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anxietyAnxiety is broadly defined as; “a feeling of worry, nervousness, or unease about something with an uncertain outcome”. It’s a good definition of the feeling but it really doesn’t begin to explain the reasons why anxiety has such a big impact on the lives of children and adults who suffer the effects, nor does it explain how prevalent the isms of anxiety as a co-morbidity with other disorders.

Despite the fact that anxiety is not part of the diagnostic criteria for autism spectrum disorders (including Asperger’s syndrome), I believe that it’s present and has a significant impact in nearly all cases. I’d venture to say that in all my interactions with adults and children on the spectrum, I have never yet met anyone who did not show signs of anxiety. Too often though anxiety is not recognized for what it is and is left untreated.

The Impact of Anxiety
When left untreated, anxiety causes significant real-world problems in many areas of life. It can impact a person’s ability to function on a day to day level and can significantly boost the negative effects of other co-conditions, such as depression, obsessive compulsive disorder (OCD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD) and panic disorder. Increased anxiety can worsen negative outbursts, meltdowns and reactions to authority figures, which can result in suspensions, expulsions, arrests and general violence.  See Invisible Anxiety: Hiding in the Classroom

Detecting Anxiety
I could probably go on all day about the different ways in which anxiety manifests itself in adults and children. Instead, I have chosen just a few examples, not all of which are obvious. Anxiety is everywhere and as a parent, you need to be aware of your child’s normal reactions and be on the lookout for unusually strong ones which could suggest anxiety.

Anxiety - clingy In babies and small children, anxiety often manifests as clingyness, called “separation anxiety”. This is typically seen when mothers meet for “mother’s group” meetings and expect their children to play together. Instead, the anxious child will not leave its mother’s side, often clinging to her leg as she talks with other adults. The infant may bury their face in their mother’s chest to avoid looking at others. Infants with anxiety issues will often cry to the point where they have difficulty breathing, particularly if a parent leaves the room. It’s important to understand that infants have no concept of “object permanence” at these young ages and that a child with an “ism” may take longer to develop this understanding.

What is object permanence? It’s the idea that an object stays where it is left, even when you leave the room. For example, a very young child with no concept of object permanence will not consider that a favorite toy is still in another room where they left it. If it’s not visible, then it’s gone. Once you understand this, it’s fairly easy to understand why some children cry as if you’ve left the country whenever you leave the room.

Infants and children all the way up to adulthood with anxiety may suffer from sleep isms too.

Open and Closed Spaces
In older children and adults, anxiety is often seen as problems handling enclosed spaces. Many children cannot sleep without their bedroom door being open. Most of the time this is simply a child wanting to keep their parents close but sometimes it’s a sign of anxiety. Some people have the opposite type of anxiety and will panic when taken to open spaces, such a large and busy shopping centers.

Social and Confrontational
Most children show a little anxiety when talking to adults they don’t know but only a few display signs of anxiety with every interaction – even interactions with adults and children whom they know very well. Sometimes even adults can handle normal interactions with most people but will show significant anxiety with someone whose body language seems confrontational.

Obsessive Compulsive Disorder can be both the result of anxiety and a contributor to anxiety. For example, a friend of mine with OCD developed an issue with a high water mark in their toilet bowl. It wasn’t an overflow, just a high water mark and it only happened once. This resulted in a “fear” of flushing which meant that once the toilet has been flushed, he had to wait until all noises (including refilling) has stopped. Then he waits a little longer just to be sure. If he is already late for an appointment, particularly if someone is urging him to leave, the anxiety can become overwhelming. Every little household incident adds to the OCD cycle which in turn adds to anxiety – it’s a self-perpetuating problem.

Object (including Food) Related
Adults and children can also develop anxiety over objects and food. In my own deep past, there is a long forgotten reason why I dislike sultanas. I started off being unable to eat cakes or biscuits containing them.  Presently, I can’t stand the smell of them, I can’t eat foods that have been stored in the same container with them or that have sat in close proximity to them. In fact, I can’t look at them – not even at a picture of them. It makes my skin crawl. I have difficulty with red wines because the taste is too close.  Even when foods, such as scones or Christmas cakes are cooked without them, I can sometimes have trouble eating them simply because they’re foods which are “designed” to carry them.

Luckily, I’m an adult and I have enough control over my life to ensure that I can walk through it more or less sultana free. Children on the other hand are often “force fed” such foods by their parents who simply think that they have an issue with the taste or that they are refusing to “just try” a particular food.  Parents are often oblivious to the stress and anxiety that this puts on their children.

Dealing with Anxiety

specific phobiasConfrontational Exposure Therapy – Some anxiety can be dealt with using simple therapy. Some therapies, such as Confrontational Exposure Therapies might be fine for adults but in my personal opinion, they are not always suitable for children. One of my friends helped me to cure a more or less lifelong fear of spiders which lead to unreasonable reactions whenever there was a spider in the vicinity. He did this by placing plastic spiders everywhere whenever he visited my house. After a couple of years of completely baseless and heart-stopping frights, I had an encounter with a real spider which I had thought was one of his plastic ones. To my surprise, I was able to release it outside. From that day onward, I’ve had normal reactions around spiders. It was a technique that worked well against my phobia and consequent anxiety but I think that if the same technique was used with a child, it would worsen the problem considerably.

Cognitive Behavioral Therapy – Another major type of anxiety-reducing therapy is Cognitive Behavioral Therapy. This therapy uses the mind to overcome anxiety. As part of this therapy, you’re encouraged to think about your negative expectations, challenge them and then replace them with more realistic ones. The therapy uses deep thought and knowledge of oneself to adjust your behavior. It’s a fairly in-depth form of therapy which is not useful for sudden encounters with anxiety. In my opinion, it is not the kind of therapy that can be used with a small child, particularly one with special needs who has less developed thought processes.  However, there are child psychologists trained to use cognitive behavioral therapy with children.

Medication – There are a number of medications which can be used to deal with anxiety. Many of these have significant side-effects, so you need to read up on them before using them. If you’re using these medications with young children, make sure that your recommending physician has experience with prescribing that particular medication to children of similar ages. Don’t simply accept the prescription but ask lots of questions. In particular, ask what changes you should expect, how soon you should expect them and how quickly the medication will enter your child’s system. You should also find out whether or not you need to “taper off” the medication if you decide to discontinue.

You’ll need to inform your child’s school that he or she is on the medication but you might also suggest that they limit their disclosure to other teachers so that their feedback can be assessed without any preconceived notions.

In small children, medication may be the best way to control anxiety until they develop the cognitive skills to use more advanced therapies.

Regardless of the method you choose, dealing with anxiety is a critical step in helping children with various isms to deal with the world around them.