Anxiety is one of the most common reasons for the referral of an autistic child for assistance. The high levels of anxiety experienced are more challenging than the diagnostic characteristics of autism. All types of anxiety disorder are more frequent in autistic children in comparison with typical children; they include specific phobias, Obsessive Compulsive Disorder or OCD, Social Anxiety Disorder or SAD, Generalized Anxiety Disorder or GAD, and Separation Anxiety.
There can be qualitative differences in the presentation of anxiety in autistic children when compared with typical children. Phobias may develop as a response to specific characteristics of ASD. For example, extreme auditory sensitivity to particular sounds – such as thunder or a teacher or child shouting– may elicit heightened, actually painful responses, with a resultant phobia of these sounds at school.
Why do autistic children experience high levels of anxiety?
Research has been conducted on the family histories of autistic children and has identified a higher-than-expected prevalence of mood disorders, and especially anxiety disorders, in family members. There may be a genetic predisposition to high levels of anxiety and depression.
There is further research to suggest there may also be a neurological reason for high levels of anxiety. Studies using neuroimaging technology of autistic children and adults have identified structural and functional abnormalities of the amygdala, a part of the brain associated with the recognition and regulation of emotions, especially anxiety and fear. There is also evidence to suggest a lack of white matter, that is, neural connections, between the amygdala and the frontal lobes.
A metaphor to help understand the function of the amygdala and anxiety is that of a vehicle being driven on a motorway. The frontal lobes of the brain are the driver, who makes executive decisions on what to do, where to go, etc. The amygdala functions as that part of the dashboard of the car that provides the driver with warning signals regarding the temperature of the engine. In the case of children who have autism, this part of the dashboard is not functioning with the degree of sensitivity of a typical emotion temperature gauge. Information on the increasing emotional heat and functioning of the engine (emotion and stress levels) are not available to the driver as a warning of impending break down and the need to ‘cool down’. If the child is unaware of internal emotional states, then anxiety will be very difficult to regulate. As one child explained, ‘I don’t have a gauge to filter how much stress I am piling on’.
In autism, the dysfunction of the amygdala can also be expressed as a tendency to have a catastrophic emotional reaction at a relative low threshold, pushing the ‘panic button’ too quickly. Typical children recognize signs of increasing anxiety much earlier and at a less intense level, and so are more easily able to manage it.
There are also environmental reasons for high levels of anxiety in the classroom, related to the child’s heightened sensory sensitivity. Throughout the school day, the child may be exposed to extremely aversive sensory experiences, such as loud and multiple voices, the aroma of a teacher’s perfume or the smell of the lunchroom or toilet; tactile experiences, such as the rubbing of labels and seams in clothing; or the glare and reflection from artificial lighting, especially fluorescent and down lighting.
Autistic children who have autism can be vulnerable to peer ‘predators’ at school: these are children who may actually enjoy rejecting, humiliating, provoking and antagonizing a child who is conspicuously socially naive and socially ‘clumsy’. They may frequently and covertly be ‘ambushed’ in the playground or classroom, such that they feel unsafe at school, and as though they are walking into a war zone when they enter the school grounds. Thus, they have a heightened sense of vigilance and apprehension for when the next aversive experience will occur, both sensory and social.
Psychological reasons for heightened anxiety include having an unusual profile of learning abilities and a high level of learning disorders, both of which will affect stress levels, particularly associated with classroom activities and tests. When combined with the recognized increased difficulties with language abilities and social reasoning, there can be an increase in general stress levels, and the development of performance anxiety.
We have a psychological term, alexithymia, to describe another characteristic associated with autism, namely a diminished vocabulary of words to describe emotions; this includes one’s own emotions as well as the emotions of other people. Clinical experience and research suggest that the autistic child can identify having an increased level of emotional arousal, but great difficulty labelling and eloquently describing the level of emotion. As an eight-year-old autistic child said, ‘I need a language for my worries.’ When asked how they are feeling at a particular time, or during a particular event, the autistic child may reply, ‘I don’t know’, which means, ‘I don’t know how to tell you’. The autistic child may therefore have difficulty telling a teacher how anxious they feel and why they are anxious. However, it may be possible to identify specific behaviours, actions and thoughts that serve as a behavioural ‘code’ for a particular feeling and the depth of that feeling.
Attwood & Garnett Events present Behaviour and Emotion Management for Children and Adolescents with Autism . This online training webcast will explore and explain signs of anxiety in autistic children, more reasons autistic children experience intense emotions, especially anxiety, and strategies for emotion expression and regulation that can be used at home and school.