Anxiety can be overwhelming for children with autism. It doesn’t need to be.
The anxiety levels commonly found in children with autism affect social skills, memory, learning, and attention spanand often lead to meltdowns. Those who live or work with kids on the spectrum are acutely aware of how disruptive anxiety can be. However, we are rarely provided with clear guidance on how to manage this anxiety. This book bridges that gap.
Through his twenty-plus years as a clinical psychologist, Dr. Lynch has devoted his career to relieving distress in kids with autism and related disorders. Lynch identifies five factors that are commonly known to elicit anxiety in children with autism and breaks down how to tackle each topic in a manageable and effective way. These factors include:
With this clear and comprehensive guide, parents, teachers, and therapists can take the first crucial step towards managing anxiety, relieving distress, and unlocking potential.
|Publisher:||Future Horizons, Inc.|
|Product dimensions:||5.90(w) x 8.80(h) x 0.60(d)|
About the Author
Dr. Christopher Lynch is a clinical psychologist who specializes in stress and anxiety management for children. He is currently the director of the Pediatric Behavioral Medicine Department at Goryeb Children's Hospital where he developed the aspirations life management program for children on the autism spectrum. Dr. Lynch has over fifteen years of experience in working with children. It is his ambition to continue to develop services and resources that provide children with the skills needed to both cope and thrive.
Read an Excerpt
If you are the parent of a child with autism, you have likely received lots of advice on what types of services your child should receive. You were probably told you have to get such services as speech and language therapy, behavioral training (ABA), sensory integration training, occupational therapy, physical therapy, individualized educational programming, social skills training, and a host of others. Much of this advice is sound. These types of services have made a crucial difference in improving the lives of children on the spectrum. However, one of the most common areas of concern for kids with autism has to do with managing anxiety and the meltdowns that often result from such anxiety. Indeed, anxiety can drastically impede or undo the progress made from all of the other services that a child with autism receives. And yet, services to help with stress and anxiety management were probably not on the list of things you absolutely must get for your child. This is unfortunate given the profound impact that anxiety has on the lives of children with autism and on those who teach, support, and live with them.
So, just how much does anxiety affect children on the spectrum and those who support them? To get a sense for this, let's consider what a typical day may look like by following a fictional account of a child whom we will call "Jason." Jason is bright and verbal. He has received many therapeutic and educational services from a young age. As you read through the scenario, consider if your child, student, or client would respond in a similar way to the situations encountered by Jason.
Morning: Before School
Jason can't stand the sound of an alarm clock, so mom must wake him up for school. This morning mom goes up, braces herself, and as gently as possible tells Jason that it's time to get up. First, Jason responds with a groan. Like other transitions, Jason doesn't like to get up unless he can do it on his own terms and at his own pace. Mom, feeling the sense of time urgency, reminds Jason that if he doesn't wake up now he is going to be late for school. This leads to an explosion of choice words, blame, and accusations directed at mom. Mom hears this every day but never gets used to it.
To help move the morning along, Jason's father prepares his breakfast. Unfortunately, dad realizes that they have run out of Jason's favorite cereal. Jason doesn't take the news very well. He yells, screams, and loudly blames his parents for the "horrible injustice committed." A lot of encouragement and pleading are needed to convince Jason to eat something else.
After breakfast, Jason goes over to the video game console. Playing video games on school mornings is not allowed, but mom and dad both have to get ready for work themselves. They only turn their backs for a minute. Too late! Jason is already playing the game. He swears that he will be off in just a minute, but one minute turns to five and five minutes turns to ten. His parents have no choice but to shut the game off themselves. More yelling and blaming.
Jason finally starts to get dressed. It's cooler than expected, so his parents give Jason an extra sweatshirt. Jason refuses: "No way! I'm not wearing that. It's itchy and tight!" After significant pleading and negotiation, they finally agree on an outfit that is acceptable. Then Jason starts to pack his book bag. He can't locate one of last night's worksheets. Major panic! Jason runs around the house searching everywhere and loudly blames his parents for losing his work. Finally, when everyone calms down for a moment, they realize that the assignment had been on the kitchen table the whole time. Jason then meticulously investigates his packed lunch. The banana has a slight brown spot on it so his father must pack him another one. His sandwich has some of the crust visible so his father must cut it off completely.
Lunch is packed, and it's out the door. Jason's mother must walk him to the bus stop and wait for the bus to arrive because Jason has a fear that the bus won't show (although this has never happened). Jason anxiously and repeatedly asks, "What time is it? What time is it?" until the bus shows. Jason's bus arrives on time and he is finally off to school. Both mom and dad are exhausted, and it's not even eight o'clock in the morning.
To be fair to Jason, he did not wake up this morning and think, "I want to make myself and others miserable." Instead, his behavior and mood were driven by anxiety. This anxiety occurred in reaction to situations that required sensory regulation, flexibility, and the ability to move smoothly from one activity to the next. For children without autism, these situations may not even have been noticed or, at the most, would have been seen as minor annoyances. For the child on the spectrum, however, such situations can result in high levels of anxiety and are often experienced as a major disruption to one's day. Some of the consequences of this anxious response are anger, frustration, and challenging behavior.
