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.

When executive functioning is compromised, there can be challenges in planning, prioritisation, organisation, impulse control and staying on task.

What are Executive Function Challenges?

Everybody is different in their executive functioning strengths and challenges, and neurodivergent individuals can have very varied ‘spiky profiles’  

People may have challenges in relation to the following areas of executive functioning:

Initiation:

• Getting going - especially when initiating uninteresting tasks. This is referred to as inertia
• Procrastination - getting past thinking about the task to doing the task

• Poor time management - not being able to foresee how long a task will take  
• Thinking you need to do something but not remembering what it is.

Working memory:

• Like a computer scratch disk - allows you to hold information in your mind while making links.
• Challenges with short term memory - remembering what has just been said or remembering a sequence
• Processing different streams of information - like listening to someone while remembering you need to remember your keys, for example.

Emotional and impulse control:

• Not having internal prompts to remind you what task you need to do next, in order of importance  
• Getting frustrated at yourself for forgetting to do important things, especially when others see you as lazy or incompetent  

• Difficulties regulating alertness to complete hard tasks when the interesting parts have been done.
• Finding it hard to shut off your busy brain which can affect sleep patterns
• Experiencing RSD (Rejection Sensitive Dysphoria) which can be extremely debilitating  
• Being impulsive and not considering the context  
• Difficulty adjusting and graduating your pace, or changing gear. This can lead to an all or nothingmindset.

Focusing:

• Challenges sustaining focus
• Difficulties shifting from one task or topic to another  
• Slower gaining information and losing focus easily

Hindsight and foresight:

• Harder learning from past experiences and then repeating the same actions again and again

• Difficulties with predicting future challenges

Time awareness:

This has been called “time blindness” by Psychiatrist Russell Barkley

• Remembering to put appointments into your diary
• Allocating the appropriate time to a task
• Splitting a task into parts and recognizing how long each will take

Developing strategies to make everyday life easier

The good news is that once we recognise our executive function challenges, we can develop strategies that reduce the negative impact to help make everyday life easier.  

You may already have some personal strategies in place. Here are some that might be helpful if you haven’t already considered them:

Check your barometer  

Throughout the day check in with yourself. How are you coping? Do you need to take time out? Do you need a drink or something to eat? When we are tired, hungry or overloaded it can make it harder to manage new information or juggle multiple tasks.

Minimize clutter  

Make sure your workspace isn’t too distracting. Separate similar items into groups.  Use colour coding and visual prompts to help organise information on reminder charts or visual diaries.

Visualise and prioritise tasks

Use a wall-planner that visually highlights appointments, deadlines and daily tasks. Use colour coding to prioritise tasks. Create a list of actions at the beginning and end of each day and mark priorities. Carryover lists to the following day.

Take regular breaks

When in hyperfocus mode it can be difficult to remember to take a break which can lead to burnout, and if atask is uninteresting, it can be difficult to complete. Try the Pomodoro method to improve concentration. Work for 10 minutes then take a  5-minute break and increase the time if appropriate.  

Break down overwhelming tasks

If a task feels too big to handle break it down into small parts using the Kan Ban Method where you can break down large tasks visually into small parts, on post-its. Remember to congratulate yourself as you move forward, however small it is.

Make it more interesting

Try to automate ‘boring’ tasks and choose some pleasure stuff after more tedious tasks.

Increase dopamine levels

Choose some music that helps you to focus. Take regular breaks, you could even try dancing around if you feel stuck and try again.

Reminders and alarms

Use timers and set alarms to remind yourself when your deadlines are. Put all tasks and appointments into an electronic diary as soon as you know about them. Set reminders before the deadlines rather than at the deadline itself.

See the bigger picture

Try and gain an understanding of how all the different aspects of work link together in a  project or assignment. If you work as part of a team understand how your work links with others.

Supportive software

There are various types of software and apps that can help with planning, organisation and processing.

For example, Mind-mapping software, such as Inspiration and Mind Genius may be useful to map out ideas and workflow effectively or using text-to-speech and speech-to-text software could help speed up the processing of large documents.

Setting various reminders and alarms on your phone can be useful too. For things such as appointments, it can work well to set a reminder for the day before, then an hour before, giving you time to plan if necessary.

Be kind to yourself

It is not surprising that these differences can often impact on other factors such as self-esteem, energy levels and base level stress. Gaining an understanding of ourselves and the reasons why we find some things more difficult can really help in the management of this.  

Some days will be harder, or you will feel less motivated, and that’s ok. Practice your strategies and remember to always be kind to yourself and find what works for you.  

What is an informant?

If you’re preparing for an autism assessment, it’s important that you choose a reliable informant to support you through the process.

An informant is someone who can share important context about you and your childhood with our clinicians. This will help our clinical team to gain a wider understanding of how you experience the world.

