1. What is Anxiety?

Anxiety is the mind and body’s response to a perceived threat to our physical or psychological wellbeing. It is more than just a feeling of being worried or stressed and should be taken seriously.

For some children, feelings of anxiety can arise so frequently and persistently that it can affect their quality of life, and their day-to-day life for a prolonged period. The most challenging aspect of anxiety in children with autism is that anxiety can be felt more often, more acutely and can present in a range of diverse ways.

Anxiety in children with autism may be expressed as:

• Restlessness
• Difficulty focusing
• Refusing to go to school or take part in an organised activity
• Perfectionism
• Avoidance
• Crying
• Tantrums
• Headaches
• Upset stomach or stomach pain
• Meltdowns about things in the lead up to or after an event, such as not having their favourite socks, clothing, or pencils
• Difficulty in transitioning from one task to another
• Stimming or other repetitive behaviours
• Self-harm
• Difficulty sleeping and relaxing

Children with autism often have difficulty understanding and communicating their emotions which can contribute to their feelings of anxiety, isolation, fear, and confusion.

Common Anxiety Triggers

The Australian website Raising Children  have a comprehensive section about common anxiety triggers in primary and secondary school aged children.

Common anxiety triggers often involve social situations, and the uncertainty that surrounds knowing how to behave and react in ways that are socially acceptable and positive.

Common triggers include:

• Changes in routine
• Changes in environment
• Unfamiliar social situations
• Sensory sensitivities
• Fear of situations, activities, or objects
• Transitions – either activity based, socially based or developmental

2. What is Depression?

Depression and anxiety exist both independently of autism and comorbidly. Depression is a mood disorder and can significantly impact both quality of life and self-esteem.

Children with depression experience prolonged feelings of sadness, anger, irritability, frustration, fatigue, isolation, and a loss of interest in day-to-day activities. Both anxiety and depression can be clinically diagnosed, and a well-rounded treatment plan can include medication, exercise, diet, social skills, cognitive behavioural therapy, acceptance therapy, sleep therapy, counselling and family therapy and meditation. It is important to seek medical help and advice as soon as possible.

Children with autism are more likely to experience anxiety and depression because of the likelihood of attention to detail, differences in memory, perspective and recall, and coping with the increased pressures associated with different developmental journeys from their peers and increasing complex social roles, expectations and situations.

Cognitive, emotional, and behavioural signs of depression include:

• Difficulty focusing
• Indecision
• Forgetfulness
• Negative thoughts – negative mindset
• Sadness and irritability
• Feeling numb or detached
• Fatigue
• Restrictive or excessive eating
• Unexplained physical symptoms e.g., headaches or stomach aches
• Insufficient or excessive sleeping

Rumination is very common among children with autism, the process of holding on to thoughts or feelings about a negative interaction or experience and having extreme difficulty in letting go or putting feelings and experiences into perspective.

3. How to Identify Triggers and Apply Strategies

Parents, carers, family members, teachers, support team members and friend can all help by observing children in different environments and creating a list of situations or triggers that are likely to result in your child feeling anxious, depressed, or overwhelmed.

Identifying common triggers allows all the people who support your child’s daily growth, development and learning to anticipate what situations or experiences may be triggering and develop strategies to help support your child during these times. Some strategies may require trialling, amendments, and changes. We can then teach these strategies, with the end goal being that your child will know what works best for them, and how to help themselves cope with their specific challenges.

This knowledge increases your child’s self-esteem, self-confidence, and positive sense of self identity.

4. What is a Meltdown?

Meltdowns are common amongst children with autism. All children have tantrum behaviour, which is disruptive and meets a child’s need for attention, control, or to express tiredness and frustration. A meltdown is different in that children are not seeking attention, or control.

A meltdown is like a technological system shut down, in that the cognitive, emotional, behavioural, and sensory systems are overwhelmed and cannot cope. A meltdown is not an act of defiance, it is not deliberate or premediated, and requires empathy and compassion rather than discipline or shame. One of the biggest challenges parents of children with autism face is the lack of understanding surrounding meltdowns, and how best to support children experiencing this confronting, upsetting, unsettling and often embarrassingly public experience.

5. Developing a Strategic Plan with Immediate Actions and Long-term Strategies

Immediate actions are key to helping children cope with meltdowns irrespective of where they occur. They are vital to minimise any danger to your child, or others, and to reduce any shame or embarrassment your child feels once they are feeling better.

Immediate Actions:

• Stay calm, and if you are in a crowded/busy/moving environment try diversion or distraction.
• Create a safe space for your child, as best you can. Ask people not to stare or to move along.
• Minimise sensory input, so reduce noise, minimise lighting, ask other adults and children to leave – and any other actions that may reduce information overloading.
• Reassure you child that they are safe, and you are there for them. Use a calm, quiet voice and be as clear and concise as possible e.g., “I’m here, you’ll be ok.”
• Allow your child time, to process what has happened. Offer a drink of water.
• Use calming strategies such as fidgets, a comfort item, breathing regulators, timers.