To help prevent minor blips from escalating into full-blown episodes (aka "meltdowns"), parents often have to tread carefully in the morning. Much of the morning may be spent either preventing their child from getting anxious in the first place or trying to reassure him or her when things don't go according to plan. This can be time-consuming and fatiguing. It also saps the energy of the child experiencing the anxiety.
The School Day
Anxiety is not left outside of the school doors. School can create anxiety and frustration for any student. However, anxiety is often magnified for the student with autism. To get a sense for this, let's follow Jason as he goes through his school day.
Jason does not like the sound of the morning bell, so he covers his ears as he enters school. The intensity of this action is noticed by his peers, who consider it odd. The hallways are crowded and Jason has problems navigating his way without bumping into somebody. This is annoying to the students he accidentally bumps into and results in severe discomfort for Jason. The first class is English and the in-class assignment is to read a poem and then discuss what it means. Jason can read the poem with ease but has difficulty with understanding its meaning. He interprets metaphors literally and the students in his group have to stifle their laughs. History is next. The class is covering the Age of Exploration but Jason wants to talk about his favorite historical topic, which is the American Civil War. He interrupts several times to spout facts about the Civil War until he is reprimanded and threatened with detention. After history, there is math. This is a strength for Jason but he does not like to show his work and loses points on an assignment as a consequence.
Lunch comes after math. This is a time that Jason dreads. To him, the cafeteria is crowded, smelly, and noisy. There are some kids that he can connect with sitting together at a table but Jason won't sit with them because the table is too near to the trash cans. He ends up sitting by himself, away in a corner.
Gym comes after lunch. Gym is always a struggle for Jason but it has been particularly challenging lately as the class is doing basketball. Not only does Jason have problems with dribbling and making a shot but he also gets confused by the rules and cannot tell when and whom to pass the ball to. A member from the opposing team yells, "Jason, I'm open!" in an attempt to trick him. Jason easily takes the bait and passes the ball to the other team, much to the dismay of his teammates.
Various frustrations occur throughout the rest of the afternoon classes: in science, Jason has to do group work with kids he doesn't know well and this makes him highly anxious; in Spanish, Jason gets upset when he realizes that he did the wrong page for homework; in computer class, Jason's screen freezes and he needs a lot of reassurance from the teacher to calm down enough to solve the problem. It's near the end of the school day and Jason is now frustrated and exhausted. Although he is a smart kid, by the end of the school day Jason carries with him more experiences of failure than of success.
For the student with autism, school can be an overwhelming place to be. Sensory overload, academic frustration, and a multitude of social challenges often combine at school in a way that is extremely challenging. School is also the place where, much of the time, the student has to follow the agenda of other people rather than his own and this can be distressing. For these and other reasons (which I put into five groups that I like to call my "five prime suspects"), school often makes the student with autism anxious. Such anxiety at school creates distress for the student and can make it difficult to learn effectively. In some cases, school-related anxiety can also lead to behavioral challenges. These challenges can disrupt the flow of the classroom and are draining on teachers and staff. Anxiety at school can also add to the social difficulties that kids with autism already have. For example, anxiety can lead to behaviors that make the child stand out (such as screaming during fire drills) and can lead to social isolation (such as standing alone at recess because the child is nervous about what to say to get a conversation started).
The end of the school day is often looked forward to by other kids as a time to enjoy and relax. For kids on the spectrum, stress and anxieties often continue; a lot of things can "go wrong" before, during, and after school. When things "go wrong," a child on the spectrum may not be able to shrug it off. Most kids can accept that these sorts of things happen all the time and they quickly adapt. For kids on the spectrum, however, these are not minor inconveniences. These situations represent a major, unexpected turn of events and often result in major anxiety. Let's see what happens to Jason after school and into the evening and how this contributes to his anxiety.
Jason has soccer practice after school but when they turn up to the usual practice field, the coach explains that they will have to change to another field because of maintenance issues. The other kids have no problem with this but Jason begins to worry aloud, "But that's not our field. How are we supposed to practice on another field?" The coach has to reassure Jason that practice will be the same as it always is even though the field is different.
When Jason comes home it's time to eat, but his parent's attempt to add an extra ingredient to dinner does not go unnoticed. "Are you trying to poison me?" Jason exclaims. His parents have to scramble to make him his usual dinner with the exact same preferred ingredients as always.
After dinner, it is time for homework. Jason has forgotten to bring home a worksheet from science class. This creates great frustration and anxiety and mom has to go over to a friend's house to get a copy.
By the time homework is done, everyone is drained. Jason starts playing a video game. When it is time to start to wind down for bed, his parent's gently ask him to turn off the game but Jason loudly protests, "You don't understand! I am just about ready to reach level sixteen! It will be just five minutes." The parents wait but time goes on; five minutes turns into twenty minutes and they have no choice but to turn the game off. This is not the kind of experience that any parent would want their child to go through right before bedtime, but they had no choice. Jason's reaction prolongs the amount of time it takes for him to settle down enough to get to bed, but he eventually does so. The day began with frustration and anxiety and ended with frustration and anxiety.
