Autism and Anxiety-continued

Anxiety is such an innate part of autism and much of the behavior exhibited by individuals with autism is directly related to anxiety. I wish I knew that years ago when I was first working with kids with autism.  Because kids with autism are anxious! Unfortunately, teachers and adults working with these kids just don’t recognize that anxiety. We see the behaviors they exhibit, and react to their behaviors instead of the underlying anxiety which causes their behavior.

Kids with autism don’t understand their feelings of anxiety and don’t even know how to explain how they feel to adults-even parents.  Even if they know enough to explain it, they likely don’t have the specific language to describe exactly what’s going on with their minds and bodies. They just know that they feel bad and upset, and usually don’t even have the words to say what is upsetting them.

Most of us as adults can usually recognize our own anxiety, and we may even know why we feel anxious. But that’s not typically true of kids with autism. I’ve often said that individuals with ASD need to be able to recognize their feelings of anxiety and identify what causes them to be anxious in order to manage their anxiety. We can’t manage what we don’t understand. But unfortunately, I think this is a long, on-going process, which probably takes years, along with much maturity, experience and self-awareness.

With kids with ASD, it’s up to us as teachers, therapists and parents to recognize their anxiety, identify what causes it, and help these kids understand and learn to manage their anxiety, to the best of their ability. In the meantime, we adults need to recognize and manage their anxiety for them.

When I look back on the students with autism that I worked with, I can now see their anxiety and subsequent behavior, often out of control behavior, with a clearer, non-judgmental  eye.  In the moment, we adults typically react to bad, aggressive behavior, thinking only of stopping or controlling the behavior.  We often assume their behavior is a result of task avoidance, temper tantrums over changes or not getting what they want. We don’t usually see the overwhelming anxiety that initiates the behavior.

I once had a student who lashed out at anyone who got too close to him. He would hit with lightning speed and great force, hurting adults and students alike. Needless to say, it was difficult to work  with him. Adults at school didn’t like this student because of his behavior, and would get angry when he attacked people around him-for seemingly no reason.  What we didn’t see was how scared and anxious this boy was all the time.  He had a difficult time understanding what was going on around him. He was easily overwhelmed and didn’t even have the language or speech capability to tell us he was upset.  Instead of attempting to calm him down and explain things in a way he’d understand, he was punished and isolated.  This was a great disservice to this student, and I’m sad to say the story doesn’t have a happy ending.  When this student got older and stronger, and more out of control, public education could no longer deal with him.  He was eventually sent to a residential placement where he was heavily medicated.

This is not an unusual situation. Many kids with ASD, especially those who are at the lower end of the spectrum and have poor cognitive and language skills, end up in residential placements due to out-of-control behavior.  As adults, we need to take a serious look at the anxiety that drives the behavior of these kids.  Because I’m now convinced these kids all have fear and anxiety.  And overwhelming, sensory-filled situations, with added confusion and poor understanding of what’s going on, only causes their anxiety to hit the roof! And then we see out-of-control behaviors. I now know that my students with ASD love school, love the structure, and all want to do a good job. But their sensory integration issues, confusion, and language difficulties just add to their anxiety and prevent them from doing their best in school.

Anxiety in children with ASD can include many different behaviors. learn to recognize the anxieties of your students and children. Here are some:

  • looking anxious, fearful, worried or stressed
  • increased self-stimulation-frequency, intensity, and duration(i.e from subtle rocking to frantic, fast rocking)
  • a change in their self-stimulation, such as a self-stim behavior you haven’t seen before or typically don’t see
  • attempts to block out sensory (i.e: covering their ears, closing eyes, verbalizing or vocalizing loudly)
  • shutting down and not responding at all
  • increased echolalia, including reciting movie scripts
  • increased refusals, negative responses, including negative echolalia, often spoken with agitation
  • attempts to escape the environment, or hide
  • extreme focus on an activity(as if to block everything else out) and not responding to others
  • covering themselves up with blankets, pillows, a jacket or anything
  • walking around in circles, walking aimlessly
  • not letting anyone get near them
  • screaming/yelling or talking loudly
  • self-injurious behavior, including picking at scabs, fingers or pulling out hair
  • aggression toward others or objects

We need to explain to our children and students with ASD just what anxiety is and work with them to figure out what causes them to be extremely anxious.  We need to help them understand that there are ways to decrease anxiety and feel better. We need to start teaching them self-calming strategies from the time they are young in order that they will continue to learn to manage their anxiety as they get older.

Next time I will talk about ways to manage anxiety for people (young and old) who have ASD. Managing anxiety and behavior is the key to helping people with ASD get out of their comfort zone, make friends, learn new things and be successful in the world.

I’d love to hear about your experiences with anxiety and how you have dealt with anxiety when it happens to your children or students. And I’d love to read your comments about my blogs.

Until next time,


Autism and Anxiety

Anxiety and Autism

People with ASD always have some level of anxiety-period. It’s part of the condition of autism.  Some people will say that it’s the cause of many of the behavior problems associated with autism. When you add confusion, over sensory stimulation, fear, negative thoughts and an inability to respond appropriately to a problem situation, that level of anxiety is going to hit the roof.  This is often what happens to people with autism.  Fear and anxiety and the inability to problem solve causes them to freak-out and do irrational things.  Anxiety limits what people with autism will attempt to do in their lives, including job opportunities, new relationships, exploring their community and trying new things.

There’s a reason people with autism like routine and predictable situations, and why they hate change and anything they can’t control.  Change and unpredictability can cause fear and anxiety. And most people with ASD are battling anxiety constantly-especially when they are outside of their comfort zone and interacting with others. As a result, many adults with autism are trapped in their own homes because they would rather stay in a safe place than attempt going out and dealing with their anxiety. Temple Grandin once said at a conference I attended that she takes medication for anxiety and won’t step out of her home without her taking her meds.  That says a lot for what adults with autism are dealing with, and most of the adults with ASD that I know take some form of medication to relieve the anxiety in their lives.

Unfortunately, anxiety doesn’t just go away and stay away.  People who suffer from anxiety and panic attacks need to learn how to control them effectively.  Sometimes that requires medication, which we know many children and adults with ASD take on a regular basis.  But medication isn’t always effective and furthermore, all medication has side effects.  Although it helps, medication alone is usually not the answer when battling anxiety.  People with autism need to recognize what causes their anxiety and learn to control it, or at least manage it to the best of their ability.  That takes self-examination, acceptance and practice.

Later this week I’ll talk about ways to recognize anxiety and determine what causes anxiety for an individual.  And then I’ll talk about ways to manage/control your anxiety. Anxiety won’t go away, and if not managed it can lead to depression. More on all that later.

Until then, stay positive!