Autism & Anxiety: 15 Things To Know About Dealing With A Double Diagnosis
Some form of anxiety is something everyone faces at one time or another, but excessive worrying, phobias, panic attacks, and anxiety disorder can all be debilitating to any individual. The fear of a potential threat or danger is usually irrational, too often unseen, and for the most part it is fought internally. Add to that the communication problems that come with Autism Spectrum Disorder (ASD) and both diagnosis and treatment of anxiety become much harder. However, there is help for individuals on the autism spectrum with mild to severe anxiety and lots of ways for both the person and caregivers to help manage anxiety disorders.
1. WHAT ANXIETY DOES (AND DOESN’T) LOOK LIKE
Stress can be a part of everyday life, but for many individuals it becomes something much more than general, temporary worrying. It’s common to be stressed with homework or before starting a new job, but anxiety is much more than that. Anxiety is a recurring or constant feeling of fear or dread of a perceived threat that can be triggered by specific situations (like public speaking), stimuli (like loud noises), or the body’s natural “fight or flight” response. Unfortunately, many who suffer from anxiety do so privately, hiding their fears, worries, and even panic attacks from others. Someone suffering from anxiety may very well show signs that they are distressed, but conversely they may also have a smile on their face.
2. THE VICIOUS CYCLE
One of the worst parts of an anxiety disorder is what is known as the vicious cycle. Anxiety can come on as the result of a specific event or trigger, or it may develop slower over a period of time. But once the anxiety begins, many begin to worry about the anxiety itself. Those with social anxiety or panic attacks may begin to worry not only during the panic attack, but start to worry about when the next panic attack may happen, who might see them have a panic attack, or if they will be able to get help when anxiety sets in. This anxiety about the panic attacks only puts the individual in a more worried and nervous state which will inevitably lead to another panic attack. Thus the vicious cycle sets in, where the anxiety becomes the object of fear, replacing or being added to the original fear.
3. THERE’S A PREVALENCE OF ANXIETY IN THOSE WITH ASD
According to several studies a large percentage of those on the autism spectrum will be diagnosed with an additional, or comobid, disorder. The number of those with a comorbid diagnosis of an anxiety disorder is around 40 percent. The most common forms of an anxiety disorder accompanying autism are specific phobia related, such as the fear of choking, thunderstorms, or any other specific fear. Other anxiety disorders commonly diagnosed alongside autism are social anxiety, separation anxiety, and panic disorder. Knowing that anxiety is a common problem for those with an autism spectrum diagnosis is a key factor is recognizing it, treating it, and even being prepared for it.
4. SPOTTING THE DIFFERENCES BETWEEN ANXIETY AND SENSORY OVERLOAD
For someone on the autism spectrum, sensory issues can trigger similar responses to that of anxiety. Because of that it can sometimes be difficult to tell the difference between the two; and often the two actually overlap at the same time. There is a difference between the two, however, and being able to tell the difference will determine the appropriate next steps to take and can mean the difference between feeling better or not. There’s no easy answer for telling the two apart, but people with autism and those around them need to keep this distinction in mind when it comes to treatment.
5. LOOK FOR THE PHYSICAL SIGNS AND CUES
Since children and adults on the spectrum have varying degrees of difficulty with communication, they may not tell you when they are anxious. Neurotypical individuals often try to hide their anxiety, so a communication problem only adds to that. Being able to spot some of the physical signs of anxiety can help you step in when your child or loved one needs it most. Some physical signs or symptoms of anxiety include a fast or pounding heartbeat, sweaty palms or sweating in general, avoidance/aversion or the “flight or fight” response behavior, or alternately suddenly becoming rigid/unmoving with tensed muscles. Some stimming can also be a sign of anxiety, such as tearing up paper, pulling at clothing, or similar behavior. If someone is unable to communicate exactly how they are feeling at that moment, it helps to be looking at body language for cues.
6. CALM ACCEPTANCE IS THE KEY
The most effective means of dealing with anxiety – for both neurotypical individuals and those on the autism spectrum – is an understanding and accepting the fact that anxiety is only anxiety, and the best way to overcome the fear is to accept it for what it is. Many who suffer from panic attacks feel as if they are having a heart attack during the episode. However, being able to accept that it is only anxiety causing those symptoms instead of giving into the fear will help stop anxiety in its tracks before it can turn into the vicious cycle.
7. EMPATHIZE INSTEAD OF RATIONALIZE, AND NEVER JUDGE
When dealing with someone going through anxiety, it is crucial to be source of calm, protection, and support. Telling either a child or adult that they shouldn’t be anxious because the thing they are afraid of isn’t real or isn’t going to happen does nothing to alleviate their fears during an episode of high anxiety. It is important to discuss the fears to overcome them, but during an episode is not the time to rationalize away the fear or make it seem trivial. The fear itself, caused by an anxiety disorder, is often irrational by nature so rationalizing it in that moment will only frustrate the person at best or close them off from seeking help at the worst. Any form of judgment will only make the individual more anxious about having an episode around that person again, which can dramatically increase the vicious cycle. Simply being a calming, reassuring presence is essential to help someone through an episode of anxiety or a panic attack. For someone with autism, pressure treatment (a heavy blanket or a tight hug) may help; others may need to be reassured verbally that everything will be okay. Each person will need help in his or her own manner, and it is essential to give that comfort and support during that time.