Identify Causes:

• Make notes in a diary about where meltdowns occur, the time of day and what happened prior to the meltdown.
• You may be able to see a pattern of usual places, sensory stimulation, activities, experiences and times when meltdowns are more at risk of happening.

Minimising Triggers:

Common triggers for meltdowns include:

• Sensory overstimulation: crowds, shopping centres, markets, sporting matches, public announcements, events where loudspeakers or AV equipment is used.
• Changes in routine: a substitute teacher at school, a special school event like a concert, sporting carnival or camp, a power shortage or blackout, roadworks or upgrades affecting travelling, friends being sick and not at school.
• Anxiety in social situations: birthday parties, catch-ups with more than three people (navigating group dynamics),
• Communication difficulties: difficulty in identifying, labelling, and expressing feelings.

Once you have established what the common triggers are for your child, you can begin to create visual supports, timetables, lists, travel maps, menus, processing steps and social stories to help guide your child’s expectations and explain likely and unlikely outcomes.

Providing limited choice options (this, or that) is also an effective coping strategy that allows your child some input and choice, without overwhelming them with options or information.

The aim of these tools is to help your child become more familiar with what is expected behaviour, and likely social interaction. Demystifying firsts, by explaining what is likely to happen in each situation, helps provided a degree of certainty that reduces the degree of anxiety and catastrophising (imagining or predicting the worst possible outcome) that your child may experience.

6. How to Develop Self-Confidence and Positive Self Esteem

The easiest way to develop self-confidence and self-esteem in children is to focus on their strengths, special interests, and talents:

• Allow your child time and space to practice their strengths, because this allows them to gain a sense of accomplishment and achievement in an area or subject that feels interesting, motivating, and safe.
• Use visual records, such as a jar of coloured marbles. Whenever your child shows positive actions, decision making, communication, behaviour modelling or reflection, put a coloured marble in the jar. Children with autism can ruminate on mistakes, so if this starts to happen, or your child feels negatively about themselves – you can share with them a visual reminder of all the times they have done well.
• Feedback, instruction, discussion, and conversation are all examples of times where you can control the narrative about your child’s strengths and challenges. A positive mindset and social skills can be learned and taught. Always be thoughtful, compassionate, and supportive when talking to your children and your family about autistic behaviour, as this narrative becomes your child’s inner voice.
• Social acceptance and friendships are particularly important in building self-esteem and self-confidence. You can support your child by teaching them about the characteristics of a good friend and how to maintain healthy friendships.
• Developing self-confidence and self -esteem also requires lots of opportunities to learn how to self-regulate and self-care. A positive autistic identity will help your child to learn about themselves as well as appreciate differences in others.
• Encourage and reward positive self-talk and self-reflection.
• Sometimes focusing and rewarding effort can be more successful in creating positive behaviour and attitudes than focusing on outcomes.
• Try using different methods to support your child’s learning. Adapt goals to fit your child’s developmental learning curve and use chaining or laddering techniques to break down learning into smaller, manageable tasks and skills. This allows children to build up their confidence and motivation throughout the learning process rather than just at the end when a goal is complete.
• Encourage flexible thinking and flexibility in creating coping strategies. Your child, their abilities, strengths, and challenges will change over time. Adapting and changing strategies to best fit their needs is going to increase their self-esteem as they feel more confident in recognising their wants and needs and helping themselves or asking for support.

Summary:

• Anxiety is the mind and body’s response to a perceived threat to our physical or psychological wellbeing. It is serious, it can significantly affect our health, well-being, and quality of life.
• Common anxiety triggers often involve social situations, and the uncertainty that surrounds knowing how to behave and react in ways that are socially acceptable and positive. (Knowing what to do, and when to do it.)
• Depression is a medical condition. It is serious, and refers to feelings of sadness, helplessness, frustration, or disinterest that do not go away or change in different environments or circumstances.
• There are cognitive, emotional, and behavioural signs that children may be depressed. If you suspect your child is anxious or depressed, please contact your GP, and seek help and support as soon as possible.
• You can begin to identify the triggers that contribute to your child feeling anxious or depressed and develop strategies to help them cope during these challenging times.
• A meltdown is not an intentional, or disciplinary type of behaviour. Meltdowns are a sign that your child is completely overwhelmed and unable to process information.
• Meltdowns can also have common triggers. Once you identify these triggers you can help develop strategies specific to your child needs to help reduce their frequency and intensity in the short and long term.
• The easiest way to develop self-confidence and self-esteem in children is to focus on their strengths, special interests, and talents.
• Developing self-confidence and self-esteem requires opportunities and experiences, positive narratives, and the development of a positive autistic identity.

Sources:

• Ref: https://www.learningsuccessblog.com/files/pin_original_image_233202086933541156_ts1483042527_8d9123035810d1ce2fad123cb7629492.jpg
• Ref: Maslow-large.jpg (1500×1442) (scratchsleeves.co.uk)
• Ref: IAN Research Findings: Issues of Attention and Mood in Children with ASDs, Their Siblings, and Parents | Interactive Autism Network (iancommunity.org)