Anxiety is a normal part of development, but research confirms that people with autism experience elevated levels of anxiety in comparison to their typically developing peers. An extensive review of the literature by White et al (2009) revealed that up to 84% of individuals with autism meet the criteria for clinically diagnosed anxiety disorders.
Due to characteristic communication difficulties, an autistic person may have severe anxiety issues but have a decreased ability to express it. As noted by Howlin (1997), “…the inability of people with autism to communicate feelings of disturbance, anxiety or distress can also mean that it is often very difficult to diagnose depressive or anxiety states.”
Anxiety may manifest in an autistic person through:
- social phobia
- excessive worry/rumination
- obsessive compulsive behaviour
- hyper-vigilance, or seeming “shell shocked”
- avoidance behaviours
- rigid routines and resistance to change
- stimming and/or self-injurious behaviour
- controlling behaviours – oppositional defiance
- shut down
Dealing with change
People on the autism spectrum can find change very stressful. Due to the behavioural, information processing and sensory aspects of their diagnosis, many people on the autism spectrum often prefer familiar environments with a predictable routine. Restricted and repetitive interests, sensory processing differences and heightened anxiety can make even small changes stressful. Planning ahead and preparing for changes in everyday routines and activities is important:
“Reality to an autistic person is a confusing, interacting mass of events, people, places, sounds and sights… Set routines, times, particular routes and rituals all help to get order into an unbearably chaotic life. Trying to keep everything the same reduces some of the terrible fear.” – Jollife, et al (1992) in Howlin (2004), ibid, p.137.
Change is an inevitable part of every person’s life. Teaching a person strategies to cope with changes in their environments and routines helps to build resilience and independence. Preparing people on the spectrum for upcoming changes is referred to as “transition planning”. The purpose of transition planning is to enact change in a way that feels safe and predictable for the individual on the autism spectrum. Effective planning helps reduce stress and anxiety and helps prevent behavioural issues that may occur because of either expected or unexpected change.
Everyday changes and “horizontal planning”
Some everyday changes or new situations a person with autism may need preparation for might include:
- leaving the house
- having visitors at your house
- going somewhere new, such as the dentist
- switching between activities or tasks during play or learning
- doing things in a different order from time to time – for example, having a bath/shower before dinner rather than afterwards
- eating new foods
These frequent changes that may occur on a daily basis are known as horizontal transitions.
Many people on the spectrum have strong visual learning and thinking styles. Visual strategies can therefore be an effective way in which to communicate upcoming changes. Common visual strategies used in horizontal transition planning include Social Stories™, social scripts, task lists, schedules such as timetables, daily planners and calendars. The National Autistic Society (UK) have published a thorough guide on the various uses of visual supports.
When visiting a new place, having photos to prepare the individual for what to expect can be helpful. Pictures can be obtained through websites or by exploring a location via the Google maps street view function. Requesting images may also be an option, for example, contacting the doctor’s practice and requesting a recent image of the doctor and the consult room in advance of the appointment.
There are an ever-increasing number of apps that can help with autism-related challenges. The Autism Association of Western Australia has developed an online resource, Autism Apps, that offers reviews of a large number of available apps, as well as:
- Guides on how to use an iPad effectively
- Suggestions for how to support people with autism using technology
- Tips for selecting a useful app
- Information related to the National Curriculum and Evidence Based Practice for supporting individuals with autism.
Longer term changes and “vertical planning”
Progressions from one life phase to another are known as vertical transitions. The progression form primary school to high school is an example of a vertical transition experienced by children in the middle years. The Amaze/Autism Tasmania information sheet, Effectively Preparing Individuals with Autism Spectrum Disorder for Transitions, provides strategies to help individuals with autism transition to new environments.
Research has revealed some good practice guidelines for preparing for major life transitions:
- Gather information: What change is about to occur? When, where, and who with? How has the person reacted to previous transitions and changes? What transition strategies have helped in the past?
- Develop a plan: Meet with all the key people who will support the person through the change to develop a plan to support the transition.
- Create supports, such as visual sequences, social scripts, transition stories, sensory supports, and short movies.
- Implement the plan.
- Evaluate and review: Was the transition support plan effective? What should be changed for next time?
Bullying can happen to people of all ages and abilities, but people with developmental differences or disabilities are especially vulnerable. Bullying involves an imbalance of power and takes physical or psychological form. Psychological bullying includes threatening, coercive and manipulative behaviour.
Useful strategies to address bullying can be found in this information sheet.