Autism and AnxietyAutism and Anxiety

High levels of anxiety – as normHigh levels of anxiety – as norm Increased anxiety states for specific Increased anxiety states for specific

reasonsreasons Global levels of high anxiety due to Global levels of high anxiety due to

environmental factorsenvironmental factors Possible as high as 90% of Possible as high as 90% of

individuals have a recognisable individuals have a recognisable anxiety disorderanxiety disorder

Secondary Psychiatric Secondary Psychiatric DisordersDisorders

Not a primary mental illnessNot a primary mental illness Result of environmental factors Result of environmental factors High level in people with Autism High level in people with Autism

compared to peer groupscompared to peer groups Better support should lead to a Better support should lead to a

better prognosis and reduction in better prognosis and reduction in secondary conditionssecondary conditions

Specific Reasons for Specific Reasons for AnxietyAnxiety As a result of specific neurological As a result of specific neurological

differences in Autism:differences in Autism:– learning processeslearning processes– communicationcommunication– social interactionsocial interaction– Theory of MindTheory of Mind– Executive FunctioningExecutive Functioning– emotional recognitionemotional recognition– Sensory processingSensory processing– Central CoherenceCentral Coherence– obsessionsobsessions

Direct learning vs Indirect learning

Examples of indirect learning / development:

Theory of Mind

Social skills

Social cues

Non verbal communication

Learning ProcessesLearning Processes

◈Accurate interpretation

◈Metaphor / sarcasm / irony

◈Need for accuracy / lack of tautology

◈Echolalia / palilalia / delayed echolalia

◈Delayed processing

◈Meaning transferability

◈Expressive vs receptive skills

Verbal CommunicationVerbal Communication

◈Prosody

◈Facial expression

◈Body posture

◈Inference

◈Contextual information

Non Verbal CommunicationNon Verbal Communication

◈Recognising the ‘unwritten rules’

◈Assessing situations

◈Reacting appropriately to the PNT social circumstance

◈Adapting social skills to the PNT situation

Social SkillsSocial Skills

◈Conversational turn taking

◈Following the leads of others

◈Understanding ‘friendships’

◈Group settings

◈Sharing

◈Participating in game scenarios

Social CuesSocial Cues

◈Alexithymia

◈Mentalising abilities

◈Empathy

◈Trust

◈Appearance of rudeness

Theory of MindTheory of Mind

◈Planning

◈Impulse control

◈Sequencing

◈Scripting

Executive FunctioningExecutive Functioning

◈ Identifying the pattern or underlying rules

◈ Attention to detail

◈ Knowing what is relevant and redundant

◈ Recognising the 'big picture'

Central CoherenceCentral Coherence

OBSESSIONSOBSESSIONS

Can be socially inappropriate

Need boundaries around obsessive behaviour

Must recognise that obsessive behaviours can be used as coping mechanisms

Obsessions may be misinterpreted

Sensory Sensory DifferencesDifferences

◈ Neuro-physiological differences in Neuro-physiological differences in

filtering processesfiltering processes

◈ Can have major impact on Can have major impact on

behaviourbehaviour

◈ Environmental aspects can Environmental aspects can

influenceinfluence

Global ReasonsGlobal Reasons

Resistance to ChangeResistance to Change Environmental factorsEnvironmental factors TrustTrust Sense of self/diagnosisSense of self/diagnosis PhysicalPhysical

Hypothesis - resistance to change

Individuals with Autism have Individuals with Autism have significantly lower ‘stability rates’ in significantly lower ‘stability rates’ in

their day to day lives than the their day to day lives than the neurotypicalneurotypical

This may lead, in part, to an explanation of

‘resistance to change’

Dependent on:

Communication

Understanding other people

Social awareness

Predictability

Fulfilled expectations

Shared sensory environment

StabilityStability

Autism and Resistance to Change

1

2

Neurotypical 24 Hour Period

Stable

Unstable

BullyingBullying

Individuals with Autism are highly Individuals with Autism are highly vulnerable:vulnerable:– don't 'fit in'don't 'fit in'– will not necessarily follow traditional will not necessarily follow traditional

social convention (fashion, etc.)social convention (fashion, etc.)– problems with adhering to social rules problems with adhering to social rules

within society (classroom, playtime, within society (classroom, playtime, employment, social arenas, etc.)employment, social arenas, etc.)

– communication problemscommunication problems– poor PNT ToMpoor PNT ToM

EDUCATIONEDUCATION

PROBLEMS INCLUDEPROBLEMS INCLUDE Cognition can hide core defects Peer group Lack of understanding from staff Transference of problems (home to school/work/service

and vice-versa) Academia takes preference over social and emotional

development. Can lead to... Isolation Poor self-esteem Poor motivation Depression Unrealised potential

Ethics, Morality, and Ethics, Morality, and NormalisationNormalisation

It is essential that individuals with Autism are treated with

respect for their way of thinking and behaving, and that ‘normal’

value bases are not enforced upon them