Anxiety and autism
Anxiety can affect every human being at some point in their life.
We have all experienced times when our pulses race, our palms get sweaty, thoughts become unclear, and we are unable to move forward for a moment in time to reach a goal.
For autistic individuals however, this may not be a moment in time, but nearly every moment, as a person strives to fit into a world that may not make sense to, or that may not fit, them.
What is anxiety?
Anxiety is a physiological (bodily) and psychological (mental) response to stimulus from the world around us:
- Everyone experiences anxiety
- Some people may have more stressors in their world for a short period of time but are able to overcome them
- Some people may require extra support or medical intervention e.g. talk therapy or medication to get over significant or prolonged anxiety provoking events
- Some people may have ongoing, significant triggers and/or anxiety that require ongoing support or may lead to a diagnosis of an anxiety disorder or depression
- Anticipation anxiety may occur if an event has happened in the past to cause anxiety and may occur in the future causing a person mental anguish and fear over this possibility
- Research has shown that people on the autism spectrum generally show heightened signs of anxiety more often than peers that are not autistic due to the underlying characteristics of autism
What are some signs of anxiety?
Every person is unique and different and will respond to anxiety in different ways on different days!
For a person on the autism spectrum, anxiety may look and sound like:
- Tapping pencils or other items
- Moving around more
- Moving around less
- Seeking out preferred activities or items
- Talking more or faster
- Becoming silent or non-responsive
- Saying “no” to undertaking new or challenging tasks
- Saying “no” to even preferred things as anxiety increases
- Engaging in “stimming” (self-stimulatory behaviours) that act as a calming mechanism
- Going red in the face
- Getting into the personal space of others
It is important to see what may be going on for the individual; to be able to read the signs that they are anxious and understand what the stressors may be and help to interpret the behaviours as communication that they are not coping.
What can you do if you see a person on the spectrum showing signs of anxiety?
Try to see it for what it is
Communicating a need or want that they may be unable to express in another way.
- If I am tapping my pencil – do I need to fidget with something?
- If I am making a noise – am I trying to drown out other noises that hurt my ears?
- When I am swearing – am I overwhelmed by too much work?
- When I run around the room – do I need a movement break?
- If I swipe my work onto the floor – has too much been presented to me at once?
- If I push someone away from me – are they too close to me?
Focus on supporting individuals to learn how to be calm and in control
This is a lifelong journey and taken one step and one day at a time.
For most autistic individuals the goal is to help them to learn how to engage in activities that support calming. These are taught when they are calm – to be used when a person starts to become heightened.
Generally, most parents, carers, teachers, support staff etc. will say “But when they are calm I know they can…..” e.g., focus, undertake the task, tell me what they should have done!
The key here is to help a person learn to be calm and use these skills when they need them, across contexts and with different people.
There is no once size fits all approach. Every person will need different tools and strategies in their toolbox to use at different times of need.
Some examples of calming strategies may be:
- Acceptance Commitment Therapy activities
- Scaling your responses when experiencing different feelings
- Active movement breaks
- Heavy lifting activities
- Sensory block out such as getting into a tent
- A body sock
- Engaging in an activity that brings you joy
- Breathing techniques such as square breathing
- Visualisation techniques
- Distracting the mind and shifting attention
- Squeezing a stress ball
- Throwing grip balls at a target
- Punching a punching bag
- Reframing thoughts
- Interoception activities
Think about some of the tools or activities that you may use to self sooth and calm such as listening to music, going for a walk, debriefing with a friend. Does the person on the spectrum have the opportunity or ability to undertake any of these things?
Create a visual schedule for calming routines
To support a person to learn a calming routine it can assist to have this as a visual sequence they are able to follow.
This may be with pictures, words, video model or photos and can then be shown or modelled to the person so they may engage in the routine, eventually independently of needing a person there to support them. To begin with it is important to support the person in co-regulating, that is, to notice the signs that a person is becoming anxious and guide them in using the strategies by providing visual and verbal prompts.
As this is a life skill, it is important to pair this with something that will motivate, such as a reward schedule or time to do something enjoyable after they have calmed. Calming in itself is not motivation enough.
Sometimes things may appear to get worse before they improve! It is important to try to continue through this period as it is a change to how things were done and with time and patience, things can and will generally improve.
Remember, everyone becomes anxious sometimes, but most of us have the tools and ability to get through these times. People on the autism spectrum may need additional support and guidance to develop skills needed to calm and self soothe, and it will take patience and time for this to happen.