As I tried to support my loved one, and as you begin to support yours, you will quickly realize that it is not a simple task. You will have to "dig deep" to pull out all of your resources to be up to the task. There is no easy fix, nor will you or I inherently know what to do. I had to ask for help, learn about anxiety disorder, and seek advice from those more informed and experienced in supporting someone who is experiencing anxiety attacks. You will have to seek more information as well and remember that all you learn will not magically work each time.  It is a process.

It is important to understand that the person experiencing the anxiety will be feeling out of control and may say or do things that can be upsetting to you or to others. Do not take things personally.  The individual being supported has to trust or believe that you truly care and are there to try to provide some relief no matter what. Trust, care, and patience are vital skills to have in order to begin to provide relief.

In the book, Stress and Coping in Autism (2006), many professionals in the field of autism offer their perspectives on the impact of stress and anxiety on individuals with autism as well as strategies to reduce that impact. While most offer quite similar suggestions, their ideas are influenced by their profession (i.e., speech and language pathologist, medical doctor, educator etc.). Diane Twachtman-Cullen, a licensed speech-language pathologist specializing in autism spectrum disorders, has an excellent opening statement:

"The first thing that needs to be said about stress (anxiety) reduction in ASD is that it requires the caregivers to understand both the internal and external factors that predispose students to stress (anxiety). The importance of this cannot be overstated; as such knowledge provides a roadmap for intervention. For example, if caregivers understand that students with autism find chaotic, unpredictable environment stressful, they will know to increase predictability and routine. Likewise, if they understand that because of their executive function deficits, students with ASD are unable to hold things in working member or to behave in an organized goal-directed manner without external supports, they will know to provide the visual and organizational supports that these students need to be successful. Furthermore, if caregivers understand that students with autism - particularly if they lack a conventional communication system - are likely to use idiosyncratic or aberrant behavior to express their wants and needs, they will be less apt to judge them as behaviorally disorder and more included to teach them alternative communicative behaviors (pg. 319-320)".

Dr. Tony Attwood uses the metaphor of a toolbox to "fix the feeling" in his chapter (2006). He discusses the emotional toolbox and the various "tools" that can be available for the student with ASD who is also anxious and fearful.  The tools include:

Physical tools (represented by a hammer)

• Physical exercise: walk, run, trampoline
• Sports: basketball, dancing
• Creative destruction: recycling
• Bite an apple
• Break a pencil
• Running
• Tearing up old clothes to make rags
• Squeezing oranges

 Relaxation Tools (represented by a paintbrush)

• Seclusion
• Massage
• Reading
• Repetitive action
• Sleep
• Art
• Stress ball

 Social Tools (represented by a two handed saw)

• Talk to family member or friend
• Talk to a pet
• Share the problem
• Seek a second opinion
• Find someone to help change the mood
• Develop close friends
• Helping someone - volunteering in an interest area

 Thinking Tools (represent screwdriver, wrench perhaps)

• Self-talk (I can stay calm)
• Create a series of statements to help reassure (I will ask for help when I need it).
• Put events in perspective - use logic ( a strong point for many with ASD)
• Completing a task involving a favorite interest or activity
• Cue-controlled relaxation

 Special Interest Tools

• Repetitive and ritualistic activities - time limited
• Personal special interests - time limited

 Other Tools

• Medication
• Mood diary
• Environmental assessment of individual's sensory world
• Encourage self-control using reward/prize

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