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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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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Anxiety can be challenging for anyone to experience – it can keep you from doing the things you love, meeting new people, or often from pursuing new goals. Now imagine these typical hardships being paired with sensory challenges. Self-advocate, Raven Pressor, shares her first-hand perspective of experiencing anxiety alongside ASD and shares some advice on how to support individuals like herself dealing with this common comorbidity.
Raven, thanks so much for speaking about this personal topic. Can you tell us a little bit about yourself?
I’m Raven and I’m 36 years old. I live with my parents, and my hobbies include video games, crochet, knitting, reading, and spending time with my cat and two geckos. I have ASD and anxiety, and was not diagnosed with ASD until I was about 24 years old.
How would you describe the feeling of clinical anxiety to someone who has never experienced it?
For me, it first feels like I’m a little shaky and edgy. It can escalate into a queasy stomach, racing heart, tight throat that makes it feel hard to breathe, lightheadness or dizziness, and a weird tingly feeling in my face and hands. These symptoms occur during a full-blown panic attack. There are also emotional symptoms too, like an intense desire to return home if I’m out (a fight or flight response) and generally afterwards, some amount of shame at the loss of control.
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As I consider making goals, whether for the whole year of 2018 or just for upcoming situations I know will be challenging, I utilize a pattern I learned in my first semester of college. This strategy may be familiar to you too. It’s called making “SMART” goals, which is an acronym that stands for specific, measurable, attainable, realistic, and timely.
Using this strategy has helped me find success in areas where I truly want to make changes or grow personally. In the past when I was not realistic, I would make goals that were far too grandiose which resulted in my giving up easily, and being unable to actually see any progress. Now I concentrate on smaller but attainable changes, and once I reach them I push the goals out further. I also set only one or two goals at a time in order to keep my focus.
For example, I struggle with asking repetitive, anxiety-provoked questions of others. Instead of setting a goal like, “I will stop asking repetitive questions,” I set a SMART goal. Applying the SMART strategy to the goal would look like this:
S (specific): I will reduce my repetitive, anxiety-provoked questions at home. I will enlist the help of a family member to give me cues when needed and keep me accountable to my goal. I will reduce the questions to two times each.
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