- Supporting Students with Asperger's Syndrome Who Present Behavioral Challenges
- A Brief Explanation of Discrete Trial Training
- Applied Behavior Analysis: A Focus on Outcomes
- A Challenge to Reframe our Thinking About Behavior
- Concerning Consequences: What Do I Do When...?
- Consequences, Behavior, and My Birds
- Don't Forget About Self Management
- Ever Had a Crisis Kind of Day?
- Movement Difference: A Closer Look at the Possibilities
- Movement Differences Among Some People with Autism: an Impetus to Re-Examine Behavioral Issues
- Observing Behavior Using A-B-C Data
- Positive Behavior Supports Creating Meaningful Life Options for People with ASD
- Ten Steps Towards Supporting Appropriate Behavior
- The Challenge of Combining Competing Input in the Classroom
- "Your Attitude Just Might Be My Biggest Barrier"
- Applied Behavior Analysis: The Role of Task Analysis and Chaining
- Tips for Choosing a Provider for Applied Behavior Analysis (ABA)
- What to Consider When Looking for a Qualified ABA Provider
- Assessment Day: Questions About the Communication Development of Your Young Child with an Autism Spectrum Disorder
- “If They Could Only Tell Me What They Are Thinking.” The Need for Augmentative Communication for Individuals with Autism Spectrum Disorders
- Aiding Comprehension of Individuals with Autism Spectrum Disorders During One-on-One Interactions
- Can Social Pragmatic Skills Be Tested?
- Comprehension of the Message: Important Considerations for Following Directions
- First Steps and the Journey to a Diagnosis of ASD for a Child under Three
- Functional Categories of Delayed Echolalia
- Functional Categories of Immediate Echolalia
- Initial Guidelines for Developing a Communication Intervention Plan for Individuals with Autism Spectrum Disorders and Significant Limitations in Communication Ability
- Long and Short Term Strategies for Reducing Specific Repetitive Questions
- Successfully Using PECS with Children with ASD
- Meeting the Challenge of Social Pragmatics with Students on the Autism Spectrum
- Opportunity to Communicate: A Crucial Aspect of Fostering Communication Development
- Reading with Your School-Age Child: Building Vocabulary One Word at a Time
- Social Communication and Language Characteristics Associated with High Functioning, Verbal Children and Adults with ASD
- The 21st Century Speech Language Pathologist and Integrated Services in Classrooms
- The High Functioning Person with an Autism Spectrum Disorder: A "Tourist" in His Native Country
- The Role of the School Speech Language Pathologist and the Student with Autism
- Using a Visual Support to Enhance WH Question
- Visual Resources for Enhancing Communication for Persons with Autism Spectrum Disorders and Other Disabilities
- Visual Schedules and Choice Boards: Avoid Misinterpretation of their Primary Functions
- Visual Supports: Sources for Symbols for Receptive and Expressive Communication
- What is the Picture Exchange Communication System or PECS?
- Articles - Communication
- Articles - Communication
- Articles - Communication
- Articles - Communication
- Articles - Communication
- Articles - Communication
- Articles - Communication
- PICO - A Decision Making Tool For Selecting Apps
- Helping Your Child to Develop Communication Skills
- Evidence-Based Practices for Effective Communication and Social Intervention
- Important Predictors
- The Use of Technology in Treatment of Autism Spectrum Disorders
- Collaborative Teaming
- Educational Programming
- Academic Supports for College Students with an Autism Spectrum Disorder
- Advice from Adults with Autism Spectrum Disorder to Teachers Regarding Literacy Instruction
- Advice for Peer Tutors
- Applying the Ziggurat and CAPS Model in Your School District
- Aspects of Support for Learning
- A Young Adult's Guide to Deep Breathing as a Relaxation Technique: A Personalized Fact Sheet
- Can Schedule Usage Training Include Elements of Literacy Instruction?
- Clean Up Your Act! Creating an Organized Classroom Environment for Students on the Spectrum.
