Autism Awareness Day #4

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Anxiety. We have all experienced anxiety at some time or other.  Perhaps some have experienced more debilitating levels of anxiety than others, but I think most can relate to the feeling of being anxious. http://www.beyondblue.org.au/ state that over three million Australians are living with depression or anxiety.

You may be surprised to know that – “Anxiety disorders are the most common mental health problems experienced by young people. In Australia, anxiety disorders are estimated to affect about one in every 10 young people aged 18-24 years (1), with the rates higher among young females (14%) compared to males (8%). The most common anxiety disorders reported by young Australians are social anxiety and post-traumatic stress disorder.” http://www.headspace.org.au/what-works/research-information/anxiety

Children with Autism commonly suffer from anxiety. This anxiety can be caused by many factors related to their condition such as sensory sensitivities, communication and social difficulties.  This anxiety is seen in their school life, social and family life and is such a significant part of the condition that anxiety is described in the Diagnostic Statistical Manual 5 as an associated feature of Autism Spectrum Condition.  From:  http://www.autismtraining.com.au/public/index.cfm?action=showPublicContent&assetCategoryId=1139

The baseline anxiety level for individuals on the spectrum is often higher than most. I like to use this example – someone accidentally steps on your toe.  If you’re pretty relaxed and everything has gone smoothly that day, you tend to just say “that’s OK” and you shrug it off.  However, if you’ve had a trying day and you’re feeling uptight, your natural reflex is often anger and irritation.  Imagine if most days your base line was more like the second example?  Might you be more likely to be tearful? Might you be more likely to strike out verbally or physically if challenged? Might you just generally be less resilient than other days?  I think most of you would answer ‘yes’ to these questions.  When individuals with Autism Spectrum Disorder display behaviours such as aggression, irritability, perfectionistic tendencies, concentration issues, fear of new and unfamiliar situations, constant questioning and a need for reassurance, muscle tension, headaches, difficult or aggressive behaviours, sensory issues, increase in repetitive behaviours or restricted interests – it’s worth exploring whether anxiety is contributing to these choices or these behaviours.  The presenting problem is rarely (if ever) the actual problem!

James has clinical levels of anxiety. It is the largest part of his ASD “fruit salad”.  Yesterday was the last day of school for him.  Yesterday afternoon, the children had an Easter Liturgy at school.  Typically, if I attend these events I end up with James on my lap within ten to fifteen minutes, crying.  It’s really difficult! I want to be involved with these kinds of school events to show my support, and I want to be there for Tom – but it is so clearly distressing to James it’s hard to know sometimes if it’s worth it – but we plug along!  I decided that given that the liturgy was at 2:30pm that I would go.  If everything went to hell, we would then be going home directly afterwards in any event.

When I showed up, I immediately located Tom’s little blonde head. I looked for James but couldn’t find him anywhere.  I wondered if maybe he was too distressed to come over to the hall (happens a few times a week – he hates the hall) and if perhaps he was over sitting in his ‘safe spot’ in the office.  I looked outside the hall and in the distance spied a boy with his hat pulled over his face, clearly distressed, and being consoled by a lovely young male teacher who I knew had been James’ relief teacher that afternoon.  The hat moved backwards on the child’s head and sure enough it was James.  I ventured outside the hall and happily waved to him and to his lovely teacher.  James was distraught – crying and finger biting.

His teacher, bless him, was almost more upset than James. He explained that the children had been making Easter Eggs baskets and that they had decorated boiled eggs.  Sadly, on the way down to the hall, James had dropped his egg and it had cracked.  James was devastated.  The poor teacher was trying to console James by offering alternatives – we have extra eggs upstairs, you could definitely have one of those eggs etc.  James just said – “That was my egg. There’s only one ‘my egg’ and now it’s broken!”  In the end, I thanked the lovely teacher for his help and concern and said I’d take James into the hall with me.  It was clear there was going to be no immediate solution to the egg crisis.

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James sat on my lap, I held him firmly (he loves this) and he cried for at least 10 minutes. He buries his head in my neck and you can hear him inhaling deeply – in essence smelling me – but it’s comforting to him.  He says, “I’m smelling you because I love your lovely Mummy smell!” He was biting his fingers and hands, and then moved on to my necklace.  Fortunately a friend sitting beside me had some Mentos in her bag which he chewed on for a bit.  He didn’t seem to be settling so I whispered in his ear, “James – do you think you could teach me how to decorate Easter eggs like you did today? Because I’d really like to make my own egg and maybe tomorrow we could all make some eggs at home.”  He sat up, stopped crying and said, “I could definitely teach you how to decorate the eggs Mum. I think you should make a pink one because you like pink. And Tom definitely would want a blue one! ….”  And that was the end of that!  The switch was flicked!

Anxiety is a monster. Even with medication, James still struggles with anxiety every day.  He has worked really hard on developing coping strategies with his psychologist, and his teachers and support teachers have been wonderful in helping him manage at school.  I worry about how his levels of anxiety will impact on his functionality in the long term but I try to focus on the day to day, and ensuring that we talk about it and develop strategies for managing anxiety.  He is definitely making some gains.

As individuals who support those with Autism, I think it’s critical to always consider anxiety and stress, and the possible impact it may be having on the individual and their behaviour and general well being. Equally, if the statistics are correct, there are likely to be 2-3 students in every classroom suffering from anxiety. These individuals may be ASD but equally, they may not.  Any strategy or process we put into place for individuals with Autism will ultimately benefit every individual in the classroom or workplace. We need to teach anxiety management skills and practise them every day.  We need to talk about anxiety and normalise it where we can.  We need to ensure that these individuals have sufficient preventative breaks or down time throughout the day to keep their stress levels down.  We need to discover ways to communicate with these individuals about where they are at and how they are feeling – visual supports are useful for this.  Most of all, we need to be aware.  Let’s be aware and let’s be informed.  With awareness comes understanding.  With understanding comes acceptance.  With acceptance comes inclusion.  Where there is inclusion, there is an acceptance and respect for diversity.

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