Anxiety is a feeling of fear or worry when we think that something may go wrong. Most people experience it when rushing to catch a train or before exams or interviews. We also experience it when meeting people for the first time because we worry about what the other person may think about us. We feel anxiety in our mind and body \u2013 our heart rate goes up and we may feel sweaty, and we find it hard to concentrate or listen to others. Sometimes, anxiety drives us to do things that we need to do. We look at its positive side and accept it as a part of life.<\/span><\/p>\n For some people, anxiety is either too frequent or too intense; it arises for no reason or an imaginary reason, and it is hard to be rid of. It may interfere with day-to-day life, for example, making it hard to leave the house, to start a new activity or meet other people. It may also interfere with attention and learning and may make them fidgety, irritable and upset.<\/span><\/p>\n Anxiety or fears are common in children; they are commoner in children with autism (affecting about 40%). Anxiety in children shows itself somewhat differently than in adults:<\/span><\/p>\n Social anxiety, provoked when one has to meet another person or people, is the commonest form of anxiety in autism (29%); general anxiety about minor things, such as a fear of dogs, crossing the road or shifting from one activity to another, is also common (13%). In addition, some children have panic disorder (10%), and others have some specific fears, for example, agoraphobia \u2013 when the person feels trapped and fearful in a situation as in open spaces, shopping malls, train carriages, and wants to escape.<\/span><\/p>\n In some children with autism, anxiety gets worse with age. Adolescents with high functioning or milder forms of ASD may first come to notice of teachers or parents because of their fears and anxiety.<\/span><\/p>\n Sensory processing helps us pick out the most relevant information and make sense of the whole situation when only some of the information is available, such as guessing the object when we can only see a part of it or filling in missing words in a sentence. This failure of making sense of the situation becomes a source of uncertainty and ongoing anxiety.<\/span><\/p>\n We all have feelings, often provoked by a thought or memory, or seeing or hearing something. When we become aware of our feelings and emotions \u2013 being worried, angry, happy, rushed, or just bored then we do something to manage our feelings \u2013 by thinking this will pass, it is not a big deal, or we can sort it out later \u2013 or we act on our feelings \u2013 talk to someone or do something. This is how we maintain our mental balance. In autism, the feelings are often confused and chaotic, making it hard for people with autism to express or manage or act on their feelings. This creates a few problems for the person: \u00a0a. they may become anxious or fearful of not knowing what is going on, b. it becomes hard for them to take the right action, c. their actions or behaviour are not helpful for them and may cause further problems, and d. they may suppress or bottle up their feelings leading to a build-up which explodes when it becomes too much.<\/span><\/p>\n Uncertainty is not knowing about a situation or a person or an object:<\/span><\/p>\n While uncertainty is hard for everyone, it is particularly upsetting and distressing for people with autism. To avoid being upset, they might try to avoid the situation or work too hard to prepare for it, like gathering too much information or endlessly seeking assurance, repeatedly asking questions or ruminating, reading up or preparing for something that is relatively rather a minor issue. it may also make them highly anxious particularly if they have difficulty in managing their emotions and feelings. It may affect their thinking, make them more hostile, or cause physical symptoms such as excessive sweating, feeling hot or shaky or increased heart rate.<\/span><\/p>\n We all become stressed and anxious \u2013 that is life! However, to carry on, we need some downtime \u2013 some time to relax and wind down. We have our preferred way of doing it that we have learnt over some time, and it works for us; some people are better at relaxing and recharging, and they seem to be better able to cope with the stresses and demands of life. It is hard for people with autism to know when to relax and how to relax. But, if they are given a structure to recognise their stress and are helped to practice some relaxing methods, they too can learn it.\u00a0<\/span><\/p>\n Most people become anxious when facing uncertainty. Even for children who become anxious easily, some situations act as triggers or starting points for anxiety:<\/span><\/p>\n For example, there can be two types of warning about a fire alarm:<\/span><\/p>\n and:<\/p>\n <\/p>\n <\/p>\n The colourful \u2018Zones of regulation\u2019 can also help a child label the intensity of how distressed, anxious, or upset they are.<\/p>\n Once they have used rating and labelling, they can communicate their emotions to others and learn how to manage them. Recognising and labelling is the first step in managing emotions.<\/span><\/p>\n Look at \u2018Helping children\u2019s emotional regulation\u2019 to find out more.