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:

• Create daily schedules, weekly calendars and lists
• Establish set routines at school and at home
• 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.

A Power Card is a brief script including the special interest and how that special interest deals with a certain situation. It should be written at the individual’s comprehension level and should include relevant pictures or graphics. Initially, the script should be read on a scheduled basis as the student learns to use the Power Card.

The Power Card is the size of a trading card and includes a small picture of the special interest and the solution to the problem situation broken into 3 to 5 steps. The Power Card is created from the script and can be carried by the student.

Power Card Example:

FRONT

BACK

Resources:

Power Card Example Websites: http://journals.cec.sped.org/cgi/viewcontent.cgi?article=1539&context=tecplus www.asperger.net http://paraelink.org/asds3/asds3_4.html Reference: Gagnon, E. (2001)

Power cards: Using special interests to motivate children and youth with Asperger syndrome and autism. Shawnee Mission, KS: Autism Asperger Publishing

III. Narratives can help to teach how to deal with certain situations and even how to self-regulate. Narratives usually offer key pieces of understanding that help the individual to see a situation more fully and have some strategies with which to navigate that situation more successfully. By including their own feelings about the situation, the individual can also feel “heard” or validated about their perspective.

There have been several pioneers in this type of intervention, most notably Carol Gray of The Gray Institute, who is the author of Social Stories™. There are several books and many internet resources available on this specific strategy.

A narrative is a brief story or vignette that describes a specific situation with clarifying information. Depending on the challenges presented by the individual, the story or vignette may give insight into why this is important to others and what they might do differently in order to achieve success in this situation.

• Illustrations & Graphics: The teacher or parent can make a narrative come alive through a variety of illustrations and/or graphics. Clipart, images from copyright free sources or even photographs of the child and his/her peers may be incorporated throughout. These pictures can add interest and offer a visual understanding of the expectations or desired behavior. Strive to include illustrations and graphics of positive and desired behaviors as this is what we want the brain to process and incorporate. Leave the universal sign for “no” and other “don’ts” for other strategies such as replacement cards or flip cards.
• Audio Features: If you use PowerPoint or an iPad/iPod application, you can easily incorporate sound in a variety of ways. If a student is especially attentive to particular sounds, then include them to increase the novelty and student motivation. The sounds could include anything from clocks ticking to trains blowing. Another idea is to narrate the story so that the student can hear it as he/she reads it independently. Teachers, peers or parents can serve as narrators with a little planning.

Here are some resources on how to write social stories/narratives:

https://vkc.mc.vanderbilt.edu/assets/files/tipsheets/socialstoriestips.pdf

http://www.friendshipcircle.org/blog/2013/02/11/12-computer-programs-websites-and-apps-for-making-social-stories/

http://www.oneplaceforspecialneeds.com/main/library_social_stories.html

IV. A feelings chart can be a tool for communicating feelings, and dealing with those feelings effectively. The feelings chart may be on a scale of 1-3 or 1-5, with level one indicating that the student is most calm.

If possible, you can increase the effectiveness of this strategy by decorating the different levels with pictures/clip art that reflect a student’s interest. I have created feelings charts with different expressive pictures of Mario Bros, dinosaurs and even The Dukes of Hazzard characters!

Once the child understands what each level means, then it is most critical to identify calming activities for each level. Each of us responds differently to different experiences and this should be highly personalized in order to actually help the student calm down when needed.

As an example, I find shopping to be very enjoyable and calming. However, my best friend finds the very same experience to be frustrating and adds to her stress level. Most people respond positively to either gross motor [large muscle] activities, simple repetitive tasks, or a soothing sensory experience as calming mechanisms. The key is to find what specific activities within these categories might work for an individual.

Some examples of gross motor [large muscle] activities include, but are not limited to:

• Walking
• Running
• Bicycling
• Jumping
• Exercising in general

Some examples of simple, repetitive tasks include, but are not limited to:

• Reading
• Listening to music
• Gardening
• Needle Work
• Fishing

So now, your job is to help your son identify those activities that are most calming and soothing to him when he starts to feel anxious. I have been surprised by some of the ideas that emerge once I ask this question.

One student explained to me that Origami was very calming for him, which makes sense in the fact that it requires focus with the hands, much like gardening or needle work. Another student told me that they found it soothing to sweep the floor. Whatever works for that person should be incorporated within the feelings chart to have a plan for difficult times that all agree upon.

Feelings Chart Example:

I hope that added structure, a Power Card, a Social Story and/or Feelings Chart might provide some relief to your son’s anxiety. I look forward to learning more about your son in order to provide additional tailored resources. Until then . . .

All my best,

Lisa Rogers