Has your ASD (high functioning autistic) child given you some indication that he is nervous about starting back to school? He may have even said, “I’m not going!!!”
What youngster hasn't dreaded September, the end of summer and the return to school – but for many ASD students, the prospect of school produces a level of fear so intense that it is immobilizing, resulting in what's known as school-refusal behavior. Some children with autism spectrum disorder have been known to be absent for weeks or months.
Some may cry or scream for hours every morning in an effort to resist leaving home. Others may hide out in the nurse's office. Some children who miss school are simply truant (i.e., they'd just rather be doing something else), but sometimes there are genuine reasons to fear school (e.g., bullying, teasing).
Anywhere from 5% to 28% of kids will exhibit some degree of school-refusal behavior at some point, including truancy. For children with anxiety-fueled school refusal, the fear is real and can take time to overcome. Families may struggle for months to help an autistic youngster get back into the classroom. Ignoring the problem or failing to deal with it completely can lead to more-serious problems later on. Individuals who experience school-refusal behavior and anxiety disorders in childhood may face serious ramifications in adulthood.
Psychologists say and studies show the following:
Alcohol, drug use: A study of kids ages 9 to 13 with an anxiety disorder showed that those who still had the disorder seven years after treatment drank alcohol more often and were more likely to use marijuana than those whose disorders had resolved.
Depression: Teens and young adults ages 14 to 24 that had social anxiety were almost three times as likely to develop depression later on than those without the anxiety disorder.
Different life choices: Psychologists say they've seen young people with persistent anxiety make fear-fueled choices that can have long term effects, such as selecting a less-rigorous college or a less challenging career.
Psychiatric treatment: A study of school-refusing kids showed that about 20 to 29 years later they received more psychiatric treatment than the general population.
School refusal affects the entire family. If a child doesn't go to school, it may be hard for a parent to keep her job. Children are at heightened risk when starting a new school, and especially when entering middle school. It is the perfect storm with the onset of puberty, a huge transition and a chaotic academic environment.
Well-meaning moms and dads can make things worse by allowing an anxious youngster to miss school. Such an accommodation sends the message that school is too scary for the youngster to handle and the fear is justified. Overprotective moms and dads rush in way too quickly to shield their Aspie from any experience that creates distress.
Untreated, a youngster on the spectrum with school-refusal behavior is likely to fall behind academically, which can then lead to more anxiety. And there may be longer-term consequences. A 1997 study followed 35 students (ages 7-12) treated for school refusal. Twenty years later they were found to have had more psychiatric treatment and to have lived with their parents more often than a comparison group.
Some ASD teens with unresolved anxiety may go on to self-medicate with alcohol and drugs. A 2004 study followed 9- to 13-year-olds who were treated for an anxiety disorder. Seven years after treatment, those who still had the disorder drank alcohol more days per month and were more likely to use marijuana than those whose disorder had resolved.
Children with school-refusal behavior may have (a) separation anxiety (i.e., a fear of being away from their moms and dads), (b) a social phobia (i.e., an inordinate fear of being judged), or (c) a fear of being called-on in class or being teased. A specific phobia (e.g., riding the bus, walking past a dog, being out in a storm, etc.) may be present as well. Other kids are depressed, in some cases unable to get out of bed.
Because many children complain of headaches, stomachaches or other physical symptoms, it can be difficult to tell whether anxiety, or a physical illness, is to blame. (Note: Anxiety-fueled ailments tend to disappear magically on weekends.)
Autistic kids with school refusal may complain of physical symptoms shortly before it is time to leave for school or repeatedly ask to visit the school nurse. If the youngster is allowed to stay home, the symptoms quickly disappear, only to reappear the next morning. In some cases, the child may refuse to leave the house. Common physical symptoms include headaches, stomachaches, nausea, or diarrhea. Tantrums, inflexibility, separation anxiety, avoidance, and defiance may show up, too.
