Autism and Anxiety Disorders: Treating Anxiety in Autism Patients

April is world autism awareness month, so there is no better time to bring to light not only the challenges associated with autism but also the most common conditions that impact this community. Children and adults on the autism spectrum are more likely to have an anxiety disorder than others. And research suggests they also may face challenges with getting an anxiety diagnosis and treatment.

Autism can make it difficult to be diagnosed. This is partly due to the difficulty in communicating and socializing with others. Language and learning difficulties can make it difficult for children to express their emotions and symptoms. A condition known as alexithymia can make it difficult for fluent speakers to identify and describe their feelings.

ASD youth may have difficulty understanding the standard anxiety assessments. A 2014 study found that measuring anxiety in ASD can be difficult because of uncertainty.

Researchers are creating tools to help doctors differentiate between sometimes overlapping symptoms to make diagnosing anxiety in children or teens on the spectrum easier. Roma A. Vasa, M.D. is a child psychiatrist specializing in anxiety and autism at the Kennedy Krieger Institute, Maryland.

According to U.S. health statistics, around 40% of people live with autism, and as much as half of those with autism are diagnosed with anxiety disorders. This compares to 7% of children and 19% of the general population.

Vasa and the doctors of the Autism Treatment Network have published recommendations to help doctors diagnose and treat anxiety in young people with autism.

* Check for physical signs such as restlessness, tremors, and sweating.

Ask your child’s parents and teachers about anxiety signs. Is the child’s behavior changing in certain situations?

* Fix any anxiety-provoking issues at home and school. Bullying, learning and speech difficulties, and insufficient school help may fuel anxiety.

* Address any medical conditions such as insomnia or medication that can fuel anxiety.

* Think about how anxiety affects your daily life and where it is located.

The next step after someone has been diagnosed with an anxiety disorder is to find treatment. Are anxiety medications and therapies originally developed for autism patients equally effective for those on the spectrum?

This is a difficult question to answer. There is very little research into anxiety treatments for people on the spectrum. No proven methods exist to determine which medications work best for autism and which symptoms. However, this does not necessarily mean that there is no effective treatment.

Vasa and other pediatricians offered advice on how to treat children and teens in a medical journal article. Based on data from typically developing youth, they identified four possible selective serotonin reuptake inhibitor antidepressants for anxiety symptoms. While the findings are encouraging, Vasa says they don’t have any data on how to prescribe these medications for autism. Therefore, Vasa suggests “starting low and moving slowly” and closely monitoring the child’s reactions. These children are incredibly vulnerable to side effects.

Cognitive behavioral therapy (CBT), used by researchers to treat autism’s standard features, has also modified. This includes using concrete language, pictures, lists, videos, or social stories and tapping into the special interests of autistic people. A review of 14 studies that included autistic children without intellectual disabilities found that individual and group CBT therapy reduced anxiety symptoms moderately. Another adapted CBT study found that almost a third (33%) of autistic children who had completed group therapy were “free from their primary diagnosis.” Vasa states, “What’s exciting is that other research teams are now trying to adapt this therapy for people with intellectual disabilities and for the younger population.”

Vasa states that researchers also look into two factors that could fuel anxiety. They are difficulty managing emotions and problems with accepting uncertainty. These characteristics help improve treatment outcomes. An autistic adult study found that anxiety levels were linked to problems in understanding, regulating, and identifying emotions. These researchers suggested that mindfulness-based therapies may be beneficial. People may taught special breathing techniques, relaxation techniques, meditation, and other mindfulness-based exercises.

Some studies have shown that CBT and mindfulness are effective anxiety treatments for autistic adults. Two researchers from the U.K. suggest that more research be done to find treatment options, especially for autistic adults.

This blog post was adapt from the original material by Marina Sarris (SPARK Staff writer).

  • See SPARK’s Autism and Anxiety Disorders blog.
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SPARK provides an online research study for individuals diagnosed with autism. It is open to all family members and those who have a child with autism. The SPARK study gathers data about co-occurring mental conditions. April is World Autism Awareness Month. This is a great time to highlight not only the difficulties associated with autism but also the most common conditions that affect this community.


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