Kids with High-Functioning Autism (HFA) are more likely to be lonely than “typical” kids. Research shows that they face considerable challenges in making and keeping friends. When a youngster comes home and says, "no one likes me" or "everyone hates me," it can be hard for a mother or father to tell the difference between "temporary exclusion" versus "ongoing rejection."
Resources for parents of children and teens on the autism spectrum:
“How should I handle my teenage son’s emotional instability? Specifically, how can I tell the difference between 'normal' moodiness that occurs in adolescence and depression? My son seems to have significantly more ‘downs’ than ‘ups’. He’s usually very grouchy and pretty much stays to himself. Is this typical for teens with level 1 autism? Should I be concerned? What can I do to help?”
Moodiness and depression are common among teens in general. And young people with Asperger’s (AS) and High-Functioning Autism (HFA) are at even greater risk for these comorbid conditions. Teens on the autism spectrum have a “developmental disorder,” which means that their emotional age is significantly younger than their chronological age.
For example, the teenager may be 16-years-old, but still have the social skills of a 9-year-old. This dilemma causes problems for the teen due to the fact that he or she experiences great difficulty in relating to same-age peers, which in turn may result in rejection from the peer group – and this contributes largely to the AS or HFA teen’s lack of self-esteem and depression.
In addition, cognitive control systems lag behind emotional development making it hard for AS and HFA teens to cope with their emotions. Furthermore, beyond the biological factors, a lot of other changes are occurring during adolescence (e.g., experiencing first loves and breakups, butting heads with parents, start of high school, etc.). No wonder some teens on the spectrum struggle through this time in their life.
Unfortunately, other complicating factors are at play during the teenage years:
Difficulty with transitions— Largely due to the uneasy transition toward adulthood, most teens on the spectrum experience an increase in anxiety. It is during this time that they are dangling between the dependency of childhood and the responsibilities of adulthood. It can feel intimidating to prepare to leave high school, head off to college, or into the job market. All these factors induce more mood swings and anxiety in AS and HFA teens.
Peer-rejection— Many teens on the spectrum are deliberately excluded from social relationships among their age group. As a result, they often choose to isolate themselves, which makes a bad problem worse. A teenager who feels rejected often spends too much time playing video games and on social networking sites, thus losing touch with peers even more. Teens who are ostracized by their peers also tend to underachieve academically.
Poor social skills— Most young people with AS and HFA experience social skills deficits. As a result, interactions with peers become very unpleasant. The more they “fail” in connecting with peers, the more they isolate. They want to “fit-in” and be accepted, but simply haven’t figured out the social politics needed to find and keep friends.
Low self-esteem— Peer-group rejection results in a decline in their self-image, a state of despair, behavioral difficulties, loneliness and seclusion.
So as a parent, how do you know when to wait out the moods – and when to worry? The truth is that it's difficult to know, because every teenager is different. Rapid physiological changes are occurring during adolescence. Therefore, a degree of vacillation between "ups" and "downs" can be expected. However, there is big difference between teenage mood swings and genuine depression. The major symptoms of depression may include:
changes in appetite
episodes of moping and crying
fatigue
loss of enthusiasm or interest in favorite activities
headaches
insomnia
irritability
mood swings that seem out of proportion to the circumstances
negative self-concept
outbursts of anger
painful thoughts that manifest themselves in relentless introspection
persistent anxiety
persistent sadness
poor school performance
sense of hopelessness
withdrawal and isolation
If an AS or HFA teenager is suffering from depression, parents can expect to see the following symptoms unfold in three successive stages:
Inability to concentrate, withdrawal from friends, impulsive acts, and declining academic performance
Acts of aggression, rapid mood swings, loss of friends, mild rebellion, and sudden changes in personality
Overt rebellion, extreme fatigue, giving away prized possessions, expressions of hopelessness, and suicidal threats or gestures
Other common symptoms of depression in adolescents include: eating or sleeping too much, feeling extremely sensitive, feeling misunderstood, feeling negative and worthless, poor attendance at school, self-harm, and using recreational drugs or alcohol.
