There are numerous research studies which suggest that a child with autism spectrum disorder (ASD) may also experience bouts of (social) anxiety. One study, published in the Journal of the American Academy of Child & Adolescent Psychiatry, suggests that 70 percent of children on the spectrum also had at least one mental health disorder, with social anxiety being most common. It is important to note that the majority of children will express anxiety and nervousness at some point growing up (whether on the spectrum or not). However, social anxiety, the fear of new people and social situations, can be found more so in children on the spectrum. Social anxiety can make it difficult to complete daily tasks and activities. Children with ASD often find it difficult to reason what another person might be thinking or feeling, or how that person might react. Due to this, people and situations can seem unpredictable, which can make children feel stressed and anxious.
There are a few things to look out for to help determine whether your child is feeling anxious. Given that some children with autism may find it more difficult to communicate verbally, he/she will tend to show these feelings in an outward manner. To outsiders, this display of anxiety and stress may seem to come across as “challenging behavior,” yet in reality, it’s simply your child trying to communicate that he/she isn’t feeling particularly well.
Some common signs of children on the ASD spectrum feeling anxious may include:
- Insisting on routine and sameness while being fearful of change and different events which may occur.
- Trouble sleeping, overthinking situations, or potential situations.
- Having more “tantrums,” especially in a situation in which they are not entirely familiar (such as in a supermarket).
- Avoiding or withdrawing from social situations, or failure to interact with other children.
- Relying on specific rituals and routines such as lining objects up in a straight line.
- Doing things to hurt themselves, such as head-butting objects, excessive scratching, and biting their skin.
As a parent, I’m sure you want to get rid of everything that makes your child anxious and nervous. However, you can’t, and even if you could, it wouldn’t much benefit your child in the long run. There are a few things, though, you can try to ease your child’s anxiety/nervousness, and encourage him/her to manage personal levels of stress and anxiety.
1. Determine your child’s triggers
If your child is able to communicate his/her feelings and emotions to you, ask what makes him/her feel uncomfortable. Makes notes, and once completed, sit down with your child and begin to make a plan on ways you can make him/her feel more comfortable within these situations. If your child has difficulty communicating and understanding his/her feelings, review how the child reacts in different scenarios. For example, if your child becomes fidgety in a restaurant, jot down the surroundings and what he/she was doing, and you should eventually gain an understanding of what may set off the anxiety. Common anxiety triggers for children on the spectrum can include changes in routine (such as a cancelled lesson or plan), changes in environment (such as rearranging furniture), different social situations (such as parties at somebody else’s home), or sensitivity to particular sensory situations (such as bright lights or loud noises like in a shopping center.) Following a gained understanding on what can impact your child, you can begin to make a plan and set goals. The younger the child is when you begin this, the better.
2. Rehearse anxiety-provoking situations
Practice stressful situations with your child in a safe environment. Rehearsing the situations which make your child nervous may give him/her a better understanding on how they work and will present him/her with a visual understanding. For example, before a dentist appointment or hairdresser appointment, explain to your child the steps of what will happen. It may be beneficial to visit the particular place beforehand and ask someone to explain what will happen to your child. If your child gets anxious in social situations, you can always ease him/her into it by role-playing before doing the actual thing. Pretend you are the hairdresser or the dentist, and remember to encourage and give praise when he/she does well.
3. Use visual aids
Children with ASD are often visual learners, rather than learning from long lectures. Invest in visual materials such as pictures, social stories, photographs of real places you visit often, and visual timetables so you can communicate where you are going and what will happen. For example, if you are going shopping, you can show your child a picture of the shop so he/she can begin to prepare for the event which may occur. By creating a visual timetable, this will also allow your child to understand what activities he/she will be doing throughout the week. Look at this with your child regularly, ensuring you update any changes to the week as soon as possible as most children who feel anxious about a change in routine may prefer to know in advance.
4. Teach your child relaxation techniques
Begin to teach your child relaxation techniques when he/she is calm as it can help him/her better absorb the techniques. Following this, when your child does feel anxious, you can gently guide him/her to try them out. The most common relaxation techniques include deep breathing, counting slowly to 10, jogging around the garden a few times, looking at a favorite book or something which holds importance, or going to a quiet part of the house and closing his/her eyes for 20 seconds.
5. Cognitive behavioral therapy (CBT)
CBT is a widely accepted form of therapy to help break the cycle of severe anxiety—if it is used effectively in children with at least some form of verbal ability. CBT is typically used to change the way your child may think, specifically from negative to positive. If your child is experiencing severe anxiety that is affecting everyday life, it may be worth looking into CBT therapy. There also numerous online applications which offer CBT for anxiety, stress, and mild depression if you find therapy too costly.
One application which offers CBT and other mindfulness techniques is “Feel Stress Free.” This was created and developed by leading psychologists and psychiatrists in the UK using clinically proven techniques to build resilience to stress, anxiety, and mild depression. They are offering a code to provide a free month to help remain relaxed as you support your child through any difficulties he/she may face. For free full access for a month, use the code STRESSFREE0917.
Andrés Fonseca, MD, MSc, MRCPsych, FRSA, is a consultant psychiatrist with 20 years of clinical experience. He is a member of the Royal College of Psychiatrists and dual qualified in old age and adult psychiatry. He holds an MSc in psychiatric research methodology from UCL and is honorary lecturer at UCL (division of psychiatry) and University of Roehampton (psychology department). He is cofounder and CEO of Thrive, a company that develops software to improve mental health combining computerized cognitive behavioral therapy and other eTherapy techniques with games and game dynamics to enhance engagement.
This article was featured in Issue 69 – The Gift of Calm This Season