Many children with autism have higher rates of anxiety than their peers. Specifically, nearly 40 percent of children and adolescents with autism are estimated to have clinically significant anxiety or at least one anxiety disorder (Van Steensel et al. 2011).
Anxiety is experienced when errors in thinking that include exaggerating threat or danger as well as minimizing the ability to cope with that threat or danger, occur. There are three components to anxiety: cognitive, physical, and behavioral. Cognitive components are the thinking errors or unjustified beliefs. For instance, over generalizing that if something goes wrong, everything will go wrong. Or, if something unpleasant happens, it will happen over and over again.
The physical component of anxiety is the body’s physical response to anxiety such as nausea, muscle tension, sweating, headache, or fatigue. Lastly, the behavioral component is how someone responds to their anxiety. For example, avoiding situations, crying, fleeing, or non-compliance. These components can look different depending on the individual. In addition, the sequence of events that occur when anxiety is present can also be different depending on the person or situation.
Ways to Support Children With Autism
One way parents can support their children with autism is by using a framework like Circles of Comfort© (Persike & Nichols, 2016). Beginning with the outer circle, parents or caregivers can provide supports to reduce the overall symptoms of anxiety. If anxiety persists, individuals move on to provide more supports until they reach the inner circle, consisting of resilience and coping strategies.
Circles of Comfort© (Persike & Nichols, 2016) consists of the following layers: sensory; environment and predictability; relationships and special interests; opportunities to succeed; and coping and resilience strategies.
Significant associations exist between intense-responsivity of sensory information and anxiety in individuals with autism (White et al. 2009; Baker et al. 2008; Pfeiffer et al. 2005). By addressing sensory needs first, we may be able to eliminate feelings of anxiety and prevent places or objects, that is paired with an unpleasant sensory stimulus, from creating an association with fear and anxiety. In addition, by addressing the sensory needs first, individuals will be at an optimal level to learn and take in new information, making it easier for them to learn resilience and coping strategies if needed.
The following tools may be useful when helping address the sensory needs of your child:
- Zones of Regulation by Leah Kuypers
- The Alert Program by TherapyWorks, Inc.
- The Out-of-Synch Child by Carol Kranowitz
In addition, implementing a calming area into the home can be a beneficial tool. A calming area is an area within the home designated as a place to escape stress, prevent anxiety, and regain control if high levels of anxiety occur. This area should be seen as a positive place, not a time-out or punishment and can include fidgets, calming scents, and visual supports to support mindfulness activities. Furthermore, including an occupational therapist to your child’s team to help develop sensory supports, breaks, or diets may be beneficial as well.
Anxious children often fidget. Fidgeting may help children avoid an unpleasant or uncomfortable feeling (Cohen 2013). By simply providing connection and love to your child during these times rather than humiliation and shame, you help them feel safe and secure, which may help them to become aware of or express their emotions.
Environment and Predictability
A predictable environment helps all of us better regulate our emotions and decrease our anxiety. Environments that are safe, consistent, controlled, and only changed very gradually, at the pace determined by each child, can help decrease the symptoms of autism by helping decrease exaggerated fear memories from occurring (Markram et al. 2010).
The following visual supports help provide predictability and structure throughout the day:
- Daily schedules
In addition, the Name It to Tame It book coined by Dan Siegel MD and Tina Payne Bryson, PhD can be another beneficial strategy to increase predictability and ease anxiety. Parents or caregivers, create a book that gives facts about what will happen in a specific situation or activity, states feelings the individual may exhibit during the situation or activity, and gives strategies to help deal with feelings during the situation or activity.
Relationships and Special Interests
We find safety in relationships. By connecting with someone, we help calm them. Every time we receive comfort, our calming system becomes faster and more efficient. Therefore, we can help regulate responses to stress by connecting safely with others. Providing empathy is a powerful tool that helps develop relationships and connections with others.
According to Theresa Wiseman, there are four components to empathy:
- Understanding perspective
- Avoiding judgment
- Recognizing emotions
- Connecting and communicating emotions
Some examples of empathetic acknowledgments of children’s emotions are as followed:
- “That was really frightening.”
- “You really want to stay home with me today.”
- “You want to ride the horse, but you are feeling a little scared.”
- “We can wait together until you are ready to join your gymnastics class.”
- “I’m listening. Tell me more.”
Developing trusting relationships is essential when supporting individuals with autism. Simply by seeing a safe person, anxiety decreases. Sometimes, anxiety can make children see the world through a lens of danger. When this happens, they misinterpret their environment and surroundings causing them to perhaps miss that the people around them are calm and feel safe.. The Second Chicken Question technique developed by Lawrence J. Cohen, PhD may help when this occurs. Rather than trying to rationalize, reassure, or use logic to reason away your child’s fear, try asking them the following question: “Would you look in my eyes and see whether or not I’m scared?” This helps children come out of their fear state and find safety in another person.
Engaging in activities we enjoy makes us feel happier. In addition, weaknesses are diminished when individuals with autism participate in their special interests. Emotional memory also plays a great role in emotional regulation. The more positive memories someone has in an environment, the more emotionally regulated they are in that environment. By allowing individuals to engage in special interests, we help them create positive memories within a variety of environments, which in turn helps someone with autism be more emotionally regulated.
The following resources are useful when working to include special interests throughout the day:
- The Power Card Strategy 2.0: Using Special Interests to Motivate Children and Youth with Autism Spectrum Disorders by Brenda Smith Myles and Elisa Gagnon
- Just Give Him The Whale!: 20 Ways to Use Fascinations, Areas of Expertise, and Strengths to Support Students with Autism by Patrick Schwartz and Paula Kluth
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Opportunities to Succeed
Avoidance is a significant problem with anxiety, and when anxious situations are avoided, it reinforces that the situation is scary or fearful. This does not mean that we should force children to engage in activities that are anxiety producing to them when they are not ready. Rather, we can help support children, by meeting them where they are and providing supports to help them succeed in fearful or anxious situations.
The following resource may be helpful when doing so:
- The Opposite of Worry: The Playful Parenting Approach to Childhood Anxieties and Fears by Lawrence J. Cohen
The feeling that comes with successes is brought on by a surge of dopamine. This signals us to keep doing whatever we did that led us to succeed. By increasing your child’s opportunities to succeed, you are giving them a neurological boost for future success. You are also increasing positive emotional experiences, which leads to positive emotions and increased emotional regulation.
Coping and Resilience Strategies
Finally, some individuals may need to learn new skills to help them manage their anxiety. Several resilience and coping strategies exist. For instance, teaching someone to label their emotions, in a few words, helps them feel calm. In addition, people with autism often have difficulty understanding how their actions affect others. Without this ability, they feel helpless to change their situation, which increases feelings of anxiety. Attribution retraining teaches someone to assess their circumstances so that there is a sense of hope that they can control and improve their situation.
The following strategies can be used to help with attribution training:
- Visual choice mapping
- The Eclipse Model: Teaching Self-Regulation, Executive Function, Attribution, and Sensory Awareness to Students with Asperger Syndrome, High Functioning Autism, and Related Disorders by Sherry A. Moyer
By addressing anxiety in individuals with autism, you are strengthening their pathways of calm, which over time, will decrease the likelihood of anxiety. To better support your child with autism, employ some of these strategies while using the Circles of Comfort© (Persike & Nichols, 2016) framework to help organize your thoughts and supports.
This article was featured in Issue 84 – The Journey to Good Health and Well-Being