Growing Up With Autism Spectrum Disorder And Anxiety
The world was so unknown and stressful to her. I was her safety net.
Fearfulness, it seems, has been associated with autism since it first got its name. When Dr. Leo Kanner described the disorder he called autism, he noted that some of his young patients were worriers. If not for his boyish voice, Alfred, 9, “might have given the impression of a worried and preoccupied little old man,” Dr. Kanner wrote in 1943. Many of the children he described would react with “horror” and “panic” at vacuum cleaners, loud noises, or moving objects.10
Susan Gilroy understands the fearfulness that can affect people with autism. Her daughter, Lindsay, 39, has autism and anxiety. When she was a child, Lindsay desperately wanted things to remain the same. “Insistence on sameness” is a defining symptom of autism,5 but it also may be related to anxiety.11 The girl would get very upset if her mother closed the kitchen cabinet doors, or if she left her sight. “The world was so unknown and stressful to her. I was her safety net,” Mrs. Gilroy explained.
In her late teens, Lindsay’s anxiety grew and led to aggressive behavior. A service provider worked with her to help identify her emotions and manage anxiety. “They helped her develop some coping skills, such as deep breathing, counting, and clenching her hands when anxious, that she still uses today,” Mrs. Gilroy said. Medication also helped.
Autism Communication And Social Anxiety
It is a well-known fact that children with autism experience much more social interaction problems than children with developmental delays. Approximately 30% to 50% of individuals with autism cannot reach the appropriate level of speech. Lack of social interaction is one of the first symptoms that strike us in making the diagnosis.
Social interaction disorder is thought to be associated with autism and this has a direct effect on anxiety. Difficulty communicating with their peers is an example . A high-functioning autistic person is aware of his or her social interaction disorder, and his anxiety increases as he misinterprets social cues and experiences social failure.
Some researchers say that children with high-functioning autism have higher anxiety tendencies than those with low-functioning. They explain this by saying that the functionality level of the child with autism is low because he will have difficulty in expressing his anxiety experience. In other words, they say that because the individual with autism cannot express his anxiety correctly, it is under-reported.
Unlike the studies conducted so far, in this study, as the communication problems of children with autism increase, their anxiety decreases, which is contrary to the studies conducted so far. This information is incompatible with literature.
Do All Autistic People Have Anxiety
A considerable proportion of individuals with ASD also fulfil the criteria for SAD, meaning it is possible to have both disorders. It is thought that around 30% of autistic children qualify for a diagnosis of social phobia.
A reason for this may be because those with ASD often struggle socially and are at risk of being bullied. As a result of the trauma of being bullied and fear of this happening again, these individuals may develop social anxiety as a result.
It is not just SAD which is common in those with ASD â in a review of around 30 studies of autistic children, almost 40% had at least one associated anxiety disorder.
Due to the struggles of trying to navigate a neurotypical world, those with ASD may find life very anxiety-inducing which may be why so many of them develop anxiety disorders.
Although a lot of people with ASD experience anxiety, not all of them do and find that they can navigate their way through the world in a way which is comforting to them.
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Treatment Of Social Anxiety And Suggestions For Families
Since social anxiety is often perceived as an ordinary shyness, families do not care much about this situation and do not need treatment. However, social anxiety is a problem that can be eliminated with early diagnosis and correct treatment.
Psychotherapy is used extensively in the treatment of social anxiety. If deemed necessary, drug therapy should be used. Since social anxiety causes problems in all areas of a childs life, the treatment team should be in cooperation with the family and school.
In psychotherapy, situations that cause anxiety in the child are determined and methods of coping with these situations are tried to be gained. In addition, wrong and negative thoughts in the child are tried to be changed. In order to get more positive results from the process, the school and the family should be more understanding towards the child, motivate the child by giving responsibilities appropriate for their age, and avoid displaying an oppressive or overprotective attitude.
In the treatment of social anxiety in children, families also have some duties. First of all, they must be good models for their children and provide correct communication with their children. Parents should encourage and reward their childrens attempts to communicate with others. With the rewarding system, they increase the permanence of the behavior.