Starting school, moving, and other stressful life events may trigger the onset of school refusal. Other reasons include the youngster’s fear that something will happen to a parent after he is in school, fear that she won’t do well in school, or fear of another student. Often a symptom of a deeper problem, anxiety-based school refusal affects 2 to 5 percent of school-age kids. It commonly takes place between the ages of five and six and between ten and eleven, and at times of transition, such as entering middle and high school. Kids who suffer from school refusal tend to have average or above-average intelligence. But they may develop serious educational or social problems if their fears and anxiety keep them away from school and friends for any length of time.
What Can Parents Do?
The most important thing a mother or father can do is obtain a comprehensive evaluation from a mental health professional. That evaluation will reveal the reasons behind the school refusal and can help determine what kind of treatment will be best. Your youngster’s pediatrician should be able to recommend a mental health professional in your area who works with kids on the spectrum.
The following tips will help you and your Aspie develop coping strategies for school anxieties and other stressful situations:
Arrange an informal meeting with your youngster’s teacher away from the classroom.
Emphasize the positive aspects of going to school: being with friends, learning a favorite subject, and playing at recess.
Encourage hobbies and interests. Fun is relaxation, and hobbies are good distractions that help build self-confidence.
Expose kids to school in small degrees, increasing exposure slowly over time. Eventually this will help them realize there is nothing to fear and that nothing bad will happen.
Help your Aspie establish a support system. A variety of people should be in your youngster’s life—other kids as well as family members or educators who are willing to talk with your youngster should the occasion arise.
Learn about your Aspie’s anxiety disorder and treatment options. For more information about school refusal and kid’s anxiety disorders, type "anxiety" and/or "school problems" in the search box at the top of this page.
Meet with the school guidance counselor for extra support and direction.
Talk with your Aspie about feelings and fears, which helps reduce them.
Try self-help methods with your Aspie. In addition to a therapist’s recommendations, a good self-help book will provide relaxation techniques. Be open to new ideas so that your youngster is, too.
Treatment—
Cognitive behavioral therapy (CBT), in which clients learn to change negative thoughts and behavior, is the main treatment for school-refusal behavior and the anxiety disorders that often underlie it. The primary technique is exposure therapy, where children gradually face and master their fears.
CBT is very effective. Recent studies have shown that about half to 70% of children with anxiety disorders treated with CBT will have a significant improvement in function and decrease in their symptoms. Some specialized school-refusal clinics have success rates that are even higher.
Antidepressants such as Zoloft (sertraline) or Prozac (fluoxetine) are often prescribed for kids with anxiety disorders, although their use in kids is controversial.
Psychologists stress the importance of seeking treatment quickly—after as little as two weeks of missed school. The longer they've been out of school, the poorer the prognosis.
Resources for parents of children and teens on the autism spectrum:
Understanding the implication of ASD (high-functioning autism) can bring a greater level of tolerance and acceptance for those with the condition.
Here are some traits and behavior patterns commonly seen in ASD:
• A youngster can be helped if parents consistently work with him and highlight his strengths and work consistently on his weaknesses.
• ASD is often detected when a youngster starts preschool. He will generally interact better with his teacher than his peers and may display silly, loud, aggressive or socially withdrawn behavior.
• Kids on the autism spectrum express their feelings in unpredictable ways. Sometimes they may seem emotionless and other times they may display extreme emotion that is not appropriate to the situation.
• Kids with ASD prefer routine and structure and can become irritable and distressed if the unexpected happens.
• Gross and fine motor skills are often underdeveloped, causing problems in sports and balance.
• Intense preoccupations often center on certain toys or areas of interest. Common obsessions are dinosaurs and forms of transport and how they work.
• Interrupting conversations is a common problem as the youngster does not understand the social signals that allow conversation to move from one to another.
• It is possible to teach social skills but it is a long slow process and often requires parental intervention to repair social damage when they act inappropriately.
• Many kids are perfectionists and struggle if they fail to produce perfect schoolwork. Encourage them to move on, and create distractions if necessary to get them to continue working.
• Most children with the disorder are of average or above average intelligence.
• Older kids may enjoy a club that is focused on their interest – for example, coin or stamp collecting.
