How to cope with Anxiety and Fear

Anxiety symptoms and reactions are very common in individuals with autism spectrum disorder (ASD). They can interfere with functioning across home, community and school settings. Scientific studies have found that from 11 to 84 percent of youth with autism suffer from anxiety symptoms – intense fear, trouble concentrating, rapid heartbeat, tension, restlessness or sleeplessness. Lisa Rogers with Educating Diverse Learners answers a reader’s question about helping her son overcome his daily stressor. 

Q: Dear Lisa,

My son has fears. One thought gives him daily anxiety: that of his pants not staying up. We tried belts that he buckles too tightly. He still fears the pants will fall and the buckle gives extra sensory problems. We tried sweatpants that he ties tightly, still fearful. All day he hikes his pants up. I tried to show him the pants can’t fall down but this doesn’t help. He also insists on wearing underwear two sizes too big. He is 8 and diagnosed as PDD-NOS. Could you direct me to any information to help him? This fear is causing multiple meltdowns daily. I don’t know what to do.

Thank you.

-Anonymous

A: Dear Mom or Dad,

Multiple meltdowns each day can certainly take its toll on your son and your family. I understand how critical this issue is for you and will do my best to provide helpful information for you to consider.

In order to be most helpful, I do need to ask a few questions first.

  • Is your son able to explain in any way what is causing or contributing to this fear? You mention that this is a current situation and so any insight about the reason for this development will be helpful. As you know, children on the autism spectrum are often rule-driven and literal in their interpretation of language. Perhaps something an adult said with good intentions about the importance of keeping your pants up or a scene from a movie could be a root cause? On the surface this might seem silly, but this can help in better understanding your son and his very real fear.
  • If your son is able to communicate through words or pictures, you might try cartooning as a way to acquire insight. When he is calm and all is well, you can sit together and draw a cartoon where you ask him to describe his thoughts while he is walking with his pants snug and tight around his waist. If not too stressful for him, you could even draw a picture with pants falling down on a stick figure and ask him to describe his ideas/feelings about this.
  • Have you already tried suspenders or even overalls to provide a sense of security beyond a belt or tie? It sounds like there are compounding sensory issues and so these might not be feasible options.

For now, here are a few ideas to consider . . .

I. Due to neurological differences, individuals with autism often experience a higher level of stress and anxiety. Structure, however, makes events predictable and helps to reduces stress, confusion, and anxiety.

So while you want an answer to your immediate problem, adding structure may be a critical preventive key to decrease anxiety which may be contributing to the presenting problem. A few ways to add structure at both school and home include the following:

  • Establish set routines at school and at home
  • Create daily schedules, weekly calendars and lists
  • Use visual cues like checklists with photos
  • Establish clear visual cues so that they can understand what work is expected, how much work is required, and how they know when they are finished the work
  • Make transitions predictable and regular
  • Provide tools, such as “surprise cards” to help deal with unanticipated or even planned changes in the routine

Here are a couple of resources for building structure at home:

http://www.freeprintablebehaviorcharts.com/autism_and_routines.htm
http://asdteacher.com/picturechoiceboard/

II. Does your son have any favorite characters or things? If so, these special interests can be used to help him deal with his anxiety/fear about his pants falling down. Power Cards have been found to be effective for some children with special interests.

A Power Card involves including special interests with visual aids to teach and reinforce academic, behavioral and social skills to individuals with Autism Spectrum Disorders. By using their special interest, the individual is motivated to use the strategy presented in the scenario and on the Power Card. It’s a positive strategy that is often entertaining as well as inexpensive and simple to develop.

It can be used when an individual lacks the understanding of his/her expectations, to clarify choices, to teach cause and effect between a specific behavior and its consequence, to teach another’s perspective, to aide in generalization, or as a visual reminder of appropriate behavioral expectations of a situation.

Using Topic Cards to Develop Social Skills in ASD Youth

Topic cards are similar to scripts in that they can help students engage in a variety of topics, beyond their own interests. They are different in that they include just a few words that describe a topic that launch a student or group students in a particular direction. 

Using Choice to Increase Academic Success

A teacher had created a special lunch group to help a student at the middle school level engage in appropriate teen conversations. She had one main interest and it would dominate every conversation. Her interest was in princesses and everything having to do with them. For most young teen girls, princesses were not much of an interesting topic for them.