Inability To Make Eye Contact: Autism Or Social Anxiety
My husband and I had a hilarious conversation this week where he asked me , Do I have Autism?
I say that he was mostly joking because a little piece of him was seriously wondering if his social anxiety symptoms meant that he was Autistic. They dont, but a lot of the signs overlap so it was a valid question.
My husband and oldest daughter both have social anxiety, and, for the most part, their anxieties manifest in similar ways.
For both of them, eye contact is painfully uncomfortable with people they dont know and terribly distracting with people they do know. I mentioned to my husband that Id recently read the statement, Children with Autism can either give you their eye contact or they can give you their attention, but they cant do both.
He nodded his head emphatically and said, Yes! Thats me!
To which I responded, But youre giving me your eye contact right now.
He said, I am, and its not uncomfortable because youre my wife, but you dont have my full attention.
So much of his mental energy was focusing on not looking away from me, in order to be respectful in our conversation, that he didnt have much mental energy left to really hear what I was saying.
And I realized in that moment why my husband says, Huh? four hundred times a day, even though hes looking right at me. Or why he doesnt remember me telling him about plans weve made, even though he said okay after I told him.
One is more logical. One is more emotional.
Happy parenting, friends.
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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:
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: Anxiety and Panic Struggles.
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.
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What Is The Difference Between Social Anxiety And Avoidant Personality Disorder
There is debate over whether APD is a more severe type of SAD. Often, they are diagnosed together and can overlap in symptoms. Both share an intense fear of being embarrassed or judged in social situations.
They may often be described as shy, awkward, or fearful as well as demonstrating similar behaviours such as avoiding social situations, avoiding interaction with strangers, and socially isolating from others.
However, while APD typically involves patterns of avoidance in most or all areas of life, SAD may only involve avoidance in a few specific social situations, so therefore the Diagnostic and Statistical Manual of Mental Disorders continues to categorise them separately.
Most of the differences between APD and SAD are in how severe and debilitating the personâs symptoms are. Those with APD have more severe anxiety compared to those with SAD.
They are also more likely to socially isolate themselves and be less able to function and form relationships than people with SAD.
Those with SAD are more likely to put themselves into social situations despite feeling anxious as they are more likely to endure the anxious, rather than those with APD who would find these situations too distressing and would avoid them as much as they can.
People with APD would also be less likely to pursue jobs that require any kind of social interaction with others.
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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Can You Have Social Anxiety And Avoidant Personality Disorder
It was originally thought that APD only occurred in association with SAD. However, it is now believed that APD can occur in the absence of SAD.
That being said, around one third of those with APD are also diagnosed with SAD. SAD is also thought to be the most common co-occurring condition in those with APD with a study finding that as many as 48% of those diagnosed with APD also met the criteria for SAD .
How Common Is Anxiety
Anxiety disorders are the most common mental disorder in the United States, affecting about 18% of the general population. Research has shown that the incidence of anxiety in people with autism may be significantly higher than in the general population. One systematic review of the published research on anxiety and autism found that almost 40% of children with autism and 50% of adults with autism experience some sort of anxiety disorder . Adolescents and school-age childrenwith autism have the highest prevalence of clinical and subclinical anxiety compared to other age groups with autism. This mirrors patterns found in the general population.
Specific phobias are the most common form of anxiety disorder among people with autism. A person with a phobia experiences extreme distress when exposed to a specific stimulus or situation. Obsessive-Compulsive disorder and social anxiety disorder also occur frequently.
Anxiety and autism can interact in ways that intensify the challenges for a person living with these disorders. The symptoms of autism may make anxiety more challenging to manage. At the same time, the symptoms of anxiety may create barriers for a person with autism as they work with clinicians and therapists, interact with friends and family, and pursue personal or professional goals.
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Social Anxiety Vs Generalized Anxiety
Tausig clarifies that people with social anxiety are more focused on situations involving people, such as giving a presentation at work or meeting friends for dinner.
It has to do with someone feeling that others evaluations of them are going to be negative, she says.
A small 2020 study of six autistic men ages 25 to 32 indicated that social anxiety could develop for similar reasons in autistic and nonautistic people, including negative social experiences.
