Autism Spectrum Disorder Causes High Anxiety Levels

When someone has an Autism Spectrum Disorder (ASD) such as Asperger's syndrome, they will experience far greater anxiety in their daily life than the vast majority of people. Anxiety is perhaps the greatest source of stress for those with an ASD and worry can be an almost constant companion, with intermittent episodes of intense fear or panic.

We do not know exactly why those with an ASD are more anxious than typical adults. There are a few explanations.

Neurology of the brain: ASD is considered as a neuro-developmental disorder that changes the structures and functioning of specific components of the brain. For example, we know that those with an ASD are likely to have structural and functional changes to the amygdala, which processes emotions, especially anxiety.
Painful environmental experiences: One of the diagnostic criteria for ASD is hyper-sensitivity to specific sensory experiences. For example, "sharp" noises, such as someone shouting, can be perceived as excruciatingly painful. There can be a phobic reaction to a range of auditory, tactile, visual, and olfactory sensations that will be experienced throughout the day. Anxiety occurs when there is an increased risk of such aversive experiences.
High levels of anxiety: Often, those with ASD feel highly anxious because of either being a frequent victim of "predators" (especially at school), a fear of failure and ridicule, a lack of clarity on what to do in a new or unanticipated situation (often social), or a combination of the three.
Sensitivity to negative emotions: Anxiety can also be created by an extraordinary sensitivity to the negative emotional thoughts of others.

Those With ASD Find Many Ways to Deal With Their Anxiety

Being highly anxious most of the time is emotionally and physically exhausting and can lead to hyper-alertness, constant vigilance/racing thoughts, difficulty sleeping, and stress-related medical conditions. So how can a person with an ASD cope with an almost constant feeling of nervousness and fear? There are many strategies that are known to effectively alleviate anxiety. While some are helpful, there are a handful of strategies that should be avoided.

10 Strategies Frequently Used to Cope With ASD and Anxiety

Constructive	Destructive
1. Physical activity	1. Excessive control
2. Relaxation	2. Routines and rituals
3. Special interests	3. Emotional explosions
4. Time with animals or a favorite person	4. Alcohol and drug misuse
5. Diet and nutrition
6. Sleep

Four Destructive Coping Strategies for Anxiety

I will start with the strategies that are often used to cope with anxiety by those with ASD, but should be avoided because they can be destructive for friendships and relationships.

1. Excessive Control

When prone to anxiety, there is a tendency to develop strategies to control everyday experiences that have the potential to trigger greater anxiety, or even panic. Such strategies can include defiantly refusing to engage in a particular activity, or the use of emotional blackmail, such as threats to damage something or hurt someone, in order to escape having to comply with a request or expectation to participate in an activity that has previously been, or is anticipated to be, a new cause of intense anxiety. Sometimes psychologists describe these anxiety management strategies as Oppositional Defiant Disorder (ODD) or Pathological Demand Avoidance (PDA).

While these strategies can be effective in avoiding anxiety for the person with an ASD, they are not appreciated by typical people, who accuse the person with an ASD of being a control freak or a domestic terrorist. Being excessively controlling or threatening usually has a detrimental effect on friendships and relationships and can lead to arguments and anger. It is important that the person with an ASD communicates clearly why a particular situation is perceived as creating intense anxiety, and that others work collaboratively with the person to use strategies other than avoidance to alleviate anxiety. The person should be encouraged to be brave, and should be supported in any situation associated with anxiety.

2. Routines and Rituals

Another effective strategy for managing high levels of anxiety is the use of excessive routines and rituals, which reduce anxiety by being soothing and relaxing. It is interesting that the new diagnostic criteria for ASD in DSM-5 (American Psychiatric Association 2013) include the diagnostic criterion of:

B2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal and non-verbal behavior (e.g. extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take the same route or eat same food every day.) (page 50)

My clinical opinion is that these behaviors are simply means of alleviating chronic high levels of anxiety rather than a distinct and unique diagnostic characteristic of ASD. These strategies may be effective, but the routines and rituals can become excessively prolonged and interfere with being able to engage in other activities. There can also be extreme distress if the routines and rituals are interrupted or prevented.

3. Emotional Explosions

Another strategy that is not recommended is to have a quick, destructive release of anxious energy, to "cleanse the system." Anxiety is an emotion that is valued for survival. Anxiety alerts the body to potential danger and enables survival by responding with a release of energy for "fight" or "flight."

But what should be done with that high level of emotional energy? When the response is fight (as in fighting the tiger that wants to eat you), clearly physically fighting or arguing with someone to absorb the energy is not a wise action for obvious reasons; high levels of anxiety release high levels of energy and strength, and unfortunately the cognitive control of actions (thinking before responding) seems to be switched off when experiencing such intense anxiety. If there is an irresistible urge to have an emotional explosion, an alternative can be a "controlled explosion" through "creative destruction." For example, a person can release emotional energy by crushing the contents of a recycling garbage container, such as cans or cardboard packaging.

4. Alcohol and Drug Misuse

At low levels of consumption, alcohol is a relaxant and is a tempting means of dissolving anxiety. However, consumption of alcohol below a permitted age is illegal. This is for sound reasons.

- Alcohol not only acts as a poison that temporarily affects brain functioning, but also as a disruption and inhibition to brain development during adolescence and the early adult years.

- Alcohol impairs thinking, reasoning and judgement, hence laws that prohibit driving when under the influence of alcohol. People who are intoxicated are not smart, and those with an ASD need all their intellectual abilities at their peak to process social situations and cope with so many aspects of life.

In the long term, excessive consumption of alcohol can cause a clinical depression and affect friendships, relationships and employment.

Marijuana can alleviate anxiety and create a feeling of isolation from the social world. It is a very tempting option for those with high levels of anxiety, such as young adults with an ASD. However, it is illegal in most states and countries, potentially addictive, and reduces motivation and intellectual capacity. For these reasons it is not recommended as a strategy to alleviate anxiety.

If drugs are to be used to manage anxiety, there are prescription medications that are effective, so long as they are used as prescribed. Those with ASD are not unique in having high levels of anxiety and could potentially have access to a range of medications that have proved successful.

Six Constructive Coping Strategies for Anxiety

As noted in the table above, there are many constructive strategies that can be used to cope with anxiety. These strategies can be divided into six major groups that provide a range of anxiety reduction solutions.

1. Physical Activity

Physical activities and regular exercise are a ways of releasing emotional energy and clarifying thinking. People who have an ASD are notoriously poorly coordinated and, sometimes, being clumsy in sporting activities during the school years and being teased by peers regarding physical abilities and dexterity can lead to the belief that physical activity is to be avoided. However, we know that physical activity can be more effective than medication and even psychotherapy in alleviating anxiety. It may help to consult a personal trainer who can assess body type and personality to determine which physical activities would be most effective. This does not have to be team sports, and can include solitary practice sports such as cycling, swimming, horseback riding, or going to the gym. Regular exercise is excellent for mental and physical health. And, Asperger qualities of perfectionism and determination can contribute to success in a chosen sport. I know of several famous sports personalities who have Asperger's syndrome who serve as great examples.

2. Relaxation

Anxiety results in tension that can be relieved by relaxation activities, particularly meditation. In Western cultures, there is a growing awareness and appreciation of the value of activities such as yoga that encourage a general sense of well-being and provide an antidote to anxiety. Low levels of relaxation can be achieved by being comfortable and engrossed in listening to music that is calming and relaxing, while deeper levels of relaxation can be achieved using the many different meditation techniques. Many clinical psychologists are now using meditation in their range of psychological treatments for anxiety.

Another relaxant for those with an ASD is solitude, in the sense of being alone, rather than lonely. Actually being away from people and some sensory experiences can be a means of reducing anxiety, but how easy is it to ever be alone at work? It may be possible to talk to a manager about being able to retreat to a safe, secluded sanctuary at break times. Solitude can be emotionally refreshing and a means of true and deep relaxation.

