anxiety and ASD

Monthly Milestones | October 2018

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Ask the Expert – Cognitive Behavioral Therapy 101

It is not uncommon that a diagnosis of autism spectrum disorder (ASD) is accompanied by the presence of another mental health disorder. Most often, a comorbid diagnosis of an anxiety disorder or attention-deficit/hyperactivity disorder (ADHD) is present. Signs/symptoms of anxiety that may be displayed include: worried thoughts about performance, social interactions, and/or situation-specific concerns or fears. Hallmark features of ADHD include: difficulty sustaining attention, staying on-task and seated, and waiting one’s turn.

Research-supported interventions for the treatment of anxiety disorders include behavioral therapy and cognitive-behavioral therapy (CBT). Behavioral therapy may be chosen over CBT when the child is young, autism severity is greater, or the nature of the anxiety is fear-based or situationally-based in which exposure to the feared situation (for example: weather, toilets, or public speaking) is the most effective intervention. Behavioral intervention also may be favored over CBT due to challenges with perspective-taking that may interfere with being able to identify errors in thinking and challenging distorted thoughts.
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Ask the Expert: Heather Dukes-Murray, PhD

Anxiety, Autism, and Interventions: Playing to One’s Strengths and Supports

Anxiety can be a part of daily life for many individuals with autism. Rates of clinically significant comorbid anxiety in autism have varied widely, with some estimates as high as 40%. Regardless of verbal abilities, cognitive abilities, or developmental level, signs of anxiety present similarly. Stress reactions termed “Fight, Flight, or Freeze” are common. “Fight” can look like irritability, meltdowns, explosions, aggression, or yelling. “Flight” can look like leaving a situation, eloping, or refusing to go to a stressful environment. “Freeze” can look like non-responding, putting one’s head down, or ignoring others. All of these are signs of high anxiety. Cognitive Behavioral Therapy (CBT) is one of the most effective therapeutic techniques to reduce anxiety. However, CBT can be a verbal-heavy, somewhat abstract intervention. It is important to identify your child’s learning strengths and weaknesses, then adapt the CBT techniques to fit your child.

Know triggers (and make sure your child and those involved with your child know them too!) – For a week, document when your child demonstrates anxiety symptoms, what happened before and during, what you and your child each did. Look for patterns and minimize anxiety triggers. Ideally, work with your child and their therapist to make a plan to overcome the anxiety associated with that trigger. For example, if your child is anxious in social situations and large groups are a trigger, work with a therapist to build a plan to engage in increasingly social situations while practicing coping skills. Diffusing a trigger is empowering and helps build confidence to take on other anxiety triggers.
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