How Anxiety Shows Up In Autism Spectrum Disorder
Research suggests that anxiety is more common in autistic people.
A 2019 study of sibling pairs indicated that about 20 percent of autistic people had anxiety compared with about 9 percent of the population controls.
Many people are fully aware theyre struggling in ways their peers may not be, and that they have some sensitivities and issues that their peers may not, says Dr. Jephtha Tausig, a New York City-based clinical psychologist.
Cognitive Behavioral Therapy And Psychotherapy
Cognitive behavioral therapy shows a lot of promise for reducing anxiety in both people who are autistic and those who arent.
One 2013 study of autistic children ages 7 to 11 with anxiety indicated a significant improvement in anxiety symptoms in the participants after 16 weeks and 32 CBT sessions.
The sessions focused on emotional regulation and social coaching to improve peer interactions.
How Do I Recognize The Early Signs Of Autism
8 Basic Early Autism Signs in children First 6 months: No big smiles or other warm, joyful expressions. By 9 months: No back-and-forth sharing of sounds, smiles or other facial expressions. By 12 months: Lack of response to name. By 14 months: No babbling or baby talk. By 16 months: No back-and-forth gestures, such as pointing, showing, reaching or waving. By 18 months: No spoken words. More items
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Develops Symptoms After Early Childhood
Your child developed and behaved like most children until they reached the age of 6 or older. Then symptoms that seem to point to autism sprang from nowhere.
In order to for be diagnosed with autism, your child must have first shown symptoms at an early age, even if those symptoms only caused problems in later years. A brand new symptom at age 12 or 14 may look a little like autism, but the likely cause is something else.
What Are The Educational Options
The Individuals with Disabilities Education Act of 1990 assures a free and appropriate public education to children with diagnosed learning deficits. The 1991 version of the law extended services to preschoolers who are developmentally delayed. As a result, public schools must provide services to handicapped children including those age 3 to 5. Because of the importance of early intervention, many states also offer special services to children from birth to age 3.
The school may also be responsible for providing whatever services are needed to enable the child to attend school and learn. Such services might include transportation, speech therapy, occupational therapy, and any special equipment. Federally funded Parent Training Information Centers and Protection and Advocacy Agencies in each state can provide information on the rights of the family and child.
In planning the IEP, its important to focus on what skills are critical to the childs well-being and future development. For each skill, parents and teachers should consider these questions: Is this an important life skill? What will happen if the child isnt trained to do this for herself?
A childs success in school should not be measured against standards like mastering algebra or completing high school. Rather, progress should be measured against his or her unique potential for self-care and self-sufficiency as an adult.
Adolescence
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Phobic Thinking Versus Age
Children may express anxieties and fears verbally, or indirectly through their play. Disruptions in themes during play or conversation can indicate an anxiety or fear has been triggered. Many fears are common at different ages . It is developmentally normal for young children to experience separation and stranger anxiety. Around the same time preschoolers develop metacognitive and metalinguistic skills, their imaginary play abilities also shift allowing for more imaginary fears, like ghosts or monsters in the closet. Nightmares may also be common at this time. As children reach school-age, their fears become more realistic such as fearing being hurt, doing poorly at school, or experiencing natural disasters. As they grow older, 8- to 12-year-olds worry about how their peers view them, and their own emotional well-being. While these fears may be common, they are a concern if they are causing significant distress for the child, such as problems with sleep or school, and/or causing distress for the childs family. Phobias are fears triggered by specific situations , objects , or social situations, resulting in clinical levels of anxiety symptoms such as panic attacks or generalized anxiety . Dr Donna Pincus book, Growing Up Brave, provides expert strategies for assessing and helping children with fears and anxiety. See also the resources on her website: http://childanxiety.net/index.htm.
S.L. Pillsbury, R.B. David, in, 2008
Difficulty Maintaining Eye Contact
People on the ASD spectrum may avoid eye contact because it can cause them stress or pain. This goes beyond not meeting a strangers gaze adults on the ASD spectrum consistently struggle to make or maintain eye contact even with people they are comfortable around, including family, friends, and coworkers.
The lack of eye contact doesnt mean theres a lack of interest. Adults on the ASD spectrum may experience high levels of stimulation in their brain when making eye contact with others, so avoiding eye contact is a way of avoiding anxiety or physical discomfort.
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Anxiety And Autism Spectrum Disorders
Anna Merrill, Graduate Assistant
Many children with autism spectrum disorders will receive another diagnosis at some point in their development. In a 2008 study, seventy percent of a sample of children with ASD ages 10 to 14, had also been diagnosed with another disorder. Forty-one percent had been diagnosed with two or more additional disorders . These additional disorders, or comorbid diagnoses, can at times be extremely debilitating for individuals with autism spectrum disorders. The most common types of diagnoses are those related to anxiety.
