Autism and Anxiety
We are all vulnerable to feelings of anxiety at various points in our lives and our responses to such can depend on the elements of our ‘fabric’ – those parts of us that make up who we are, the support we have and our abilities to know what to do, how and when.
Some of the elements that make us the individual and unique characters we are, are our personality, temperament, gender, age, life experience, health status, family structure and place in the familial hierarchy; physical, psychological and cognitive abilities, race, religion, culture, economic status…….and so on.
For a person on the autism spectrum, the impact of an adverse event, for example experiencing bullying, can heighten their experience of resulting anxieties and impact on many of these elements to a debilitating level.
A notable response to anxiety causing experiences is an involuntary condition in an autistic person, appropriately termed – exposure anxiety (as referred to by Donna Williams, an internationally renowned Autism consultant and author). This condition can present as being mildly affective through to being severely incapacitating for the autistic person. It can deeply affect a person’s daily functioning and/or, for example, when social contact or personal performance (e.g. in the classroom) is required or happens in the moment.
When an autistic person is experiencing exposure anxiety, you may observe them, for example, looking down at their feet, or wringing their hands or their hands may be set flat against their thighs, looking fearful or frozen to the spot, or outwardly distressed (e.g. behaviour outburst) and so on. Also, their fight or flight response may be exaggerated and efforts to return their state to a relative calm may be very difficult.
Other indicators of a person experiencing exposure anxiety can be, for example, when the individual feels incredibly self conscious and overloaded and ‘speaks’ through ‘characters’ or phrases from TV shows; jingles; objects; as another person or retreats to a corner, drawing up the knees to their chest; mumbling; tumbling words etc.. Each person’s response to anxiety can be as individual as they are.
Underlying and possibly influencing the intensity of this experience may be undiagnosed and/or previously known medical/health, physical or psychological conditions, such as intolerances to certain substances in foods, depression, phobias etc..
When assisting an autistic person or child with dealing with exposure anxiety, assuming other co-morbid conditions are simultaneously being addressed appropriately, a counsellor, parent or other helper can be most effective in helping alleviate anxieties with and for the (autistic) individual by assuming a non-confrontational/indirect approach with them.
Being non-confrontational can involve, for example;
**being seated beside (nearby) them – not directly in front of them;
**not demanding eye contact (expecting or ‘demanding’ eye contact can ‘shut down’ the autistic person to being receptive to any mutual conversation and it is disrespectful of/to their ‘being’ and dignity);
**speaking at a moderate pace and in a calm, warm manner;
**allowing for quiet times or lulls in the conversation (to allow time for them to process what is being discussed);
**maybe not launching straight into talking directly about the person’s issues of concern – but a short, general conversation surrounding ‘things’ which can make one happy and some ‘things’ which can make one anxious and so on.
**being genuine in your care, desire to help and interaction with them. An autistic person can ‘pick’ a ‘fraud’ or non genuine character a mile off. Their intuition and perception of ‘you’ will immediately determine whether they wish to participate in a conversation, interaction with or trust you.
These are only but a few of the conditions which help create a situation conducive to really assisting an autistic individual presenting with exposure anxiety.
We can assist the autistic person/child to manage and control their exposure anxiety by offering our understanding, empathy and, for example, ‘what to do; how to do and when’ and with behavioral/cognitive management skills and teachings inherent in Cognitive Behaviour Therapy, as well as ensuring that any other ‘conditions (medical or otherwise) are equally addressed.
Other important elements of helping a person eliminate or reduce anxiety can be role playing, modeling, drawing pictures, sand play/therapy, social interaction skills assistance, incorporating their passions and interests, experiencing soothing activities (e.g. horse riding, going to the beach), writing in a journal, music, dance, relaxation exercises….. the list could be endless. The chosen methods, ultimately, are those that are suited to the individual.
P.s. A sense of humour enjoyed with the autistic person is of paramount importance to their happiness, growth, learning experience, wellbeing, bonding with you, learning from you and their feeling of understanding, acceptance, respect and unconditional positive regard from you.
Donna Williams, an internationally renowned Autism consultant, is believed to be the first published author to have written on the subject (and regarding the term) – ‘Exposure Anxiety’, as it can apply to persons on the Autism spectrum. Her book, “Exposure Anxiety – The Invisible Cage”, informatively explores this subject.