Autism Spectrum Disorder: ASD And Anxiety In Children

Boy with heart shaped paper

Autism Spectrum Disorder (ASD) comes with a variety of challenges. For many children, it can mean issues with compulsiveness and repetitive behaviors, learning and social deficits, and a resistance to change. ASD also can manifest with various emotional difficulties – although not specifically linked, we know that ASD and anxiety frequently appear together in children.

Kids with ASD and anxiety can have physical symptoms (example: racing heart or a stomach ache) or their anxiety may also show up in the form of rituals that can help calm them (for instance: shredding paper). Because many autistic children are either non-verbal or have trouble communicating, an outward display of anxiety may be their only way of telling you that they are distressed.

Autism And Anxiety Comorbidity

“40% of young people with ASD have clinically elevated levels of anxiety or at least one anxiety disorder, including obsessive compulsive disorder”, according to an article by Dr. Elisabetta Burchi and Dr. Eric Hollander of the Autism and Obsessive Compulsive Spectrum Program at Montefiore Medical Center and the Albert Einstein College of Medicine.

They stress the importance of anxiety treatment for children with autism spectrum disorder. “While untreated comorbid anxiety has been associated with the development of depression, aggression, and self-injury in ASD, an early recognition and treatment may convey better prognosis for these patients“.

Some studies have shown that high-functioning children suffer from more anxiety disorders than do lower functioning children on the spectrum. Additionally, other research reports that adolescents and teens with ASD may be more challenged by anxiety than their younger peers.

How To Recognize Anxiety In Asperger’s and ASD

It can be difficult to spot the signs of anxiety in a child who has ASD for a couple of reasons: kids who are verbal may not be able to recognize and express their emotions, while children who are nonverbal can’t tell you that they are afraid or worried.

Also, children with ASD often display common behaviors that can look similar to those found in anxiety disorders. For example, the compulsions that are carried out in obsessive compulsive disorder can look much like the repetitive behaviors that a child with ASD will use, however the autistic child may not actually be anxious.

Although there are no specifics to watch for, anxiety often presents in the form of physical or behavioral issues. The signs may not be apparent in a younger child, but may show up in later years as they mature and their world expands to include school and other settings.

  • Social anxiety may show up in the form of avoidance of social situations. This keeps the child from experiencing interaction with peers and the opportunity to practice social skills.
  • Separation anxiety may be present if the child acts out when being parted from their parent, such as when a babysitter comes to the home or when the child goes off to school for the first time.
  • Phobias are anxiety responses to specific fears (i.e. fear of insects or acting out after being startled by a loud noise).
  • Distress about changes in routine can show up in the form of physical rituals or repetitive behaviors that the child uses to soothe themselves until they can calm down.
  • Controlling behavior or threats to hurt themselves or someone else are often a sign of high levels of emotional distress.
  • In adolescents and teens, alcohol and drug abuse are destructive coping methods that may be used to mask anxiety.

Treatment For Autism And Anxiety

Research has shown that behavioral interventions are helpful for many ASD children who have anxiety. One of the most effect therapies for treating autism and anxiety is cognitive behavioral therapy (CBT). This therapy is best for a child who has some verbal abilities.

CBT teaches kids how to uncover the fear beneath their anxiety so they can challenge their negative or inaccurate thoughts. For instance, if a child has anxiety about going to school, they may actually be afraid of getting lost and not being able to find their parents again.

Once the fear has been identified, the therapist can use small doses of exposure therapy to provide the child with evidence that they are safe. In the case of school anxiety and the resulting fears surrounding being separated from a parent, exposure therapy might involve having the child spend a minute or two in a room without their parent. When mom or dad come back in, the child feels safe. As the length of time apart from their parent increases with an end result of the parents returning, the child’s anxiety level can begin to decrease when they are away from the parent in other situations.

Depending on the child, an anxiety medication, such as a selective serotonin reuptake inhibitor (SSRI) like Prozac, may also be used in combination with behavioral therapy.