• On a positive note, this aversion to rule-breaking means the youngster is less likely to experiment with smoking, drinking, drugs, and sex as he matures.
• Rules are very important and a youngster may become angry if a game is not played fairly or his peers break school rules.
• Short stories can be useful in teaching social skills. Use one page visual aids that teach about listening to others and keeping quiet and still while they talk.
• The youngster may appear cold and uncaring but it is not deliberate. He does not think about others and cannot understand the social graces that keep society functioning.
• They find it hard to generalize. If taught that they shouldn’t hit a youngster at school, they do not automatically make the connection that they shouldn’t hit a youngster in the mall.
• They have excellent thinking skills where things are concerned but are extremely poor at interpreting human relationships.
• They will often seek out other people to talk to about their interests. The conversation is usually one-sided – more like a lecture where they talk about their knowledge and aren't interested in feedback.
• Things are interpreted very literally, meaning that sarcasm, playful teasing and figures of speech are not understood.
There is hope for kids who have autism, and with training and support from their family and health professionals, they can live meaningful, productive lives.
Here are some important parenting tips to implement ASAP:
1. Although it is not the youngster’s fault, he will still ultimately be the one to take the consequences of his behavior. It will help your youngster if you can explain the consequences clearly and logically when your youngster is able to listen.
2. Celebrate your child’s humor, creativity, and passion.
3. Do you want to understand the child`s actions? Just ask yourself: What behavior would make sense if you only had 4 seconds to live?
4. Don’t argue; nag; or attempt unsolicited and spontaneous transplants of your wisdom to your youngster. Instead, either a) decide that the issue is aggravating but not significant enough to warrant intervention; or b) make an appointment with your youngster to discuss the issue.
5. Especially with teens, negotiate, negotiate, and negotiate. Parents need to model negotiation, not inflexibility. Don’t worry about losing control: the parent always gets to decide when negotiation is over and which compromise is accepted. Remember: negative behaviors usually occur because the child is spinning out of control, not because he is evil. While evil behavior would need to be aggressively squelched, the much more common overwhelmed behavior needs to be calmly defused.
6. Forgive your youngster and yourself nightly. You didn’t ask to live with the effects of ASD any more than did your youngster.
7. Head off big fights before they begin. Seek to diffuse, not to inflame. When tempers flare, allow everyone to cool off. Serious discussion can only occur during times of composure.
8. If it is working, keep doing it. If not, do something else.
9. If your youngster has a meltdown, the most important thing to remember when dealing with these situations is to try to figure out what caused them. Your youngster is not doing this to intentionally annoy you; he is doing it because he has reached his limit of tolerance in whatever he is dealing with. If you feel his meltdown was caused by a change in routine, reassure him of the routine for the rest of the day and that the routine will not change the next day, if that is the case.
10. Imagine your youngster delivering your eulogy. What do you want him to say about you? Keep those bigger goals in mind as you choose your interactions/reactions to your youngster.
11. Instead of punishing wrong behavior, set a reward for the correct behavior you would rather replace it with. Rewards should be immediate, frequent, powerful, clearly defined, and consistent. Also remember that a behavior always gets stronger before it changes.
12. Keep a sense of humor. Seek to enjoy – not to scream.
13. Pick your fights. Is the issue at hand worth chipping away at your relationship with your youngster? Can your youngster really control the offending behavior at this moment?
14. Plan ahead. Give warnings before transitions. Discuss in advance what is expected, and what the results might be. Have the youngster repeat out loud the terms he just agreed to.
15. Recognize that attention issues in the youngster are only the tip of the iceberg that the whole family must address.
16. Remember that a youngster on the spectrum is still a youngster with thoughts and feelings, and that you are the adult this youngster looks to for support and guidance.
17. Remember that these young people have two time frames: Now, and Huh. There is no future. There is only now. The past is non-negotiable.
18. Review this text, and others, periodically. You are going to forget this stuff, and different principles will likely be needed at different stages.