Behavioral Interventions And Skill
Beyond coping mechanisms, specific behavioral strategies often help autistic people with anxiety. These may improve social interactions and academic or professional performance.
Social skills training
Tausig says social skills training can help autistic people interact with others, such as knowing to say hello when they enter a building or asking someone about their day.
A small 2013 study involving 58 adolescents ages 11 to 16 suggests that people who participate in social skills training have better knowledge of friendship skills and less social anxiety than their peers.
Applied behavioral analysis
Applied behavioral analysis centers around decreasing unhelpful behaviors that may draw unwanted social attention.
For example, a student can ask to leave class if theyre anxious rather than disrupting the other students.
This method involves rewarding desirable behavior and setting consequences for undesirable behavior.
But not everyone wants to replace behaviors related to autism, such as flapping.
A of six studies concluded that only autistic people who were participating in ABA and using pharmaceutical agents experienced an improvement in symptoms and skills that enhanced their lives.
At the same time, Tausig advises against forcing ABA on anyone.
Everybody is different, she says. If theres a struggle to get them to the ABA facility or welcome the ABA person to school or home and its not getting anywhere, I dont know it makes sense to push things further.
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Behavioural Signs In Infants Between 6 And 12 Months Can Predict Asd
A 2005 Canadian study published in the International Journal of Developmental Neuroscience, with over 200 participants was the first to pinpoint specific behavioural signs in infants as young as 12 months that can predict, with remarkable accuracy, whether a child will develop autism.
Autism is one of the most prevalent disorders today, and while a bio marker was finally found last year to help with early diagnosis, its normally only 80% effective, and so far mostly being used on higher risk infants. Also it is found using an MRI, and wait times can be long. Most doctors instead must rely on parent observations, observing the child themselves, and using standardized tools like the Checklist for Autism in Toddlers . However these tools are made for children who are 18 months and older, a long time especially when early detection and intervention can help with many of the frustrations that develop from communication problems.
Because of the research done, a scale was developed to help doctors with early assessment in infants as young as 6 months . The Autism Observation Scale for Infants has been a fantastic new tool to help parents and doctors get an early diagnosis.
Diagnosing Anxiety In Autism
Mental health providers and physicians can diagnose anxiety in someone with autism, although it may be more challenging than in a typically-developing child or adult.
Youth may have language or learning problems that make it harder for them to describe their symptoms and emotions.12 Some, even if they speak fluently, may not connect their symptoms to having anxiety. Several research studies say that anxiety seems highest in fluent speakers with autism,2 although fewer studies exist of people with nonverbal autism and anxiety.
Anxiety is typically diagnosed based on answers to questionnaires, not by blood tests or brain scans. But the standard tests for measuring anxiety may not work as well in youth who also have ASD.12,20 Researchers are developing and testing autism-specific tools for diagnosing anxiety, Drs. Hardan and Vasa said.
If someone with autism receives an anxiety diagnosis, what’s next? What does research says about effective treatments? What steps can family members, schools, and others take to help? See part 2 of this series, What Anxiety Treatments Work for People with Autism?
- Watch Dr. Antonio Hardan’s one-hour webinar on Anxiety in ASD at SPARK for Autism.
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Autism Signs By 3 Months
- They don’t follow moving objects with their eyes: “Babies at high risk for autism don’t follow caregivers as they move in the visual field,” says Dr. Frazier. “They may be more intrigued by something like a blanket.”
- They don’t respond to loud noises.
- They don’t grasp and hold objects.
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Autism And Autistic Disorders
Isolated in worlds of their own, people with autism appear indifferent and remote and are unable to form emotional bonds with others. Although people with this baffling brain disorder can display a wide range of symptoms and disability, many are incapable of understanding other peoples thoughts, feelings, and needs. Often, language and intelligence fail to develop fully, making communication and social relationships difficult. Many people with autism engage in repetitive activities, like rocking or banging their heads, or rigidly following familiar patterns in their everyday routines. Some are painfully sensitive to sound, touch, sight, or smell.
Children with autism do not follow the typical patterns of child development. In some children, hints of future problems may be apparent from birth. In most cases, the problems become more noticeable as the child slips farther behind other children the same age. Other children start off well enough. But between 18 and 36 months old, they suddenly reject people, act strangely, and lose language and social skills they had already acquired.
As a parent, teacher, or caregiver you may know the frustration of trying to communicate and connect with children or adults who have autism. You may feel ignored as they engage in endlessly repetitive behaviors. You may despair at the bizarre ways they express their inner needs. And you may feel sorrow that your hopes and dreams for them may never materialize.
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Types Of Anxiety And What Parents Should Look For
Anxiety presents itself in many forms. While a person with autism can experience any form of anxiety, researchers found specific phobias, obsessive-compulsive disorder , and social anxiety are the most likely to occur in people with ASD.