Symptoms caused by depression can vary from child to child. To discover the type of depression your AS or HFA teenager has, your physician may add one or more “specifiers.” A specifier simply means that your teen has depression with specific features, for example:
Seasonal pattern: depression related to changes in seasons and reduced exposure to sunlight
Mixed features: simultaneous depression and mania, which includes elevated self-esteem, talking too much, and increased energy
Melancholic features: severe depression with lack of response to something that used to bring pleasure and associated with early morning awakening, major changes in appetite, feelings of guilt, agitation or sluggishness, and worsened mood in the morning
Catatonia: depression that includes motor activity that involves either uncontrollable and purposeless movement or fixed and inflexible posture
Atypical features: depression that includes the ability to temporarily be cheered by happy events, increased appetite, sensitivity to rejection, a heavy feeling in the arms or legs, and excessive need for sleep
Anxious distress: depression with unusual restlessness or worry about possible events or loss of control
Treatment—
1. Psychotherapy: Different types of psychotherapy can be effective for depression in AS and HFA teens (e.g., cognitive behavioral therapy). Psychotherapy can help your teen:
regain a sense of satisfaction and control in his or her life
ease depression symptoms (e.g., hopelessness and anger)
learn to set realistic goals for his or her life
identify negative beliefs and behaviors and replace them with healthy, positive ones
identify issues that contribute to his or her depression
change behaviors that make depression worse
find better ways to cope and solve problems
explore relationships and experiences
develop positive interactions with peers
develop the ability to tolerate and accept distress using healthier behaviors
adjust to a crisis or other current difficulty
2. Alternative Therapies: Therapies other than face-to-face office sessions are available and can be highly effective for teens on the autism spectrum (e.g., as a computer program, by online sessions, or using videos or workbooks). These can be guided by a therapist or be totally independent.
3. Social Skills Training: Teens on the autism spectrum experience depression largely due to their awkwardness in interpersonal relationships. Thus, social skills training is perhaps the best method for combating depression in these young people. A major goal of social skills training is teaching AS and HFA teens:
how to understand verbal and nonverbal behaviors involved in social interactions
how to make "small talk" in social settings
the importance of good eye contact during a conversation
how to "read" the many subtle cues contained in social interactions
how to tell when someone wants to change the topic of conversation or shift to another activity
how to interpret social signals so that they can determine how to act appropriately in the company of others in a variety of different situations
Social skills training assumes that when “special needs” teens improve their social skills and change selected behaviors, they will raise their self-esteem and increase the likelihood that others will respond favorably to them. The AS or HFA teen learns to change his or her social behavior patterns by practicing selected behaviors in individual or group therapy sessions.
4. Medication:Many types of antidepressants are available, including:
Other medications can be added to an antidepressant to enhance antidepressant effects. Your physician may recommend combining two antidepressants or adding medications (e.g., mood stabilizers or antipsychotics). Anti-anxiety and stimulant medications can also be added for short-term use.
Other things that parents can do to combat moodiness and depression in their AS or HFA teenager include: encouraging physical activity; praising the youngster's skills; promoting participation in organized activities; reminding your youngster that you care by listening, showing interest in his or her problems, and respecting his or her feelings; and setting aside time each day to talk to your youngster (this step is crucial in preventing further isolation, withdrawal, and progressive depression).
Kids with and Asperger’s (AS) and High-Functioning Autism (HFA) commonly experience anxiety. Estimates report that as many as 80% of kids on the spectrum have anxiety disorders such as specific phobias, social anxiety disorder, panic disorder, or generalized anxiety disorder. Physical complaints with no apparent medical basis is often an indicator of anxiety (e.g., stress in a social situation, a demanding school setting, sensory sensitivities, etc.).
Factors that can make existing anxiety even worse can include an introverted temperament, having highly anxious parents, high levels of family stress or conflict, and a family history of anxiety.
Signs of school anxiety in AS and HFA children include the following:
Behavioral Signs—
Abnormal failure or delay to complete everyday responsibilities
Change in eating habits
Change in sleeping habits
Frequent lying
Nail biting
Pacing
Significant change in school or work performance
Trouble getting along with classmates and/or teachers
Cognitive Signs—
Anxious thoughts or feelings
Chronic worrying
Impaired concentration
Impaired speech (e.g., mumbling or stuttering)
Reduced or impaired judgment
Repetitive or unwanted thoughts
Trouble with remembering things (e.g., homework assignments or deadlines)
Unusual desire for social isolation
Emotional Signs—
Feelings of being overwhelmed
Feelings of sadness and/or depression
Irritability
Less than normal patience
More frequent or extreme pessimistic attitude
Reduced or eliminated desire for activities once enjoyed or regularly done
Restlessness
Sense of isolation
Trouble coping with life’s issues
Physical Signs—
Chest pain with or without tachycardia
Clenched teeth
Fatigue
Flushed skin
Getting sick more often than normal
Headaches
Heartburn or indigestion
Involuntary twitching or shaking
Irregular bowel movements
Muscle aches
Nausea
Trouble sleeping
Unusual changes in weight
Other signs include:
Shutdowns
Shadowing parents around the house
Severe tantrums when forced to go to school
Regressive behavior
Refusing to go to school
Nightmares
Meltdowns
Feeling unsafe staying in a room by themselves
Fear of being alone in the dark
Excessive worry about harm to themselves
Excessive shyness
Exaggerated, unrealistic fears of animals, monster, burglars
Clinging behavior
Let’s take a deeper look at all the things that can contribute to your AS or HFA child’s anxiety level:
1. There's a lot of pressure for students to learn more and more – and at younger ages than in past generations. For example, while a few decades ago, kindergarten was a time for learning letters, numbers, and basics, most kindergarteners today are expected to read. With test scores being heavily weighted and publicly known, schools are under great pressure to produce high test scores. That pressure gets passed on to the students, and no one feels that pressure more than a child on the autism spectrum.