A further source of relaxation can come from being in nature, walking, or camping in a natural environment, with few social encounters and only natural sensory experiences. It can also be relaxing to engage in activities that enable one to appreciate the patterns and symmetry in mathematics or architecture, or immerse oneself in repetitive, soothing and creative pursuits such as knitting, embroidery, carpentry or the repair of watches and machinery.

3. Special Interests

There are many reasons why someone with an ASD has a special interest (one of the diagnostic criteria), but one of the reasons is that time engaged in the interest may act as a 'thought blocker' to anxious thoughts. Being so engrossed and hyper-focused on an activity creates a barrier to anxiety and provides time devoid of anxiety. Being engaged in the special interest can actually be a time of intense enjoyment and achievement. However, there needs to be an awareness that the engagement in and enjoyment of the interest can be almost addictive, yet those without ASD may not understand how valuable the special interest has become in preserving mental health.

Sometimes the origin of a special interest is to overcome fear by acquiring knowledge; for example, fear of the sound of thunder may lead to a special interest in weather systems. The special interest can also be a means of escape from everyday worries. The person can create and enjoy living in the relatively safe imaginary world of fiction or internet games in which they are valued, socially successful and free from anxiety. This is a useful strategy, but needs to be one of many, so that the activity does not become irresistible and compulsive. Unfortunately, if the special interest has become the primary means of effectively alleviating anxiety, any thwarting of access to it will result in severe agitation.

There is another aspect to special interests relevant to emotion, and especially anxiety management and depression. Having high levels of anxiety is mentally and physically exhausting, which in the long term can contribute to feelings of being emotionally drained. Time engaged in the special interest, therefore, can be re-energizing time.

The average person may not always appreciate the many valuable aspects of the special interest for someone with an ASD. They may need to perceive the time engaged in the interest with more tolerance and understanding. However, it is important to come to a compromise so that the interest does not take up excessive amounts of time or prevent the person with an ASD from engaging in some family activities.

4. Being With Animals or a Favorite Person

There are social strategies that can reduce anxiety. For example, spending time with adoring pets that make a person feel safe or being with someone who seems like a 'sponge' that can soak up a person's worries can be helpful. It's a great idea to have pictures of pets or significant calming and accepting people on a mobile phone or nearby. An audio recording of a supportive friend saying positive and reassuring comments can also help during anxious moments.

For those experiencing difficulty expressing anxiety to a friend or family member in a face-to-face conversation, using e-mail or texting to communicate can allow for greater eloquence in describing and disclosing inner thoughts and feelings by typing rather than talking.

5. Diet and Nutrition

I have become increasingly aware of the importance of having a good diet filled with nutritious foods as a means of reducing a propensity for anxiety. While junk food may be tasty and easy to acquire and eat, and even provide some comfort in the short term, the problems outweigh the benefits. Not only does excessive consumption of fats and refined sugars lead to weight gain, it also has a role to play in increasing anxiety. On the other hand, studies have shown that diets rich in whole foods, fruit, vegetables, nuts, complex carbohydrates, and lean protein can have a beneficial effect on both sleep and mood. Healthy food contributes to a healthy mind.

6. Sleep

Sleep has many functions, one of which is to refresh mind and body. People who have an ASD are notorious for having both a poor sleep pattern and inadequate sleep. The sleep cycle associated with ASD can be unusual, for example, taking some time to actually fall asleep, (especially if worried about events during the day or anticipated tomorrow), and a tendency for there to be a disturbance of the depth and quality of sleep subsequently. Attention to diet and medications, such as melatonin, can help establish a reasonable sleep cycle. If problems persist, I recommend a referral to a sleep clinic at a local hospital to explore how sleep might improve. Having restful and deep sleep can lead to an improvement in the ability to manage emotions such as anxiety.

You Can Learn to Control Your Anxiety

Although the majority of those who have an ASD will experience high levels of anxiety, we have developed constructive strategies to reduce the intensity and frequency of feeling anxious. When I talk to my clients who have ASD and are seeking guidance and therapy in managing their anxiety, I often share advice that I have found to be true, "Instead of anxiety controlling you, you can learn to control your anxiety."