Anxiety in Autism

There are three anxiety concepts that are going to help you to understand anxiety in general, and in an autistic child.

  1. Anxiety is a result of how someone is perceiving life experiences.
  2. Anxiety is almost always future focussed – anticipating a potentially bad or painful situation will happen based on experiences from the past.
  3. Anxiety is about Control and Prevent

Before we get into these three concepts, however, let’s first talk about what anxiety might look like in Autism.

In autism, anxiety can present itself in many ways, such as:

  • Being more insistent on routines or rituals.
  • Avoidance behaviours.
  • Meltdowns.
  • Self-harming including head banging, scratching, cutting, or biting themselves.
  • Aggressive behaviours towards you or others.
  • Obsessive behaviours like lining objects up, ritualistic behaviours or spinning objects.
  • Stimming behaviours like rocking, spinning or hand flapping.
  • Echolalia Anxiety – repetition of words, phrases or noises when stressed.
  • Selective Mutism in social situations or when anxiety is felt.

The challenging part of this list above, is that you may see these behaviours whether anxiety is present or not, so becoming observant about what is going on for your child will be imperative to helping you to help them to manage their anxiety.

If the behaviours above are associated with anxiety, they are really just a symptom of what’s going on for your child, not the cause. To understand the real cause let’s look at the first concept from today’s lesson:

#1 - Anxiety is a result of how someone is perceiving their life.

When we experience an event, we experience with the five senses – we see it, hear it, taste it, touch it, and / or smell it.

The sensory information goes into the brain for evaluation.

The brain asks: “What is this that I see, hear, taste, touch and smell? Have I seen it before? Do I have a reference point of this event, or an opinion? What does this event mean and what does it mean about me and my survival?”

The brain accesses the memories that are kept in the hippocampus and says, ‘What have we got stored in our memory bank hippo? Is this experience dangerous or safe? What do we need to do about this?”

Depending on how your child is evaluating the events, based on their past memories, beliefs or reference points, they determine a response – a physical response: their emotions and their bodily response like sweating, shaking or tensing; and a behavioural response. The behavioural response will always be an attempt to pursue pleasure and avoid pain.

When trying to understand your child’s anxiety, we need to try to get a sense of how they are perceiving the events they are anxious about?

There are several influences that have come from your child’s experience of life to date that may have become contributing factors to an anxiety mindset. Some of these could be:

  • Someone of influence tells them what they should or shouldn’t do and they feel they have to play by those rules or else.
  • Developing a fixed viewpoint of right vs wrong leading to inflexibility and fear of doing something wrong or fear of failure.
  • Where your child is at in their brain development isn’t giving them the whole picture of how an experience will occur.
  • Difficulties with social imagination can cause an autistic person to struggle to understand someone else’s point of view or predict their behaviour. They only see the outcome through their own perceptions and thus the world can feel very confusing and unpredictable.
  • Experiences from the past where they have been hurt, scared or had an adverse outcome becomes their reference point of something bad happening again in the future. (PTSD may also be a contributing factor).
  • Not yet having the skills to deal with a difficult situation (eg social situations) which may lead them to feel anxious and want to avoid certain situations.
  • Inability to communicate or express their emotions and thoughts accurately.
  • An actual threat to their physical or emotional survival (eg loud noises can feel like an actual threat to someone with sensory processing challenges).

Because the brain is always interested in survival, it’s always looking to pursue pleasure or avoid pain. It’s trying to feel good and avoid feeling bad. That will always be the agenda behind our behaviours.

It’s important to understand that what may seem like a perceived threat to you, may be an actual threat to them. For example, being in a shopping centre and being exposed to what feels like loud or traumatising noise, can feel like a literal threat to your child’s survival, but may seem insignificant to you.

Therefore it’s super important to delve into the world of your child and try to understand – what must they be thinking to be feeling this way? What information are the referencing to be thinking and feeling anxiety?

#2 - Anxiety is almost always future focussed – anticipating that a potentially bad event could happen.

What makes this thinking / feeling / behaving loop even more complicated when it comes to anxiety, is the brain doesn’t just think about what’s happening in this present moment.

It’s constantly thinking about what’s coming up. It’s accessing the hippocampus to reference memories, learnt knowledge and beliefs and using it to predict any potential problems in the future so it can activate the appropriate physical and behavioural responses that will prevent them from physical or emotional harm.

The problem is, when the brain does this, the person feels this in real time. It doesn’t matter to the hippocampus whether the event is happening in the now or is imagining or anticipating a future, it still sends the same messages to the body to react the same.

That means your child is often responding to an anticipated future in real time.

You could be seeing avoidance behaviours or coping behaviours in a child when there doesn’t seem to be anything happening right now.

