious when there's a change in routine, daily or weekly visual schedules can help prepare him. When you know a change is coming up - for example, no swimming lessons in the school holidays - you can show this on your schedule. Leading up to the change, look at the schedule regularly with your child so that he knows the weekly routine will be different.

Some children find it helpful to be warned about a change or an event a day in advance. Some like to know a week in advance. But for some, too much warning can mean they worry until the event happens.

Rehearse stressful situations
Preparation is the key for some children with ASD and anxiety. Rehearsing or practising situations that your child finds stressful can help her understand the situation in a visual way, with the addition of physical preparation as well.

For example, if going to the hairdresser makes your child feel anxious, you could try taking him for a practice run. You could ask the hairdresser if you could come at a time of day when it's quiet and calm, then go through the steps with him. Or perhaps he could watch someone else get their hair cut.

If your child gets anxious in social situations you could practise these together. You could practise different situations and take turns playing different roles. Try to keep the scenarios short and simple, and encourage and praise your child.

Getting help with managing your child's anxiety

A psychologist might be able to help if your child with autism spectrum disorder (ASD) is very anxious. Psychologists have specialised training in mental health conditions, and can work directly with your child and family to develop strategies for reducing anxiety.

Psychologists use a range of approaches, including:

  • cognitive behaviour therapy - this helps children develop skills to change their thinking in situations that make them anxious
  • interventions using gradual exposure to help children face their fears - for example, the stepladder approach
  • Social Stories™ - these can help prepare children for unfamiliar or stressful situations that generally make them anxious
  • relaxation training to help your child learn to relax.

Mental health occupational therapists are another option to help your child with managing anxiety.

You can ask your GP or paediatrician to recommend a psychologist or therapist.

Medication can also help reduce anxiety symptoms in children with ASD. It's usually recommended only when anxiety is affecting a child's everyday life and behaviour strategies haven't reduced the anxiety enough. You can speak to your GP or paediatrician about this option.