Feeling Anxious?
1
Asperger’s
Syndrome
and Anxiety
And what
to do
about it…
2
Remembering the triad of impairments
• Communication
• Social interaction
anxiety
• Rigid thinking
3
Double whammy
Autistic features lead to more causes of
anxiety and because of the autism, individuals
have less ability to cope with the anxiety.
→ A much lower threshold for getting into a
panic and fewer strategies for getting out of it.
Students with an ASD in a panic tend to
become more rigid / obsessive.
→ A huge anxiety spiral.
4
We know that young children with autism
are prone to develop mood disorders and
some children seem to be almost constantly
anxious...One of the problems faced by
children with Asperger’s Syndrome who use
their intellect rather than intuition to
succeed in some social situations is that they
may be in an almost constant state of
alertness and anxiety, leading to a risk of
mental and physical exhaustion.
Dr Tony Attwood
5
Then there is the
autistic tendency to
awfulise
....They are all staring at
me!
....I can’t do it.
.....He’ll never be my friend
now!
.....That’s it! I’ve ruined my
work!
6
So no surprise then that...
• ...a pupil is terribly upset by
an unexpected change to
routine
• ...a child has phobic
reactions to sensory
experiences e.g. school bell
• ....a youngster might not
want to go to school
• .....a student is silent
(sometimes mute) and does
not seek adult attention
• ....a child has a desperate
wish to exert control over
his surroundings.
7
Jekyll and Hyde
Some children will react to stresses at school by
“freezing” during school hours and then “exploding”
in response to the slightest problem at home.
Consequently, when parents’ reports of a child’s
behaviour at home differ radically from that child’s
behaviour at school, teachers should not...attribute
it to their superior “behaviour management” skills
and the parents’ presumed inability to “handle”
their child.
Clare Sainsbury
8
More symptoms of anxiety
“I sometimes display mild
obsessive-compulsive
symptoms such as having to
repeatedly return to check
that the front door is closed,
or that the gas is off, I have
my keys, I have all the right
things in my bag etc. As a
child I would often have to
get out of bed at night to
make sure the stacks of
books in my room were lined
up properly at exact right
angles.”
“Anxiety can also be
associated with
perseveration and “stuck”
thinking: I can end up
going on and on and on at
people when I’m worried
that they may not
understand, or do exactly
what they say they will.”
Clare Sainsbury
9
Results of too much anxiety can go
Inwards
• Self-criticism
• Depression
• Even thoughts of
suicide
• Self -blame
Outwards
• Criticism of others
• Expressions of anger
• Expressions of
frustration
• Blaming others
10
Vicious circle
Thoughts of
school
Feelings of
anxiety
Sense of relief
Fewer
painful
thoughts
and feelings
Scary thoughts,
images,
memories
Strong
physical
reactions
Avoiding school
Sense of
impending
doom
11
Virtuous
circle
Thoughts of
school
Decreased
anxious
thoughts
Greater sense
of coping
Fewer
painful
thoughts
and feelings
Increased
confidence and
relaxation
More
engagement
with school
Decreased
physical
reactions
Greater sense
of coping
12
Three Types of Help
•
Tackling known causes of anxiety
•
Working round the autism
•
Working with the person
13
Tackling known causes of anxiety
14
Schopler’s iceberg metaphor
Aggression
Specific
Behaviours
•
•
• Pushing
• Hitting
• Spitting
• Swearing
• Poor social judgement
Unawareness of feelings of self and others
• Sensory hypersensitivity
Frustration over communication problems
Underlying deficits
15
Refusing to go to
Art
Uncertain about
where to sit
/which group to
join / how to join
in socially..
Poor motor skills:
feels he cannot
achieve well
Difficulties in
organising
materials in
own space
More noise and
movement around the
room making the
environment less
controlled
16
17
Once causes are identified
• Scaffold teaching
tasks
• Try backward
chaining
• Avoid the problem
completely!
• Provide social
support
18
Working round the autism
19
Working round the autism
Provide increased structure
→to improve predictability
→to reduce anxiety
How?
• Daily schedules
• Warning re change
• Routines and rules
20
Working around the autism
Remove ambiguity/ uncertainty
→to reduce anxiety
How?
• Task lists (mini schedules)
• Reminder systems: visual prompts
• Those little things (like where to sit)
• Watch your language (give simple, clear instructions
and talk in do’s, not don’ts)
• Social stories to explain situations and guide
• Giving scripts for positive self-talk
21
Working with the person
22
Working with the person with ASD:
putting “money in the bank.”
Use signs of anxiety as a signal
→Provide support / calming activity
→to reduce anxiety
How?
• Additional adult / buddy
• Task then “cool box” / reward time
• Time at crucial points of the day to chill
(All easier at primary but still possible at secondary)
• Affirmation / reassurance
• Teaching positive self-talk
23
Working with the person: emotional
education
Identifying feelings → learning to comply with
strategies given → learning self-help strategies
How?
• Labelling and recognising feelings (use visual
prompts)
• Rehearsing given exit strategies
• Scaling
• Anxiety programme (cognitive behaviour therapy)
• Relaxation techniques
• Calm cards
24
Time for Tea
25