Because their body is responding as if the threat is in real time, your child may not understand what’s happening in their body that makes them feel anxious and will engage in coping behaviours to try and reduce their anxiety.

In addition, the anxiety mindset if only ever focussed on what could go wrong. When anxious, the body is in survival mode, so your child is looking for evidence of threats, not evidence of their safety or security.

#3 – Anxiety is About Control and Prevent

This concept is probably the most important one out of the three concepts and will help you to understand why your child may be behaving the way they do and how it is associated with anxiety.

When you look at the diagram above, you will see that the behaviour is just the result of how you think and how you feel.

As mentioned before, behaviour always has the agenda to pursue pleasure and avoid pain. It’s the body’s survival mechanism.

What that means is the behaviour that you are seeing in your child is a survival strategy designed to attempt to control something to go right (by their standards) or prevent something from going wrong.

This will always be based on their perception or reference point of right and wrong to begin with, which can be problematic in itself.

For example,

  • A child who is stimming when in a stressful situation, can be using those actions to control (regulate) their emotions.

  • A child who is refusing to go to school could be preventing being teased or feeling worth-less among his peers or preventing the feeling of confusion when they don’t understand the work.

  • A child who is acting aggressively may have learnt that when she behaves aggressively other people cater to what they want or leave them alone, thus is trying to control the outcome.

  • Alternatively, anxiety can be about feeling out of control. Aggressive behaviours or meltdowns can occur for these reasons too.

  • Self-harming is a behaviour designed to soothe or distract. They may find the self-harming act comforting, they may like the sensation, or may use it to distract themselves from stronger, more painful emotions.

  • Echolalia anxiety – the repetition of words or phrases or noises, can take their attention off anticipating a future they don’t want to deal with or don’t know how to deal with, or it can feel soothing when a child is anxious.

  • Obsessive compulsive behaviours occur when the child feels other areas of their life are uncontrollable. The OCD behaviour becomes the one thing they can control, thus becoming another coping or calming strategy.

When you look at these examples, you can start to see the intelligence of the human mind and body. While we may initially look at these behaviours and see them as problematic, from a survival perspective, they are actually quite ingenious.

Your child is just trying to learn how to survive and has adopted certain behaviours to try and fulfil this objective.

While yes, some of these behaviours need to be addressed due to health and safety, we have to first recognise that there is a reason for these behaviours and it’s all about what can be gained or what needs to be avoided to feel good and avoid feeling bad.

So how is knowing this information helpful?

Firstly, it’s helpful because you can start to look at the anxiety behaviours as a survival strategy not as naughty, disobedient or dysfunctional behaviour. You can start to look at what your child is trying to control or prevent.

Secondly, it’s helpful because now you can get curious about the thought process leading to these feelings and behaviours, and thus get to the real source of the problem.

Start by asking yourself these questions:

What is my child trying to control right now?

What is my child trying to prevent right now?

Why does it make sense that my child is using this strategy (their behaviour is the strategy) to control or prevent?

And the most important question, how can I help my child to manage this situation, so they don’t feel so anxious about it? How can I help them to control or prevent in more productive ways?

The first step to helping your child with anxiety is about understanding and curiosity first.

The ‘why’ behind their anxiety (ie their thoughts, beliefs, reference points and memories driving their emotions and behaviours) is going to dictate your approach to reducing the anxiety.

For example,

  • A child who is anxious because they think everyone hates them, needs help to identify why they are likable, see evidence of people who do like them, or help them to find opportunities to feel good in a social situation.

  • A child who is anxious because they have a memory of how something went wrong before, may need strategies to plan the next event, help to see ways the situation can go differently, or help to see other points of view they may not be considering.

  • A child who is hurting themselves when anxious or overwhelmed, may need alternative strategies to use when feeling overwhelmed.

  • A child who is fixated on a something needing to go a certain way, may need help to talk through why they need things to go a certain way and what their fear is if it doesn’t go to plan.

While they are learning to adopt a new viewpoint, they may need help to cope with things when they don’t go to plan and be gently exposed to gradual conditions where they have to practice more flexibility (depending on the situation of course).

How to apply this article to your child

This article first focuses on the ‘why’ behind anxiety in your child. 

Why are you seeing these anxious behaviours?  Why is your child feeling anxious in certain situations?

To understand, ask yourself the following questions:

  • What is my child trying to control right now?
  • What is my child trying to prevent right now?
  • Why does it make sense that my child using this strategy (behaviour) to control or prevent?
  • How can I help my child to manage this situation, so they don’t feel so anxious about it?
  • How can I help them to control or prevent in more productive ways?

Because going into observation mode is going to help you make sense of the behaviour, which from that point either makes it obvious what you need to do to help your child, or gives you ideas on how to source information to help your child.