An exploratory study
published in the journal Autism
reported on a series of 5 focus groups with parents of children and adolescents
with ASD and anxiety as a first step in identifying the triggers, behavioral
signs and cognitive processes associated with anxiety. Seventeen mothers of 19
children with a diagnosis of ASD participated in the focus groups. All children
(12 boys and 7 girls) had received ASD diagnoses from local clinical services
and were reported to experience significant levels of anxiety that had an
impact on their functioning.
The following is a summary of key themes identified by parents in relation to triggers, symptoms and impact of anxiety in their children with ASD.
The following is a summary of key themes identified by parents in relation to triggers, symptoms and impact of anxiety in their children with ASD.
Anxiety
triggers/Stressors
1. Change or disruption to
routine.
2. Confusion and worries
about social and communication situations.
3. Specific fears and
phobias.
4. Sensory oversensitivity
and overstimulation.
5. Being prevented from
preferred repetitive behaviors and interests.
6. Too many demands or
expectations.
Presentation of
anxiety
1. Increase in challenging
behavior.
2.
Avoidance/withdrawal/escape.
3. Increase in levels of
arousal.
4. Increase in sensory,
repetitive, and ritualistic behavior.
5. Physical sensations
associated with anxiety.
6. Cognitive distortions
and errors in thinking.
Impact of anxiety
1. Personal distress in
children, parents, and siblings.
2. Increase in challenging
behavior and stereotyped behaviors.
3. Restriction of
activities/opportunities.
4. Negative impact on
quality of life for child and family.
Parent Perspectives
Across groups, parents
gave markedly similar descriptions of the triggers and behavioral signs
associated with anxiety. Parents’ perspectives on the anxieties of their children
indicate that there are many overlaps with anxiety as experienced in the
general population. Shared triggers included social worries, specific phobic
stimuli, and expectations that are, or are perceived to be, too demanding.
Common features of the presentation of anxiety include an increase in arousal
and avoidance/escape behaviors.
There were, however, a
number of autism-specific triggers and symptoms of anxiety identified in
children with ASD. Key features were the intensity, pervasiveness and
persistence of the anxiety. Changes and disruptions to routines, sensory
sensitivities and social difficulties associated with difficulties in perspective-taking
and social expectations appeared to be ASD-specific triggers. Situations that
were reported to trigger anxiety often reflected autism-related difficulties in
processing style or sensory sensitivity.
The majority of comments about the presentation of anxiety fell into the categories of challenging behavior and avoidance/withdrawal, indicating that behavioral manifestations are the major expressions of anxiety in children with ASD. When asked about their anxious thoughts, the most prominent theme that emerged was the difficulty that children with ASD have in expressing their anxiety verbally, particularly at times of severe distress. Although this is also occurs with many typically developing children, it may be a particular difficulty for children and youth with ASD given the challenges they face in understanding and expressing emotions and pragmatic language difficulties. In addition to similar descriptions of the triggers and behavioral signs associated with anxiety, the impact of anxiety was reported to be often times more substantial than the impact of ASD itself.
The majority of comments about the presentation of anxiety fell into the categories of challenging behavior and avoidance/withdrawal, indicating that behavioral manifestations are the major expressions of anxiety in children with ASD. When asked about their anxious thoughts, the most prominent theme that emerged was the difficulty that children with ASD have in expressing their anxiety verbally, particularly at times of severe distress. Although this is also occurs with many typically developing children, it may be a particular difficulty for children and youth with ASD given the challenges they face in understanding and expressing emotions and pragmatic language difficulties. In addition to similar descriptions of the triggers and behavioral signs associated with anxiety, the impact of anxiety was reported to be often times more substantial than the impact of ASD itself.
Implications
Although this study did
not specifically address assessment and intervention/treatment issues, several
implications in these areas emerged. For example, when parents and children
with ASD are asked to describe their experiences in a semi-structured,
non-directed manner, they largely focus on features more specific to the ASD
population that are not typically measured on most standard anxiety measures.
Although there are broad-based measures that evaluate emotional/behavioral
difficulties in children with neurodevelopmental disabilities, a significant
gap remains in the resources available to clinicians and researchers for
measuring ASD-specific aspects of anxiety. This argues for the inclusion of
observational methods in the assessment of anxiety: using multiple informants,
multimodal assessment techniques, and methods.
Recommendations for future
research include focusing on larger groups and control samples, and systematically
investigating the link between ASD cognitive processing styles and anxiety. The
authors propose that further exploration of the similarities and differences
between shared and ASD-specific triggers, manifestations, and effects of
anxiety using a variety of methodologies will contribute to the development of
more appropriate assessment measures and ASD-specific models of anxiety which
can then guide treatment for more effectively.
Ozsivadjian, A., Knott, F.,
& Magiati, I. (2012). Parent and child perspectives on the nature of
anxiety in children and young people with autism spectrum disorders: a focus
group study. Autism,
16, 107-121. DOI: 10.1177/1362361311431703
Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books, A
Best Practice Guide to Assessment and Intervention for Autism and Asperger
Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. He is also the editor of a text in the APA School Psychology Book Series, Autism
Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and
Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd edition).