Article originally published on Psychology Today.
5 essential modifications.
by Christopher Lynch, Ph.D., author of "Totally Chill: My Complete Guide To Staying Cool".
Anxiety disorders are common in autism, and this is just as true for children as it is for adults (e.g. Leyfer, et al., 2006)
In a previous article, I explored some of the reasons why kids on the autism spectrum have such high rates of anxiety and how to use this knowledge to develop effective accommodations.
Establishing supports to lessen the impact of anxiety should still be a first-line strategy. However, no amount of support or environmental prevention strategies will fully eliminate anxiety across all settings and situations. Life is just too unpredictable and there are myriad of factors that can fuel anxiety in autism.
Given the high prevalence of anxiety in autism, it is important to equip children with coping tools they can use when feeling overwhelmed.
What type of relaxation skills should be taught?
Effective relaxation skills work by preventing our nervous system from spiraling into a state of panic. Once we have interrupted this chain of events we can then begin to redirect our nervous system from a state of anxious arousal to a state of calm.
There are relaxation strategies that target the body, strategies that target the mind, and activities that address both.
Some examples (for illustrative purposes only, not a substitute for formal training):
Diaphragmatic/"Belly" Breathing: When we become anxious our breathing becomes rapid and shallow. This kicks off a chain of physiological events that can fuel panic. To reverse this process, a child can learn to take slower, deeper breaths from the belly. Lowering the diaphragm muscle on the inhale (resulting in the stomach expanding outward) allows for greater expansion of the lungs and, thus, more oxygen.
Progressive Muscle Relaxation (PMR): Muscle tension sets in at the earliest stages of distress. Although this tension can maintain anxious arousal, it often occurs beyond our awareness. With PMR, a person is instructed to go through various muscle groups-first tensing and then relaxing them. With practice, it becomes easier to detect and reverse muscle tension (note: for those who find tensing muscles to be uncomfortable, a Body Scan technique is an effective alternative).
Relaxing Imagery: The mind can concoct all kinds of vivid, terror-filled scenes that can both cause and worsen anxiety before and during stressful situations. The use of pleasant imagery is a way to counter these scenes. When we can hold a pleasant image in our minds, the nervous system will follow suit.
Meditation: When anxious, the mind tends to dwell in a future that is full of "what ifs". Meditation can help to bring awareness back to the present.
Activities that Combine Mind and Body
Kids on the spectrum are far more similar to other kids than they are different and many teaching techniques will be the same as for any other child. However, there are modifications for the autistic child that can bolster learning and motivation.
1) Justify the Technique: The child on the spectrum wants to know why they are being asked to learn something. Learning needs to be relevant and make sense. Scientific explanations help. I like to explain how the nervous system responds to stress and anxiety and the reasons why relaxation techniques work to counteract this response. Although the terms and concepts will vary depending upon the age and developmental level of the child, I find that these kind of explanations can really kickstart motivation for a wide range of kids.
2) Use Visual Supports: Autistic children tend to be visual learners. Incorporate visuals into teaching relaxation skills whenever possible. Demonstrate how the body reacts to stress and how to do relaxation techniques through drawings, online videos, charts, graphs, etc. Visuals can also help to prompt and remind a child when to use a technique (e.g. showing cue cards with pictures displaying a skill).
3) Be Wary of Abstract Terms: Speak accurately but plainly when teaching techniques. Avoid abstract, metaphorical language such as "be as cool as beans" or "breathe in the goodness". When comparisons are needed concrete phrases work best (e.g. "your stomach should expand like a balloon filling up with air".)
4) Be Aware of the Stressors Associated with Autism: Anyone working with kids on the spectrum should be aware of the different types of stressors associated with autism. These include coping with change and transitions, sensory sensitivities, challenges with language processing, the strain of being in social situations (where support/understanding is lacking), and frustration that can arise when learning styles are not accommodated for. Knowledge of these stressors can help with integrating relaxation techniques into an overall plan of support.
5) Emphasize Generalization: When teaching a skill, emphasize when and how to implement that skill across different settings and situations. Don't assume that this will occur automatically. Instead, provide specific, real-life examples and clear guidance on when and how to use techniques. Enlist the help of parents, teachers, and other support persons to gently remind and prompt the child to use skills in real time.
Relaxation techniques can help any child to cope better with stress and anxiety. With some modifications, children on the autism spectrum can also acquire these valuable coping skills.
Leyfer, Ovsanna T., et al. "Comorbid psychiatric disorders in children with autism: interview development and rates of disorders." Journal of autism and developmental disorders, 36.7 (2006): 849-861
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