The following is a transcript of the question-and-answer portion of Mark Hutten's seminar on "Aspergers and Anxiety: What Parents and Teachers Need To Know":
Question: Both of my boys have Aspergers, but one exhibits a lot of anxiety, whereas the other does not seem anxious at all. Is there a good explanation for that?
It’s very normal for different children to have different temperaments. Some children are more outgoing and seem to be impervious to feelings of anxiety, whereas other children may always seem to be anxious. But it’s very possible for the more anxious child to learn skills to help manage his anxiety better so he can participate in activities, do well in school, and not be held back due to anxiety-related issues, and so on.
Question: How common is anxiety in children with this syndrome?
Anxiety is extremely common. It’s estimated that up to 80% of people with Aspergers experience intense anxiety symptoms. It can take the form of obsessive-compulsive disorder, specific fears and phobias, and generalized anxieties. Also, 1 in 15 children with Aspergers meet the diagnostic criteria for depression, which can be both a cause and a result of anxiety. We don’t know exactly what causes the depression, but it’s likely a combination of the child’s realization of his difference from peers and the ostracizing that occurs from these peers. Bullying is an extremely common problem among children with Aspergers, and this often leads to an increased rate of both anxiety and depression.
Question: How should I go about choosing a child therapist for my 12-year-old Aspergers son?
In the field of child anxiety as it specifically relates to Aspergers, there are some therapists who have been specifically trained in implementing what we call ‘cognitive-behavioral therapy’ – or CBT. Cognitive-behavioral methods are essentially a set of skills that Aspergers children can learn to help them change their fearful thoughts, anxious behaviors, and to reduce their physical feelings of tension.
Cognitive-behavioral approaches to treating child anxiety have been found to have high levels of success. For example, a child who is experiencing panic attacks might learn how to identify anxious thoughts that trigger panic attacks, learn how to change his anxious feelings, and learn how to change anxiety-triggering behavior. In any event, ideally you will want to seek a Child and Adolescent Psychiatrist who specializes in CBT specific to the Aspergers condition.
Question: How long will it take before I see a change in my Aspergers son once he has started this cognitive-behavioral therapy?
That’ll depend on his unique set of symptoms. At one of our facilities in Indianapolis, children are typically treated within 7-12 sessions for difficulties like specific fears, panic disorder, generalized anxiety disorder, and obsessive compulsive disorder. In some cases, however, additional sessions are needed to help a child make the maximum progress. But even then, 15 sessions will usually be the max.
Question: I'm an anxious person also. Is it possible that I give this anxiety to my Aspergers daughter?
Although research has shown that anxiety may be heritable, there are many other ways that fears can be acquired. Your daughter may have a more anxious, inhibited temperament, which may make her more vulnerable to feeling anxious. Fears are often acquired through the media, through modeling from others, and so on. Fears might also occur after children have experienced some form of trauma. So, although you may feel you are anxious, it is not likely that you simply are ‘giving’ an anxiety disorder to your daughter. There are ways that you can interact with her, though, that may function to increase her anxiety, and it might be important to examine such factors with a therapist.
Question: What do anxiety symptoms look like in a child with Aspergers?
Not much is known about what anxiety symptoms actually look like in a child with Aspergers, but there are symptoms that overlap with Anxiety Disorders, for example: avoidance of new situations, irritability, somatic complaints, and withdrawal from social situations. Another set of anxiety symptoms may be unique to children with Aspergers, for example: becoming ‘silly’, becoming explosive, having anger outbursts or what we call ‘meltdowns’, increased insistence on routines and sameness, preference for rules and rigidity, repetitive behavior, and special interest.
Question: What is the difference between cognitive-behavioral treatment and other kinds of treatment for anxiety?
CBT is focused on teaching children and parents specific skills for changing their fearful thoughts, anxious and tense physical feelings, and avoidant behaviors. Other types of therapy are more focused on using play therapy and/or talk therapy to produce change. There’s a lot of evidence suggesting that cognitive-behavioral techniques are quite successful in reducing anxiety in Aspergers children. Other forms of therapy have less empirical support.
Question: Will my child’s anxiety go away naturally or does he need treatment?
This is an excellent question, and one that is commonly asked by parents. Many childhood fears are part of normal developmental. Fears tend to rise and dissipate at predictable ages in a kid’s life. A child might develop a fear of the dark at age 4, which dissipates by the time he’s 6. Also, it’s normal for children to feel fearful of loud noises when they are very young. However, no matter how old your son is, if he is experiencing a fear that is beginning to interfere with aspects of his functioning, such as academic, social or family functioning …then these fears may warrant treatment.
Very often, successful short-term therapy can help to alleviate an Aspergers child’s fears and help him return to healthy functioning. If you’re unsure whether your son’s fear is normal, or whether it is interfering in his life, it may be a good idea to consult with a psychologist to determine whether he could benefit from treatment.
Question: You say that cognitive-behavioral treatment is the best treatment for anxiety symptoms in children with Aspergers. What does it consist of exactly?
CBT is a time-limited approach designed to change thoughts, emotions, and behaviors and has been shown to be successful in treating Anxiety Disorders in Aspergers children. It should consist of both a child component and a parent component. In using CBT, children should be helped to identify what their own anxiety symptoms look like.
Activities like feeling dictionaries (which is a list of different words for anxiety) and emotional charades (which is guessing people's emotions depending on faces) are helpful in developing this self-awareness. Worksheets, written schedules of activities, and drawings can be added to increase structure during therapy sessions. Games and fun physical activities are important to include in group therapy because they promote social interactions. A reward and consequence system should be used to maintain structure and prevent anger outbursts. Also, to build on the attachment between child and parent, it is important to have parents learn the techniques and coach children to use them at home.
Other useful techniques may include body brushing and massage, chewing gum or sucking on a candy cane to relieve pressure in the jaw, deep pressure activity like lying under a heavy blanket or cushions, physical energy burn like running and jumping on a trampoline, redirection and distraction, and whole-body activities like tug-of-war or rolling on the floor.
As a side note, know that kids with Aspergers tend to have perfectionist attitudes in many areas of their lives. This can be witnessed through their obsessive-compulsive behaviors, repetitive patterns of behavior, and their difficulty coping with change. Now …this self-imposed perfectionism can contribute to their anxiety and pressure to perform. So, since Aspergers kids usually place extreme and unrealistic demands on themselves, it’s important to not push the child too far in therapy. Small steps and taking it ‘one therapy session’ at a time will go a long way in effecting permanent positive change in the child. Go slow, have realistic therapeutic expectations, and monitor progress – these are the big 3 in CBT as far as I’m concerned.