Recognizing and Responding to Anxiety in Children with Special Needs

Although most of us don’t need hard-core evidence on the topic, Dr Lawrence Fung from Stanford Medicine states, “Anxiety is a very common co-occurring condition in the neurodiverse community. About 20 to 30% of male adults on the spectrum have anxiety disorder. Females with autism spectrum condition have even higher rates of anxiety. The prevalence of anxiety is up to 40% in females on the spectrum. In some clinics the prevalence of anxiety in patients on the spectrum is even higher (up to 80 or 90%).”

While this study was specifically focused on autism, we know that people who learn and process the world in a different way than most, experience higher levels of anxiety. After all, why wouldn’t they? Everywhere we go we hear that anxiety is off the chain! Sometimes we forget that kids with disabilities deal with the same crazy world as the rest of us, but oftentimes without the knowledge of why things happen the way they do, which could make the world a whole lot scarier.

Signs of Anxiety

When we consider what would be noticeable in the average person who’s experiencing anxiety, we might see:

• Recurring fears and worries
• Irritability
• Trouble concentrating
• Strong desire for sameness (sometimes to an obsessive degree)
• Extreme self-consciousness or sensitivity to criticism
• Withdrawal from social activity
• Avoidance of difficult or new situations
• Chronic complaints about stomachaches or headaches
• Drop in grades or school refusal
• Repeatedly seeking reassurance
• Sleep problems

Sound familiar? I am guessing your answer is, “Yes.” If we know that the average person is experiencing these things, imagine what a child who cannot express themselves must be feeling. It is important, however, to separate behavior that’s part of typical child development from an anxiety issue, such as a 2-year-old having a tantrum when their parents go to work or when there’s an unexpected loud noise. Not feeling well also needs to be ruled out before assuming your child is dealing with an anxiety issue. A quick trip to your pediatrician is a good first step.

Take the ABC Path

When a behavior analyst starts to consider the development of a positive behavior intervention plan, the first thing they do is look for the antecedent/behavior/consequence, or ABC. If you can identify what is causing the anxiety by looking at the antecedent, or the thing that came before the expression of anxiety, this should help you create the interventions that will help your particular child. In the same manner that not all kids like the same foods, not all strategies are gonna work for everyone. Sometimes a trial-and-error process is required.

Some of the things that could very easily cause, or grow, anxiety in children with disabilities are their need for sameness, poor communication skills, inability to process information at the rate that the teacher is delivering the instruction, fine motor skills that are not yet adequate enough to get paper-pencil tasks done, deficits in understanding socially appropriate behaviors and how to engage with other children in a way that is expected. With all those barriers in place, how could they not have anxiety?

Where to begin…..

The good news is that there are strategies that can be implemented in both the home and the school to help reduce the feelings that lead to anxiety. Start by identifying activities that bring a sense of relaxation or calm. Chances are good that you yourself already use some of these when you get stressed out in traffic, or during IEP meetings 😮 Practice these coping strategies together when you and your child are calm, so you’ll be familiar with them when anxiety strikes. You do NOT want to push your child to breathe deeply when they are in a full-blown episode of anxiety. Here are some things you can try:

• Model the behavior you wish to see – if you’re stressed out, your child is HIGHLY likely to be the same.
• Grab some headphones to block out sounds or listen to music.
• Use less words at a quieter tone and more visuals than usual. How many of us turn the car radio off when we are in a dangerous driving situation? There’s a reason for that.
• Go for a walk (down the hallway or around the block)

• Count up or count down.
• Teach emotions. There’s a great program called Little Spot that I see working well with kids, and no, I don’t make any money by recommending it. Lol
• Squeeze a stress ball or therapy putty (OTs are great with regard to self-regulation strategies)
• Give hugs, cuddles or a weighted blanket or vest.
• Think about a favorite thing or place.
• Draw.

• Use social stories for anything that you think they might not be sure of. These are especially helpful when there are changes in routine (ideally before the change takes place).
• Identify and label a “safe space” or “quiet area” where they can catch a break but be sure to build in parameters (amount of time they spend there), or it could easily be used as an escape.

• Teach deep breathing. For some of us, closing our eyes during deep breathing makes this a 3-pointer. And if your kids can visualize a place they love to spend time, even better!
• EXERCISE. I’m a huge proponent of this one. I don’t know how I would function without my gym time. When my son was young, 10 jumping jacks would be all he would need to regroup his focus, reduce his stress, and get his juices flowing again.
• Role-play any or all of the above. Carve out time each day, or even once a week, to practice ways to reduce anxiety and deal with the stressors of everyday life.

Here’s a BONUS – We know that kids who spend more time on tech have higher levels of anxiety. Research tells us that it causes reduced attention spans, decreased patience, less social development, public judgement and compare and despair via social media, and insomnia, each of which can easily increase irritability and anxiety. If you’ve got a child who loves to watch the same videos over and over again, be mindful that they can become very obsessive (play-rewind-play-rewind), which in itself can cause increased anxiety. Monitor your child’s use of technology and ensure that there is an equal dose of outdoor play each day.

No one wants to suffer through bouts of anxiety, but in today’s world, it’s difficult to escape. However, with some sound strategies and loving support, we can all learn to deal with some of the hurdles that lie before us.