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The holiday season is just around the corner, and you can feel the excitement in the air! For most of us, the lights, glitter, family gatherings, shopping, and travel are all thrilling this time of year. When you are a parent of a child with an Autism Spectrum Disorder, all of these thrilling experiences can also be a major cause of stress. All of the extra sensory stimulation, as well as the changes in schedule and routine, might become a significant source of anxiety for your child, causing him or her to become overwhelmed. So, in an effort to lower the stress level for you, your child, and the rest of your family, we decided to put together some proactive suggestions that will hopefully help all of you to enjoy this magical time of year.
Keep a routine. Since change is difficult for many children with ASD, try to maintain routines and stick to schedules (as much as possible). Use a visual timer (we are fans of the Time-Timer, as children can actually “see” the time passing without any anxiety-causing sound) and give a “First…Then” chart a try!
Prepare, prepare, prepare! Help your child understand what will occur BEFORE it happens with a social story (write your own or choose from those readily available online). Construct a calendar that visually represents when events will occur and refer to it often. If you are hosting (or planning on attending) a large family gathering to celebrate the holiday season, prepare a mini photo album that includes pictures of all those who will be in attendance and their names (review it with your child prior to the event). If you are celebrating locally, it might be helpful to plan a brief visit ahead of time, or plan to arrive before the other guests, to allow your child to become familiar with and comfortable in the environment.
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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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