8. TALK ABOUT IT AND MAKE A PLAN
After an episode of anxiety has passed, it is healthy and productive to talk together about their worries and fears. This is the time to use rationalizations. Someone with ASD may have trouble expressing their exact emotions, so one good method for communicating anxiety and confronting it can be a card system. As many with autism avoid direct confrontation, having a card they can give to a family member or friend that says they are feeling anxious is a helpful tool. Discussing those specific fears and writing out a plan of action is another great tool. The person with autism and anxiety will then be able to go to the card or sheet that explains what to do when they are feeling anxious. This plan of action should be made when he or she is feeling calm and happy, and can be a resource they carry with them to remind themselves what to do when that perceived threat triggers anxiety.
9. USE HUMOR TO TURN ANXIETY ON ITSELF
The opposite of being afraid of something is being able to laugh at it. As the old saying goes, “Humor is the best medicine.” This is particularly true when it comes to anxiety. If at all possible, work to find humor in the anxiety. If anxiety causes heavy breathing, a pounding heart, and sweating, one example would be to saying that they would normally have to run around a lot to get that sweaty but they were able to bypass all that and get the same results sitting in a chair. It may seem like a small thing, and it can certainly be difficult to find humor in anxiety, but being able to laugh at what once scared you (or still scares you) will be both psychologically calming and will also help trigger the body’s natural calming protocols instead of the the fight or flight response.
10. CALMING TECHNIQUES TO HELP WITH A PANIC ATTACK
There are a number of techniques and tools at your disposal to help go from anxious to calm that can help stop a panic attack or anxious episode. The first of these is deep, steady breathing. Long breaths drawn in through the nose and out through the mouth will tell the body that everything is okay, and it will also help shift the concentration from worry to something productive. Another crucial thing to do at the beginning of any episode is to recognize and say to oneself that it is only anxiety (then remember all the times you beat it in the past, and you’ll beat it again this time). That immediate recognition that you’re anxious – and not in danger – puts you in the right mindset. It is also a good idea for children or adults to have place they can go to feel safe when they start feeling anxious. This could be anything from a bedroom or a fort to stepping outside or taking a short break from class in the library (with the school’s participation). Having that “somewhere safe” to go to allows for the fight or flight response to run its course, and also gives a goal or plan of action.
A special sensory game is also a great tool for combatting anxiety or panic attacks by getting all the attention and thoughts onto something else. When anxiety strikes, instead of all the racing thoughts of the perceived threat, have the person use each one of their senses to find something in the room or environment, counting down from five. That could be five different things they can see, four things to touch with different textures, three things they can hear, two things that smell different from each other, and one thing they can taste (candy comes in useful here). Any combination of five items with the five senses works, and it redirects all the focus and mental energy into something completely different.
11. TAKING ON FEAR THROUGH EXPOSURE, ONE SMALL STEP AT A TIME
Overcoming anxiety and fears through gradual exposure is a form of Cognitive Behavior Therapy, and is considered the most effect method of dealing with anxiety. The gradual, controlled exposure allows the person to face what is causing the anxiety a little bit at a time, and a little bit more each time. The more exposure they get, the more comfortable they will be as that setting or scenario will not only be familiar but they will also know that they can handle it. For social anxiety, a good first step is working on social interactions by role playing with a couple family members, and then some trusted friends. For a phobia, often doing research or watch a documentary on the subject can provide both safe exposure and facts to be used when controlling the perceived threat. Like everything else, it is important to remember that this will be a process, with ups and downs, and often starts out slower and builds gradually.
12. REWARD POSITIVE BEHAVIOR AND ACHIEVEMENTS
Positive reinforcement is another essential aspect of managing and dealing with anxiety. Progress can often be hard to see but meeting achievable goals are necessary to gaining a more positive mindset. Younger children especially may not be able to fully appreciate or understand the more abstract sense of accomplishment in making small strides, so having a special reward for meeting a goal, making steps to face fears, or implementing anxiety-reducing steps can help a lot. This might be in the form of cookies or candy, a new toy, or anything else that reinforces the positive strides. It also gives the person something to look forward to once the anxiety episode has passed and will help get their minds off of the anxiety and onto something positive, shortening the panic attack.
13. DON’T SET A TIMELINE, JUST KEEP MOVING FORWARD
Like with anything else in life, there will be good days and bad days when it comes to anxiety. Someone with an anxiety disorder can become very narrow sighted when it comes to his or her own progress, since that person is usually living just in the moment due to the constant worrying. Taking a step back and looking at where you started with anxiety and where you are today will not only show you all the progress you have made but will also be an encouragement to keep moving forward. If someone with anxiety thinks that they have to “be better” by a certain time, then that’s just one more thing to worry about. As long as you’re making strides in a positive direction, slow or fast, you’re doing it right.
14. MAKE SURE YOU’RE WORKING ON THE ANXIETY, NOT AVOIDING IT
ASD parents know certain triggers can cause sensory overloads, and they usually know how to avoid those those situations. That is certainly a good practice, but the same approach to anxiety can be unhealthy. Identifying stress triggers and avoiding anxiety altogether puts you and everyone involved in a rigid routine that can make the anxiety even worse if and when that routine is broken. It is far healthier to approach anxiety with a plan of slowly overcoming those feelings than staying away from them. Slowly facing one’s fears is the best treatment for anxiety, while avoiding them just delays getting better.
15. ALWAYS LOOK TOWARDS A POSITIVE FUTURE
Slow and steady wins the race, and that is especially true when it comes to dealing with anxiety for those with autism. Communicating feelings of fear and worry is hard enough without the added communication barriers that often come with ASD. When trying to help someone with autism deal with anxiety, it is important to look for physical cues, use methods that will work for that individual – whether it is a card system, relaxation practices, or a combination of several techniques – and a determination to not give up with the knowledge that anxiety can be overcome and put in the past.