There are many disorders which have anxiety as a comorbid condition including depression, ADHD, and Autism Spectrum Disorders. Today I am going to be talking about the last disorder mentioned on my list and that is the association between anxiety and Autism Spectrum Disorders. April is Autism Awareness Month and so I thought this would be a great opportunity to share my personal perspectives as the mother of a child who has both autism and anxiety related issues.
There are many studies out there to show that a high percentage of children and adults with autism or Asperger’s Syndrome (considered to be a high functioning form of autism) suffer from anxiety related disorders. In one report entitled, “Research: Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment” the authors state that anxiety disorders are common for people with developmental disabilities including autism but they may not be diagnosed and treated as often as for those people without developmental disabilities. They go on to say that people with autism may suffer from Generalized Anxiety Disorder, Obsessive Compulsive Disorder, phobias, and other anxiety related disorders at much higher rates than the general population.
But the problem is that identification and treatment of anxiety for persons on the autism spectrum may be difficult because some of the symptoms of autism may obscure the anxiety symptoms. Things like difficulties in communication and behavioral problems may make it difficult to see that the individual with autism may also have an underlying anxiety disorder.I know about these difficulties in assessing anxiety in a person with autism as I have experienced this with my own son, Max.
One of the first memories I have about Max’s anxiety was when we visited a carousel for the first time. He was about three years old and was yet to be diagnosed with autism. We wanted to take him on a carousel ride at an amusement park. It seemed the most mild and non-frightening (to us at least) ride that we could think of to take him on. Most children are either delighted or even bored by the prospect of riding on a merry-go-round. But not Max. Max was immediately terrified. As we tried to board the ride he screamed and bucked like a little colt ready to run. He wanted no parts of the carousel. This was one of his first phobic reactions and it was certainly not the last. Max would grow to develop many phobias over time. I was puzzled by his reaction at first, but as I learned more about both anxiety and autism I began to understand some of my son’s responses to his environment.
After Max was diagnosed with autism, I began to research about his disorder. One of the primary symptoms of autism can be a problem with regulating and processing sensory information. Many children who are on the autism spectrum will have something called “Sensory Integration Disorder.” What this means in everyday language is that some ASD children and adults can have a wide range of variability to how they react to sound, touch, taste, smell, and visual stimuli in their environment. For example people who are not on the autism spectrum or who do not have Sensory Integration Disorder (SID) may be able to tolerate the sound of a garbage truck, car horn, or leaf blower. But for the child or adult with SID, the sound may be processed as much louder than it really is. It may be perceived as so loud as to be painful. The person with SID may react to such stimuli by covering their ears, crying, or running away. I began to understand why my son would scream or cry or attempt to escape when he would hear sounds like a hair dryer, vacuum cleaner, or even carousel music. He was frightened.
Imagine a world where at any moment, something frightening may happen to trigger a rush of adrenaline to your body. Your senses are heightened to be alert for any possible danger which could manifest in a loud sound, a glaring color that hurts your eyes, or an unexpected touch which may be felt as a shock to your system or even pain. This is the world that an individual with autism must cope with everyday. Imagine then, too, that you are a person trying to deal with all these sensory assaults and you don’t have good communication skills. You are not able to tell someone what this feels like. For some people on the autism spectrum, the world can be a frustrating, chaotic, and frightening place. It is little wonder that we see anxiety manifest as behavioral problems. For those who do not have the words to talk, behavior is their primary way of communicating. It is sad when these attempts are misunderstood and not only the behavior but the person is labeled as “bad” or “abnormal.”
Over the years I have developed a keen gut sense about the origin of some of my son’s behaviors. Not always, but usually, anxiety is the underlying reason for many of his acting out behaviors. He is simply trying to communicate that he feels stressed, anxious or downright terrified. It would take another entire post (or book) to talk about treatment options and to tell you what has helped my son cope with his anxiety and phobias. I do hope to continue talking about all that I have learned here from my experience parenting and teaching my son as I think the methods we have found to work for us can also help others not only with developmental disabilities but also for people who suffer from anxiety in the general population.
If you want to read more about Autism Awareness I would encourage you to come over to visit ADHD Central where both Miss Eileen and I have written articles in honor of Autism Awareness Month. We would love to see you there!
Davis, E., Saeed, S., & Antonacci, D. (2008) Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment. Psychiatric Quarterly, 79 (3) 249-263.