AAAP Today

​AUTISM AND ANXIETY

Social withdrawal and social skills deficits are common signs of autism spectrum disorder (ASD). But, are they also signs of a co-occurring anxiety disorder?

The most common form of anxiety is social anxiety, also known as social phobia. Signs of social phobia are fear or anxiety in relation to people (being near or having to interact with others); fear of judgment or criticism by others; dread and panic before certain situations and ruminating on the event afterwards, and physical symptoms such as shaking, nausea and increased heart rate.

Social anxiety often first appears in adolescence, when the young person becomes aware that their performance will have an impact on their ability to handle social relationships. Social anxiety can affect as many as 65% of teenagers with the high-functioning form of ASD.

Social anxiety can have reciprocal effects vis-à-vis social skills – poor social skills can lead to social anxiety, and conversely, social anxiety can lead to poor social skills.

Anxiety is not a central feature of ASD, is not necessarily life long, and does not affect the individual’s innate communication skills. It is a separate condition from ASD, but there can be similarities in behavioral outcomes – isolation, low self-esteem, and avoidance of social situations.

Anxiety has neurobiological and as well as psychological elements that can impact social and cognitive functioning. Professionals working with persons with ASD should check for the co-occurrence of anxiety. Parents’ and other family members’ help should be asked to detect the presence of any of the broad range of anxiety symptoms, including physical symptoms such as trembling hands and increased heart rate, or cognitive symptoms such as excessive fears and worry. Recognizing which specific anxiety symptoms are involved is important in order to design the specific type of treatment appropriate to the specific anxiety symptom.

Interventions for alleviating social skills deficits, a core feature in high functioning ASD, referred to as Asperger’s syndrome, should consider and assess the contribution of anxiety in the social difficulties of the patient.

Treatment options for anxiety include cognitive, behavioral, and psychopharmacological interventions.

Reference: Bellini, S (2004) Living in fear: Anxiety in adolescents with autism spectrum disorders. The Reporter, 9 (3), 1-2.

TIPS FOR DEALING WITH BEHAVIORAL PROBLEMS IN AUTISTIC ADULTS

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​​B​ehavioral problems can be the autistic person’s response to or expression of distress. Those problems can include compulsive and ritualistic behaviors, noncompliance, disruptiveness, ​irritability, ​or aggression. Caring for a person, adult or child, with autism who exhibits ​difficult behaviors can be challenging. Understanding the whys underlying those behaviors, and making some simple adaptations can help decrease the​ir​
occurrence​.

Some factors that could be the cause of such problems:

​1. ​Autistic persons like schedules, timings, and organization. Routine helps them feel safe and comfortable. Changes in routine can cause a lot of distress.

​2. Persons with autism also experience hunger, thirst, stomach aches, headaches, tiredness, etc. Some may not be able to distinguish all these symptoms from one another, may not understand why they are uncomfortable.

​3. Inability to communicate needs, desires, ​pains ​or discomforts.

​4. Autistic persons have difficulty with social skills. They can feel distress when faced with social demands that are too much for them.

​5. ​Hypersensitivity to or the opposite, a need for more sensory stimulation.

Reducing the occurrence of problem behaviors:

​1. Structure and routine help to make people with autism feel safe and comfortable. Introduce structure through schedules. Whenever there is going to be a change in schedule, make sure the person is prepared for it well in advance.

​2. ​Positive social interactions and family support.

​3. ​Illness​. Consider and assess overall health.

​4. Engage the person in meaningful activities relevant to their sensory need. For example, sports, music, art.

​5. Identify the factors in the environment that cause distress. Eliminate them when possible, or adapt the environment to the sensory need. For example, some may need a dark room​, soothing colors,​
or a quiet environment.

​6. Help the person to communicate better and express their need. Teach the person words that describe what they want. Use picture cards, communication boards, or hand gestures.

Reference: adapted from Sharon Dominica, healthguideinfo.com, 10/27/2010

​IS GASTROINTESTINAL (GI) DISORDER A CAUSE OF AUTISM?

Findings from a recent research study found no support for GI disorders as a cause of autism.

GI symptoms do appear to occur in many children with autism and should be clinically evaluated and appropriately treated. The research sample consisted of 111 children with GI symptoms, of whom 61 had been diagnosed with autism and 50 were non-autistic.

Observations of gastrointestinal (GI) abnormalities in autistic children had led to speculations that GI disorders cause autism. Restriction of gluten and casein in diets of persons with autism was a frequent response to that speculation. Gluten and casein free diets are known treatments for celiac disease, an autoimmune disorder of the small intestine. The effectiveness of gluten-free and casein-free diets for reducing symptoms of autism has not been supported by medical research.

Reference: Rafail I. Kushak et al, 2016. Journal of Pediatric Gastroenterology and Nutrition; also, Wolters Kluwer Health, in www.sciencedaily.com/releases/2016/02/160225153612