Preventing Meltdowns

Although we have addressed the topic of meltdowns previously, it is a topic that needs to be revisited often, given the intense nature of the meltdown. “People with autism, new research suggests, may have an unusually large and overactive amygdala. This may be one reason why people with autism are easily overstimulated and have a hard time understanding and managing emotions.” – University of Washington

meltdown

This is one of many neurological findings that helps to explain how meltdowns are very different from tantrums. They originate from a neurological place of sensory differences: an over-abundance of neuronal pathways. The brain, whether through too much sensory input, cascading thoughts, chemical overload or some cumulative effect of all of these, gets overwhelmed!

I know individuals with autism can help understand the horror of the meltdown better than any observer. So I would like to refer to Carly Fleischmann for her unique perspective. The following is an excerpt from her website:

Using Scripts to Develop Conversational Skills for Students with ASD

Actors use scripts to help them memorize dialogue as part of their performance. Once they have memorized the script, then they can recite the words from memory adding meaning through inflection, tone and pauses. One of the common strengths of students with an autism spectrum disorder is that of rote memorization.

script, social skills, asd

Therefore, a script may be an excellent tool to build conversational skills. Scripts are written sentences or paragraphs that individuals can memorize and use as supports in social situations. From greetings to asking for help to engaging in a conversation, a script can be a simple and discrete visual support.

When possible, student interests may be incorporated to heighten motivation to use this strategy. If a student likes Harry Potter books, a script can incorporate pictures that represent events from that book that relate to the content of the script.

Scripts can also support students that tend to shift the conversation back to their own special interest.

Sensory Processing Disorder and Autism: Auditory

First, let’s have sensory processing disorder explained by someone with a personal experience with it. Watch this video of Amythest Schaber, a person living with an autism spectrum disorder.

Differences in auditory processing are one of the more commonly reported sensory processing impairments. In one chart review of developmental patterns in 200 cases with autism 100% of the participants demonstrated difficulties with auditory responding.

During a Meltdown

A meltdown is scary and lonely. A change in routine can be enough to tip the scales in sensory input and cause what is titled a “meltdown” where a person with autism or asperger syndrome temporarily loses control due to emotional responses to environmental factors. They aren’t usually caused by one specific thing.

Triggers build up until the person becomes so overwhelmed that they can’t take in any more information. In previous blogs, we have addressed the complex topic of meltdowns. While the main message is to have a plan to PREVENT a meltdown, we must also be prepared if a meltdown does occur.

Portrait of unhappy screaming teen girl

I will start by outlining what NOT to do. I think this is best said coming from someone that has lived through a meltdown with neurological implications.  The following is an excerpt from a message from Mr. John Scott.

Meltdowns: What Not to Do

My meltdowns can be very frightening and confusing for those around me. I work very hard to appear as capable and composed as possible throughout each day, so when I finally lose it, people are shocked to see me act so “autistic.” I cry, scream, break things, flap my hands, and pound my fists against my head. I haven’t found the perfect remedy for my meltdowns, but I do know what makes them far worse… 

If I am having a meltdown… 
– DO NOT become angry with me or raise your voice. 

Autistic meltdowns may be frightening to observers, but at their most intense, they are nothing less than pure psychological torture for the person experiencing them. I feel as if I am caught in a war zone, terrified for my very life. My senses are on fire and I have very little control over myself. I may feel threatened by intense emotional displays. This is very dangerous. 

– DO NOT attempt to restrain me. 
I understand that my tantrums are scary, as I’m well over six feet tall, but you must remember that I am far more frightened than you are. I would never intentionally hurt anyone, but if you approach me in a hostile manner, or attempt to use any force without my permission, I may lose the last bit of self-control I have. 

– DO NOT ask me what is wrong. 
Trust me, when I’m banging my head into the wall I do not want to discuss my emotional triggers. 

– Most importantly, DO NOT tell me to “snap out of it.” 
Trust me, I would if I could. Don’t patronize or belittle me by acting as if I could control myself if I only tried harder. This is a good way to make the situation ten times worse.
You may know me from my column here on WrongPlanet. I’m also writing a book for AAPC. Visit my Facebook page for links to articles I’ve written for Autism Speaks and other websites.

CLICK HERE  for the entire posting.

I would like to add one more . . . this is not the time to say “Use your words.”  As the brain escalates in a meltdown, the ability to be rational and articulate diminishes.

So now for what TO DO?