Researchers also suggested that the core traits of autistic people may contribute to their social anxiety, though more research on the topic is needed.
Questions To Ask And Points To Make
Whittaker says asking questions and further discussing factors that may be triggering symptoms can help provide clarity on a diagnosis.
She recommends covering these bases:
- the age and year of the diagnosis
- anything going on at school or home at the time of the diagnosis
- description of symptoms, including how frequent and how long theyve been present
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Autism Vs Social Anxiety
Autism is a lifelong developmental disability that causes issues with communication, social, verbal, and motor skills.
The most important fact about autism is that it is a spectrum disorder implying that its effects vary from person to person. Autism and anxiety are somehow linked to each other.
Autism is a non-curable disease but the treatment can be done to give a better life to the person. The main task to start treatment is to identify the characteristic of ASD which help you with the diagnosis.
There are many children with autism spectrum disorders who will receive another diagnosis at some point in their development. And the most common diagnoses are related to autistic anxiety.
As told by psychologists, there are numerous diagnoses under the heading of Anxiety Disorders. but the presence of excessive worry and fear is the major force behind them.
The reason behind the prevalence of specific anxiety disorders in youth with autism was found at the below-mentioned rates:
|Autism Anxiety Disorder
As seen in children with ASD, there are many common behaviors that overlap with anxiety symptoms. For example, OCD has some obsessions and compulsions.
It may look similar to behaviors in children with ASD.
How To Tell Whether It Is Autism Or Sad
The best way to differentiate between SAD and ASD is through a formal diagnosis from a healthcare professional such as a psychologist or neurologist.
The screening for autism can be a lengthy process and involves observations of the individual and can include interviews with teachers, caregivers, and the person being evaluated.
ASD is typically diagnosed in childhood, but some autistic adults may have never received a formal evaluation. It can be a lot more difficult to receive an autism diagnosis in adulthood, which leads many to self-diagnose themselves.
A diagnosis is usually easier as this may just involve talking through the symptoms with the patient and assessing whether they meet the diagnostic criteria. When diagnosing, it is important not to rule out the possibility that the individual may have both disorders.
One way to tell the difference between ASD and SAD is to notice how the person responds to invites to social events. Someone with SAD may be more likely to avoid the social event altogether or choose to attend but endure it with a lot of anxiety.
Those with ASD may choose not to attend because they would just prefer not to, or they may attend but might not be interactive or their conversations may be one-sided.
Do you need mental health help?
Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/
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Handling An Autism Or Social Pragmatic Communication Disorder Diagnosis
Parenting a child with SCD or ASD can be a challenge, and unanswered questions and concerns simply breed more unnecessary worry. Trust your instincts and seek the professional, qualified assistance needed to screen your child and obtain an accurate diagnosis.
The sooner you have a concrete diagnosis, the better able you and the experts will be at providing the essential tools and support your child needs to be successful.
To learn more about social pragmatic communication disorder and autism, contact Sarah Dooley Center online or at 804-521-5571.
Asd & Social Anxiety Diagnosis
A psychologist can diagnose autism and/or social anxiety disorder using the Diagnostic and Statistical Manual of Mental Health Disorders 5th Edition . The DSM-5 is a handbook published by the American Psychiatric Association that helps healthcare professionals make diagnoses.
A healthcare professional will ask about symptoms and may observe a person in social situations before making a diagnosis. Sometimes a pediatrician or physician will recommend seeing a healthcare professional who can properly diagnose ASD, social anxiety, or other specific mental conditions. Ask your doctor for more information.
The DSM-5 diagnostic criteria for autism include:
- Persistent differences in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact
- Repetitive patterns of behaviors, such as lining up toys
- Symptoms were present in early development, even if they went unnoticed
- Symptoms interfere with daily functioning, such as schoolwork
The DSM-5 diagnostic criteria for social anxiety disorder include:
- Fear of judgment in social situations
- Consistent anxiety in social situations that does not fit the context
- Avoidance of social interaction
- Fear of social interaction that impedes day-to-day life
- Having fear for at least 6 months
Note that social anxiety can develop in children or adults.
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