Due to the difficulties socializing for those on the spectrum (ASD), having ASD and anxiety are often two co-occurring issues. Regarding all teens, social anxiety is common as they want to fit in with their peers, but this anxiety is amplified when being on the spectrum. By learning about how these issues function together and how to tactfully intervene, you can help your teen lead a fulfilling life as a young adult. 

How these issues function together

There are disconnections between ASD and anxiety. According to one article, “as opposed to most other psychiatric disorders of childhood, there is no cure for autism and related conditions and the prognosis is often poor,” hence, ASD is a genetic condition. On the other hand, anxiety is a little more environmental-based as it can develop under certain circumstances; nevertheless, some people (such as those with ASD) are more susceptible to develop it. 

But there are also connections between ASD and anxiety. Following a review of the scientific literature on social competence deficits in autism, “treatment approaches for higher functioning individuals with ASD” and approaches for the treatment of anxiety are similar. Simple anxiety treatments may include self-care (relaxation techniques and stress management), therapy (cognitive-behavioral and psychotherapy). ASD intervention treatments are listed within the section below. 

There is further evidence from a study where participants were 15 [people] with high-functioning autism, 15 with a specific learning impairment, and 15 typically developing children between the ages of 8 and 12 years. And on a broad anxiety measure (self-report), the high-functioning autism group scored significantly higher on total anxiety than the specific learning impairment group and the typically developing group. Concerning specifically social anxiety, the same study supports that deficits in social functioning can significantly affect social interactions and interfere with the ability to establish lasting and meaningful friendships, leading to rejection and isolation, which may also contribute to the development of anxiety and depression.

Signs and symptoms of anxiety in teens with autism

While many people experience anxiety, anxiety symptoms may present themselves differently in teens with autism versus their neurotypical peers. For example, teens with verbal limitations may not be able to express their feelings with words and instead may act out physically. Teens on the spectrum may also struggle to properly identify their feelings, citing feelings of a stomach ache instead of expressing that they are feeling nervous. Some other examples of how anxiety may present itself are:

• Specific phobia: a specific phobia, namely an intense, irrational fear of something that poses little or no actual danger, may arise early in the course of ASD because of over responsiveness to sensory stimulation. For example, a teen with a sensory disorder may begin to fear a crowded cafeteria at school because of the intense amount of stimuli. Because they are anticipating that sensory overload, they may develop anxiety around eating lunch at school. 
• Obsessive-compulsive disorder: characterized by unwanted and intrusive thoughts and consequent compulsive behaviors. OCD is often present in people with ASD and identifying OCD in these patients is important because while the engagement in repetitive behaviors which is typical of ASD is unrelated to distress. Compulsions on the other hand are performed as a coping mechanism to relieve anxiety.
• Social anxiety: as children become teenagers, their environment becomes more demanding, and struggles with social skills can play a part in the development of social anxiety. Social anxiety, defined as intense anxiety or fear of being negatively evaluated in a social or performance situation, in turn, leads to avoidance of social situations, therefore limiting the teen’s opportunities to practice social skills, and may predispose the individual to negative reactions from peers and even bullying. 
• Separation anxiety: social impairment may evoke overprotective reactions from parents that in turn may strengthen avoidance behavior in the child; separation anxiety may then arise when the patient has to separate from attachment figures, for example at the moment of leaving the family for college.
•  Other atypical symptoms of anxiety: youth with ASD often experience symptoms of anxiety that do not necessarily fit within a diagnosis, for example, intense levels of distress related to changes in their routine or environment.

Regardless of how anxiety presents in your teen, it is important to seek out help from mental health professionals to help alleviate their symptoms and create a treatment plan.

How to tactfully intervene

If you see your teen struggling with their anxiety, there are a few things to keep in mind when addressing those concerns. Drawn from the literature in the general pediatric population, a set of specific recommendations was compiled as part of the intervention program for parents, as they work with their teens to face fears.

1. Encourage and reward the teen for their effort and engagement in brave behaviors
2. Ignore excessive displays of anxiety
3. Distinguish between realistic and unrealistic fears so that an appropriate treatment direction can be established 
4. Convey confidence in the child’s ability to handle their worry/anxiety
5. Model courageous behaviors
6. Work together with spouse/partner to develop a plan for facing fears
7. Share coping skills and create controlled fear-facing scenarios with other professionals

Helping your teen build coping skills

It can be difficult to watch your teen struggle with anxiety. It’s not just a matter of telling them that they are safe or that everything will be OK. 

• Find a physical outlet. Teens feeling anxiety may find having a physical outlet for that emotional energy helpful. If your teen tends to get physically agitated when they are feeling anxiety, you can have them practice taking a walk or doing ten jumping jacks to relieve some of that energy. 
• Social stories. Social stories explain social situations to people on the autism spectrum and help them learn socially appropriate behavior and responses. Social stories can help teens prepare for situations that may cause anxiety. For example, if your teen is anxious about the first day of school, you can create a social story for them to prepare for what will be expected of them. Depending on your teen’s needs, this could be a schedule of how your morning will go from leaving your house to arriving at school or a detailed schedule of their classes and routes they will take through the school building. 
• Practice. For many people experiencing anxiety, having the ability to practice situations that cause those anxiety symptoms can be beneficial. If your teen struggles with family gatherings, you can help them practice how they will greet family members or how they will come to you when they need a break or feel overwhelmed. This practice helps teens feel more prepared and better understand what is expected from them, and what they can expect from you. 
• Try comfort items. If your teen has a collection they love, a weighted blanket, or a favorite book, taking a break from a stressful situation and going to spend time with their comfort items can be beneficial to help them calm down and refocus when they are feeling anxious. 
• Relaxation techniques. Teaching your teen relaxation techniques such as deep breathing or counting to ten can help them feel grounded in a stressful situation. Begin by practicing these techniques when your teen is already calm and relaxed so that they feel comfortable using these techniques and can draw on those skills when they are feeling anxious. 
• Have an exit strategy. For many teens on the autism spectrum, anxiety symptoms are made worse when they feel like they are trapped in a situation. It can be very helpful for your teen to know that they are able to leave a situation when it becomes too overwhelming. In school, talk with your child’s teacher to see if an aid can assist your teen in leaving a noisy classroom for a quiet area if they are experiencing anxiety. At your family holiday celebration, let your teen know that you are available to go for a walk if they need to decompress or have a room set aside for them to relax and refocus. 
• Find outside help. Anxiety is not something teens will just outgrow and we can’t expect it to go away on its own. For teens with autism experiencing anxiety, their best course of action is to work with mental health professionals who can diagnose their anxiety and work with them to create a treatment plan towards healthier coping skills. 

New Focus Academy Can Help

At New Focus Academy, we know each student comes to us with a unique mind, background, skill set, and personal experience. We create an environment of success when most of our students are used to failing. Our positive reinforcement approach empowers students to take small steps leading to big changes and overall wellness. Our team works with your family and child to find specific evidence-based approaches that will help to build confidence, social growth, and motivation to become productive and self-sufficient. 

New Focus Academy gives all teens the chance to lead fulfilling lives; the residential treatment center helps teens on the spectrum with anxiety and other social challenges find success.  For more information call (435) 383-4369.