Managing anxiety in children with autism spectrum disorder
Anxiety is a normal part of children’s development, but children with autism spectrum disorder (ASD) can experience anxiety more intensely and more often than other children. It can help to get your child to notice anxious feelings and use strategies for managing anxiety.
Children with autism spectrum disorder (ASD) feel many of the same worries and fears as other children.
But when children with ASD get worried or anxious, the way they show their anxiety can look a lot like common characteristics of ASD – stimming, obsessive and ritualistic behaviour and resistance to changes in routine.
How anxiety affects children with autism spectrum disorder
The world can be a confusing place for children with autism spectrum disorder (ASD).
They might find social or unfamiliar situations overwhelming and hard to understand. They often have difficulty working out what another person might be thinking or feeling, or how that person might react. As a result, people and situations can seem unpredictable, which can make children feel stressed and anxious.
On top of that, children with ASD, especially younger children, might have trouble telling you if they’re feeling anxious. Instead, you might notice an increase in challenging behaviour. So your anxious child might:
insist even more on routine and sameness
have more trouble sleeping
have meltdowns or temper tantrums
avoid or withdraw from social situations
rely more on obsessions and rituals, such as lining up or spinning objects
stim – for example, rocking, spinning or flapping
do things to hurt herself, such as head-banging, scratching skin or hand-biting.
Reducing anxiety and managing anxiety
Anxiety is a natural part of life and something that everyone experiences at some stage.
You’ll never be able to get rid of everything that makes your child anxious or stressed. Even if you could, it wouldn’t be helpful for him. But there are some things you can do to help ease your child’s worries, and encourage him to manage his own anxiety levels.
Find out what makes your child anxious Because children with autism spectrum disorder (ASD) can have trouble with understanding and communicating emotions, you might need to read your child’s signals and work out what makes her feel stressed.
Some of the common triggers for anxiety include:
changes in routine – for example, when a weekly piano lesson gets cancelled because the teacher is sick
changes in environment – for example, when some furniture gets moved, there’s new play equipment at the local park, or you move house
unfamiliar social situations
sensory sensitivities – children with ASD might be scared by certain noises or be sensitive to bright lights, specific flavours or food textures
fear of a particular situation, activity or object – for example, sleeping in their own bed, going to the toilet, balloons or vacuum cleaners.
Once you’ve worked out some of the things that make your child feel anxious, it can help to make a list of them, so that you can find ways to help your child manage these situations.
Give your child lots of opportunities to practise dealing with these things and situations in a safe environment. It helps if other people who look after your child – for example, child care workers, teachers and family members – also know what makes your child feel anxious and what they can do to help him with managing anxiety in these situations.
Help your child recognise anxious feelings Your child might need to be taught what anxiety is, what it feels like in her body – for example, her palms get sweaty, her heart beats faster, her hands flap – and what she can do to calm down.
You could try drawing an outline of a person’s body. Inside the outline, help your child draw or write what happens in each part of his body when he feels scared or worried.
Use relaxation and calming strategies Help your child come up with a toolbox of things she can do to help herself calm down when she starts feeling anxious or stressed. These might be:
counting slowly to 10
taking five deep breaths
running around the yard five times
doing 50 jumps on the trampoline
looking at her collection of favourite or special things
reading a favourite book
closing her eyes for a few moments
going to a quiet part of the house.
Get your child to practise these strategies when he’s calm. Once he knows the strategies well, you can gently guide him to try them when he feels anxious.
Use visual techniques Because children with ASD are often visual learners, visual timetables, Social Stories™, picture schedules or photographs of them in certain situations can help them know what to expect.
For example, if your child gets anxious when you drop her off at school, you could take some photos of what you’ll be doing while you’re not together. You could include photos of you driving home, grocery shopping, gardening and so on, as well as a clear picture of you coming back to pick her up. You could also have photos of what your child will be doing – walking in the school gate, sitting in the classroom, playing sport, eating lunch and so on.
If your child gets anxious when there’s a change in routine, daily or weekly visual schedules can help prepare him. When you know a change is coming up – for example, no swimming lessons during the school holidays – you can show this on your schedule. Leading up to the change, look at the schedule regularly with your child so that he knows the weekly routine will be different.
Some children find it helpful to be warned about a change or an event a day in advance. Some like to know a week in advance. But for some, too much warning can mean they worry until the event happens.
Rehearse stressful situations Preparation is the key for some children with anxiety. Rehearsing or practising situations that your child finds stressful can help her understand the situation in a visual way, with the addition of physical preparation as well.
For example, if going to the hairdresser makes your child feel anxious, you could try taking him for a practice run. You could ask the hairdresser if you could come at the end of the day when it’s quiet and calm, then go through the steps with him. Or perhaps he could watch someone else get their hair cut.
If your child gets anxious in social situations you could practise these together. You could practise different situations and take turns playing different roles. Try to keep the scenarios short and simple, and encourage and praise your child.
