ANXIETY AND MANAGEMENT IN ASD

1. ANXIETY AND MANAGEMENT IN ASD Dr Clodagh Doyle Consultant Clinical Psychologist NHSCT Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

2. Aims of Session • Definition of anxiety • Prevalence of anxiety • Anxiety and ASD • Symptoms • Strategies Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

3. ANXIETY • What is anxiety? • Anxiety is a NORMAL EMOTION – it helps us cope with difficult, challenging or dangerous situations. • Anxiety is COMMON – there are times when we all feel worried, anxious, uptight or stressed. • But anxiety becomes a PROBLEM WHEN IT STOPS YOUR child from enjoying normal life by affecting their school, work, family relationships, friendships or social life. • This is when ANXIETY TAKES OVER and your child has lost control. (from Paul Stallard : Anxiety) Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

4. Definitions • Fear – reaction to real environmental threat that is focused on a specific object, individual or circumstance eg chased by a dog. It’s a normal emotional response essential for survival • Worry – thoughts and beliefs about possible problems that may occur in the future ie focused upon distal events • Anxiety – a general, frightened response to a source that is not readily identifiable and may be out of proportion to environmental threats –ie excessive worry re common life situations Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

5. Prevalence in the general population • Anxiety disorders represent the most common type of psychological distress in school-age children (eg Kashani & Orvaschel, 1990) • 25.7% 8 yr olds meet diagnostic criteria for an anxiety disorder • Anxiety in childhood is most common risk factor for depression in adolescence and early adulthood • Anxious children are more likely to be anxious adults ie anxiety disorders have a persistent course Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

6. Anxiety and ASD • 84.1% of children with pervasive developmental disorder met the full criteria of at least one anxiety disorder Muris et al (1998) 35% of children with ASD met criteria for an anxiety disorder (Wood & Sze, 2007) • 65% of young people in clinic presented with clinically significant levels of anxiety (Atwood, 2004) Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

7. Anxiety and ASD • Why? - rigidity of thought and behaviour - difficulties with change; transitions; social situations - communication and language difficulties - sensory difficulties - difficulty recognising signs of anxiety Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

8. Anxiety and ASD • Poor copings /resource strategies • Hypervigilance to things/people in their environment • Difficulty recognising and discriminating between others feelings • Difficulty predicting outcomes Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

9. Anxiety and ASD • Risk factors: • Awareness of difference • High trait anxiety • Family tension • Bullying/victimisation • Adverse life events • (Tantam,2000) Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

10. Anxiety and ASD • Anxiety and fear are factors in behaviour difficulties and challenging behaviours. • Anxiety more common in those with diagnosis of Aspergers Syndrome or High Functioning Autism (White et al,2009). Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

11. Symptoms of Anxiety • Exercise: think about what the symptoms of anxiety are. Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

12. Symptoms Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

13. Components of anxiety • Affective – feelings of fear, panic, agitation, nervousness • Cognitive – worry, negative thoughts, poor concentration, attentional biases • Physiological – increased heart rate, stomach aches, muscle tension, perspiration, sleeping difficulties • Behavioural – flight, fight, freeze, reassurance seeking Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

14. Body cues for Anxiety Symptoms • “FLIGHT–FIGHT” reaction: • • shortness of breath • • tight chest • • dizziness or light-headedness • • palpitations • • muscle pain, especially head and neck pain • • wanting to go to the toilet Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

15. • shakiness • • sweating • • dry mouth • • difficulty swallowing • • blurred vision • • butterflies or feeling sick. Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

16. What do we do? • Tool–box: promote self-regulation • Relaxation • Distraction • Create predictability – visual schedules, visual cues/symbols • Emotional education – teach about emotions; signs of anxiety • Social stories • CBT type approach • Social skills training Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

17. TOOL BOX PHYSICAL ACTIVITY TOOLS THINKING TOOLS SOLITUDE SPECIAL INTERESTS SOCIAL TOOLS RELAXATION TOOLS Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

18. Relaxation tools – slow release of emotional energy • Breathing • Relaxation training • Repetitive action • Lego/Drawing • Music – listening/playing • Sleep • Reading Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

19. Physical Activity Tools – quick release of physical energy • Exercise – eg trampoline • Sport • Creative destructive • Swing Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

20. Social Tools • Spend time with family member or friend • Seek advice • Solitude • Be with a pet Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

21. Thinking Tools • Put event in perspective • What would you like to do • Flexible thinking eg •“It might have been an accident. I should check before I get angry” • Social story Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

22. Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

23. Relaxation • Relaxation allows child to change their physiological arousal • It counteracts the physical feelings of anxiety • Taught to a child when they are feeling calm • Individual and group exercises Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

24. Types of relaxation • Progressive muscular • Visualisation/imaginative • Breathing exercises Group exercises - relaxation - breathing Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

25. Relaxation • Group exercise Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

26. Distraction • Distractions are mental operations – typically mindless • Goal is to engage mind in something simple or routine that the worry thoughts are prevented • ie distraction helps to take your mind of the negative/worrying thoughts • It helps you take control of your thoughts by thinking about something else Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

27. Additional techniques • Worry time • Worry box/safe • Therapeutic stories • Talking back to worries • Turning volume down on worry thoughts • Turning the tape off. Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

28. Cognitive Behaviour Therapy • What is COGNITIVE BEHAVIOUR THERAPY? • Cognitive Behaviour Therapy (CBT) is based on the idea that how we feel and what we do are due to the way we think. • Focuses on relationship between • Cognitions – what we think • Affect – what we feel • Behaviour – what we do Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

29. CBT ENVIRONMENT Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

30. CBT SCHOOL PLAYGROUND Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

31. CBT • Monitoring and identification of thoughts, feelings an behaviour • Psychoeducation • Learning alternative ways to manage anxiety/unpleasant emotions • Challenging the unhelpful thoughts Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

32. CBT • Coping and positive self talk • Learning new behaviours • Coping plan/target setting • Practice Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

33. CBT To summarise: • STOP Plan • S = pay attention to signs of anxiety • T = pay attention to anxious thoughts • O = think of other helpful thoughts • P = praise and plan for next time. Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

34. Modifications of CBT for Young people with ASD • More concrete and visual: worksheets, pictures, social stories, thermometer, feelings diary • Use of special interests • Adapt to suit developmental level • Include social skills training • Use a written schedule • Concrete language • Creativity • Questioning though use of role play or give choices/alternatives Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

35. Summary • Young people with ASD are vulnerable to anxiety • Emotional education is key. • Use “tool-box” for helping strategies • CBT useful – requires modifications • Parents have important role • UNDERSTAND AND SUPPORT Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT

36. Thank you for listening Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT