One of the most common co-morbid conditions within ASD is an anxiety disorder. Whether anxiety is part of the diagnostic make-up of the spectrum or whether anxiety warrants an “additional” diagnosis (hence becoming a co-morbid condition) is akin to the “chicken or the egg” dilemma. Because anxiety rears its ugly head in every way conceivable for individuals with ASD—often in ways beyond the neurotypical’s ability to comprehend—the ways in which schools target anxiety with special education services is critical to success. As most know, to qualify for any special education service that is documented on an Individualized Education Plan (IEP), a student must be medically diagnosed and it must be documented how this diagnosis interferes with his or her ability to learn and function within the school setting.
What to Expect from School/What You Won’t Have to Ask for
Looking through the lens of ASD, anxiety and special education is understood in broad terms, with typical, almost cookie-cutter accommodations made regularly. That is, schools recognize anxiety as a function of many behaviors, are willing to accept “anxiety” as a reason for inappropriateness, and, accordingly, can be convinced that a behavior is related to “anxiety” before it is related to many other symptoms. If you are noting a bit of cynicism, you are correct.
It is not that I wish to downplay the role of anxiety—it is an ugly monster. My frustration stems from the pattern that an explanation such as an anxiety disorder must become trendy, almost cliché, to be an “acceptable” reason to provide the services that should be given without justification. Think about the ubiquity of a visual schedule because children with ASD “learn best” visually (when some, in fact, learn better orally). In some senses, strategies (a new, meaningless buzzword I am hearing repeatedly in KC Metro schools) not necessarily designed to target anxiety are now being “anxiety-approved” without individualization. Yes, anxiety is part and parcel of ASD; no, it does not look the same in all. To say the least, this concerns me: A bunch of buzzwords are lumped together for the show of learning.
Cynicism aside, you can expect the following accommodations/strategies/intervention for anxiety to be “offered” with little hesitation by most schools.
· Creating and following a visual schedule
· Creating a safe place for the child during times of high anxiety
· Allowing time at the beginning of the day and the end of the day for transitioning
· Allowing the child time to use relaxation techniques at time of high anxiety (often packaged as part of the “5 Point Scale”)
· Using small group activities throughout the day
· Providing information on any changes in schedule and help the student cope when these situations occur
· Extended or altered passing periods in middle and high school
· Incorporating time for breaks/sensory breaks into the school day
· Adding extra time for test taking or allow the student to take tests in the resource room or library
Beyond the Cookie-Cutter: What to Ask for…With Fingers Crossed
What your child needs to combat anxiety during the school day has a lot to do with what triggers the anxiety in the first place. The acquisition of appropriate services becomes even more complicated when it affects your child’s ability to learn but does not necessarily impact a child’s academic abilities. One could read this in the following manner: The anxiety runs interference during initial, teacher instruction; one-on-one instruction with a teacher or, more likely, with a parent at home is a calmer environment in which your child readily learns the material. It follows, then, that a sign that anxiety could be playing a role in your child’s classroom-based efforts is how quickly work is completed at home.
Because there are infinite anxiety triggers for children with ASD, I have decided to compile not the most common strategies I have recommended to schools, rather the most individualized and hopefully useful ideas for you and your child.
· Issuing a Ticket: When a question has been asked and answered more than once, that is too much. This interrogation could be a sign of perseveration or rigidity or, often times, anxiety. I encourage parents and teachers to use a ticket system in which each “question” costs one ticket. When the tickets are gone, so too are the answers (even to new questions). It can be tough to ignore, but that breaks the cycle.
· Worry Box: Allow the child to compile all of his or her worries in strips of paper in a box; before lunch and at the end of the day, review the worries to assess how significant and appropriate they truly were.
· Paraeducator: Anxiety can affect the initiation and completion of work; this manifestation of anxiety can be serviced through the assistance of a dedicated paraeducator to teach the routine and skills necessary for starting work in a timely fashion. The paraeducator’s job is two-fold: a) to redirect avoidance behavior (“Joe, the task at hand is number X”), and b) manage Joe’s anxiety through reassurance. Paraeducators are not always the solution; sometimes, they can unwittingly exacerbate the situation. It is wise to develop a plan with the team and your child’s therapist/counselor as to how to manage the anxiety.
· Anxiety Chart: This can visual depict where and what anxiety feels like; it can also provide representations of different levels of anxiety. Such a chart should be used in all settings. One client shared that he felt like a “rat” (“something is scratching me, I’m a little upset”), so I suggested the paraeducator should reassure him of his safety and ability to complete the task at hand.
· Break after Recess: While this seems like giving a break after a break, many kids on the spectrum find recess to be highly stressful and anxiety-ridden. Some down time after recess (or even lunch) can derail anxiety and reboot for learning.
A glaring omission has been made purposefully on my part: the effects of anxiety on socialization. “Social goals” are typically not incorporated in IEPS, especially if socialization is the only area affected by the anxiety.
When Benjamin Franklin said, “Do not anticipate trouble or worry about what may never happen,” he obviously did not know an individual on the autism spectrum. “Anticipating” or identifying anxiety triggers and considering (not worrying) what might happen can help children on spectrum learn to manage their anxiety.