For Jason, problems related to anxiety may still not be over. Anxiety can continue to plague a child even in his sleep. Sleep disorders are quite common in children on the spectrum and sleep disturbances are often heavily impacted by anxiety. Some sleep issues that can occur in children with autism include insomnia, irregular sleep patterns, nightmares, and sleep terrors. However, Jason has had a rough day so the least we can do, in this account, is give him (and his parents) a decent night's sleep!
The Close Relationship Between Anxiety and Autism
The close relationship between anxiety and autism is clearly evident in my clinical work. Although anxiety is not listed as a core symptom for autism, it is often the prime reason why kids with autism are brought to my office. My clinical experience is often echoed by those on the spectrum. Temple Grandin is often quoted as saying, "The principle emotion experienced by autistic people is fear." John Elder Robison, author of Look Me in the Eye: My Life with Asperger's, has said, "Like many others with autism, it leaves me fearful and anxious whenever I must deal with new people or strange situations. I know this anxiety is shared by countless others on the spectrum. I hide it well, but the fear and anxiety is always with me." There are numerous other memoirs, blogs, and other sources of information from those on the spectrum that express how pervasive anxiety can be for those with autism.
My clinical observations and the experiences of people with autism are backed up by a growing body of research which is confirming high levels of anxiety amongst those on the spectrum. This research not only confirms high levels of anxiety in autism, but also highlights how anxiety impacts behavior and functioning. Here are a few of the findings on anxiety and autism:
Children with autism are more likely to suffer from anxiety, with close to 40 percent of young people with autism having at least one diagnosable anxiety disorder.
Parents often report that the impact of anxiety in children on the spectrum can be more substantial than the impact of autism itself.
Symptoms of autism, such as restricted interests, are closely associated with anxiety levels. The higher the anxiety, the greater the degree of symptoms of autism.
Why Work to Reduce Anxiety?
All humans experience anxiety. In many ways, anxiety can be adaptive. Anxiety helps to warn us of danger and is a cue that something needs to be dealt with. We humans wouldn't have lasted on earth for very long if we couldn't be anxious. We would have easily fallen prey to such calamities as attacks by animals, accidents, and severe weather events. When mixed with other feelings, such as excitement, anxiety can even help to add vitality to our lives. This is why people go on roller coasters and watch scary movies (two things that many kids with autism also enjoy). However, high levels of anxiety — especially anxiety that is unwanted and difficult to control — has a number of ill effects that can negatively impact on the lives of kids with autism and those who support them.
High levels of anxiety cause distress for the person experiencing it. As we saw with Jason, the child with autism doesn't wake up in the morning thinking, "I want to make myself and everyone around me miserable." High anxiety is a distressing feeling. Nobody wants to experience it, including kids with autism. Anxiety creates a number of distressing physical symptoms such as heart palpitations, excessive perspiration, trembling, queasy stomach, dizziness, and so on. Anxiety also results in uncontrollable worry and can lead to feelings of panic.
Anxiety can also present challenges for those who support kids with autism. Parents often talk of "walking on eggshells" and having to brace themselves before announcing an unexpected change of plans to their child. A great deal of time is spent on trying to provide structure and consistency for the child with autism. This can often have a direct impact on a family's lifestyle (e.g., can't go out to eat when it's busy, can't go to events without lots of advance notice, must avoid loud places, and so on). At school, teachers can be challenged as a result of a student's anxiety. Anxious students with autism may perseverate on particular topics and be very difficult to redirect. This can be unintentionally disruptive to the class. Students with autism may also require a very high level of structure and preparation for transitions and this can be taxing on resources such as time and energy.
Anxiety can also have a negative impact on other areas of functioning. I discovered this while running a social skills group for teens with autism while I was living in Ireland. The groups felt a bit stilted and the members weren't really interacting as much as I had hoped. I decided to start each meeting off with a relaxation exercise. Each week the members learned and practiced a new way to relax. Not only did the members show a great interest in learning how to manage anxiety, but their social interaction improved immensely. Not knowing effective "social skills" was only part of the problem. A big part of the problem (maybe the biggest part) was the anxiety that the members were experiencing in a social situation.(Continues…)
Excerpted from "Anxiety Management for Kids on the Autism Spectrum"
Copyright © 2019 Christopher Lynch.
Excerpted by permission of Future Horizons, Inc..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Chapter One: Anxiety 24/7
Chapter Two: Clues to Anxiety
Chapter Three: Identifying the Five “Prime Suspects”
Chapter Four: Prime Suspect #1: Rigidity
Chapter Five: Prime Suspect #2: Sensory Sensitivities
Chapter Six: Prime Suspect #3: Social Challenges
Chapter Seven: Prime Suspect #4: Communication Barriers
Chapter Eight: Prime Suspect #5: Task Frustration
Chapter Nine: Coping Skills for Body and Mind
Chapter Ten: The Five Prime Suspects at School
Chapter Eleven: Embracing Strengths
Chapter Twelve: Coping 24/7