- Change is Good! Supporting Students on the Autism Spectrum when Introducing Novelty
- Classroom Choreography: The Art of Scheduling Staff and Students
- Complexities of Instructional Support
- Creating a Circle of Support
- Critical Features of Early Intervention: Merging Best Practices
- Developing Long Term Relationships Between School and Parents
- Early Intervention for Young Children on the Autism spectrum: Parent’s Perspective
- Educating Students with Autism: Are There Differences in Placement?
- Establishing Long Term Goals: What Are We Hoping to Achieve
- For General Education Teachers: Helpful Questions to Ask About Students with ASD
- Get Engaged: Designing Instructional Activities to Help Students Stay On-Task
- "Ham It Up and Get It Cookin!!" Thoughts From Dr. Greenspan
- Home-School Communication
- "I Can Do It Myself!" Using Work Systems to Build Independence in Students with Autism Spectrum Disorders
- “I Wake Up for MY Dream!” Personal Futures Planning Circles of Support, MAPS and PATH
- Life After High School...So Now What
- Literacy Resources
- Lovaas Revisited: Should We Have Ever Left?
- Making the Most of Morning Meeting
- Motivating Students Who Have Autism Spectrum Disorders
- Moving from Preschool to Kindergarten: Planning for a Successful Transition and New Relationships
- Peer Support Programs
- Promoting the Educational Success of Students with Autism: The Role of the Parent-Staff Relationship
- Planning for Successful Transitions Across Grade Levels
- Practical Steps to Writing Individualized Education Program (IEP) Goals: And Writing Them Well
- Practical Recommendations for Utilizing a Range of Instructional Approaches in General Education Settings
- Recognizing Different Types of Readers with ASD
- Reframing Our Thinking and Getting to Know the Child
- Restricted Repertoires in Autism and What We Can Do About It
- School Cultures that Support Students Across the Autism Spectrum
- Service Learning: Something to Think About
- Supporting Staff Using Coaching Model
- Supporting Students with Asperger's Syndrome
- Teaching Students Who Are Low-Functioning: Who Are They and What Should We Teach?
- Theory of Mind in Autism: Development, Implications, and Intervention
- There is No Place Called Inclusion
- The Road to Post-Secondary Education: Questions to Consider
- Tips for Teaching High-Functioning People with Autism
- Tips to Consider When Including a Student with ASD in Art, Music, or Physical Education
- Transition: Preparing for a Lifetime
- Transition to Middle School
- Transition Time: Helping Individuals on the Autism Spectrum Move Successfully from One Activity to Another
- Understanding the Design and Power of a Personal Schedule
- Using Visual Schedules: A Guide for Parents
- Who Are We Working for Anyway? Avoiding Personal Agendas at Meetings to Better Support Individuals Across the Autism Spectrum
- Structured Teaching Strategies: A Series
- Growing Up Together
- How to Open A Combination Lock/Locker
- Supporting Youth with Autism Spectrum Disorders Through Postsecondary Transition
- Curriculum Materials and Programs for Individuals on the Autism Spectrum
- Implementation and Effectiveness of Using Video Self-Modeling with Students with ASD
- Video Self-Modeling How To and Examples
- Advocates: Qualities to Look for and Choosing the Correct One for YOU
- Considering an Overnight Camp Program for your Child on the Autism Spectrum?
- Finding or Starting a Support Group
- Making the Most of the Holidays for Your Family and Your Son/Daughter on the Autism Spectrum
- Selected Bibliography for Families of People within the Autism Spectrum
- Selected National Resources for Information on Autism Spectrum Disorders
- Selected Resources for Understanding and Supporting Siblings
- Setting the Stage for Parent-Professional Collaboration
- Siblings Perspectives: Some Guidelines for Parents
- What About the Dads?
