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Understanding Anxiety Workshop Summary

Jemma Swales has developed this workshop organised by SHINE for Autism with the intention of educating parents/carers about Anxiety.


Anxiety is a normal part of an individual’s development, but children and adults with autism spectrum disorder (ASD) can experience anxiety more intensely and more often than other individuals.  It can help to get the individual to notice anxious feelings and use strategies for managing this anxiety.


Anxiety or autism spectrum disorder?


Individuals with autism spectrum disorder (ASD) feel many of the same worries and fears as others.  But when children and adults with ASD become worried or anxious, the way they show their anxiety can look a lot like common characteristics of ASD – stimming, obsessive/ritualistic behaviour and resistance to changes in routine.


Reducing an individual’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 individuals with autism spectrum disorder


The world can be a confusing place for individuals with 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 them feel stressed and anxious.

On top of that, individuals 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, they may:


   •     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 themselves, like head-banging, scratching skin or hand-biting.


Reducing anxiety and managing anxiety for an individual 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 the individual with ASD.  Even if you could, it wouldn’t be helpful for them.  But there are some things you can do to help ease their worries, and encourage them to manage their own anxiety levels.


Find out what makes them anxious


Because individuals with ASD can have trouble with understanding and communicating emotions, you might need to read their signals and work out what makes them feel anxious or stressed.


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


   •     changes in routine

   •     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 the individual feel anxious, it can help to make a list of them, so that you can find ways to help them manage these situations.


Give the individual lots of opportunities to practise dealing with these things and situations in safe environments.  It helps if other people who look after the individual – for example, child care workers, teachers and family members – also know what makes them feel anxious and what they can do to help them with managing anxiety in these situations.


Help the individual recognise anxious feelings


They might need to be taught what anxiety is and what it feels like in their body.  For example, when they feel anxious their palms may become sweaty, their heart beats faster, and their hands flap.  


You could try drawing an outline of a person’s body.  Inside the outline, help the individual draw or write what happens in each part of their body when they feel scared or worried.


Use relaxation and calming strategies


The individual might also need to learn what they can do to calm down.  You can help them come up with a toolbox of ways to help them calm down when they start 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 them to practise these strategies when they’re calm. Once they know the strategies well, you can gently guide them to try them when they feel anxious.


Use visual techniques


Individuals 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.


If they become anxious when there’s a change in routine, daily or weekly visual schedules can help prepare them.  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 the individual so that they know the weekly routine will be different.


Some people 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 individuals with ASD and anxiety.  Rehearsing or practising situations that they find stressful can help them understand the situation in a visual way, with the addition of physical preparation as well.


If they become 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 them.


Getting help with managing their anxiety


A psychologist might be able to help if the individual with ASD is very anxious.  Psychologists have specialised training in mental health conditions, and can work directly with the individual and their family to develop strategies for reducing anxiety.


Psychologists use a range of approaches, including:


   •     cognitive behaviour therapy

   •     interventions using gradual exposure to help individuals face their fears

   •     Social Stories™ – these can help prepare individuals for unfamiliar or stressful situations that                    generally make them anxious

   •     relaxation training to help them learn to relax


Mental health occupational therapists are another option to help with managing anxiety.  You can ask your GP or paediatrician to recommend a psychologist or therapist in your area.


Medication can also help reduce anxiety symptoms in individuals with ASD.  It’s usually recommended only when anxiety is affecting an individual’s everyday life and behaviour strategies haven’t reduced the anxiety enough.

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