ANXIETY AND MANAGEMENT
IN ASD
Dr Clodagh Doyle
Consultant Clinical Psychologist
NHSCT
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Aims of Session
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Definition of anxiety
Prevalence of anxiety
Anxiety and ASD
Symptoms
Strategies
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
ANXIETY
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What is anxiety?
Anxiety is a NORMAL EMOTION – it helps us cope with
difficult, challenging or dangerous situations.
Anxiety is COMMON – there are times when we all feel
worried, anxious, uptight or stressed.
But anxiety becomes a PROBLEM WHEN IT STOPS YOUR
child from enjoying normal life by affecting their school,
work, family relationships, friendships or social life.
This is when ANXIETY TAKES OVER and your child has lost
control.
(from Paul Stallard : Anxiety)
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Definitions
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Fear – reaction to real environmental threat that is
focused on a specific object, individual or circumstance eg
chased by a dog. It’s a normal emotional response
essential for survival
Worry – thoughts and beliefs about possible problems
that may occur in the future ie focused upon distal events
Anxiety – a general, frightened response to a source that
is not readily identifiable and may be out of proportion to
environmental threats –ie excessive worry re common life
situations
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Prevalence in the general
population
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Anxiety disorders represent the most common type of
psychological distress in school-age children (eg Kashani &
Orvaschel, 1990)
25.7% 8 yr olds meet diagnostic criteria for an anxiety
disorder
Anxiety in childhood is most common risk factor for
depression in adolescence and early adulthood
Anxious children are more likely to be anxious adults ie
anxiety disorders have a persistent course
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Anxiety and ASD
84.1% of children with pervasive developmental
disorder met the full criteria of at least one
anxiety disorder
Muris et al (1998)
35% of children with ASD met criteria for an anxiety
disorder (Wood & Sze, 2007)
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65% of young people in clinic presented with
clinically significant levels of anxiety (Atwood,
2004)
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Anxiety and ASD
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Why?
- rigidity of thought and behaviour
- difficulties with change; transitions; social
situations
- communication and language difficulties
- sensory difficulties
- difficulty recognising signs of anxiety
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Anxiety and ASD
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Poor copings /resource strategies
Hypervigilance to things/people in their
environment
Difficulty recognising and discriminating
between others feelings
Difficulty predicting outcomes
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Anxiety and ASD
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Risk factors:
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Awareness of difference
High trait anxiety
Family tension
Bullying/victimisation
Adverse life events
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(Tantam,2000)
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Anxiety and ASD
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Anxiety and fear are factors in behaviour
difficulties and challenging behaviours.
Anxiety more common in those with
diagnosis of Aspergers Syndrome or High
Functioning Autism (White et al,2009).
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Symptoms of Anxiety
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Exercise: think about what the
symptoms of anxiety are.
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Symptoms
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Components of anxiety
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Affective – feelings of fear, panic, agitation,
nervousness
Cognitive – worry, negative thoughts, poor
concentration, attentional biases
Physiological – increased heart rate, stomach
aches, muscle tension, perspiration, sleeping
difficulties
Behavioural – flight, fight, freeze, reassurance
seeking
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Body cues for Anxiety Symptoms
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“FLIGHT–FIGHT” reaction:
• shortness of breath
• tight chest
• dizziness or light-headedness
• palpitations
• muscle pain, especially head and neck pain
• wanting to go to the toilet
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
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• shakiness
• sweating
• dry mouth
• difficulty swallowing
• blurred vision
• butterflies or feeling sick.
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
What do we do?
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Tool–box: promote self-regulation
Relaxation
Distraction
Create predictability – visual schedules, visual
cues/symbols
Emotional education – teach about emotions;
signs of anxiety
Social stories
CBT type approach
Social skills training
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
TOOL BOX
THINKING TOOLS
SPECIAL
INTERESTS
RELAXATION TOOLS
PHYSICAL ACTIVITY
TOOLS
SOLITUDE
SOCIAL TOOLS
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Relaxation tools – slow release
of emotional energy
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Breathing
Relaxation training
Repetitive action
Lego/Drawing
Music – listening/playing
Sleep
Reading
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Physical Activity Tools – quick
release of physical energy
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Exercise – eg trampoline
Sport
Creative destructive
Swing
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Social Tools
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Spend time with family member or friend
Seek advice
Solitude
Be with a pet
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Thinking Tools
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Put event in perspective
What would you like to do
Flexible thinking eg •“It might have been an
accident. I should check before I get angry”
Social story
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Relaxation
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Relaxation allows child to change their
physiological arousal
It counteracts the physical feelings of
anxiety
Taught to a child when they are feeling
calm
Individual and group exercises
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Types of relaxation
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Progressive muscular
Visualisation/imaginative
Breathing exercises
Group exercises
- relaxation
- breathing
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Relaxation
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Group exercise
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Distraction
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Distractions are mental operations – typically
mindless
Goal is to engage mind in something simple or
routine that the worry thoughts are prevented
ie distraction helps to take your mind of the
negative/worrying thoughts
It helps you take control of your thoughts by
thinking about something else
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Additional techniques
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Worry time
Worry box/safe
Therapeutic stories
Talking back to worries
Turning volume down on worry thoughts
Turning the tape off.
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Cognitive Behaviour Therapy
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What is COGNITIVE BEHAVIOUR THERAPY?
Cognitive Behaviour Therapy (CBT) is based
on the idea that how we feel and what we
do are due to the way we think.
Focuses on relationship between
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Cognitions – what we think
Affect – what we feel
Behaviour – what we do
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
CBT
THOUGHTS
FEELINGS
ENVIRONMENT
BEHAVIOUR
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
CBT
WHAT I
THINK
HOW I FEEL
OTHER
SAD, SCARED
CHILDREN
DON’T LIKE
ME
SCHOOL PLAYGROUND
WHAT I DO
STAND ON MY
OWN; DON’T
TALK TO
ANYONE
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
CBT
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Monitoring and identification of thoughts,
feelings an behaviour
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Psychoeducation
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Learning alternative ways to manage
anxiety/unpleasant emotions
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Challenging the unhelpful thoughts
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
CBT
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Coping and positive self talk
Learning new behaviours
Coping plan/target setting
Practice
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
CBT
To summarise:
STOP Plan
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S = pay attention to signs of anxiety
T = pay attention to anxious thoughts
O = think of other helpful thoughts
P = praise and plan for next time.
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Modifications of CBT for Young
people with ASD
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More concrete and visual: worksheets, pictures,
social stories, thermometer, feelings diary
Use of special interests
Adapt to suit developmental level
Include social skills training
Use a written schedule
Concrete language
Creativity
Questioning though use of role play or give
choices/alternatives
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Summary
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Young people with ASD are vulnerable to
anxiety
Emotional education is key.
Use “tool-box” for helping strategies
CBT useful – requires modifications
Parents have important role
UNDERSTAND AND SUPPORT
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT
Thank you for listening
Dr Clodagh Doyle, Consultant
Clinical Psychologist, NHSCT