- When Your Child is Diagnosed with an Autism Spectrum Disorder
- What to Do If You Suspect Your Son/Daughter Might Have an Autism Spectrum Disorder
- For Parents: Preparing for the School Year
- Self Help/Medical
- Teaching a Young Man to Shave
- An Introduction to Possible Biomedical Causes and Treatments for Autism Spectrum Disorders
- The "M" Word
- Mealtime and Children on the Autism Spectrum: Beyond Picky, Fussy, and Fads
- Good Night, Sleep Tight, and Don’t Let the Bed Bugs Bite:
- Taking Your Son/Daughter with an Autism Spectrum Disorder to the Dentist
- Teaching a Young Woman to Shave
- Anxiety and Panic Struggles
- Anxiety and Autism Spectrum Disorders
- Having THE Talk with Your Child with ASD
- General Information
- Assessment Processes for Autism Spectrum Disorders: Purpose and Procedures
- Autism Awareness Month: Facts and Tips for Working with Individuals on the Autism Spectrum
- Diagnostic Criteria for Autism Spectrum Disorder
- Diagnostic Criteria for Social (Pragmatic) Communication Disorder
- Disability Information for Someone who has an Autism Spectrum Disorder: A Customized Example
- Getting Started: Introducing Your Child to His or Her Diagnosis of Autism or Asperger Syndrome
- Increasing Incidence of Autism Spectrum Disorders Continues in Indiana
- Standardized Tests and Students with an Autism Spectrum Disorder
- Article 7, Title 511
- What’s in a Name: Our Only Label Should Be Our Name: Avoiding the Stereotypes
- For Physicians: Diagnosing Autism Spectrum Disorders and Working with Schools
- Behavioral Issues and the Use of Social Stories
- How to “Lose the Training Wheels:” A New Way to Teach Bicycle Riding
- Living in Fear: Anxiety in Adolescents with Autism Spectrum Disorders
- Local Community Resources to Enhance Activities
- Making (and Keeping) Friends: A Model for Social Skills Instruction
- Making Camps Accessible for All
- Play in the Lives of Young Children with Autism
- Play Time: An Examination Of Play Intervention Strategies for Children with Autism Spectrum Disorders
- Social Activity Groups: Another Approach for Helping to Bridge the Friendship Gap
- Teaching Social Skills through Theatre
- The Collective Outcomes of School-Based Social Skill Interventions for Children on the Autism Spectrum
- The Value of Movement Activities for Young Children
- We All Need Exercise
- Finding a Friend in School
- Bullying and Students on the Autism Spectrum
- Incorporating Typical Peers Into the Social Learning of Children with Autism Spectrum Disorders
- Articles by Temple Grandin
- An Inside View of Autism
- Choosing the Right Job for People with Autism or Asperger's Syndrome
- Evaluating the Effects of Medication
- Genius May Be an Abnormality: Educating Students with Asperger's Syndrome, or High Functioning Autism
- Making the Transition from the World of School into the World of Work
- Social Problems: Understanding Emotions and Developing Talents
- Teaching Tips for Children and Adults with Autism
Anxiety and Autism Spectrum Disorders
Contributed by Anna Merrill, Graduate Assistant
Recently researchers at The University of Amsterdam reviewed 31 studies that focused on the presence of anxiety disorders in children under 18 years old with ASD. Upon review of these studies, researchers concluded that about 40% of children with ASD had at least one comorbid diagnosed anxiety disorder (van Steensel et al., 2011). 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. The prevalence of specific anxiety disorders in youth with ASD were found at the following rates:
• Specific Phobia: 30%
• Obsessive-Compulsive Disorder: 17%
• Social Anxiety Disorder/Agoraphobia: 17%
• Generalized Anxiety Disorder: 15%
• Separation Anxiety Disorder: 9 %
• Panic Disorder: 2%
This study and others have shown that children with ASD have more severe symptoms of phobias, obsessions, compulsions, motor and vocal tics, and social phobia than other groups 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 transportation.
Anxiety and Autism
There are many common behaviors seen in children with ASD that overlap with symptoms seen in varying anxiety disorders. For example, the obsessions and compulsions of Obsessive-Compulsive Disorder may look similar to repetitive and stereotyped behaviors in children with ASD. For this reason, there is speculation as to what psychologists should consider symptom overlap and what is a distinctly different disorder (van Steensel et al., 2011). One group of children on the spectrum that are more likely to receive a diagnosis of an anxiety disorder seems to be adolescents that have been diagnosed with Asperger’s Syndrome or high functioning autism. Many researchers speculate that this could be because teenagers with fairly high cognitive functioning may have a heightened awareness of their environment and the way they are perceived by others. As children with ASD enter into adolescence, the difference between themselves and their peers may become more pronounced (Alfano, et al., 2006). Alternatively, a child with more intellectual impairment may experience less anxiety or simply have a harder time reporting their anxieties in a way that lends itself to formal diagnosis.
