Autism and Anxiety

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. 

Autism Anxiety Medication

I talk all about medications with Lucas’s psychiatrist, (also an autism dad) Dr. Michael Murray So, if you have a child or clients on medications or you’re considering medications I would check that podcast out. 

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.

Autism and Anxiety

I recently read a very helpful article that was published in 2015 called An Update on Anxiety and Youth with Autism Spectrum Disorders. It’s by Vasa and Mazurek and they summarized the whole issue of anxiety and ASD very nicely. They said that the prevalence of at least one anxiety disorder among children with ASD was almost 40%. So that means four out of 10 children who have autism also have at least one anxiety disorder. 

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%. 

How to Reduce Anxiety in Autism

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.

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Anxiety or Autism

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. 

You also may want to check out my resources on sensory overload, which is often happens alongside anxiety. I have a blog and a podcast on desensitizing kids to be able to do anything from getting eye drops in their eyes to wearing a life jacket so that they can go on with their family on a boat. All of these things require systematic desensitization. So some of this anxiety could be shaped by, for instance, giving Chrissy a pacifier when she cried. It just becomes this big cycle of problem behaviors that may be truly related to anxiety or it could be just language and learning deficits.

Getting Help

The best resource I have to help you right now is my free Turn Autism Around Three-Step Guide.  It’s for both parents and professionals, toddlers all the way up to teens and young adults. You can get this three-step guide by going to marybarbera.com/join.  

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. 

If you have a child or client who is experiencing signs of anxiety, make sure to observe what anxiety looks like for that child. Write it down and get my three step guide at marybarbera.com/join.

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Take the Free Training

Transcript

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 this is happening. Hi, I’m Dr. Mary Barbera, autism mom, registered nurse, Board Certified Behavior Analyst and bestselling author.

Each week I provide you with some of my ideas about turning autism or signs of autism around so if you haven’t subscribed to my YouTube channel, you can do that now. Chrissy was one of my clients. She would not talk at preschool. She was about three and a half years old and, um, she also had a lot of problem behaviors if her parents took her to large gatherings like parties.  Chrissy had single words she would use at home and she would also scream when it was time for bath. And she was also a very picky eater and had problem behaviors when parents tried to give her things like vegetables.  She was also addicted to her pacifier and her parents gave her the pacifier to her when they thought she was feeling anxious. Chrissy had been previously diagnosed with autism and some physician or some teachers, um, started talking about maybe this was anxiety and maybe even Chrissy maybe should be on meds. Um, but Chrissy couldn’t tell her parents how she was feeling and she couldn’t even answer simple questions.

Um, even still the family was considering meds. And 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, by his autonomic nervous system dysfunction and anxiety. I talk all about medications with Lucas’s psychiatrist and he’s also an autism dad, Dr. Michael Murray. And this is on podcast number 28. It’s a fascinating interview. So if you have a child or clients on medications or you’re considering medications, um, I would check that podcast out. I’m not saying that meds are always the answer though, and they definitely aren’t the answer in the first line of action, uh, that 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.

In preparation for this video blog, I did, um, read a very helpful article that was published in 2015. It’s a big article, um, and it gave an up, it’s called, An Update on Anxiety and Youth with Autism Spectrum Disorders. It’s by Vasa and Mazurek and they summarized the whole issue of anxiety and ASD very nicely.

They said that the prevalence of at least one anxiety disorder among children with ASD was almost 40%. So that means, uh, four out of 10 children who have autism also have at least one anxiety disorder. So 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. Those are specific phobias. Um, so that occurs in 30% of the kids with autism, and anxiety occurs the social, the specific phobia part occurs in 30%. Now another type of anxiety is very frequent and kids with autism is obsessive compulsive disorder.

Um, that occurs in over 17% of the kids with anxiety and also autism. And then just right under that social anxiety disorder is, um, occurs in 16% of the kids.  For younger kids with autism and signs, or signs of autism, separation anxiety is also a very common type of anxiety that parents often report.

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 and in one study they found 108,, uh, high functioning children with autism were studied and they were enrolled in treatment trials for anxiety and almost 91% of them met the criteria for two or more anxiety disorders.

Um, the higher functioning kids had greater prevalence of social phobia, 41% and generalized anxiety disorder of almost 26%. So before we can start talking about treating anxiety, I am a behavior analyst and I’m also a nurse and I know that we have to really assess and observe what anxiety looks like in your child or client.

Um, it’s easy to just say they’re anxious and like in Chrissy’s example, she was having feeding problems. She was addicted to a pacifier. She was, uh, not doing well at large gatherings. But, you know, all of those things, I’m sure anxiety is a part of everything we do. Um, but for Chrissy who only couldn’t understand a lot of language, only used one word utterances, couldn’t answer simple questions, um, 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, or she gets frustrated, 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?

Um, do they 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 their, what appears to be their anxiety, but we need to assess the whole child.  In Chrissy’s situation, we need to assess, you know, her language abilities, which I gave you just a brief summary of.  We need to assess with kids their difficulties with feeding, sleeping, potty training, 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, who’s also on a podcast and featured in a blog or two, um, Dr. Coplan had some wise words when we asked him if there was a medication we should consider putting Lucas on. He said, um, and which I think is still great advice. We don’t put kids on medication until a good behavioral program is in place and we know what we’re treating.

Um, so I always give this advice. I think it’s a, it’s a very valid. I also recommend and teach, uh, parents and professionals within my online courses, how to take data so, you know, if behaviors are related to anxiety, um, and they are occurring 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, you know, maybe they have a lot of anxiety, uh, when it’s time to go out to a social event with friends.  But whatever we’re doing, we need to talk and 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. Uh, what if kids make fun of me? Those sorts of things. For younger kids, we need to observe more of their behaviors? Are they having separation anxiety? Are they having obsessive compulsive behavior? I never really thought Lucas was anxious, but once we got his, his major problem behaviors controlled with a medication that I talk about on podcast 28, we did see some spillover problem behaviors that were related to anxiety.

And so he is on a, um, allergy medication that’s also used for anxiety and this has, uh, nearly cut his, all of his major problem behaviors to near zero levels. You also may want to check out my resources on desensitization, which is often needed for all types of anxiety. I have a blog and a podcast on desensitizing kids to getting eyedrops in their eyes, if they’re having a medical issue to wearing a life jacket so that they can go on with their family on a boat. Um, all of these things require systematic desensitization. So some of this anxiety could be shaped up by, like Chrissy’s parents were doing, giving her a pacifier when she cried. And so it just becomes this big cycle of problem behaviors, whether or not they are truly, uh, related to anxiety or just language and learning deficits.

The best resource I have to help you right now is my Turn Autism Around Three Step Guide, which is absolutely free.  It’s for both parents and professionals, toddlers, just showing signs all the way up to teens and young adults with severe autism. Um, you can get this three step guide by going to marybarbera.com/join.  In the three step guide is my one-page assessment, which I would highly recommend you complete, a one page plan, and I teach you in this guide, how I would recommend keeping data so that you can, um, communicate  with doctors and teachers about signs of anxiety and you can also keep track if you do start medications or other treatments, just show that this anxiety and these symptoms are decreasing. It’s a great guide for both parents and professionals.

Um, and you can once again, get the guide at marybarbera.com/join. If you have a child or client who is experiencing signs of anxiety, make sure, um, to observe what anxiety looks like for that child. Write it down and get my three step guide at marybarbera.com/join. And if you like this video blog, I would love it if you would give me a thumbs up, leave a comment or share it with someone else who may benefit. And I will see you right here next week.

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