19. The kids who need love the most will always ask for it in the most unloving ways.
20. The most important thing is to be consistent. Kids with ASD thrive on routine. Everything needs to be done at the same time, in the same way, every day, as much as possible, to give the youngster a sense of safety and security. When there will be a change in your youngster's routine, tell them as far in advance and explain what will happen. When you talk to your child, you should use a calm and even tone of voice, and use explicit language that says exactly what you mean. Do not make requests too complicated or ask a youngster to do things with too many steps at once. Try to keep your language as literal as possible. Try to be very verbal. If your youngster does something right, praise them for it.
21. The patient in ASD is the whole family.
22. This is hard work. It is also hard work for your youngster.
23. This is not a contest with your youngster. The winner is not the one with more points. The winner is the one whose youngster still loves them when they graduate from high school.
24. You do not have a standard youngster. You can view the issue as a disability. Or, you can view it as wonderful uniqueness. Or, you can view it as both. This "disability outlook" will help because it eliminates blame; sets reasonable expectations thereby minimizing anger; and points the way for parents/teachers to see themselves as "therapists" not victims.
25. You will make it through this; you have no choice.
Kids on the spectrum are for the most part bright, happy and loving kids. If we can help break through to their 'own little world' we can help them to cope a little better in society. They have a need to finish tasks they have started. Strategies can be developed to reduce the stress they experience at such times. Warnings that an activity is to finish in x minutes can help with older kids. With younger kids attempts to 'save' the task help - videoing a program, mark in a book, etc.
As the kids mature some problems will get easier, but like all other kids new problems will emerge. Some teenagers can feel the lack of friendships difficult to cope with as they try hard to make friends in their own way but find it hard to keep them. This is not always the case. Many have friends who act as 'buddies' for long periods of time. Social skills will have to be taught in an effort for them to find a place in the world ... so take all opportunities to explain situations time and time again ..... and one day.......it may work!
Resources for parents of children and teens on the autism spectrum:
"My son is 8 yrs old. He is fairly high functioning. Here's the problem. I
don't feel like he loves me. Can he truly understand love at all. He does not hug, kiss or cuddle. He never
has. He likes to have his back scratched at night, but that's it. He
struggles emotionally at school- a lot of anger. But at home you would
notice anything out of the ordinary, until supper. Same meal every
single night. He has no problems sharing emotions every once in a while with his father (who
lives outside of the home). How can I help him to open up to me?!"
Many
emotional concepts are difficult for kids with ASD. Love is probably
one of the most complicated emotions of all. The lack of empathy and
inflexibility that many kids on the spectrum live with will definitely
make understanding the concept of love difficult – difficult, but not
impossible.
It is sometimes hard to separate the idea of a person with autism loving
someone from the true source of difficulty, which is the concept of theory of mind. People with autism feel a full range of emotions: anger, sadness, joy, and yes, love.
However,
the problem lies in connecting these feelings to the feelings of
others. Theory of mind is understanding that another person's thoughts
and feelings are their own and how they can coincide with ours, even
though they are not reliant on what we are feeling.
The possibilities are there for your son with high-functioning autism.
Love is an emotion that he can come to understand. Here are some things
you can do to make sure that happens:
Behavioral therapists can use play therapy to enhance your son's
theory of mind. Pretend play can be difficult for kids with ASD due to
the close connection with understanding other's feelings. Play skills
are important for developing relationships on many levels.
Social skills therapy can help him work on social cues, facial
expressions, and basic communication, which in turn, will enhance his
theory of mind abilities.
Practice facial expression and recognition with pictures in books or
family photographs. Explain the emotion and the cause. Using the
‘say, see, hear' approach to enhance his understanding.
Social stories
and comic strips can also be used to show situations that cause
different emotional responses. Use these to explain why other people
may react in various situations.
The process of developing theory of mind is ongoing in kids on the
autism spectrum. Love is only a small part of this very complex
equation. While love may be a tricky emotional concept for kids with
ASD, the basic idea of love is very real.
Balancing
the feelings of love within a relationship is what will bring on a
variety of experiences, both positive and negative. With straight
forward discussion about feelings and emotions, your son should be able
to understand love, and be successful at it.
More resources for parents of children and teens on the autism spectrum: