Many children with autism spectrum disorders (ASD) will receive another diagnosis at some point in their development. These additional disorders, or co-morbid diagnoses, can at times be extremely debilitating for individuals with autism spectrum disorder. The most common co-morbid diagnosis is related to anxiety.
Psychologists include numerous diagnoses under the heading of anxiety disorders, but the debilitating force behind them all is the presence of excessive worry and fear. These are the more common co-morbid diagnoses found in children with ASD:
- Specific Phobia
- Obsessive-Compulsive Disorder
- Social Anxiety Disorder/Agoraphobia
- Generalized Anxiety Disorder
- Separation Anxiety Disorder
- Panic Disorder
Children with ASD have more severe symptoms of phobias, obsessions, compulsions, motor and vocal tics and social phobias than any other group of children. Even without an official diagnosis, anxiety is an important factor in the everyday lives of many children and teens with ASD. For example, anxiety can make it extremely difficult for children with ASD to do everything from making friends, to going shopping, to taking public transport.
As children with ASD enter into adolescence, the difference between themselves and their peers may become more pronounced and they will have a much harder time self-reporting their anxious symptoms – many of which may only occur internally (i.e. consistent worry). These limitations make it difficult for individuals with ASD to be diagnosed because of the difficulties they have with self reporting.
Cognitive-Behavioural Therapy as Treatment
The most effective treatment for anxiety disorders is cognitive-behavioural therapy (CBT). Cognitive-behavioural therapy uses graded exposure, or taking small steps toward facing anxiety-inducing situations, as well as teaching modes of relaxation. It also uses cognitive restructuring, or identifying and working to change irrational thought patterns, and modelling appropriate thinking. CBT is based on the premise that working to change maladaptive thinking, such as magnifying negatives or over-generalising, can lead to a change in maladaptive behaviour. To think about it another way, CBT seeks to train an individual to reconceptualise the way they process the world and then acquire skills that will allow them to apply this new way of looking at things.
There are certainly some possible issues using traditional CBT with children and adolescents with ASD. CBT is very verbally-based and often quite abstract. Some suggest that CBT may not work as well for children with ASD due to their impairments in theory of mind (a capacity necessary to engage in CBT strategies), but psychologists have shown improvement in high-functioning children with ASD after CBT.
The Role of the Parent in Treating Anxiety
Parents have an integral role in helping to treat anxiety in children with ASD. In fact, many agree that parents can not only be parents, but must be coaches, therapists, and friends as well. The following interventions are suggested steps parents can take in helping their child overcome anxiety:
1) Encourage and reward your child for his or her effort and engagement in brave behaviours
2) Ignore excessive displays of anxiety
3) Distinguish between realistic and unrealistic fears so that an appropriate treatment direction can be established
4) Convey confidence in the child’s ability to handle his or her worry and anxiety
5) Model courageous behaviours
6) Work together with your spouse or partner to develop a plan for facing fears
7) Discuss how to share coping skills and the creation of exposure hierarchies with other professionals so that gains in one setting can be generalised to other settings.
Parents can play a critical role in the treatment of anxiety in their child with ASD. As the parent, you know more about your child than just about anyone else. Being aware of anxiety triggers for your child is another important step in working to improve and anticipate stress and anxiety. Common triggers may include change in routine, lack of sleep, failure to tackle homework and highly social situations. It helps to identify and eliminate these issues before they can trigger anxiety.