Children and adolescents with autism spectrum disorders (ASD) may experience anxiety symptoms more often than other children. Many children with ASD struggle with social anxiety – or fears and worries associated with social situations, such as school, parties, and outings of all kinds.
The critical part about anxiety is: it usually leads to avoidance. The more we avoid what we are afraid of or nervous about – the stronger those fears and worries become….And the stronger the fears, the greater the avoidance….until the child’s world gets very small, often narrowing the worlds of their families as well.
So our job is to support the children to face their fears in small, manageable steps.
Here are some steps that you can take as a parent to help your child combat his/her social fears:
PHASE 1: PREPARATION: (These are the things you do to “get ready” to support your child to cope better with social fears and worries)
- Think about your child’s specific anxiety symptoms – what does he/she do that lets you know they are feeling fearful or worried? Do you notice any physical signs of anxiety – such as flushing, perspiring, increased pacing or repetitive behaviors?
- Think about the specific social situations that seem difficult for your child
- Involve your child in communicating with you about his/her fears and worries:
- If your child is verbal, try to find out about how hard situations are by presenting a series of true/false statements for them to respond to – for example: “I get scared at parties.” This will help you figure out what type of treatment plan might be most beneficial in helping your child. Use visual supports – such as index cards with “true” and “false written on them. Practice a few times with statements you know the answer to --- for example: Doug likes pizza! – You can use “I” statements with highly verbal children (“I like pizza”); however, use the child’s name (“Doug likes pizza”) for children with less flexible language.
- If your child is less verbal, think about specific social situations where you observe a “fight for flight” response. For example, when does he hide? When does she run away? When does he seem to be more withdrawn?
- Try to anticipate social situations that will be challenging for your child. What’s difficult about the social situations that are hard – is it a matter of length of time? Familiarity of the people there? The number of people there? The noise level? What matters about those social situations?
- Rank order these experiences by level of difficulty. This is called “building a hierarchy” – you basically increase difficulty at each step of the ladder. The first step is the easiest. This allows us to support the kids to practice coping in easier situations first, thus increasing difficulty level as the child demonstrates progress coping. There is no “right way” to write a hierarchy – it all depends upon the goals you have for the child. Here’s an example for a child who has a difficult time playing with other children, especially unfamiliar ones, and he doesn’t like to leave his house and be “out of his element.”
Step 1: 1:1 brief play date with a familiar child in own home
Step 2: 1:1 longer play date with familiar child in own home
Step 3: 1:1 brief play date with unfamiliar child in own home
Step 4: 1:1 longer play date with unfamiliar child in own home
Step 5: brief play date with 2 familiar children in own home
Step 6: longer play date with 2 familiar children in own home
Step 7: brief play date with 2 unfamiliar children in own home
Step 8: longer play date with 2 unfamiliar children in own home
Step 9: 1:1 brief play date with a familiar child outside of home
As you can see, the steps become increasingly more difficult as you work down the hierarchy. It usually requires several practices before children learn to cope well with each step. Notice that either the length of the activity, the number of children involved, the familiarity of the children involved, or the setting can all be manipulated at each step. Some children need to stay longer in social situations, others need to adjust better to unfamiliar peers, still others need to learn to be social outside of their comfort zones. Parents can adjust the plan, depending upon what matters most to you.
PHASE II: BUILDING COPING SKILLS (These are the tools you will be helping your child to use to cope better.)
- Fight back with facts – Tell your child what you know about their fears….Are there any facts you can share that will help them to see that their fears are not facts? For example, if your child doesn’t like to touch things other people have touched due to some fears about germs – then teaching them the facts about germs and our body’s immune system can be very helpful.
- Remember the fun – Continually send the message to your child that worrying gets in the way of having fun. Remind them of the activities they enjoy (such as drawing or playing video games) and build in time each day for them to engage in something they really enjoy. If your child doesn’t have a hobby, favorite activity or passion, try to find ways to develop one. Occupational therapists can be quite skilled at this.
- Move around – Whether it’s walking, jumping, waterplay, bike riding…any kind of sustained exercise activity is very important for supporting active coping.
- Breathe – Changing the way you breathe can really make a difference in how you feel. Try to teach your child to take deep, long breathes that make their bellies fill with air. Breathe in through the nose and out through the mouth. Try to teach them to breathe in slowly and exhale even longer. Practicing these skills in the bathtub or while waiting or driving somewhere can work well.
- Relax – Teach your child how her body gets tense and tight when she is nervous and gets more relaxed when she is feeling calm. Practice tensing and relaxing muscle groups in order to learn about these sensations. This will help your child to pay attention to her body and notice that she is feeling scared and worried.
- Talk nicely to yourself – Remind your child of positive statements he can tell himself: “I can handle this” or “Who cares what happens, as long as I do my best!”). Thoughts lead to feelings and behaviors. Try to give your child a different set of thoughts.
- Distract yourself – Remind your child of what he can think about when he’s worried that will calm him – such as naming 3 reasons why Star Wars III is the best movie ever!; or listing even numbers, or listing state capitals. For less verbal children (and those who are verbal too actually) - provide fidget toys that can be kept in the child’s pocket, or attached to his wrist or belt loops.
- Provide incentives – After facing their fears, provide the child with some time to do his favorite thing for quite a while. Saving up particular computer games or solitary play activities as rewards for facing fears can be a good strategy.
PHASE III: PUTTING IT ALL TOGETHER
Beginning at Step 1 (easiest step) of your hierarchy, coach and support your child using the skills described above in order to successfully master each step before moving on to the next step. Your goal is to decrease avoidance and increase engagement.
Social fears and anxieties are real for persons with ASD. As we support the kids in coping, there are also things we can do to create more friendly environments for kids with ASD. In future newsletters we will write about what we can do to create friendly settings for kids with ASD.
Some families include a psychologist in the execution of a coping plan. Many mental health professionals use these techniques, which are called “Cognitive-Behavioral Interventions”. Part of our work now is on developing and applying coping interventions for children with autism and other developmental disabilities. If you are interested in participating in our research on anxiety and coping, please contact JFK Partners at 303-724-7643.