Your informant’s knowledge of your early development can contribute to an accurate autism diagnosis. They can also provide you with encouragement and solidarity as you navigate the assessment process.

Who can be an informant in an autism assessment?

Choosing the right informant is a crucial step in ensuring that your assessment runs as smoothly as possible. To ensure that the information provided is accurate and relevant, an informant should be somebody who has known you since early childhood.  Informants will be asked to do two things during the autism assessment process:  

1. Complete an Informant Questionnaire  

2. Attend an Informant Interview

If you like, you can ask two different people to be your informants; one person to complete the Informant Questionnaire, and another person to attend the Informant Interview. Or you can ask the same person to do both things, as long as they fit the below criteria:

Who can complete the Informant Questionnaire?

Ideally, this should be a parent or caregiver that has known you during childhood. In the absence of a parent or caregiver, the Informant Questionnaire may be completed by a sibling, a long-term spouse or partner, or a long-term friend.

Who can attend the Informant Interview?

Ideally, this should be a parent or caregiver that has known you during childhood. If this is not possible, your long-term spouse or partner may attend the Informant Interview.  

In the absence of any of these options, please let us know as soon as possible. Please note that in the interest of clinical best practice, it is not possible for a sibling or long-term friend to attend the Informant Interview.

How does the process work?

Your chosen informant(s) will be your companion(s) throughout the assessment process, providing valuable insights and perspectives to your clinician. Here is a brief overview of what they will be required to do:

1. Firstly, they need to complete a detailed Informant Questionnaire. This questionnaire will gather important details about your early childhood, developmental milestones, medical and educational history, social characteristics, and neurodivergent traits. You will need to download the Informant Questionnaire from your client dashboard and send it to your informant to complete. When they are finished, they can send it back to you to re-upload onto your client dashboard with the rest of your pre-assessment forms.

2. Secondly, they need to attend an Informant Interview, which will last approximately 3 hours. This interview will take place via our secure online platform. You can attend this interview alongside your informant if you wish to, but you do not have to be present. This session is an opportunity for your clinician to gather more detailed information about your childhood, developmental history, and daily challenges, helping to guide their diagnosis.  

Making the right choice

Here are some factors to consider as you choose an appropriate informant:  

• If you can, choose somebody who has a basic understanding of neurodiversity or is willing to learn more. This will ensure that they share their insights in an empathetic and well-informed manner.

• Make sure that the person you choose is willing to commit to helping you through the entire assessment process.

• Your chosen informant should be somebody that you feel comfortable with and can trust. During the assessment process, you will be sharing personal and often sensitive information, so it's important that the dynamic between yourself and your informant is a safe space where everybody feels comfortable and respected.

• A well-chosen informant will approach your assessment with respect for you and your individual experiences.

• Ensure that your chosen informant understands the importance of confidentiality and respecting your privacy. All information shared during the assessment process should be treated as confidential.  

How to ask someone to be your informant

The idea of asking someone to be your informant might feel a bit overwhelming. Here are a few things to consider when initiating this conversation:

• Choose a suitable time and location to have this conversation. You should talk to your potential informant in a comfortable and private setting when neither of you is in a rush.  

• Before starting this conversation, learn as much as possible about the ProblemShared autism assessment process. You will then be able to explain to your potential informant what their specific role will be.  

• Emphasise the important role of an informant in the assessment process and ensure your potential informant realises how valuable their support is to the outcome.

• Give your potential informant plenty of time to consider your request.

What to do if you don’t have a suitable informant for your autism assessment

If you do not have a suitable informant for your autism assessment, please inform a member of our team at your earliest opportunity. A clinician will be in touch to discuss alternative options with you.

While this isn’t ideal, we endeavour to make the process of accessing a ProblemShared autism assessment as inclusive as possible. Therefore, although involving an informant is an important part of ensuring a clinically robust assessment, our team will never turn a client away for being unable to source an informant.

We may be able to come to an arrangement whereby you act as your own informant, or something similar. The sooner you communicate your situation to us, the more efficiently we will be able to find a solution.

Common mental health challenges at university

University life brings new experiences and challenges that can affect students' mental health. Some common mental health issues that students might face while studying at university include:

1. Anxiety

Students may feel overwhelming worry about exams, presentations, or social interactions, leading to symptoms like rapid heartbeat, sweating, and avoidance behaviours. For example, a student might experience panic attacks before a test or skip classes altogether due to social anxiety.

2. Depression

A student might lose interest in activities they once enjoyed, struggle with low energy, or have difficulty concentrating on assignments, which can significantly impact academic performance.

3. Stress

The pressure to maintain good grades, secure internships or jobs, and plan for a career post-graduation can lead to chronic stress. This can manifest in both physical and psychological symptoms, such as headaches and irritability.

