Understanding stress and anxiety in autism
About the training
Stress and anxiety affect many autistic children and adults, causing significant distress that may be expressed in ways that challenge the person and others who struggle to understand them.This course is designed for anyone who works with autistic children or adults and already has an understanding of autism.
We recommend this course to all practitioners because anxiety and stress are such a difficulty for many autistic people. We must understand why this is if we are to provide support that works and makes a lasting difference.
Our interactive virtual training delivery model ensures we are proud to deliver the exact same learning outcomes for you as our face to face training course, in a learner friendly and accessible way.
Trainer: Niki Daniel, Deborah Garland or Mandy Rutter
The training runs from 9.30am -1pm across both days with regular breaks.
About anxiety in autistic children and teenagers
Autistic children feel many of the same worries and fears as other children.
But autistic children might also worry or feel stressed about things that are less worrying for typically developing children. These include things like:
- small disruptions to their routines or new sensations they feel in their bodies
- unfamiliar or unpredictable social situations
- situations where it’s hard to know what other people are thinking or feeling
- their own thoughts and feelings, especially unfamiliar or unpleasant physical symptoms that are related to worried thoughts and feelings.
Reducing a child’s anxiety might reduce the behaviour associated with the core characteristics of autism, but it won’t get rid of the characteristics or behaviour.
Signs of anxiety in autistic children and teenagers
When autistic children get worried or anxious, the way they show their anxiety can look a lot like common characteristics of autism – stimming, obsessive and ritualistic behaviour and resistance to changes in routine.
Also, because autistic children have trouble recognising their own anxious thoughts and feelings, they can’t always tell 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 emotional outbursts
- 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 themselves, like head-banging, scratching skin or hand-biting.
Anxiety is a natural part of life and something that everyone experiences at some stage. But there are some things you can do to help ease your child’s worries, and encourage your child to manage their own anxiety levels.
Anxiety triggers: how to identify them in autistic children and teenagers
Finding out what makes your autistic child anxious is a first step in reducing your child’s anxiety and helping them to manage it.
Because autistic children and teenagers can have trouble with understanding and managing emotions, you might need to read your child’s signals and work out what makes your child feel anxious or stressed.
Some of the common triggers for anxiety in autistic children include:
- changes in routine – for example, not going to a weekly piano lesson because the teacher is sick
- changes in environment – for example, a new house, new play equipment at the local park, or furniture in different places at home
- 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.
- times of transition – for example, moving into a new school year, starting secondary school, or the start of puberty.
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 your child with managing anxiety in these situations.
Ways to help autistic children recognise anxiety
Your autistic child might need to learn what anxiety feels like in their body. For example, when your child feels anxious:
- their palms get sweaty
- they get a strange feeling in their stomach
- their heart beats faster
- their 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 their body when they feel scared or worried.
Relaxation and calming strategies for when autistic children feel anxious
You can help your child learn ways to calm down when they start feeling anxious or stressed. These might include:
- counting slowly to 10
- taking 5 deep breaths
- running around the yard 5 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 they’re calm. Once your child knows the strategies well, you can gently guide your child to try them when they feel anxious.
Visual tools to help autistic children prepare for anxious situations
If visual supports and social stories work well for your child, you could use these tools to help your child prepare for situations that make them anxious.
For example, if your child gets anxious when you drop them off at school, you could take some photos of what your child will be doing – walking in the school gate, sitting in the classroom, playing sport, eating lunch and so on. You could also take photos of what you’ll be doing while you’re not together, like driving home, grocery shopping, gardening and so on. A clear picture of you coming back to pick your child up would be important too.
If your child gets anxious when there’s a change in routine, daily or weekly visual schedules can help prepare your child. 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 your child knows the weekly routine will be different.
Some children like 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.
Opportunities to practise stressful or anxious situations
If you give your child opportunities to practise for situations that they find stressful, it can help your child understand these situations and feel more prepared for them.
For example, if going to the hairdresser makes your child feel anxious, you could try taking your child 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 your child. Or perhaps your child 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 anxiety in autistic children and teenagers
A psychologist might be able to help if your child 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
- therapies and supports that use 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 autistic children. 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.
Each day all of us are faced with situations or circumstances that can cause anxiety for us, sitting in a traffic jam, arriving late to a job interview, even something as silly as not understanding a joke that others find extremely funny.While those examples are not life threatening, for the individual experiencing each situation, their abilities to reason and see the whole picture can assist them to calm themselves, breathe and realize things do happen and life will go on. But, for someone with ASD, some commonplace situations can cause great anxiety.
Most people can experience frustration, stress, or anxiety in everyday life situations. There are people who learn how to cope so well that stress or anxiety has little impact on them. But for others, including individuals with ASD, stress and anxiety can cripple them to varying degrees. Remember, situations that create anxiety in one individual may not for another. What are some common stressors that individuals with ASD might experience? The following examples of common stressors at home and at school are suggested by Dr. Chuck Edington (2010) in his presentation, Emotional Regulation and Anxiety Management in Autism, and from the brochure, “Anxiety Disorders in Children” from the Anxiety Disorder Association of America (ADAA, partial listings):
Unstructured Time: Unstructured time that has no specific rules or activity which creates boundaries or limits can be very challenging. Examples of unstructured time are:
- Waiting for and/or riding the school bus
- Before and after school time
- Transitions throughout the day (place to place, person to person, topic to topic)
- Physical education
- Understanding what to do and how to do it
- Breaking down tasks
- Presentations in class
- Answering aloud in class
Sensory issues can be triggered almost any time or anywhere on a daily basis. Whether the individual is experiencing an anxious moment or not, sensory integration challenges can overpower a person’s ability to control him or herself. Sensory situations that may provoke anxiety can include:
- Crowds – school assemblies, concerts, field trips, grocery store, etc.
- Space – too large, too crowded, too bright, too loud, too smelly, etc.
- Natural disasters
- Smells – cafeteria, restrooms, cleaning materials, markers, paints, colognes,
- Food – sight, texture, taste, smell, sound when eating
- Dental or medical issues
- Showers, bathing (some individuals have shared that showers ‘hurt’ their bodies)
- Clothing – too tight, scratchy
- Brushing teeth
Social situations are already challenging for individuals with ASD and can increase anxiety in the moment or even in anticipation of an upcoming event. Some examples include:
- Novel events – unplanned and unannounced
- Changes in plans – daily school routine interrupted or family plans changed
- Adjusting personal interests with class or family plans
- Outdoor activities – concerts, picnics, recess
- Large gatherings – school assemblies, family gatherings
- Young children (who are unpredictable in many ways)
- Initiating a conversation with a peer
Routines: After a day at school where the child was able to maintain body control, listen, complete activities, and appear composed, going home and having even more expectations including typical routines, can increase anxiety and agitation. Routines such as:
- Doing homework
- Meal, bath, bed time routines
- Getting ready for school
For all of us, there are many other seemingly harmless and safe situations that occur in daily living, but to an individual with ASD, that same situation could be totally frightening and create great anxiety or panic.
Educator Dave Nelson (Nelson, 2008) director of The Community School in Decatur, Georgia, a junior high and high school for adolescents with autism, said,
“Every single one of my students has anxiety almost every day. What is so interesting, however, is how different the manifestations of that condition can be. Some students begin asking constant questions; some interrupt constantly; some retreat or run away; and some get rude or provoking. Everyone (adults included) has their own special way of showing when they’re anxious, from biting fingernails to getting headaches to talking a lot.”
Louise Page (2009), an autism therapist and mother of an individual with an autism spectrum disorder adds:
“You may observe them, for example, looking down at their feet, or wringing their hands or their hands may be set flat against their thighs, looking fearful or frozen to the spot, or outwardly distressed (e.g. behaviour outburst) and so on. Also, their fight or flight response may be exaggerated and efforts to return their state to a relative calm may be very difficult.”
Other indicators of a person experiencing anxiety an include, when the individual feels incredibly self-conscious and overloaded and “speaks” through “characters” or phrases from TV shows; jingles; objects; as another person, or retreats to a corner, drawing up the knees to their chest; mumbling; etc. Each person’s response to anxiety can be as individual as they are. “What makes the experience of helping students with their anxiety so interesting and challenging is that many times, they don’t even know how they’re feeling, so they have no foundation for trying to manage the feeling (Page, 2009)”.
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Davis, K (2012) Anxiety and panic struggles. Retrieved from Anxiety and panic struggles