  • During a meltdown a child most needs the opportunity to relax. Therefore, you should respond patiently and compassionately as you support this process. Offer choices of relaxing activities, perhaps through the use of a choice board. If the person is not able to make a choice, then simply present a pre-determined calming activity. Often, this might be an activity that incorporates a strong interest [e.g. video of SpongeBob or favorite song/music].
  • In some cases, it might be best to offer a way out of the situation through escaping the current stimulation of the environment. Again, a pre-determined location might be another room or other safe place [e.g. chill zone, motor lab, etc.].  However, it might be difficult for the individual to transition to another location if the meltdown is at its peak.
  • If there are others in close proximity, then it should be part of the plan to move them to a safe place.
  • Most importantly, do everything possible to keep the individual safe from him or herself. If they engage in head banging, protect their head by placing a pillow or bean bag between them and the floor or wall.

As you can see, there is little to really do during a meltdown. Again, all efforts should be made to PREVENT a meltdown.

by Lisa Rogers

A Technique to Counteract School Work Avoidance for Students with ASD: Academic Bingo Card

Work avoidance seems to be an ongoing issue across different settings and grade levels. In a previous blog, we discussed the use of a checklist with a strategic “sandwiching” of a less preferred activity in between two highly preferred activities. This strategy is often very effective in building success on academic activities that the student would prefer to avoid. However, not one thing works for every student, as you have probably discovered for yourself.

So this week, we will explore a similar strategy that is in a different format: a BINGO card!

Academic Bingo Card

This strategy was created in a staff meeting with a general education teacher and campus administrators trying to help a student complete work well within his grasp. By analyzing the data and student strengths, it was determined that he was capable of completing the work. In spite of the cognitive strengths, the student would cover his head up and not complete the academic tasks. So, with no work completed, the team was ready to try almost anything to get something.

The student liked dinosaurs and everything having to do with them. The student also liked games and so the team decided to create a 3 X 3 BINGO card decorated with dinosaurs as a starting point.

Then, the specific activities selected to go in each grid were selected based on student interest.

Resources for Parents About Bullying and Autism in School

Bullying and Autism is an issue that comes up often for parents of children on the spectrum throughout elementary, middle, and high school. Individuals with an Autism Spectrum Disorder (ASD) remain highly vulnerable to bullying behavior. Parents, teachers, other students, and the community must be sensitive to the particular needs of these students and vigilant in bullying prevention and intervention.

This week’s blog will point families in the direction of multiple resources available.

This first resource is quite extensive and provides a comprehensive view of bullying:

“Eyes on Bullying . . . What Can You Do? A toolkit to prevent bullying in children’s lives” 

www.eyesonbullying.org

The following are excerpts from this useful manual:

Bullying Basics

We now know that:

  • Bullying is NOT pre-wired, harmless, or inevitable
  • Bullying IS learned, harmful, and controllable
  • Bullying SPREADS if supported or left unchecked
  • Bullying INVOLVES everyone—bullies, victims, and bystanders
  • Bullying CAN BE effectively stopped or entirely prevented

Beginning in the preschool years, adults can teach children important bullying prevention skills and guide children as they practice using these skills. Social skills that form an important foundation for bullying prevention include:

  • Showing empathy toward others
  • Interacting assertively
  • Solving social problems

Bystanders also have the power to play a key role in preventing or stopping bullying.

Some bystanders… directly intervene, by discouraging the bully, defending the victim, or redirecting the situation away from bullying.

Other bystanders… get help, by rallying support from peers to stand up against bullying or by reporting the bullying to adults. Look Around…Who Is Involved?

Bystanders’ actions make a critical difference. Children and adults should think ahead about what they will do when they witness or hear about bullying.

There is also an Information Sheet on Bully Prevention at the following website:

Three Steps to Recovery After a Meltdown

Recovery may involve time to do nothing at all. For some students the recovery phase involves a process that takes him or her from a semi-agitated state to a fully calm state.

child in class

Consider the following steps:

  1. Allow the student to engage in the highly preferred/calming activity without setting the timer until he/she appears to have recovered as fully as possible.
  2. Once he/she is calm, then set the timer for 5-6 minutes. If he/she remains calm and is able to transition to the next activity, then do so and watch for early signs of repeated escalation.
  3. If he/she requests more time [by giving the timer to the adult], then honor the request and set the timer for 3 or 4 more minutes. Continue until he/she no longer requests more time or staff feel she is ready for a positive transition to the next activity.

Once the person is fully recovered, then it might be possible to debrief and make a plan to prevent future escalation. Pictures and words can help to paint a clear picture and develop a workable plan.   

By Lisa Rogers