Anxiety is a word that is often associated with individuals on the autism spectrum. If one looks up the word anxiety in the dictionary, you will find many definitions, all relating to an intense feeling of uneasiness or fear in response to a real or imagined threat. For anyone who has witnessed or experienced an anxiety or panic attack, that definition lacks the potency and impact that an actual anxiety or panic attack creates. After recently supporting a loved one through episodes of panic and intense anxiety attacks, I began to pay more attention to the word anxiety or anxious when they were used in conjunction with a student with an autism spectrum disorder (ASD). For years I’ve witnessed these words used to describe the people I was supporting. I know now I had not given the descriptors anxiety/anxious enough attention. I now view scenarios through new lens. As I witnessed my loved one go from being an intelligent, verbal, physically capable person, to one who could barely utter a word, control her crying, body movements, and her real or imagined fear, I realized that anxiety is all encompassing and can paralyze anyone in an instant. It was also apparent that simply saying, “You are okay and you don’t need to worry” was never enough. The anxiety and panic was a more powerful emotion than simple words could eliminate. It was frightening, frustrating, horrifying, and sad to witness and experience. Both my loved one and I felt completely out of control and helpless to stop the eruption of emotions and behaviors.
It took time, but once the panic and anxiety were under control and life was beginning to get back to some state of normalcy, I began to think about how many times anxiety appeared in the IEPs of students with ASD and wondered how often is it truly addressed? As I had witnessed and experienced firsthand, anxiety and panic are debilitating, to even the most capable person.
According to the Anxiety Disorder Association of America (ADAA), anxiety disorders affect 40 million US adults age 18 and older and affects one in eight children. Anxiety disorders have the potential to impact many people on the autism spectrum. “Once a general anxiety disorder develops, it tends to become chronic (Autism Help)” and will interfere with how the individual functions at home, school, or in other activities of daily living. Reassurance and comfort are not enough to calm the fears.
Dr. Tony Attwood has states that “Autism is anxiety looking for a target. Autism and anxiety go hand-in-hand. Autism affects a person’s ability to communicate with others or to understand the world around him, and that’s bound to cause anxiety (Evans, 2006)”. The numbers of individuals with ASD who experience anxiety may be as high as 80% according to Eric Storch, PhD, associate professor of pediatrics and psychiatry at University of South Florida Health (Nauert, 2009). Anxiety attacks trigger distress and impairment over and above that caused by an autism diagnosis alone he continued. Anxiety can affect adults with ASD as well as children and adolescents (Autism Help). These statements would indicate teachers and parents who support someone with ASD are very likely to also provide support to someone who experiences anxiety. As anxiety becomes more prevalent among people with ASD, those who provide support must have a general knowledge about anxiety, what symptoms to look for, and what might help when anxiety overwhelms someone.
This article discusses the following topics (click on the links below to access).
- Anxiety: What an Individual May Be Experiencing or Feeling
- What Triggers Anxiety for an Individual with ASD
- Providing Support
- Classroom Ideas to Reduce Anxiety
- Treatment Options
It is critical to realize that when someone is anxious, talking at them can increase their anxiety and behaviors. More visual, less verbal is a good rule of thumb. Both home and school could have small white boards available that can be used to write simple and concrete messages to the individual, such as, you are safe no one will hurt you or take slow deep breaths instead of merely talking to the person. The written message is there for them to see as they need it. Often, teachers and parents can exacerbate an anxious moment by pushing too hard for immediate relaxing of the body or verbal responses from the student. Be quiet, reassuring, nonconfrontational, and calm each time you are needed to support an anxious student. Remember that the individual is not thinking clearly and you will have to become their rational, calm support. “That means that you might sit near them, not demand any eye contact, be genuine in your caring and reflect that caring in your vocal tone and pace. Be sure to allow for processing time and when appropriate use a bit of humor to ease the pain (Page, 2009)."