<\/span><\/p>\n Many children with autism, who are hypersensitive \u2013 are distressed by light, noise or other sensations – benefit from reducing sensory input by using simple methods such as dark glasses or headphones. In contrast, others who have decreased sensitivities and seek sensations can benefit from giving them opportunities to do fun activities that involve visual, touch, sound or movement sensations.<\/span><\/p>\n Look at \u2018Helping Children with Sensory Processing Difficulties\u2019 to make the right programme for the child.<\/span><\/p>\n A step-by-step plan to gradually expose the child to a feared situation can help overcome a specific fear. The successful completion of each step is praised, and the next step is built on the previous one. For example, a plan to reduce the fear of dogs may look like this:<\/span><\/p>\n A vicious cycle of negative thoughts (\u201csomething wrong with me\u201d, \u201cIt is going to get worse\u201d) creates a sense of fear, and physical feelings (feeling shaky and sweaty). Breaking this vicious cycle is helped by using a mindful approach as the one described below:<\/span><\/p>\n Some useful strategies are:<\/span><\/p>\n Practice some simple activities such as lying down to the count of 10 or breathing deeply ten times, squeezing a squeezy ball, listening to music, looking at their favourite picture book or using a sensory activity.<\/span><\/p>\n Don\u2019t wait for the child to get stressed before practising these activities, rather make them part of some of the routines you do with your child every day. \u00a0 Give the activity a one or two-word name, such as \u2018airtime\u2019, \u2018sleeping lion\u2019 or \u2018squeezy ball\u2019, and make a symbol for the activity. First, show the child that symbol, then say its name and then do the relaxing activity\u2014model, prompt, and reward. Once the child has practised a particular relaxing activity quite a few times, you\u2019ll show the child the symbol or say its name whenever the child is stressed or upset, and the child may then be able to relax when they need to relax. Practice a few of these activities regularly, and then you will be able to choose the right one at the right time. If you haven\u2019t practised it before, you won\u2019t be able to use it when you need to.<\/span><\/p>\n Children often become anxious in school, and it adversely affects their learning and behaviour. Work with the school to apply the above tips. Maintain good communication. Watch out for any bullying of the child at the school.<\/span><\/p>\n An Evidence-Based Guide to Anxiety in Autism. Gaigg SB, Crawford J, Cottell H (2018). https:\/\/www.city.ac.uk\/news\/2019\/april\/new-guide-help-manage-anxiety-autism<\/a><\/p>\n Children and young people with anxiety: a guide for parents and carers. www.anxietyuk.org.uk<\/a><\/p>\n Dr Ann Ozsivadjian, Principal Clinical Psychologist, Independent Practice and Evelina London, Children\u2019s Hospital. Talk on a course.<\/p>\n <\/p>\n <\/p>","protected":false},"excerpt":{"rendered":"\n
Types of anxiety problems:<\/strong><\/h2>\n
What causes anxiety in autism \u2013 Five factors that contribute to anxiety in autism:<\/strong><\/h2>\n
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Cognitive rigidity: a difficulty in shifting from an idea<\/h3>\n<\/li>\n<\/ol>\n
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Sensory processing difficulties<\/h3>\n<\/li>\n<\/ol>\n
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Difficulty in feeling, recognising, and expressing emotions (alexithymia)<\/h3>\n<\/li>\n<\/ol>\n
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Intolerance of uncertainty:<\/h3>\n<\/li>\n<\/ol>\n
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Not knowing how to relax and be calm<\/h3>\n<\/li>\n<\/ol>\n
\u00a0<\/strong>Triggers for anxiety<\/strong><\/h2>\n
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Assessing anxiety<\/strong><\/h2>\n
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\u00a0But, not everything is anxiety!<\/strong><\/h2>\n
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Seven ways of helping an anxious child<\/strong><\/h2>\n
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Preventing anxiety\u00a0\u2013 prevention is the best approach<\/strong><\/h3>\n<\/li>\n<\/ol>\n
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Help the child get better at recognising and communicating emotions<\/strong><\/h3>\n<\/li>\n<\/ol>\n
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<\/p>\n3. Giving the right sensory experiences <\/strong><\/h3>\n
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<\/p>\n4. Supported gradual exposure to a feared situation<\/strong><\/h3>\n
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Getting better at dealing with uncertain situations<\/strong><\/h3>\n<\/li>\n<\/ol>\n
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Getting better at dealing with a new demand or situation by preparing and by practising in a supportive environment<\/strong><\/h3>\n<\/li>\n<\/ol>\n
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Help the child learn to relax and be calm<\/strong><\/h3>\n<\/li>\n<\/ol>\n
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Working with the school<\/strong><\/h3>\n
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Sources\/references<\/strong><\/h3>\n