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Anxiety and autism

Autistic and neurodivergent children in general often display anxiety because the world around them can be a very overwhelming and hard to understand place. They have difficulty understanding social interactions, reading facial expressions and gestures of others and might get overstimulated by environmental stimuli that neurotypical people barely notice (e.g. a child can’t concentrate at school because he can hear a lawn mower in the background or is disrupted by a flashing light in the hallway). Their differences in nonverbal communication (stimming, looking elsewhere when talking to you) might be misinterpreted by neurotypical people. Autistic children find security and comfort in routines as the world in general can be otherwise quite confusing and overwhelming.

Older children might be able to identify that they feel anxious and can ask for help. In younger children, however, their distress is usually communicated via challenging behaviour or having a meltdown. We believe that all children would do well if they could. When they display defiance, there is typically a lagging skill, sensory overwhelm or other underlying issue that needs to be addressed rather than just responding to the behaviour.

Below is a list of strategies that you might find helpful in managing your child’s anxiety:

  • Depending on your child’s age, either ask them what causes their anxiety or observe carefully and try to identify all possible triggers. Please note that children need to feel supported, their feelings need to be validated and only when this occurs, they are able to calm down and use self-regulating strategies.

  • Together with your child draw faces reflecting above described feelings next to the numbers. Some children might benefit from using only colours instead of numbers. It is beneficial to discuss with your child situations when they felt like 1, 2,3, 4 and 5 and write it down next to the numbers/faces so that they have a clear picture of the meaning of individual feelings and numbers.

  • Use the rating chart on a daily basis so that your child familiarises themselves with the feelings/numbers or colours. For example, you could ask your child how they are feeling right now or you can say something like, “I see you are feeling 3 right now, you are frustrated because your sister keeps making fun of you even after you told her to stop.”

  • Together with your child, identify strategies that can help them alleviate their anxiety and stress. Strategies can include calming and relaxing activities such as

• 3 slow deep breaths

• if overstimulated, use accommodation strategies such as headphones, weighted blanket, spending time in a "safe tent"

• hug with a safe person

• imagining being in their favourite place,

• playing with favourite toys,

• thinking about times they managed their anxiety well,

• thinking about things that make them happy,

• thinking about what they are good at

Or if your child is more physically active, they might benefit from

• stomping their feet, running on a spot,

• jumping on a trampoline,

• tearing old newspaper in a bin,

• punching a pillow,

• screaming in a pillow.

  • Coping strategies should be displayed on a wall or fridge as a constant reminder of what to do when feeling anxious or angry. Best practice is to draw pictures of individual strategies because picture is worth a thousand words!

  • Scenarios of what can happen (or happened), how that might make your child feel (and how others feel and what they might think) and how to soothe themselves should be role played and practised daily when your child is in a good mood and receptive. Your child will be able to learn new strategies and behaviours only when they are not distressed. When people are distressed, they react in the flight-fight-freeze mode and are not receptive to learning new approaches.

  • Autistic children often experience difficulty navigating social situations with neurotypical people. It is important for parents to respond to their neurodivergent child with empathy and understanding and wonder what their child need at the very moment. Autistic children might play differently (lining up toys, organising textas based on colour codes etc.) and it is important for them to feel okay and validated rather than asked to change.

  • Your autistic child might benefit from being warned about and prepared for upcoming changes such as different teacher next week, no swimming lesson etc, however, some children tend to worry excessively about the change until it actually eventuates.

  • There is some ambivalence around the use or external rewards such as stickers when children face their fears or do chores, but I still believe that if paired with love and care, any child is more willing to do anxiety provoking acts when their efforts are celebrated with tangible items. Being rewarded for trying suggested coping strategies will lead to implementing them more often. Even us adults choose to do things that we get rewarded for over the ones that do not yield any monetary or social reward. And children will put more effort into trying tricky and new behaviours when they see there’s appreciation of their efforts. 

  • With older children, cognitive behavioural therapy (CBT) has been recognised as an evidence-based intervention that improves the well-being of children who are highly anxious. For further details on CBT intervention please contact the practice. Furthermore, if your child experienced invalidations and rejections due to their neurodivergence, EMDR therapy together with child focused parent work might be a helpful way of addressing their anxiety or other well-being concerns.

  • Free online CBT program for children and their parents can be accessed here

  • Please remember, that children will not learn how to regulate their big feelings if they are not co-regulated by an adult with a calm brain first :-)

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