What's New at CBH
Addressing Anxiety in Autism Spectrum Disorders (ASD)
Anxiety disorders in children with autism may be expressed through various problematic behaviors, sometimes called "acting out" behaviors because the person is acting out the emotions (usually in an unconstructive way) rather than recognizing, managing, and expressing the emotions more constructively. Anxiety may lead to aggression, tantrums, bolting, screaming, engaging in stereotypic behaviors, withdrawing, echolalia (i.e., repetition of sounds or words made by another), or even self-injurious behavior. We cannot always separate behaviors typically associated with ASD from behaviors caused by a mental health disorder such as anxiety. The problem for parents, teachers, and other practitioners is how to be sensitive to the child's obvious dismay without maintaining and strengthening the problem behavior.
Depending on the situation or the behavior exhibited, we may be tempted to give attention, remove demands, or give tangibles in order to soothe or quiet the child. However, this approach presents several negative possibilities:
- While safety is our primary concern, giving undue attention can strengthen the behavior and discourage the child from developing coping skills.
- Removing the demand or allowing escape reinforces problematic behaviors; it teaches the child to act out to avoid something unpleasant. An inability to cope with demands impedes learning, independence, community involvement, and life choices.
- Similarly, using tangible items to stop problem behavior or tantrums also reinforces problematic behavior; it teaches the child to act out to get what he or she wants. This devalues functional communication. Offering "sensory items" or "sensory breaks" should not occur during the tantrum.
Instead, try these positive approaches:
- Give plenty of access to positive reinforcement and praise - specifically for being calm.
- Practice coping strategies during neutral situations. Reward "successive approximations" of the desired behavior. Successive approximations are behaviors which are increasingly similar to, i.e., behaviors which approximate, the desired behavior.
For example, if the desired behavior is to verbally ask for something using the word "please", the child might initially be rewarded for pointing at what is wanted, the caretaker can then remind the child to use words and say please. When the child begins to ask using words, even though not using the word "please", this new behavior is reinforced as being more similar to the desired behavior, and the reward is no longer provided for just pointing. This gradual process of rewarding successive approximations is called shaping, and it allows for more success than an "all or nothing" approach to learning new skills.
- Do not remove the demand, give tangibles, or give undue attention to negative behaviors. Instead use redirection and prompt for appropriate communication (through words, sign, or picture exchange system). Then quickly reinforce the positive alternative behavior.
Of course you want to show love and or concern for the child, but do this in a way that is beneficial to the child. There are many proactive strategies that will reduce the child's anxiety and increase positive behaviors:
- Visual supports are not just for children with lower cognitive abilities. They help children organize their time and understand expectations. These are crucial during stressful times, when receptive language skills are most impeded.
- Social stories can be used to prepare a child for what to expect and how to act in new situations.
- Reserve favorite items in order to reward positive behavior during stressful situations.
- Do not have a child "work for" their biggest reinforcer or items that the child perseverates (repetition of a particular response, such as a word, sound, gesture, or behavior even when the situation that prompted the response has changed) over. This may cause a child so much anxiety that successful completion of the task is almost impossible.
- Use pictures of loved ones, favorite things, and favorite places to reassure the child while he or she is calm. Teach and praise the child for accessing these items independently when upset.
- Most importantly: Build a positive and trusting relationship with your child.
Tricia Gray is a former teacher in a self-contained classroom for children on the autism spectrum. She also spent several years providing in home behavioral supports for children with disabilities. She has a Master's Degree in Special Education and is sitting for the May exam for board certification as a Behavior Analyst. Her areas of interest are behavior intervention, motivating operations, and Verbal Behavior strategies to build communication.