4. Sleep disturbances

Due to late-night studying or socialising, a student might develop irregular sleep patterns, leading to daytime fatigue and reduced academic performance.

5. Disordered eating

The desire to fit in or cope with stress might lead a student to adopt harmful eating habits, such as skipping meals or binge eating, which can have serious health consequences.

6. Substance misuse

To deal with pressure, a student might start drinking heavily during social events or using drugs, which can lead to dependency.

7. Isolation

International students or those far from home may struggle with loneliness, finding it hard to make connections in a new environment, which can exacerbate other mental health issues.

These issues can be managed through talk therapy, where experienced practitioners can create a safe space for students to navigate their challenges and find support strategies.  

Types of talk therapy on campus

Universities offer various forms of counselling to cater to the diverse needs of their students. Here are some commonly provided practices:  

• Individual therapy. One-on-one sessions with a therapist where students can discuss personal challenges privately.
• Group therapy. Facilitated sessions with groups of students who share similar experiences, providing a sense of community and mutual support.
• Cognitive behavioural therapy (CBT). A structured approach that helps students identify and change negative thought patterns and behaviours.
• Dialectical behaviour therapy (DBT). A therapy that focuses on teaching emotional regulation, mindfulness, and interpersonal effectiveness skills.
• Eye movement desensitisation and reprocessing (EMDR). A specialised therapy used primarily for trauma, helping students process and integrate traumatic memories.
• Counselling. General counselling services that offer support with academic, career, and personal issues.
• Psychoeducation. Groups or workshops that provide information on mental health topics and teach coping strategies.
• Crisis intervention. Immediate assistance for students in psychological distress or experiencing a crisis.
• Peer counselling. Support services run by trained student volunteers who offer a relatable perspective and empathetic ear.
• Mindfulness and stress management. Programmes designed to help students learn how to manage stress and anxiety through mindfulness techniques.  

Benefits of talk therapy for students

Talk therapy offers a range of benefits, positively impacting both the mental health and academic performance of university students. The benefits are numerous:

• With the guidance of their practitioner, students are free to articulate their emotions, such as addressing homesickness or expressing fear about the future. Talk therapy can assist with understanding and communicating these feelings rather than letting them fester.
• For a student grappling with procrastination, CBT can help unravel negative self-talk and replace it with motivational thoughts, leading to a more productive approach to coursework.
• DBT offers students, perhaps overwhelmed by exam stress, techniques like mindfulness and distress tolerance, which help in maintaining calm and focus during high-pressure periods.
• EMDR can be a critical tool for students dealing with past traumas, enabling them to process distressing memories and concentrate on their present studies and campus life.
• After engaging in talk therapy, students often experience a boost in confidence, which might inspire them to take on new challenges, such as leadership roles in campus organisations.
• Therapy can enhance a student's ability to communicate with peers and professors, leading to more enriching academic collaborations and personal relationships.
• As mental health improves, so does academic performance, evidenced by more active class participation and a proactive approach to complex projects.
• A previously introverted student may find the confidence through therapy to join social groups and activities, fostering a sense of belonging and community on campus.
• Self-reflection encouraged in therapy sessions can lead to significant personal insights, prompting life-changing decisions like changing a major to pursue a true passion.

Common obstacles to seeking help at university

Students may face several challenges when seeking mental health support at university. However, there is always a way to navigate these obstacles.

1. Stigma

The stigma associated with mental health treatment is a significant barrier. Many students fear being judged, misunderstood, or labelled with stereotypes. However, seeking therapy is a sign of strength and self-care.

2. Lack of awareness

Many students are unaware of available resources and the importance of mental health care, delaying their access to support. While it is the responsibility of your university to ensure that wellbeing resources are made accessible to students, it’s likely that information is readily available on their website.

3. Financial constraints

Cost can be a significant barrier for students. Affording therapy sessions or necessary medications can feel impossible, which is why most universities will offer free counselling. Many private counselling practices will also offer heavily subsidised sessions if you can show proof of being a student.

4. Long waiting times

University counselling centres might have limited staff and high demand, leading to longer wait lists. This delay can discourage some students from pursuing treatment. However, it's always worth investigating, because wait lists can often move more quickly than expected.

5. Balancing academics

The demanding nature of university life leaves little time for personal commitments like therapy sessions. Finding a balance can feel like a challenge. But most courses of counselling only take up half an hour per week, and practitioners will likely be willing to fit sessions around student schedules.

What we offer at ProblemShared

ProblemShared was founded to enhance access to the highest quality mental healthcare and neurodevelopmental support. We are here to support university counselling services across the UK meet the growing demand for care.

Our community of exceptional practitioners are available to provide capacity, diversity, and additional specialisms to in-house student counselling services.    

For more information, you can explore our university webpage.

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