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Helping children with autism spectrum disorders face their fears

Helping children with autism spectrum disorders face their fears

Children with high-functioning autism spectrum disorders (ASD) are at an increased risk for developing anxiety symptoms. Anxiety comes in many forms, from an acute fear of spiders to persistent worries about making mistakes. When these fears start to interfere with children’s everyday lives, they can have negative effects on school performance, peer relationships and family life.

Recent clinical research suggests that anxiety is treatable in children with ASD, and that the cognitive and behavioral strategies used with typically developing children can be modified for children with autism—with encouraging results. This article provides a set of basic tools to help children with ASD face their fears at home, at school and in their communities.


Do

Do identify and talk about fears

Children with autism often have difficulties recognizing when they are anxious. Sometimes, it takes an adult to help children identify situations that make them nervous, find words to express their feelings and link those feelings to behavior. For instance, if your child is resisting going to school, start by making a reflective comment: “I noticed that you don’t like going to school when you have to give a presentation. Does it make you upset to talk in front of the class?” Children with ASD may dislike words such as “fear” or “anxiety” and may initially feel more comfortable describing their feelings as “upset.” It also may be easier to make a statement about how they might feel rather than ask how they feel such as, “you look upset”. Having such conversations with your child builds a shared vocabulary for talking about anxiety, teaches self-awareness and lets him/her know that experiencing and expressing emotions is acceptable. Over time, this can help you to communicate more effectively with your child about anxiety and avoiding behaviors.

Do replace worry thoughts with helpful thoughts

Anxiety can shift the mind into overdrive. A relaxing visit to the lake can trigger a waterfall of worries: “What if I fall in? What if there are bugs in the water? What if there’s a whirlpool, and I drown?” Your child’s “active mind” can quickly lead him to catastrophize. When these worries come up, coach your child to replace them with helpful thoughts: “I’m a good swimmer. The lake is a safe place, and my parents are here if anything happens. I can do this!” Once you have modeled these helpful thoughts a few times, encourage your child to say them to him/herself so they become internalized and easy to remember in scary situations.

Do recognize the body’s signals

When danger approaches, our body naturally sounds the alarm: a racing heart, sweaty palms, a dry mouth. For children with anxiety, these physical reactions often occur in the absence of real danger, such as when separating from a parent, approaching a group of peers, talking in class or taking a test. Physical coping strategies, such as breathing deep into the belly, help to calm the body’s “fight-or-flight” response. Teaching your child to recognize these symptoms as “false alarms” can enhance self-awareness and calm somatic reactions to fear.

Do model positive coping strategies

Children learn a lot about how to manage emotions from observing adults. When you are feeling stressed, try to label the emotion, identify the body’s “false alarm” and model adaptive coping. For example, when lost on a family drive, talk aloud about your process: “I think I’m a little lost, but that’s okay because everyone takes a wrong turn sometimes. Let me pull over, take a few deep breaths and ask for directions.” Talking aloud may seem unnatural at first, but for children with ASD, it can be helpful to make your internal coping strategies more explicit. Talking aloud allows children to see your steps to success more clearly and to imitate these steps more easily in their own stressful situations. Deep breathing, reading or taking a walk together are all great ways to teach your child simple strategies for managing anxiety.


Don't

Do not underestimate your child’s strengths and ability to be brave

Both anxiety and ASD present tremendous challenges, but that doesn’t mean your child can’t rise to the occasion. Often, it takes a parent or teacher’s conviction that their children can in fact face their fears for kids to take the leap. Furthermore, sheltering children with ASD and anxiety from all stressful situations robs them of valuable opportunities to practice their coping strategies and gain the experience they will need in adolescence and beyond. It is natural to want to protect your child, compensate for his/her difficulties and avoid challenging situations. However, at times, this can disempower the child. Instead of sticking exclusively to familiar activities, try a new activity, such as karate or horseback riding, encouraging your child to take gradual, small steps toward full participation. Provide the right tools, structure and support for these experiences at a manageable pace. You may be surprised at your child’s ability to meet life’s challenges.

Do not rush your child’s process

Forcing children with ASD to face their fears before they are ready can reinforce fear and avoidance, and diminish their trust in you as an ally in managing their anxiety. Taking gradual steps is key when helping children with ASD face fears. For example, overcoming social anxiety might begin with guiding your child through role-play dialogues with a family member, and then practicing with familiar peers before attempting to strike up a conversation with a stranger. This “graded exposure” provides a manageable structure for progress to occur, and it gives children multiple opportunities to practice coping strategies and experience success. When the time comes to start a conversation with an unfamiliar peer, your child will have plenty of practice and confidence under his/her belt to take the plunge.

Do not allow your own anxiety to get in the way

Working with children with ASD and anxiety is no easy task, and it is normal to feel stressed at times. Learning to manage your own anxiety is key to helping children with ASD manage theirs. Anxiety influences our behavior in a variety of ways, affecting teaching and parenting styles in ways we may not be aware of—from diminishing our patience to sapping our problem-solving skills. Not only does our anxiety affect our children’s feelings and behavior, but it often keeps us from letting them take on new challenges. Remember that you are a model of bravery and positive coping for your child. Take a deep breath, conjure up your own helpful thoughts and reward yourself with some chocolate now and then. When you are calm, you can model bravery, be more patient with and attuned to your child’s process, and encourage opportunities for your child to face fears one step at a time.

Do not forget to encourage brave behavior and reward efforts to face fears

Children with ASD may be especially motivated by rewards: a favorite food, a prized video game or a special outing to the science museum. Help your child to face his/her fears a little at a time and reinforce the use of coping strategies, such as deep breathing with praise or a sticker. Even small acts of bravery—a socially anxious child inviting her friend over to play or a child with separation anxiety averting a meltdown as his parents leave for a dinner out—represent important steps toward facing fears and deserve to be acknowledged. Reflecting back to your child what he/she has accomplished and linking such accomplishments to rewards not only reinforces brave behavior, but it also lets the child know you are proud of him/her.


Summary
Jumping cartoon

Children with ASD and anxiety face a variety of obstacles in school, home and community environments. However, these children also have tremendous strength. With the right tools and support from an allied adult, children with ASD and anxiety can learn to face their fears. Parents, teachers and mental health practitioners can implement these cognitive and behavioral approaches to help children manage anxious feelings and participate more fully in their communities.


More expert advice about Kids with Autism Spectrum Disorders (ASD)

Photo Credits: © Mila Supynska - Fotolia.com; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Judy Reaven, Ph.D. & Jessica Stern, B.A. Judy: Associate Professor of Psychiatry and Pediatrics, University of Colorado Denver Anschutz Scho

Dr. Reaven has worked in the field of developmental disabilities as a clinician, researcher and educator since 1985. Since 2001, she has been Director of the Autism and Developmental Disabilities Clinic of JFK Partners. Clinical and research int...

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