Anxiety and panic are real and a person cannot simply relax or snap out of it on command. The fears encompass the person completely. They need compassion, patience, reassurance, and true care from family, friends, teachers, therapists, or staff people who are in their lives. Because someone has ASD does not make the anxiety or panic any less real to them. For them, due to the impact of their ASD (difficulty understanding abstract ideas or feelings), the anxiety and panic might become greater. Support people must begin to pay closer attention to the words anxiety, anxious, panic, etc. when they appear in reports or IEPs. They are not just words. They indicate real emotions that impact a person completely and can inhibit them from performing even simple tasks. In fact, the anxiety or panic may be more debilitating than their ASD. It is up to those who support individuals with ASD to be aware of anxiety and panic struggles and more important learn the best ways to provide the type of support that is truly helpful and allows the person to move through the fears and trust that they are safe and in good hands.
References and Resources
1. Anxiety Disorders Association of America (https://www.adaa.org)
2. Bellini, S. (2004) “Living in fear: Anxiety in adolescents with autism spectrum disorder”. The Reporter, 9 (3), 1-2.
3. Edington, Chuck, PhD. “Emotional Regulation and Anxiety Management in Autism” . Presentation at Oklahoma Autism Network, Autism Toolkit Series: Life 1st! September 7, 2010. Accessed July, 2011.
4. Evans, Rachel. “Autism Anxiety Overload”. https://ezinearticles.com/ November 27, 2006. Accessed July 2011, https://ezinearticles.com/?Autism-Anxiety-Overload&id=369821.
5. Nauert, Rick. Behaviorial Therapy for Anxiety with Autism. https://psychcentral.com/, October, 2009.
6. Nelson, Dave. “Autism and Anxiety”. April 15, 2008.
7. “Anxiety and Autism” (July 22, 2009). Page, Louise.
8. “General Anxiety Disorder”. June, 2011. http://www.autism-help.org/comorbid-general-anxiety-disorder.htm (reproduced with permission from a range of fact sheets available at http://www.autism-help.org).
9. “Anger & Autism Spectrum Disorders. http://www.autism-help.org/index.htm. 2008. Accessed July, 2011. http://www.autism-help.org/adults-aspergers-anger.htm. (Reproduced with permission from a range of fact sheets available at http://www.autism-help.org).
10, “Anxiety in Adults with an Autism Spectrum Disorder”. https://www.autism.org.uk/. 2010.
11. National Institute for Mental Health website for Anxiety disorders: https://www.nimh.nih.gov/topics/topic-page-anxiety-disorders.shtml.
12. “Interview with June Groden”. (November 1996). Autism Research Institute. https://www.autism.org/treatment/stress-anxiety-reduction/.
13. Panic Attacks and Autism Spectrum Disorder”. (2008). Autism Help. Accessed June, 2011 http://www.autism-help.org/adults-panic-attacks.htm. ("Reproduced with permission from a range of fact sheets available at http://www.autism-help.org").
14. “Sample Accommodations for Anxious Kids” (2009). The Children’s Center for OCD and Anxiety. Accessed February 29, 2012. http://www.worrywisekids.org/node/40.
15. Stress and Coping in Autism (2006). Edited by M Grace Baron, June Groden, Gerald Groden, & Lewis P. Lipsitt. Oxford University Press, NY. NY.
Additional Resources
Autism Society of America: (https://www.autism-society.org/).
Kim, Joseph A., Szatmari, P., Bryson, S.E., Streiner, D.L., Wilson, F.J. (June 2000) “The Prevalence of Anxiety and Mood Problems among Children with Autism and Asperger Syndrome”. Autism, vol. 4, 2: pp. 117-132.
Rudy, Lisa Jo. “Mood Disorders and Asperger Syndrome”. Updated December 06, 2019. https://www.verywellhealth.com/mood-disorders-and-asperger-syndrome-259943.
Rudy, Lisa Jo. Autism. “Anxiety and Nightmares”. Updated April 28, 2019. https://www.verywellhealth.com/autism-anxiety-and-nightmares-260202.
“Stress and Autism Spectrum Disorders”. http://www.autism-help.org/index.htm. 2008. Accessed June, 2011. http://www.autism-help.org/adults-aspergers-stress.htm ("reproduced with permission from a range of fact sheets available at http://www.autism-help.org")
Davis, K (2012) Anxiety and panic struggles. Retrieved from Anxiety and panic struggles.