By Karen Ji

A good, general definition of anxiety is that it is the chronic fear that persists in the absence of any direct threat (Pinel & Barnes, 2018). It is estimated that between 14% to 34% of people will experience an anxiety disorder at some point in their lives, and women are at twice the risk (Bandelow & Michaelis, 2015). Children are also at risk if anxiety runs in the family, as research has shown there is a notable genetic component – around 30-50% heritability (Shimaada-Sugimoto et al., 2015). Parents should take note of this if they or other family members have suffered from an anxiety disorder.

However, it is important to remember that anxiety can look very differently in children and can exist across different types of settings, such as separation anxiety, social anxiety, performance anxiety, and more. According to the Centers for Disease Control and Prevention (CDC), some symptoms or examples of behavior commonly seen in children with anxiety can include:

1. Being very afraid when away from parents (separation anxiety)
2. Having extreme fear about a specific thing or situation (phobias)
3. Being very worried about the future or about bad things happening (general anxiety)
4. Being very afraid of school/ other places where there are people (social anxiety)

Additionally, it is not uncommon for children with anxiety to be irritable and angry, more than the average child. According to the Diagnostic and Statistical Manual of Mental Disorders (5^th Ed.), children with anxiety can also have difficulty concentrating, experience sleep disturbance, or become easily fatigued.

How does anxiety look in children with Autism Spectrum Disorder (ASD)?

Various studies have shown that for individuals with ASD, the most common types of anxiety observed are specific phobias, social worries, Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder, and Obsessive Compulsive Disorder (OCD) (Kerns & Kendall, 2012). Compared to other youth without ASD, children with ASD will more likely present increased prevalence of certain symptoms, such as fear of being physically hurt, obsessive-compulsive symptoms, and social avoidance (Gadow et al., 2005). More distinct signs of anxiety in your child and/or teenager also include insisting more than usual on routine, having meltdowns, stimming behaviors, or self-injurious behaviors like skin scratching and head-banging (The Australian Parenting Website, n.d.). They may also experience some other physiological reactions, such as sweaty palms, a weird feeling in their stomach, increased heartrate, or hand flapping.

Different Strategies

There are several different options available to help your child with ASD manage or cope with symptoms of anxiety. A common form of treatment used is cognitive-behavioral therapy (CBT), which looks similar to CBT in individuals without ASD. A few differences are that CBT for children with ASD has a greater emphasis on parent/guardian involvement and social skill-building, adjusting lessons to fit the child’s cognitive ability, and really tailoring treatment to the child’s interests (Nadeau et al., 2011). Other strategies you can practice with your child include teaching them to count slowly to a certain number, take a number of deep breaths, and go through items that would best help calm them down (The Australian Parenting Website, n.d.). These include small gadgets and toys that they associate with when their symptoms and feelings of anxiety are on the rise. Similarly, social stories, or short descriptions of a particular situation and what to do/expect (National Autistic Society, n.d.), can be helpful for your child to read through as they work to process and regulate their emotions. The great thing is that these strategies can be used not only at home, but also in a school setting or in public! Developing and honing these skills can help with self-awareness and emotional regulation.

 

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Anxiety and Depression in Children. Centers for Disease Control and Prevention. https://www.cdc.gov/childrensmentalhealth/depression.html

Bandelow, B. & Michaelis, S. (2015). Epidemiology of anxiety disorders in the 21^st century. Dialogues in Clinical Neurosciene, 17(3), 327-335

Gadow, K.D., DeVincent, C.J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elemntary school-age children with PDD versus clinic and community samples. Autism, 9, 392-415. Pinel, J.P. & Barnes, S. J. (2018). Biopsychology (10th). New York: Pearson.

Kerns, C. a. (2012). The presentation and classification of anxiety in autsim spectrum disorder. Clinical Psychology: Science and Practice(19), 323-347.

Nadeau, J., Sulkowski, M.L., Ling, D., Wood, J.J., Lewin, A.B., Murphy, T.K., May, J.E., and Storch, E.A. (2011). Treatment of comorbid anxiety and autism spectrum disorders. Neuropsychiatry, 1(6), 567-578.

National Autistic Society. (n.d.). Social stories and comic strip conversations. https://www.autism.org.uk/advice-and-guidance/topics/communication/communication-tools/social-stories-and-comic-strip-coversations

Shimaada-Sugimoto, M., Otowa, T., & Hettema, J.M. (2015). Genetics of anxiety disorders: Genetic epidemiological and molecular studies in humans. Psychiatry and Clinical Neurosciences, 69(7), 388-401

The Australian Parenting Website. (n.d.). Anxiety: autistic children and teenagers. https://raisingchildren.net.au/autism/health-daily-care/mental-health/anxiety-asd