ASD and Anxiety
March 6, 2018
By: The Psychology Department
Dr. Lindsay Fletcher, Dr. Nicole Benson, and Dr. Julie Henzel
Anxiety disorders commonly occur in individuals with Autism Spectrum Disorders (ASD). Research suggests that about 40% of individuals with ASD also qualify for a separate anxiety diagnosis (Van Steensel, Bogels, & Perrin, 2011), although studies have found rates ranging from 11-84% (White, Oswald, Ollendick, & Scahill, 2009). The most commonly diagnosed anxiety disorders in individuals with ASD are specific phobia, (a fear of a certain object, place, or situation), followed by obsessive-compulsive disorder (repetitive and obsessive behaviors), and social anxiety (fear of social interactions).
It can be challenging to determine an additional diagnosis of anxiety in children with ASD. For example, social deficits and restricted/repetitive behaviors inherent to autism can make simple activities such as interacting with others, leaving the house, riding in a car, breaking away from preferred activities, or trying a new activity naturally more anxiety provoking. Anxiety symptoms are particularly challenging to discern in nonverbal children or those with more severe autism symptoms. Additionally, even verbal children with ASD tend to have difficulties articulating their anxieties.
If you are concerned that your child may be struggling with anxiety, it’s helpful to consider whether there are specific triggers to their behavior, how long these behaviors have been present, and if these behaviors differ from their normal baseline behaviors. Also, one should consider whether there have been any changes or stressors in the individual’s life. It’s important to be mindful that your child may be more sensitive to triggers such as school breaks, a change in a parent’s work schedule, or a change in babysitters or teachers. You may see some signs of anxiety such as the following:
- Physical symptoms such as a racing heart, muscle tensions, stomach ache, headache
- Increases in irritability, temper tantrums, oppositional behavior, or aggressive behaviors
- Increased difficulty going to sleep and/or staying asleep
- Increased repetitive behaviors (e.g., child is lining up more objects or stimming more frequently than usual)
- Spending inordinate amounts of time engaged in repetitive routines and becoming highly
distressed when repetitive routines are interrupted
- Difficulty moving forward with activities when hit with setbacks
- Regression in life skills/more dependence on adults
- Increase in self-injury
- More resistance in joining social situations, going to school, or going on community outings
- Increased clinging to caretakers or separation difficulties
How to Help:
As mentioned, many individuals with autism naturally experience higher levels of anxiety. Many children (and most people in general) can benefit from developing coping strategies regardless of whether or not a formal anxiety disorder diagnosis is present. These are some techniques that may help:
- Build your child’s “feeling word” vocabulary and help him or her to identify triggers to their feelings. The better they can communicate their feelings, the more likely they will be able to seek help and be able to work through anxiety-provoking situations. It may be helpful to post a feelings face poster in your house. (Example: https://smile.amazon.com/Feelings-Mood-Magnet-Today-Feel/dp/B004H61CWS/ref=sr_1_1?ie=UTF8&qid=1516213604&sr=8-1&keywords=feeling+face+chart).
- Utilize visual strategies such as visual schedules or posting events on a calendar to help your child know what to expect next.
- Review schedules and expectations for the day.
- Plan regular outings for your child to practice social and community living skills
- Social stories can be developed to help teach and reinforce coping skills or to address specific anxiety triggers.
- Develop relaxation techniques such as deep breathing, slowly counting to 10, or taking a break in a quiet area. These techniques are always more powerful if you do them along with your child.
- Help your child develop self-talk to work through stressful situations. Having functional, go-to phrases such as, “Everyone makes mistakes, I can try again next time!” can be helpful for many children.
- Have your child expend nervous energy through physical activities such as jumping on a trampoline, dancing, or running laps around the yard.
- Model healthy coping behaviors to stressful situations. It is okay to share bits and pieces of your daily challenges and how you coped with them (as long as the situations are developmentally appropriate for your child to hear).
- Teach any functional skills that may be lacking, such as how to find a different playmate if someone doesn’t want to play or how to ask for help.
- Cognitive behavioral therapy (a counseling approach that teaches the relationships between thoughts, feelings, and behaviors) has been shown to be helpful for verbal individuals with ASD.
- Practice, practice, practice! A natural response is to avoid anxiety-provoking situations or shield your child from these experiences. However, it’s important for them to have opportunities to work through their anxieties and practice their coping skills.
- Medications can be helpful in some cases; please consult your child’s physician to learn more about this area.
If you have concerns about your child’s behavior or level of anxiety, the Bridgeway Academy psychologists and Program Directors/Managers are here to help! Additionally, we encourage you to reach out to your child’s pediatrician if you have concerns.
- Van Steensel, Bogels, & Perrin, 2011: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3162631/
- White, Oswald, Ollendick, & Scahill, 2009:
- Anxiety and Autism Spectrum Disorders: https://www.iidc.indiana.edu/pages/anxiety-and-autism-spectrum-disorders