Children with autism often experience other medical issues, including anxiety. Today, I’m discussing the different types of anxiety that you may be seeing in your child or clients and I’m also going to give you next steps that you should take if your child has autism and anxiety.
Chrissy was one of my clients at three and a half years old. She would not talk at preschool and had a lot of problem behaviors, especially when her parents took her to large gatherings. Chrissy only had single words she would use at home and she would also scream when it was time for a bath. She was also a very picky eater and had problem behaviors when her parents tried to give her vegetables.
Chrissy was addicted to her pacifier and her parents gave her the pacifier when they thought she was feeling anxious. She had been previously diagnosed with autism and her physician and teacher started thinking that she may have anxiety and perhaps should try medication. But Chrissy couldn’t tell her parents how she was feeling and she couldn’t even answer simple questions.
Even still, the family was considering meds. For many kids, even for my son, Lucas, who’s now a young adult, medication was a key factor in reducing his problem behaviors, which were caused by, at least in part, his autonomic nervous system dysfunction and anxiety.
I’m not saying that meds are always the answer though, and they definitely aren’t the first line of action I would agree to take. As a nurse, as a behavior analyst, and as a mom, I know we need to get clear on defining anxiety and taking baseline data before treating with any medical interventions. So, let’s talk about anxiety and autism and the types of anxiety that are most frequently displayed in kids with autism.
The most common type of anxiety disorder displayed in children with autism is a specific phobia. We’ve all heard of phobias. They could be afraid of the doctor or afraid of dogs or afraid of heights or elevators or stairs. That occurs in 30% of the kids with autism.
Another type of anxiety that is very frequent in kids with autism is obsessive compulsive disorder. That occurs in over 17% of the kids with anxiety and autism. Just right under that, social anxiety disorder occurs in 16% of the kids. For younger kids with autism or signs of autism, separation anxiety is also very common.
Also, kids diagnosed with autism who have higher language skills have a very high prevalence of anxiety. In that 2015 study, they reviewed other studies. In one study they found, 108 high functioning children with autism were enrolled in treatment trials for anxiety. Almost 91% of them met the criteria for two or more anxiety disorders. The higher functioning kids had greater prevalence of social phobia of 41% and generalized anxiety disorder of almost 26%.
So, before we can start talking about treating anxiety, we have to really assess and observe what anxiety looks like in your child or client. It’s easy to just say they’re anxious. Like in Chrissy’s example, she was having feeding problems, was addicted to a pacifier, and wasn’t doing well at large gatherings. I’m sure anxiety is a part of everything we do. But for Chrissy who only couldn’t understand a lot of language, only used one word utterances, couldn’t answer simple questions, it’s more likely that her general delays were causing a lot of these problem behaviors.
So instead of just saying my child gets anxious or nervous, we want to really think about what anxiety looks like for your child. Does he or she cry? Do they hide their face from strangers or even from relatives? Or fall to the ground and scream when mom leaves the room and have severe separation anxiety? Do they engage in head hitting or any other self injurious behavior when a dog is present?
We also want to assess not just what appears to be their anxiety, but also the whole child. In Chrissy’s situation, we need to assess her language abilities. We need to assess their difficulties with feeding, sleeping, potty training, and dressing. Because their anxiety may be occurring just because they don’t understand the world around them and they need to be taught.
When Lucas was diagnosed with autism the day before his third birthday by Dr. James Coplan, he had some wise words when we asked him if there was a medication we should consider putting Lucas on. He said, we don’t put kids on medication until a good behavioral program is in place and we know what we’re treating.
I also recommend and teach parents and professionals within my online courses how to take data. You can record behaviors that are related to anxiety and occur in one or more settings. Do their anxiety signs occur only in community outings? Only at bath time? Only when dogs are around? Or for older kids, who are higher functioning, do they have anxiety around social events with friends?
But whatever we’re doing, we need to document what the signs are. So for a higher functioning child, they may be saying words like, “Oh my God, I’m so upset. I don’t want to go to this party.” They may have fear. “What if kids make fun of me?” For younger kids, we need to observe more of their behaviors. Are they having separation anxiety? Or obsessive compulsive behavior? I never really thought Lucas was anxious. But once we got his major problem behaviors controlled with a medication, we did see some spillover problem behaviors that were related to anxiety.
In the three step guide is my one-page assessment, which I would highly recommend you complete. I teach you in this guide how I would recommend keeping data so that you can communicate with doctors and teachers. You can also keep track if you do start medications or other treatments, to show that this anxiety is decreasing.
