A presentation by Sarita Freedman, PhD 26540 Agoura Road, Suite 100 Calabasas, CA 91302 (818) 999-9330 [email protected]

AUTISM ACROSS THE LIFE SPAN

ANXIETY & AUTISM

A presentation by

Sarita Freedman, PhD26540 Agoura Road, Suite 100

Calabasas, CA 91302(818) 999-9330

[email protected] www.saritafreedman.comwww.collegeonthespectrum.com

© 2012, Sarita Freedman, PhD

mailto:[email protected]

http://www.saritafreedman.com/

http://www.collegeonthespectrum.com/

What is Anxiety?

Worry, nervousness, fear Biologically meant to be

protective Feelings arise in the “reptilian

brain” part of the emotion center of the brain (amygdala)

Fight or flight Can also be motivating


From www.brainwaves.com

When is Anxiety a problem?

Everyone worries at one time or another!

Anxiety is a problem when:It interferes with doing your job

(school, work, chores)It makes you avoid thingsIt affects your family, friends, or

associates


What does Anxiety feel like?Physical

Fight or flight – you want to run away or you want to protect yourself by fighting back Heart palpitations Chest pain Sweating Heavy or difficult breathing/hyperventilation Stomach aches/nausea Dizziness Shaking or trembling


What does Anxiety feel like?Emotional & Behavioral

It can feel AWFUL…like you can’t stand being in your own skin

Difficulty sleeping, restlessness Fatigue and low endurance Tantrums and/or aggression Avoidance Repetitive thoughts/behaviors to avoid

worrying (OCD, different than “stimming”)


What does Anxiety feel like?Cognitive

Distractibility, unable to concentrate Confusion Poor problem solving (reptilian brain) Cognitive distortions

All or nothing thinking (black or white) Catastrophizing/minimizing Jumping to conclusions (making assumptions) Magical thinking “Should” statements


ASD can complicate anxiety

Difficulty understanding the world

Difficulty understanding emotions – own & others’

Difficulty taking another’s perspective

Social challenges Correlation between low social assertiveness

and high social anxiety© 2012, Sarita Freedman, PhD

Communication challenges

Difficulty asking/knowing when to ask for help

Learning and executive functioning challenges College students with ASD report higher anxiety

than non-ASD college students


Difficulty with transitions and shifting

Difficulty with emotion regulation

Narrow focus on preferred activities or topics (reduce anxiety; familiarity)

Need for sameness (reduce anxiety)

Sensory overload can trigger anxiety© 2012, Sarita Freedman, PhD

Managing Anxiety: General

Visual supports Calendars/Schedules Charts Pictures/written instructions Lists

Practice switching from preferred to non-preferred tasks Activity choice chart


Activity Choice Chart

Tasks Completed

CraftsBoard GamesReadingPlay OutsideWatch TVPlay with PetsComputer GamesHomeworkCookingListen to MusicPlay Video GamesArt (color, painting…)Make Believe PlayDress UpClean RoomCall a FriendBuild Stuff (legos, blocks…)Laundry

(excerpted from Developing College Skills in Students with Autism & Asperger’s Syndrome, Jessica Kingsley Publishers, 2010)

Managing Anxiety: Social

Social skills training (1:1 w/adult peer dyad peer groups) – school, home, community

Adult support faded Buddy or peer mentor (especially in

college) Theory of Mind

Perspective taking Intention/desire Social Thinking (Michelle Garcia-Winner)


Assertiveness training Learn when, how, and who to ask for

help Participation in activities with peers

Boy/Girl Scouts Acting classes, theater Clubs (especially in college)


Managing Anxiety: Behavioral

Feelings thermometer/scale (rates anxiety from 1 – 10) Offers a visual aid to see the intensity Good tool for student and parent/teacher to

compare their ratings of student’s anxiety (perspective)

Excellent way to monitor reduction in anxiety over time

Different ways to express anxiety/worries (talking, writing, drawing, reading, puppets)


Feel-O-Meter by Oceans of Emotions

Work with a professional to learn Relaxation strategies Deep breathing (4-4-4) Visualization Use of a worry box Increase self-awareness Learn to predict and prepare for stressful

situations (Social Stories/Comic Book Conversations by Carol Gray)

Other calming strategies (listen to music, rock, trampoline, time-limited video games, breaks, etc.)


Anxiety Tool Box Can include cue

cards containing all of the strategies that have worked.

Cards can be in picture format or written

Pictures, memories, music

Tool box can be actual or imaginary (doesn’t need to be a box, can be anything)


Cognitive Behavior Therapy (CBT)

Relationship between thoughts, emotions and actions

Identify cognitive distortions Learn to challenge cognitive

distortions Increase self-awareness Increase emotional awareness in self

and in others Learn coping statements/strategies (I

can do this; stress ball) © 2012, Sarita

Freedman, PhD

Anxiety: Medical Management

Get a physical to rule out medical conditions that can contribute to/cause anxiety High blood pressure Thyroid condition Other metabolic/medical conditions

Once medical causes ruled out, see a psychiatrist for a medication evaluation


Why a Psychiatrist vs. Internist?

PSYCHIATRIST INTERNIST

Knowledge base of a specialist vs. generalist

Tend to be covered by insurance because MD

Better monitoring of effectiveness/side effects

Especially with ASD, must know in’s & out’s

May be competent in prescribing psychotropic meds

Not specialists, so prescribing not as nuanced

Follow-up is not as thorough in most cases

ASD knowledge may be limited


Anxiety medication: How it works

Neurotransmitters & the Synaptic Space…a simplified explanation

Neurotransmitters = chemicals that regulate various functions, including mood

Stay in the synaptic space in order to be effective Current medications act as “reuptake inhibitors”

Spectrum of mood disorders now thought to be biochemical imbalances, much like diabetes or thyroid issues© 2012, Sarita Freedman, PhD

Societal Stigmas, Myths & Truths

Shame/embarrassment about “needing” medication or seeing psychiatrist

Medication is NOT A CRUTCH

Medication is used to balance out chemical imbalances in the brain – a medical problem


When managed correctly, no addiction

Some people may need a short course, many may need life long – so what?

Examine your pre- and mis-conceptions

You don’t have to suffer!!


Complimentary Treatments

EXERCISE!!! Natural endorphins Daily practice of relaxation strategies

& mindful meditation – these strategies will not work without consistent practice

Build both exercise and relaxation/meditation into daily routine (not just for ASD!)

Good “sleep hygiene” Develop an ethic of taking care of

yourself – commit to yourself!© 2012, Sarita Freedman, PhD

Life is about Balance!

Work

Relationships

Play

School, job, chores, daily routines

Keeping up with family, friends, romance

Video games, movies, internet, all kinds of fun


Documents

A presentation by Sarita Freedman, PhD 26540 Agoura Road, Suite 100 Calabasas, CA 91302 (818) 999-9330 [email protected]