Previously , there was a personal story about my son here. I did not think to ask his consent to publish it at the time because he was five years old. It was about his anxiety with regard to the school cross country event and how we worked together to manage that anxiety successfully. I read the story to Damian today and he asked me to delete it but he wanted me to leave the picture of his artwork up here. I have retained the information on anxiety generally.
Autism and anxiety
Children with autism experience more anxiety than other children1;2;3. The rate of anxiety among children with autism increases with increasing IQ and functional communication3. The cause of the higher rates of anxiety is not fully understood but is likely to be multi-factorial.
My opinion is that the increased anxiety experienced by children with autism is due to a combination of increased social and sensory challenges and stigma. In addition, from my experience, I believe that expectations of self and others to behave ‘normally’ contribute to increased anxiety among people with autism especially those whose differences are less visible.
To help to manage the anxiety experienced by people with autism, cognitive behavioural therapy (CBT) is recommended for trial by scientists1;2. CBT is an evidence-based practise for reducing anxiety in general populations4;5 and recent evidence indicates that it also useful for reducing anxiety among children with autism1;6.
Lang et al. summarizes CBT very succinctly as ‘a) The patient is told the origin of their anxiety symptoms to help them realize that feeling anxious is not their fault. b) The therapist works with the client to help them realize the impact of anxiety and the need for change. c) A ranking of situations or stimuli from least to most anxiety producing is created. d) Clients are gradually exposed to the least producing anxiety situations/stimuli first while simultaneously learning to control their fear. e) The client is taught a variety of coping behaviours (eg. relaxation techniques) to help them manage their anxiety’6 .
Lang et al. recommends that CBT procedures for children with autism who do not have an intellectual disability be modified by ‘reducing the emphasis on abstract discussions of thoughts and feelings and by increasing the emphasis on the graduated exposure and teaching social skills as a coping mechanism. Additionally, rewards are given to improve compliance during treatment, visual aids are used as instructional tools, and the clients’ families are encouraged to participate. For individuals who also have an intellectual disability, graduated exposure and/or functional assessment followed by a function-based intervention is recommended’6 .
Two excellent books that I have found useful for helping to manage my boys’ anxieties that work on these principles are ‘Managing Anxiety in People with Autism’ by Anne Chalfant and ‘The Panicosaurus’ by Al-Ghani.
No-one can answer the question ‘avoid or enable?’ posed earlier, as a general rule. Many factors need to be taken into consideration in each case of anxiety for each child with advice from experts and those who know the child well. However, it is worth being aware that CBT, which discourages avoidance (with the understanding that avoidance may increase anxiety) may be useful for your child. A child psychologist with expertise in autism can give further advice on any unique situations that your child may face.
1. Reaven, J and Hepburn, S. The parent’s role in the treatment of anxiety symptoms In children with high-functioning autism spectrum disorders. Mental Health Aspects of Developmental Disabilities 2006; 9(3): 1-7
2. White, S.W. Oswald, D. Ollendick, T. Scahill, L. Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review 2009; 29(3):216-229
3. Sukhodolsky, D.G. Scahill, L. Gadow, K.D. Arnold, E.L. Aman, M.G. McDougle, C.J. McCracken, J.T. Tierney, E. Williams White, S. Lecavalier, L. Vitiello, B. Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology 2008; 36:117-128
4. Compton, S.N. March, J.S. Brent, D. Albano, A.M. 5th. Weersing, R. Curry, J. Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry 2004; 43(8):930-59
5. Velting, O.N. Setzer, N.J. Albano, A.M. Update on and advances in assessment of cognitive behavioural treatment of anxiety disorders in children and adolescents. Professional Psychology: Research and Practice 2004; 35:42-54
6. Lang, R. Mahoney, R. El Zein, F. Delaune, E. Amidon, M. Evidence to practice: Treatment of anxiety in individuals with autism spectrum disorders. Neuropsychiatric Disease and Treatment 2011; 7:27-30