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Managing Anxiety in People with Autism: A Treatment Guide for Parents, Teachers, and Mental Health Professionals


Anxiety is one of the biggest challenges facing people with autism spectrum disorders (ASD) and their families. They can experience anxiety in all areas of their lives—school, family, and social life—and it compounds the difficulties they already may have with communicating, interacting socially, and controlling their emotions. Managing Anxiety in People with Autism is one of the first books to provide practical information about dealing with anxiety in people with ASD.

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Managing Anxiety in People with Autism: A Treatment Guide for Parents, Teachers, and Mental Health Professionals

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Anxiety is one of the biggest challenges facing people with autism spectrum disorders (ASD) and their families. They can experience anxiety in all areas of their lives—school, family, and social life—and it compounds the difficulties they already may have with communicating, interacting socially, and controlling their emotions. Managing Anxiety in People with Autism is one of the first books to provide practical information about dealing with anxiety in people with ASD.

Drawing on her experience diagnosing and treating anxiety in people with ASD at the treatment center she founded in Sydney, Australia, Dr. Chalfant provides clear, understandable explanations of the different types of anxiety disorders, how they affect people across the autism spectrum, and what interventions can help. The book teaches parents:
• to know how and why their child is prone to anxiety
• to understand their role in their child's anxious behavior
• to recognize and respond to anxious behavior appropriately

Case studies and research findings help to illustrate the author's points and clarify the causes and symptoms of anxious behavior.

Managing Anxiety explains a range of different types of strategies that can help manage and treat anxiety in school, home, and clinical settings and takes into consideration the different roles people play in a child's or adult's life: parent, sibling, teacher, etc. Readers learn about ways to modify behavior and/or the environment to indirectly reduce anxiety, as well as interventions, such as medication or psychotherapy, which deal with symptoms directly. The discussion of more formal interventions—psychotherapy, Cognitive Behavior Therapy (CBT), and medication—show how these methods can target specific anxieties. Because anxiety is generally more common in parents and siblings of a child with ASD, the author also offers ways they too can reduce their symptoms.

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What People Are Saying

Gary B. Mesibov
"Professionals and parents working with people with Autism Spectrum Disorders (ASD) are aware of the huge role that anxiety plays in their lives. Unfortunately, programs developed to reduce anxiety in typical people are not effective with this population. This book addresses this problem thoughtfully, comprehensively, and practically. It presents psychological wisdom for understanding anxiety in ASD and effective practical treatment approaches. It does this in a sophisticated way but with language and concepts that are understandable by parents and professionals. This book has a thorough, detailed, and conceptually clear explanation of what anxiety in ASD is, how it is experienced by people with ASD, and why it is so prevalent. It then goes on to offer a range of strategies with clear explanations and multiple examples to guide those interested in creating effective and productive interventions. This book represents a major advance in our ability to help people with ASD to confront one of their major difficulties and should be widely read and frequently used."
-Gary B. Mesibov, Ph.D.
Professor Emeritus, The University of North Carolina at Chapel Hill

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Product Details

  • ISBN-13: 9781606130049
  • Publisher: Woodbine House
  • Publication date: 7/10/2011
  • Edition number: 2
  • Pages: 150
  • Sales rank: 787,537
  • Product dimensions: 5.50 (w) x 8.50 (h) x 0.60 (d)

Meet the Author

Anne Chalfant is the founder and director of Annie's Centre, Sydney's first independent health clinic established exclusively for the health and developmental needs of children and their families. Dr. Chalfant is noted for her research into the anxiety difficulties of children with an autism spectrum disorder (ASD), which she has presented at both national and international conferences.
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Read an Excerpt

What Is an Activity Schedule?
An activity schedule is a set of pictures or words that cues someone to engage in a sequence of activities. An activity schedule can take many forms, but initially it is usually a three-ring binder with pictures or words on each page that cue children to perform tasks, engage in activities, or enjoy rewards. Depending on the child, the activity schedule can be very detailed-breaking a task into all of its separate parts-or it can be very general, using one picture or symbol to cue a child to perform an entire task or activity. Through graduated guidance (discussed below), children are taught to open their schedule books, turn to the first page, perform the task, and then turn to the next page for cues to the next tasks. The goal of teaching schedule use is to enable children with autism to perform tasks and activities without direct prompting and guidance by parents or teachers.

The schedule book for Riley, age 2, contains five pages, each of which displays one picture. The pictures show a frame-tray puzzle, a color-matching game, balls that fit in a plastic tube, felt animal cut-outs and a felt board, and corn chips on a paper plate. When his mother or instructor says "it's time to do your schedule," Riley opens his picture book, points to the first picture, goes to a nearby bookcase and gets a basket that contains the puzzle shown on page one, brings the puzzle to his little table, puts the pieces in their respective places, returns the puzzle to the basket, puts the basket on the shelf, returns to his picture book, turns the page, points to the color-matching task, and so on. The teaching procedures enable Riley to do five activities without help from his parents or instructors. Although still a toddler, he engages in independent play for ten to fifteen minutes. Before he learned to use his picture schedule, he did not play-instead, he briefly picked up toys and mouthed them, then dropped them and went on to do the same with other play materials.

Page, age 12, read at the second-grade level, and quickly acquired new sight words. After school, she followed a written schedule-a list of activities to be accomplished. Some of the activities on her list were: vacuum my room, reading homework, make pudding, fold towels, math homework, piano, exercise video, set table. Page pointed to the first item on the list ("vacuum my room"), obtained the necessary materials, and began. After completing each activity, she returned to her schedule and placed a check mark beside that item. Before new activities were added to Page's schedule, her teachers presented the new words on flash cards, and helped her learn to read them.

Many of the activities in Page's schedule were originally taught as separate lists; for example, in an earlier version of her activity schedule, the task of making pudding was separated into 19 written instructions, such as "get milk," "get bowl," and "get pudding mix." Following a written activity schedule enabled page to use after-school time to practice new skills and to help with household tasks. Before she became a proficient schedule follower, she often spent after-school hours making perseverative demands on family members, and screaming if she did not get her way.

Riley and Page are examples of the independence that children gain when they learn to follow activity schedules. Riley's mother no longer has to monitor him continuously and remove toys from his mouth, and Page's parents don't have to give constant verbal instruction or respond to her repetitive demands. The activity schedules decreased the need for adult prompting and guidance. These results were achieved with special teaching procedures.

One of our first investigations of activity schedules (MacDuff, Krantz, & McClannahan, 1993) was conducted in one of the Princeton Child Development Institute's family-style group homes. The four boys (ages 9 to 14) who participated in the study had learned many home-living skills, such as vacuuming, dusting, table setting, doing puzzles, playing with toys, and riding bikes. But they did not do these activities unless verbally instructed, and when staff members' prompts were withdrawn, they were often "off-task"-not engaged in any appropriate activity.

Using a teaching procedure called graduated guidance, we taught the boys to follow photographic activity schedules that depicted six different leisure and homework activities, such as Lego blocks, Perfection game, handwriting worksheets, and Tinker toys. For example, when a youth turned to a page of his schedule book that displayed a picture of a Tinker Toy car, he learned to point to the picture, take the Tinker Toys off the shelf above his desk, assemble the car as shown in the picture, put the Tucker Toys back in the box, return the box to the shelf, and turn to the next picture in his schedule. Because these boys already knew all the steps necessary to complete each activity, their activity schedules did not cue them to do each separate step, although for other children we often create activity schedules that do that.

When the boys were doing the activities depicted in their schedule books without much help, we carefully faded the instructor's guidance, and finally, his presence. Near the end of the study, although we changed the order of the photographs and even added new photographs, the boys continued to follow their schedules without prompts from adults and, on average, they were "on-task" or appropriately engaged during 91% to 99% of our observations.

These youths, who previously experienced considerable difficulty in pursuing and finishing activities, and in making transitions from one activity to the next, now independently completed six different activities without adult help! They looked very competent.

Imagine yourself transported to another culture. You do not understand the lauguage spoken there, and do not have a guide or translator. People ask you where you would like to go and what you would like to do, but you cannot comprehend or respond to these questions. This scenario describes the plight of many youngsters with autism who, because of their severe language deficits, are unable participate in decisions about their own activities and daily schedules. Not surprisingly, this lack of control over the events of daily life often appears to be associates with tantrums and disruptive behavior-we would probably tantrum too if we were never allowed to decide when to ear, what tasks to do next, or which leisure activity to select.

Photographic and written activity schedules provide a framework for helping children with autism learn to make choices. If we provide careful and systematic instruction, they not only learn to follow schedules, but they also learn to sequence their own activities, and to choose leisure activities that follow structured teaching sessions, homework, or home-living tasks.

Social Interaction
Pursuing our daily activities inevitably requires social exchange. But social interaction is a key deficit for children with autism, and one that should be addressed as soon as possible. Although discrete-trail training is often used to teach children with autism to imitate words, phrases, and sentences and to make verbal responses when requested to do so, this approach is not representative of the give-and-take of ordinary conversation. In discrete-trail teaching, the parent or teacher asks a question or gives an instruction and waits for the child to respond. And youngsters learn to respond and then wait for the next instruction. In deed, many children appear to become dependent upon adults' verbal prompts-instead of initiating social interaction they wait for others to do so. But in typical conversation, either partner may initiate, often with observations or comments, rather than with questions or directions, and one person may make several statements before the other replies.

Teaching children to use activity schedules creates a different framework for building social interaction skills, and sets many occasions for children to initiate conversation, rather than merely responding to others' instructions or queries. We recommend that even the first schedule for the youngest preschooler include at least one simple interaction task. A child who has not yet acquired language may learn to point to a picture in a schedule book and approach a parent for a toss in the air; a youngster who now has a few words may seek out a family member to say "Hi" or request "Tickle"; and a boy or girl who uses sentences may initiate conversation by requesting a preferred activity ("I want hug"), or reporting on a recently completed activity ("I did puzzle").

Our experience in early intervention programs, preschool, school, and group homes indicates that social interaction activities should be included in every activity schedule, and should be extended and elaborated as soon as possible. This theme will reappear in several subsequent chapters, together with specific suggestions about how to use activity schedules to build conversation skills.

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Table of Contents

Chapter 1: Independence, Choice, and Social Interaction
Chapter 2: Prerequisite Skills: Is My Child Ready for an Activity Schedule?
Chapter 3: Preparing a First Activity Schedule
Chapter 4: A Different Way to Teach
Chapter 5: Measuring Schedule-Following
Chapter 6: The First Schedule is Mastered!
Chapter 7: When Do Activities End?
Chapter 8: Increasing Choice
Chapter 9: From Picture to Words
Chapter 10: Expanding Social Interaction Skills
Chapter 11: Troubleshooting
Appendix A: Prerequisite Skills Data Sheet (samples)
Appendix B: Data Sheet (samples)
Appendix C: Language Master
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