Understanding anxiety in autistic children and teenagers

What is Anxiety?

Anxiety is a natural part of life and something that everyone experiences at some stage.  

Characterised by a feeling of mild or severe distress, anxiety is the emotional response to a detected of perceived danger. This creates an innate drive to enter protective mode, otherwise known as the ‘fight-or-flight’ or ‘freeze’ mode.

How Do Autistic Children Experience Anxiety?

Autistic children feel many of the same worries and fears as other children. Although the way they display their anxiety can look a lot like common characteristics of autism – such as stimming, obsessive, ritualistic and repetitive behaviour, and resistance to changes in routine and environment.

Autistic children often worry or feel stressed about things that are less worrying for typically developing children, like disruptions in their routine or unfamiliar social situations.  

They can also have trouble recognising their own anxious thoughts and feelings and can’t always tell you that they’re feeling anxious. Instead, you might notice an increase in changes in behaviour.

What are the Main Overwhelming Factors that Result in Anxiety for Children and Young People in Educational Settings?

Sensory Sensitivities

Autistic children may have varying degrees of sensory sensitivities to their environment especially when it comes to structured environments such as school or college. Loud noises, unpleasant smells and bright lights can be over whelming for them, often leading to exhaustion which can trigger further anxious feelings about their performance in the classroom.

Changes in routine

There are multiple transitions in a child’s day that could bring on anxiety, examples can include changing out of pyjamas into school uniform, changing classrooms frequently throughout the day and transitioning from work to leisure mode at break times and home-time.

Socialising

The pressures of fitting-in and being socially accepted can be challenging for a young autistic individual. Lack of structure in the playground and pressure to join in with small talk can make breaktimes the most dreaded part of the day.    

Autistic children are more vulnerable to bullying, often learning to mask at an early age in order to appear ‘normal’. This can cause extreme anxiety for anticipation of bullying and can in turn take its toll on mental health and well-being.  

Self esteem

Feelings of failure about not reaching expected norms and potential can have a very detrimental effect on an autistic child’s self-esteem and exasperate performance anxiety. Being told to ‘concentrate’, ‘try harder’ and ‘overcome challenges’, that are part of a child’s autistic identity can be a burden and effect feelings of self-worth.  

How Does Anxiety Manifest in Autistic Children and Teenagers?

Understanding and recognising how anxiety presents in autistic children and teenagers is a great step to identifying anxiety triggers in advance and in order to give support. Anxiety can be communicated through behaviour, such as:

• Avoidance of tasks.  
• School and/or activity refusal – this may come in the form of verbal refusal, refusing to get ready, excuses such as feeling ill, or becoming distressed when approaching the school gate.  
• The need to have control - of routines, the environment and people around them. Higher levels of control can help the person feel a greater sense of certainty and predictability.
• Obsessive, repetitive or intrusive thoughts also known as obsessive compulsive disorder (OCD).  

• Repetitive self-stimulatory behaviour - hand movements, vocal noises, ticks, pacing or jumping around are important self-regulatory activities that can help soothe anxiety. It is important to be accepting of this behaviour even if it looks different to the norm.
• Meltdowns – these can be a result of the amount of energy used throughout the day at school in order to appear normal and to hide any anxious feelings. These meltdowns typically occur on the return home and can be likened to a bottle of an extremely fizzy drink, which, once opened explodes.  
• Shutdowns - when children turn their anxious energy inwards. The child may become withdrawn, passive, quiet or struggle to make decisions.  
• Aggressive behaviour - autistic children may express their anxiety and fear through acting out physically. Aggressive behaviour becomes common when a child is in survival mode, doing their utmost to escape a scary trigger.  
• Self-harming behaviour - self-injury can take many forms, such as hitting, scratching, biting or cutting.

• Difficulty with concentration and a lack of readiness to learn new skills - when children don’t feel safe and secure it is hard for them to maintain focus on an activity.
• Bedtime refusal - heightened stress hormones impede sleep hormones. In addition, stressful events can affect sleep by increasing the number of nightmares and night terrors.  
• Separation anxiety - many autistic children form deep attachments to a caregiver, the separation from whom can often cause distress. In a school or nursery setting a child may feel less engaged than others due to being distracted by worrying about when their attachment figure will return.  
• Eating disorders - especially in girls, anxiety can trigger eating issues often driven by a need for control. There are strong links between autism and anorexia. 

Recognising and Understanding Behaviour as Communication

It is important to recognise that self-regulatory behaviours are an autistic child’s way of trying to communicate, and that it is important to not reprimand your child for what may be perceived as ‘bad behaviour’.  

Behaviour is a form of communication and recognising and understanding your child’s unique way of communicating can help you to foresee and avoid difficult situations and triggers, and to enable your child to have an easier time in the classroom.

You can work with us and your child’s teachers to put in place any required reasonable adjustments to make sure their school day go as smoothy as possible. Our dedicated team can offer advice and support on how to communicate with schools and local authorities, and to help alleviate your child’s anxiety in the classroom.