- Specific phobia: A specific phobia, specifically an intense, irrational fear of something with little or no actual danger, may arise early in the course of ASD because of over responsiveness to sensory stimulation. These phobias usually involve highly unusual stimuli like balloons popping, toilet flushing, fire alarms, and so on. But, many also present fears, like a fear of the dark, that are typical of developing children.
- Obsessive-Compulsive Disorder: Characterized by unwanted and intrusive thoughts and consequent compulsive behaviors, OCD is often comorbid with ASD.
- Social anxiety: As anxious children with autism age and their environment becomes more demanding, social communication impairment may indicate the development of social anxiety, especially if the child is high functioning and aware of his/her social incompetence. Social anxiety, which is defined as intense anxiety or fear of being negatively evaluated in a social or performance situation, leads to avoidance of social situations, limiting the childs opportunities to practice social skills and may predispose them to adverse reactions from peers, even bullying.
- Separation anxiety may then arise when the child is preparing to separate from attachment figures.
What Are The Causes Of Autism
Experts donât fully understand all of the causes of autism spectrum disorder. It seems to be genetic, but things such as parental age and prescription medications taken during pregnancy may be involved.
For instance:
- A person is more likely to be on the spectrum if a brother, sister, or parent is. But it doesnât always run in families.
- About 10% of kids with ASD have a form of genetic disorder such as Down syndrome and fragile X syndrome.
- A large Danish study found a link between ASD and advanced parental age of either parent.
- Women prescribed opioids just before pregnancy are likelier to have a child with ASD.
Some children who are on the spectrum start showing signs as young as a few months old. Others seem to have normal development for the first few months or years of their lives and then they start showing symptoms.
But up to half of parents of children with ASD noticed issues by the time their child reached 12 months, and between 80% and 90% noticed problems by 2 years. Children with ASD will have symptoms throughout their lives, but itâs possible for them to get better as they get older.
The autism spectrum is very wide. Some people might have very noticeable issues, others might not. The common thread is differences in social skills, communication, and behavior compared with people who arenât on the spectrum.
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Individual Symptoms Are Unique
ASD is, according to the description used by most clinicians in North America, a neurodevelopmental disorder meaning it becomes apparent during a childs early development and results in difficulties with their personal, social, academic or occupational functioning.
Those with ASD typically demonstrate symptoms by two to three years of age. However, many will display signs earlier in development and ASD can be reliably diagnosed around 18 months of age.
Individuals must demonstrate challenges in two domains of functioning: 1) social communication and 2) restricted and/or repetitive patterns of behaviour.
Importantly, individuals with ASD are seen to fall on a spectrum, meaning that they can experience a range of difficulties within each domain. This means that each individuals specific symptoms will be unique.
Unraveling Autism And Anxiety
In a 2017 presentation for SPARK for Autism, a research program, Dr. Hardan described three ways of thinking about anxiety in autism.9
- Anxiety is completely separate from autism. It looks exactly the same in people with autism as it does in others. Or,
- Autism increases the risk of anxiety. Difficulties in understanding the social world, or bullying, can trigger anxiety.12 Being overly sensitive to loud noises or other sensory input common to autism can make one anxious about those experiences. Or perhaps,
- Anxiety is simply part of autism, driving the insistence on sameness and avoidance of social situations that are among autism’s core symptoms.
That last theory is the subject of debate, Dr. Hardan said. As he and others explained, anxiety and autism are treated differently.
If you believe anxiety is part of autism, “there might be a tendency to overlook the anxiety and not treat it,” said Roma A. Vasa, a child psychiatrist who specializes in both anxiety and autism. “The standard treatments for autism speech therapy, occupational therapy, and special education are not going to target fears and anxiety.”
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Early Signs Distinguish Autism From Other Disorders
Motor challenges: Toddlers later diagnosed with autism have trouble grasping and manipulating objects.
A new study finds that at 9 months of age, babies who go on to be diagnosed with autism show few behavioral signs distinguishing them from either their typically developing peers or those with disorders such as cerebral palsy, speech impairments or intellectual disability.
By age 2, however, these children show difficulty with movement, communication, emotional control and problem solving, reports the study, published 19 February in the Journal of Early Intervention1.
The findings indicate that autism can be identified as early as age 2. In the U.S., the average age of autism diagnosis is 4 years.
Diagnosing children earlier can give them access to treatments, says lead investigator Rosa Milagros Santos, professor of special education at the University of Illinois at Urbana-Champaign.
Santos and her colleagues used data from the Early Childhood Longitudinal Study, Birth Cohort, a nationally representative sample of U.S. children born in 2001 and followed through kindergarten. Unlike studies that rely on parental memory or home videos to identify autisms early signs, the researchers collected cognitive, social and behavioral information as the children grew. They relied on parents to report whether their children had a diagnosis of autism at age 4.
But by definition, baby sibs dont represent the general population and may have distinct characteristics.