As we've discussed in a previous post, the causes of anxiety in individuals with autism are currently unclear. Sensory hypersensitivity may be a contributing factor to anxiety development. Additionally, some theories suggest that difficulty with social situations may also play a role. This anxiety may interfere with the ability to form meaningful personal relationships, and also may contribute to isolation, depression, and substance abuse.
Social anxiety is characterized by a strong fear of social situations and/or performance situations (such as public speaking) where embarrassment may take place. Of course, plenty of people without autism may experience anxiety in such situations. People with anxiety severe enough to disrupt daily living may experience anxiety about only performance situations, but it is more problematic when an individual experiences both types of social anxiety. This is associated with a higher level of impairment, a longer duration of symptoms, and higher co-occurrence of other conditions, such as depression. Additionally, anxiety and worry can also hinder social performance because of the anxiety, creating a self-fulfilling prophecy. Among people with autism specifically, social avoidance and increased levels of repetitive behavior may also stem from social anxiety.
Social anxiety can result from negative experiences in social situations, such as confusion and unpredictability. Difficulties in social skills are one of the contributing factors, but peers may also play a role. When an individual experiences peer rejection and victimization, it may increase social anxiety. When individuals with autism are aware of their social differences, it may also lead to higher levels of anxiety.
Interventions for Social Anxiety
When working with children and adolescents with autism and social anxiety, one option is social skills instruction. Helping children understand the emotions and thoughts of others, as well as what is expected in various social situation can help make social experiences more predictable and less confusing. Social stories are a great tool for helping to explain social situations to people with autism.
However, social skills instruction should not be limited to the child or adolescent with autism. Autism awareness programs to educate peers without disabilities should also be considered. It is important for peers have a better understanding of their classmate with autism, as well as positive ways to interact with him/her. This may decrease peer rejection and victimization, reducing negative social experiences for the person with autism. Anti-bullying initiatives may fall into this category as well.
Another strategy is to help the person with autism learn strategies for relaxation and self-regulation. Check Positively Autism's upcoming blog posts for more information on these types of strategies. As a side note to this idea, many individuals with autism say that their "stimming" behavior, such as rocking and hand-flapping, help serve a self-regulatory and calming function. It may be beneficial to allow children and adolescents to use stimming as a "tool" to calm down when anxious. However, we must also realize that this is a coping response that does not address the root cause of the anxiety or stress. Digging a bit deeper to teach the child to deal directly with the cause of the stressful situation may also be warranted.
All of the above issues should be discussed with your or your child's doctor, but particularly our next option. It is also possible that some medications, specifically SSRIs, may decrease anxiety in children with autism. Talk with your doctor before making any decision about whether medication is right for your child or yourself. Autism Speaks offers a free medication decision guide that you can use in conjunction with speaking with your doctor. http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/tools-you-can-use/medication-guide
"The Development of Social Anxiety in Adolescents with Autism Spectrum Disorders" by Scott Bellini. Focus on Autism and Other Developmental Disabilities. Volume 21, Number 3, Fall 2006.
"Anxiety Disorders and Sensory Over-Responsivity in Children with Autism Spectrum Disorders: Is There a Causal Relationship?" by Shulamite A. Green and Ayelet Ben-Sasson. Journal of Autism and Developmental Disorders. Volume 40, 2010.
"Exploring the Nature and Function of Anxiety in Youth with Autism Spectrum Disorders" by Jeffrey J. Wood and Kenneth D. Gadow. Clinical Psychology: Science and Practice. Volume 17, Issue 4, December 2010.