WHAT IS ANXIETY?
Anxiety is a physiological reaction, which we all have experienced. Anything and a lot of things can make us anxious, to varying extents. One can say anxiety is like the body’s smoke alarm. During a fire, the preparatory smoke rings the bell and alert us before a bigger fire sets in. So we prepare ourselves for ‘fight’ or ‘flight’ based on the severity of the situation and our coping as well.
Anxiety presents with various signs and symptoms, which could be psychological, like poor concentration, excessive worry, fears and phobias; autonomic or bodily reactions, like increased sweating, deranged blood pressure, urinary urgency; physical, which could be restlessness, muscle tension or behavioral like irritability, anger, social withdrawal or avoidance.
ANXIETY IN AUTISM:
Like all the physiological systems, this alarm system also works and functions differently in different individuals; and based on that, the bell might ring differently, in different volume and different tune. It might sound different to different observing individuals as well. So what’s different in autism? Autism, scientifically being neuro developmentally ‘different’, the ‘neuronal discharge’ and hence, the behavioural outcome, turns ‘different’ and looks even more ‘different’ to the ‘usual’ eyes and perception. The expression of anxiety, or the occasional outburst, is an explanation of it, including the coping and acceptance to it.
Ultimately, children with autism, probably best described as different (but NEVER as ill or sick child) the very natural anxiety ‘turns’ or ‘looks’ pathological even for professionals with sufficient knowledge and experience about it. Like all the systems of the body, the ‘anxiety system’ can definitely turn sick for anyone, which, might need treatment and over treatment shows adequate response, too. We need to be very mindful and particular about the fact that any different expression of anxiety need not be pathological always, neither does it always need treatment. In a much simpler example, you might like red and I might like blue, from dress to car colour, which definitely doesn’t make the other’s choice as ill or sick, and doesn’t need to be changed.
THE ATYPICAL ANXIETY IN AUTISM:
How could the anxiety be different in people with autism than in people without autism? It’s mostly the expression, extent, and also the unpredictability. Though the underlying reasons remain the very same, as mentioned earlier. Autistic individuals may perceive the threat differently, and express it differently too.
The situation turns tough when this difficulty interferes with communication and expressing oneself. The anxiety reaction might stay suppressed for long, without any hint to others, leading to sudden altered outbursts, without much control. The high association of other neurodevelopmental challenges also further add to the problem by improper understanding of the situation, altered judgment about the perceived threat or outcome of it, leading to more expressive or different responses. The altered sensory system and its responses are also quite responsible for the different expression of the anxiety in people with autism.
Autism, is very rightly conceptualised as a spectrum, in current mental health nomenclature. It is understandable as the visible outcome of its various manifestations are broad, and the anxiety reactions are no exception. As children with autism grow up, they face different kinds of challenges as the anxiety situations change, and the response patterns also change accordingly.
The society’s expectation and way of responding to this has turned quite fixed and stereotyped with every person, as they turn older, further piling up stress and the resultant anxiety levels.
PREDICTORS OF ANXIETY:
Various researches have shown greater autism spectrum symptoms, anxious cognitive style, difficulty in language expression and compromised IQ. These could be predictors of anxiety reactions in autistic individuals, with more chances of atypical anxiety presentations, which could be increased fidgeting, self injurious behaviour, sudden anger spells or even hitting the perceived threat, further complicating the situation. Among various anxiety disorders, social anxiety in Autism has persistency been seen to be more common, present in every third autistic
individual, which might need professional intervention.
WHAT CAN BE DONE?
There is no lack of assessment scales established or novel treatment/therapy approaches focussing anxiety as a whole, or anxiety in autism individuals. The predictability of assessment tools or the usefulness of therapies has shown promising results in multiple populations and variable situations as well.
Without going into intricate details of each of them, we should know and remember there are available medicines and various therapies as well, which works excellently if prescribed or applied properly, without being overprescribed, or trying too many novel therapies which haven’t received enough scientific evidence yet.
Autism specific cognitive behavioural therapy, applying social stories and trying for cognitive restructuring, behavioural and cognitive modification to teach increased predictability, visual scheduling can be very useful for autistic children. Where, the parental understanding and role in anxiety management along with differential reinforcement for alternate behaviour are specifically needed for younger children.
To conclude, anxiety is universal and very much present in people with autism, probably with an increased prevalence than otherwise detected. Because of the different communication patterns or highly associated other neurodevelopmental problems, the very naturally expressed anxiety reactions could look as ‘pathological’ to a naïve eye, especially when we focus on the expression over the reason or context.
However, one shouldn’t forget everyone’s anxiety has a reason, and any form of excessive anxiety in Autism could be managed with proper understanding of the reason of anxiety, and if needed with suitable professional care and intervention.
Dr. TANAY MAITI
MBBS, DPM, DNB Psych
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