In this presentation we are going to look at how anxiety levels can be impacted by change and particularly by unexpected or unscheduled changes to a normal routine.
Anxiety is described as… “A feeling of worry, nervousness, or unease about something with an uncertain outcome”
So if take a closer look at that definition of anxiety… “unease about something with an uncertain outcome” We can all agree that most of us have felt anxious about something with an uncertain outcome.
For example the feeling you get prior to an exam or waiting for the result of that exam.
And managing these levels of anxiety can be a real challenge for people with autism.
Many children and people with autism rely heavily on routine and sameness to help them to manage their day to day activities.
This routine is really important as most people with autism lack social imagination. This affects their ability to predict what’s coming next and any break in regular routine can drive up their levels of anxiety.
This need for predictability can make the child with autism vulnerable to anxiety when a routine is changed or altered without firstly preparing them for that change.
This anxiety can be most acute when there is uncertainty surrounding what is to happen next.
Unfamiliar surroundings, faces and sounds can also drive up anxiety levels for children and people with autism.
Let’s look at some of the reasons why children and people with autism may become anxious:
- A break in regular routine
- Being unable to predict what’s happening next
- A sense of loss of control of their immediate environment
- Issues and difficulties with sensory processing exposure or a fear of exposure to sensory stimuli that may cause discomfort (e.g. loud or unfamiliar noises, bright lights etc.)
- Emotional recognition: the ability to read other peoples emotions can drive anxiety in people with autism (Theory of Mind)
- A difficulty in coping with change due to a deficit in social imagination.
- Difficulties with communication and being able to express their feelings and emotions.
Now let’s look at some ways to mitigate that anxiety:
Children with autism can manage and cope better with anxiety and stress once they are prepared in advance for any change to their normal routine.
If you know about the change in routine in advance, use that time to inform the child with autism what will happen next prior to the change occurring.
This can be done verbally or visually. By showing the person a picture of the place or activity that is outside of their normal routine.
If the person uses a daily schedule, the place or activity can be included in that schedule.
Stressful situations related to change can be reduced or avoided if the daily schedule is changed in advance and the change is highlighted and positively re-enforced for the child with autism.
It is normally unannounced changes to routine, where the person with autism is unprepared for that change that will drive anxiety levels up which can result in a negative reaction.
Some strategies often used to help people with autism cope with change are: Familiarisation & Social Stories.
The purpose of familiarisation is to reduce the likelihood of anxiety, stress and possible meltdown. Familiarisation will pre-prepare the child what could be an anxious and stressful situation.
So Let’s take an visit to the Doctor as an example.
As a part of this process a “Social Story” may be developed to outline why a particular situation is happening, in this example; a Doctor’s Visit and what will happen during the visit and how that person is expected to behave during that time. The purpose of the Social Story is also to prepare the child or person with autism for what will happen during that time and thereby reduce the levels of anxiety and stress that may occur.
Here we can see a “My visit to the Doctor Book”. You can use a copybook or notebook to create your book.
The first page introduces the receptionist Karen who works with Doctor Alan. A picture is used and the majority of surgeries are happy to cooperate once the situation is explained to them.
The next page introduces the waiting room Then Doctor Alan is introduced…
Next is the inside of the Doctor’s surgery.. And The simple procedure of the Doctor looking in the child’s mouth.
The purpose of the visit is to help the child feel better … this is the outcome Then home in Mum’s car and back to regular routine if possible..
It is also possible to mitigate an anxious or stressful situation by having a familiar object or item available to the child or person with autism. For example a favourite toy, book or other object that may calm the person once they engage with it.
Once again it is important to control the immediate environment for a person with autism and minimise stimuli such noise, light, and smells.
Exposure to such stimuli can drive anxiety and stress levels for a person with autism. In the case of a Doctor’s visit it may be an idea to keep the child outside the waiting room in a less challenging environment until the Doctor is ready to see them.
Now let’s take a look at some ways to reduce anxiety and stress for children and people with autism.
- Consistency in their schedule and routines.
- Use visual supports to map out what is coming next.
- Always be aware of the sensory environment and exclude as much unwanted sensory stimuli as possible.
- As much preparation as possible for unscheduled events.
- Schedule regular Sensory Breaks.
- Create a Sensory Space (Quiet Place) free from sensory stimuli for the person to relax and de-stress.
- Prepare calming strategies for the person with autism when they get anxious.
- Use social stories to prepare the person or child with autism for a planned out of schedule event.
- Use positive re-enforcement: the use of a motivating item to achieve appropriate behaviour.
- Always use a calm voice and avoid becoming stressed yourself.
