Anxiety and Autism
Constant and Common Challenges
Stress and Anxiety
Stress is a normal part of everyday life. Everyone experiences stress. Some stress is normal and good, inciting mind and body into taking evasive action in face of a threat or danger. But when stress continues longer than the stressful event or situation it becomes potentially harmful. Constant stress, though, has the potential to turn into a chronic anxiety that is positively harmful to health. Research shows that people with autism experience elevated levels of anxiety compared to neurotypical others, with a review of literature by White et al (2009) showing that no less than 84% of individuals with autism meet the criteria for clinically diagnosed anxiety disorders. Figures as high as that strongly suggest that having autism makes a person likely to develop anxiety, maybe the kind of constant anxiety that leads to chronic illness. It is not so much having autism that leads to chronic anxiety but having to deal with the constant stress of social situations when you are autistic. Owing to characteristic difficulties with social interaction and communication, a person with autism may develop severe anxiety issues that, over time, get worse owing to a decreased ability to express their problems to others. Problems can go undetected and undiagnosed for years and years, leaving the person with autism open to developing any number of chronic illnesses. As Howlin argues (1997), “…the inability of people with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states.”
Anxiety can manifest in a person with autism through such following phenomena:
- social fear;
- phobias of various kinds;
- excessive worry/rumination;
- obsessive compulsive behaviour;
- hyper-vigilance;
- the appearance of being “shell shocked”;
- avoidance behaviours;
- procrastination;
- insistence on rigid routines;
- controlling behaviours;
- fear of and resistance to change;
- stimming;
- self-harm;
- meltdown;
- shut down.
Dealing with change
Due to the behavioural, information processing, and sensory aspects of their condition, people with autism prefer familiar, non-surprising environments with predictable routines and regular features. Restricted and repetitive interests, sensory processing differences and heightened anxiety mean that people who are autistic can find even the smallest of changes very stressful. They therefore tend to be change-averse, seeking to stick to the familiar. That makes planning and preparation vital when it comes to prospective changes in everyday routines and activities:
“Reality to anautistic person is a confusing, interacting mass of events, people,places, sounds and sights… Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life. Trying to keep everything the same reduces some of the terrible fear.” – Jollife, et al (1992) in Howlin (2004), p.137.
Planning and Preparation
Change is a normal part of everyday life, but is immensely difficult for those on the autism spectrum. Given the difficulties of coping with social interaction and communication, people with autism will cling to the familiar and resist change. But change is often unavoidable, and often desirable. It is therefore imperative to teach strategies which enable people with autism to cope with upcoming changes in their environments and routines, building autonomy and resilience on their part. and independence. Effective planning has the effect of initiating change in such a way as to make it feel safe and predictable for the autistic person, thereby reducing stress to prevent any behavioural issues that may arise as a result of changes in the familiar.
Everyday changes
Everyday changes that a person with autism may need to plan and prepare for may include:
- having visitors at your house;
- leaving the house;
- visiting another's house;
- going somewhere specific, such as seeing the doctor or the dentist;
- attending a job interview;
- doing things in an order that deviates from the norm.
Such changes which occur at the level of everyday life are known as horizontal transitions.
Since many people onthe autism spectrum have strong visual learning and thinking styles, visual strategies may be an effective way in which to communicate what is entailed by changes that are in the offing. Visual strategies can involve schedules such as timetables, daily planners and calendars. There are many others, but these are the ones I use. I have been known to write forthcoming dates in calendars I have pinned up on the wall, promptly forgetting to check. That makes the point that you have to develop the habit of using any supports regularly as intended.
Whenever somewhere newis to be visiting, a photographic image is helpful. I always explorean unfamiliar location by using the Google maps street view function, planting my little man a little distance away and then walking the journey to the destination.
There are a number of apps that can aid those on the spectrum meet the challenge of upcoming change. These can be discovered on the autism pages available on the Internet.
Changes over a longer term and “vertical planning”
Changes which involve ashift from one life phase to another are known as “vertical transitions.” Here, we are “moving on up.” The move from primary school to junior and then to senior school, and then onto sixth form, college, and/or university represents such a shift. I demonstrated the same attitude throughout all these changes. I always experienced difficultieswhenever I entered a new environment, difficulties which persisted and which gave me a real fear and loathing of these places. And then as I familiarised myself with the no longer new and stabilized myself around an identifiable routine and pattern, I started to enjoy myself and flourish. And then, just as I had gotten the hang of it, I was made to move on up to the next level. It is no wonder that I developed a tendency to repeat and stay on the same level. For instance, I did History at A level at a sixth form college, passed with distinction, only to go to night school after leaving to do History at A level yet again. I also returned to the university four years after earning my first degree to enrol on the same course to do different modules. I was comfortable with the familiar and enjoyed the feeling of knowing what I was doing. I didn't know then that I was autistic. What I really needed was help in order to transition to a new level in a new environment.
There is, therefore, a need to identify good practice guidelines to enable people with autism plan and prepare for undertaking major transitions in life:
Information gathering: identify precisely what is involved in the prospective change or changes. The “wh” questions never fail when it comes to eliciting essential information: who, what, where, and when? Past history is also useful in indicating how successfully previous changes and transitions have been undertaken and identifying which strategies have succeeded in the past.
Planning and Support: Coordinate with all key personnel involved in change andput in place a plan that ensures support in the process of transition.
Implement the plan.
Monitor: Identify what worked and what didn't. Keep what was effective, change what wasn't.
