By Dr Michelle Garnett and Professor Tony Attwood
Introduction
Overwhelming anxiety is a daily occurrence for many autistic people. Why do autistic individuals experience high levels of anxiety, and how are these high levels of daily anxiety maintained? Genetics and neurology are the main underlying reasons for high anxiety in autism, but there are other reasons too. One of those is the coping mechanism of avoidance. This blog explores how anxiety is maintained by avoidance. Next week we explore how to assist a young child who avoids too much.
Too much avoidance
Anxiety is a normal part of life. All children need to learn how to cope with and manage anxiety to learn and become independent, but children can only learn how to manage anxiety if they are exposed to and learn to cope with situations that cause anxiety. If children are not exposed to situations that cause them anxiety, then anxiety becomes a much greater problem.
Why do children avoid anxiety?
Children naturally want to avoid situations, experiences, or objects they are anxious about as they are perceived as potentially threatening or dangerous. If you are in danger the automatic and appropriate response is to leave the dangerous situation. Similarly, if you were previously in a dangerous situation, the automatic and appropriate response is to avoid entering that situation in the future. For e.g., imagine your child is playing on the school playground when they kick a ball into the middle of the nearby street. Your child runs into the street to collect the ball. As they reach the ball, they notice a car coming toward them. In a matter of seconds, they automatically think, “this is not safe,” feel fear and experience physiological arousal (body signs for anxiety). They decide to run back to the curb. As soon as they reach the curb they think “I am safe,” they feel a rapid reduction in their fear and anxious body signs, as well as a feeling of relief. In the future, when the ball is kicked into the middle of the road your child, remembering their experience, avoids running onto the road and asks a teacher to collect the ball. When they start remembering what happened last time they experience a sudden rush of anxiety, but as soon they decide to ask a teacher to collect the ball their anxiety reduces, and they experience a sense of relief. In this situation, experiencing anxiety has helped your child avoid real danger and survive.
However, avoidance becomes a problem when your child believes there is danger and really there is none. For example, imagine your child approaches a group of children on the playground. In a matter of seconds, they automatically think, “These kids are going to do something bad to me. I can’t cope. I can’t do this,” and they feel fear. Then they decide to walk away from the other children and stand by your side. As soon as they walk away from the other children and stand by your side, they feel a rapid reduction in their fear and anxious body signs, as well as a feeling of relief. In the future, when they see a group of children in the playground they will avoid approaching them. When they think about approaching them, they remember what happened last time and they experience a sudden rush of anxiety but as soon as they decide to stay by your side their anxiety reduces, and they experience a sense of relief.
In this situation, avoidance has not helped your child. In this situation:
- Avoidance has taught your child that avoiding situations quickly reduces anxiety.
- Avoidance has stopped your child from learning the “bad thing” they feared is unlikely to happen. For example, the children in the park were unlikely to do something bad to your child.
- Avoidance has stopped your child from learning they can cope.
- Avoidance has stopped your child from learning that anxiety also usually decreases if they remain in a (safe) situation.
In a nutshell, children are motivated to avoid situations associated with anxiety because avoidance quickly reduces their anxiety in the short-term. But in the long-term, avoidance ensures that your child’s anxiety continues because it stops your child from learning that what they feared is unlikely to come true and that they can cope with the situation.
How do children avoid anxiety?
Children can avoid anxiety in many ways. Some of these may be easily observed but others can be very subtle.
- Refusing to enter a situation
- Running away
- Hiding
- Refusing to attempt a task
- Acting in an aggressive way (to be removed from a situation)
- Acting in a defiant or disobedient manner (to be removed from a situation or to have the feared task removed)
- Complaining of being sick (to be removed from a situation)
- Staying in a situation but refusing to participate
- Saying they don’t know how to complete a task (either to avoid a feared task or to avoid making a mistake or to avoid receiving criticism)
How we help children to avoid anxiety
As parents, we influence our children, and they influence us. It is very distressing for us, as parents, to watch our children experience pain, illness, distress, or anxiety. So, when a young child is quick to show anxiety, a parent may act to reduce their child’s anxiety because it is so difficult to watch our child suffer. Consider the following ways in which you may assist your child to avoid anxiety-creating situations at times.
- Removing your child from the anxiety-provoking situation
- Removing the cause of your child’s anxiety
- Keeping your child away from situations that have caused anxiety in the past
- Keeping your child away from new situations in case your child experiences anxiety
- Completing tasks for your child
- Assisting your child to complete tasks
- Lowering your expectations for your child
- Making decisions for your child
There are times when we need to protect our children and make decisions for them but often helping children to avoid their anxiety and over-protecting, over-assisting, and over-controlling them will maintain their anxiety in the long term.
Summary
In this blog, we have discussed how avoidance of situations can increase anxiety in all children. Children can be very clever about how they avoid anxiety-producing situations and parents can assist their young children to avoid these situations. It is appropriate to protect our children from situations that are dangerous, and it can be difficult to discern when to assist a child to approach a situation, and when to protect them from that situation. In our blog next week, we will discuss how to assist your autistic child to approach feared situations, in a way that accommodates their autism.
Further Resources
If you are a parent of an anxious autistic child or an educator or health professional who works with anxious autistic children, we recommend that you attend our upcoming event, Support and Therapy for Autistic Children and Adolescents.
With our colleagues Dr Julia Cook, Dr Louise Ford and Dr Stef Runham we co-wrote the “Fun with Feelings” programme, which is a 10-Step Programme for parents and/or professionals to assist their young autistic child to manage their high levels of anxiety. The above blog is an excerpt from the resulting book:
Garnett, M. S., Attwood T., Ford, L., Runham S. and Cook J. (2020). Ten Steps to Reducing Your Child’s Anxiety on the Autism Spectrum: The CBT-based “Fun with Feelings” Parent Manual. Jessica Kingsley Publishers: London.
The companion volume was written to assist parents and professionals to teach their young autistic children about emotions:
Garnett, M. S., Attwood T., Ford, L., Runham S. and Cook J. (2020). Having Fun with Feelings on the Autism Spectrum: A CBT Activity Book for Kids Age 4-8, Jessica Kingsley Publishers: London.
We highly recommend these two books to anyone living or working with an autistic and anxious 4-8 year old child.
