Life is stressful. For individuals with autism spectrum disorder (ASD) and developmental disabilities, doubly so. Imagine navigating a world that is bright and loud and confusing, where you often don't understand the native "language." It's no wonder so many kids develop acute anxiety in response to such stressors.
In some, that anxiety manifests outwardly, in aggressive or self-injurious behaviours. For others, it gets turned inward -- by avoiding all situations that are beyond their control or obsessively engaging in repetitive behaviours.
"Anxiety is the tip of the iceberg," said Dr. Jonathan Weiss, Associate Professor of Psychology at York University and Federal Chair in Autism Research and Care, speaking at a recent seminar at Geneva Centre for Autism.
With 30 per cent of youth with ASD affected by three or more mental health conditions, including anxiety and depression, it's critical these children are given the tools to experience the world in a more adaptive way.
Although anxiety itself is unavoidable -- and even, in small doses, useful -- there are healthy ways to manage it. Two effective ways to treat anxiety in children aged 8-15 are cognitive behaviour therapy (CBT) and mindfulness.
The first step involves detective work. What is it about a particular situation that triggers anxiety? What is the child trying to avoid or escape? Social stories and Google searches are useful in outlining expectations and setting out facts, thereby eliminating all those harmful (and improbable) "what if" scenarios. Start with mild exposure to the anxiety-provoking situations, keeping the environment as structured and controlled as possible.
Cognitive Behaviour Therapy
The child with ASD must learn to identify a broad range of emotions and corresponding facial and body expressions, then encouraged to tune into their bodies and rate the intensity of their emotion using a "feelings thermometer."
Imagining the worst possible outcome is often their go-to reaction.
We feel what we feel. Although our emotions are always valid, our thoughts about a given situation are often skewed and in need of revision. Imagine, for one reason or another, you are fuming, and someone comes along and urges you "not to be angry." Ditto when someone tells you to breathe deeply. It simply doesn't work. If anything, such advice dispensed in the heat of the moment may probably only stoke your already-raging fire.
CBT acknowledges the present feelings while attempting to redress the damaging thoughts behind them. We all have scripts we write for ourselves. In autistic individuals, those scripts or schemas are often far from compassionate or resilient. They can be downright toxic: This homework is hard. Ergo I suck at math. Ergo I will certainly fail the class. Ergo I suck. I'm stupid. I can't do anything right.
Dr. Weiss talked about visiting the dentist, an experience that is collectively viewed, at best, with ambivalence. I love going to the dentist, said no one ever. Yet so much of our experience depends not the situation but how we frame it in our minds. For most of us, going to the dentist -- though unpleasant -- is a necessary evil if we want clean, healthy teeth. We may not like it, yet we know the appointment will be bearable and won't last long. Such perspective does not come automatically for those with autism who tend to think in terms of absolutes, distorting and "catastrophizing" everyday situations. Imagining the worst possible outcome is often their go-to reaction.
However, we know life is not black and white, but full of gradients. We can model positive thinking patterns and self-statements. What's the worst that can happen? What's the likelihood of the drill cutting into you? Will it happen for sure? What happened last time? Come up with a backup plan together to prepare and empower the individual.
Mindfulness
Contrary to popular belief, mindfulness is "not about clearing your mind." Rather, it's about being aware in the moment without responding to or judging it.
Mindfulness teaches us to shift our focus by the nth degree. We each hold a spotlight, and can choose to shine it wherever we like. While the drill is in our mouth, we can acknowledge the unpleasantness of the moment while concentrating on the music in our ear buds or visualizing a beach in the Bahamas...
The beauty of mindfulness is that there is no right way or wrong way to practice. One helpful meditation directs focus to the soles of the feet. It doesn't matter whether you are sitting or standing or fidgeting. The key is to start small, and make the exercise habitual. It needn't take more than a few minutes at a time. To be effective, mindfulness should be viewed as a family ritual that contributes to everyone's well-being, not merely a chore to be carried out by its autistic members.
If anything, our world is becoming more stressful, not less so. By nature, individuals with autism bear the brunt of that stress. Through the combination of CBT and mindfulness, the hope is that we can teach our kids to control their anxiety so it doesn't control them.
Dr. Weiss will be speaking about Mental Health and Emotional Regulation at Geneva Centre for Autism's International Symposium on 30 November-2 December 2016 in Toronto. For more information, click here.
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