Children and teens with ASD, in general, 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 with self-report. There are some who argue that we may need to develop different ways of measuring anxiety in individuals with ASD. For example, a better way to possibly assess levels of anxiety is to interview adults that interact on a regular basis with the individual. However, reports from adults are not necessarily consistent. For example, Gadow and colleagues (2005) found that teachers reported significantly higher levels of anxious behavior than parents. This could be because parents and/or teachers are not reliable in reporting these behaviors, or it’s possible that anxious symptoms are more likely to occur in school than at home. Therefore, there is obviously room for improvement in the measurement of anxiety in children and teens with ASD.
Cognitive-Behavioral Therapy as Treatment
The most effective treatment for anxiety disorders is cognitive-behavioral therapy (CBT). Cognitive-behavioral 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 modeling appropriate thinking. CBT is based on the premise that working to change maladaptive thinking, such as magnifying negatives or overgeneralizing, can lead to a change in maladaptive behavior. To think about it in another way, CBT seeks to train an individual to reconceptualize 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. In order to deal with these issues, Moree and Davis (2010) find that incorporating more concrete visuals and child specific interests, as well as parent involvement, are all extremely important. 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 (Wood et al, 2009).
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 recommendations are part of the “Face Your Fears” intervention developed by Judy Reaven and colleagues:
1) Encourage and reward your child for his or her effort and engagement in brave behaviors
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 behaviors
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 generalized 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, and highly social situations. For more ideas about anxiety triggers see Kim Davis’ article on anxiety on this website: http://www.iidc.indiana.edu/index.php?pageId=3562.
Looking for more information? Check out these books, websites, and mobile applications about anxiety and ASD:
Chalfant, A.M. (2011). Managing Anxiety in People with Autism: A Treatment Guide for Parents, Teachers and Mental Health Professionals. Bethesda, MD: Woodbine House.
Baron , M.G., Groden, J., & Lipsitt, L.P. (2006). Stress and Coping in Autism. New York, NY: Oxford University Press.
Lipsky, D. (2011). From Anxiety to Meltdown: How Individuals on the Autistic Spectrum Deal with Anxiety, Experience Meltdowns, Manifest Tantrums, and How You Can Intervene Effectively. Philadelphia, PA: Jessica Kingsley Publishers.
Buron, K.D. (2006). When My Worries Get Too Big! A Relaxation Book for Children Who Live with Anxiety. Shawnee Mission, KS: Autism Asperger Publishing Company.
The Social Navigator: http://www.socialnavigatorapp.com/social_navigator.php
The Autism 5-Point Scale EP: https://itunes.apple.com/app/autism-5-point-scale-ep/id467303313?mt=8
Alfano, C.A., Beidel, D.C., & Turner, S.M. (2006). Cognitive correlates of social phobia among children and adolescents. Journal of Abnormal Child Psychology, 34 (2), 182 – 194.
Gadow, K.D., Devincent, C.J., Pomeroy, J., & Azizan, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Austism, 9 (4), 392 – 415.
Moree, B.N. & Davis III, T.E. (2010). Cognitive-behavioral therapy for anxiety in children diagnosed with autism spectrum disorders: Modification trends. Research in Autism Spectrum Disorders, 4 (3), 346 – 354.
Reaven, J. (2011). The treatment of anxiety symptoms in youth with high-functioning autism spectrum disorders: Developmental considerations for parents. Brain Research, 1380, 255-263.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, Gillian. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47 (8), 921-929.
Van Steensel, F.J.A., Bogels, S.M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14, 302-317.
Wood, J.J., Drahota, A., Sze, K., Har, K., Chiu, A. & Langer, D.A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50 (3), 224-234.