2. Just as it can be stressful to handle a heavy and challenging workload, some students experience stress from work that isn't difficult enough. Many children with AS and HFA have average to above-average IQs (sometimes into the “gifted” range), and can become easily bored and disengaged if the subject matter is not challenging enough. They may respond by acting-out or tuning-out in class, which leads to poor performance, masks the root of the problem, and perpetuates the difficulties.
3. Many of us have experienced test anxiety, regardless of whether or not we're prepared for exams. Unfortunately, greater levels of test anxiety hinder performance on exams. Due to the fact that the AS or HFA child already has an element of anxiety to contend with throughout the day, the added pressure of an exam may prove to be too much anxiety-overload, resulting in either a meltdown or shutdown.
4. With the overabundance of convenience food available these days - and the time constraints we all experience - the average youngster's diet has more sugar and less nutritious content than is recommended. This can lead to mood swings, lack of energy, and other negative effects that exacerbate the stress levels of “already-anxious” kids on the spectrum.
5. While most “typical” kids would say that their peers are one of their favorite aspects of school, peers can be a source of stress for students on the spectrum (e.g., due to being rejected, teased, and bullied). Concerns about not having any friends, not being in the same class with someone who actually is a friend, not being able to keep up with peers in one particular area or another (e.g., gym class), interpersonal conflicts, and peer pressure are a few of the very common ways kids with AS and HFA can be stressed by their social lives at school.
6. In an effort to give their “special needs” child an edge, or to provide the best possible developmental experiences, some parents enroll their child in too many extra-curricular activities. As the child becomes a teenager, school extracurricular activities become much more demanding. College admissions standards are also becoming increasingly competitive, making it difficult for a college-bound high school student to avoid over-scheduling himself. All of this adds up to stress-overload.
7. Many parents of children on the autism spectrum report that their child is not getting enough sleep to function well each day. As schedules get busier, even younger kids are finding themselves habitually sleep-deprived. This can affect health and cognitive functioning, both of which increase anxiety levels and impact school performance.
8. Noise pollution from school hallways, strange smells coming from the cafeteria, the buzz of florescent lighting, and other environmental stimuli have been shown to cause stress that impacts the AS or HFA child’s performance in school.
9. As you know, there are different styles of learning. Some students learn better by listening, others retain information more efficiently if they see the information written out, and still others prefer learning by doing. Students on the spectrum usually learn best through visual forms of instruction. If there's a mismatch in the child’s learning style and the teacher’s teaching style, this often leads to a stressful academic experience.
10. Due in part to the hectic schedules of parents, the sit-down family dinner has become the exception rather than the rule in many households. While there are other ways to connect as a family, many families find that they’re too busy to spend time together and have both the important discussions and the casual day recaps that can be so helpful for “special needs” kids in dealing with the stressful issues they face. Due to a lack of available family time, many parents are not as connected to their children - or knowledgeable about the issues they face - as they would like.
11. A good experience with a caring teacher can cause a lasting impression on an AS or HFA youngster's life – BUT so can a bad experience. While most teachers do their best to provide “special needs” students with a positive educational experience, some students are better suited for certain teaching styles and classroom types than others. If there is a mismatch between student and teacher, the student can form lasting negative feelings about school or his own abilities.
12. Many schools now have anti-bullying policies. Though bullying does still happen at many schools, help is generally more accessible than it was years ago. The bad news is that bullying has gone high-tech. Many kids use the Internet, cell phones and other media devices to bully HFA and AS kids, and this type of bullying often gets very aggressive. One reason is that bullies can be anonymous and enlist other bullies to make their target miserable. Another reason is that they don't have to face their targets, so it's easier to shed any empathy that they may otherwise feel.
What can be done to reduce school anxiety in AS and HFA children? Here are a few suggestions:
1. You may have tried to “reassure” your anxious child. But oftentimes, these reassurances sound “empty.” Saying something such as “It's going to be fine” is not likely to help a nervous AS or HFA youngster. When he begins to worry, you can use it as an opportunity to have more dialogue and find out what is making him so anxious. The more information you have, the better job you can do to help him feel more comfortable in the school environment. Thus, do a bit of an investigation to get to the root of the problem. For example, your child may become extremely anxious getting on the bus in the morning, during transitions, in the lunch room, during gym class, while taking a quiz or test …just to name a few. On a scale of 1 to 10 (with 10 being the highest level of anxiety), your child is not at a level 10 all day. Most likely, there are only one or two situations that launch him to that level. Address those situations first.
2. Try to find out if your child is refusing to go to school due to real anxiety issues, or some other reason. Answers to the following questions may help to determine the motivation behind school-refusal:
What specific tangible rewards does your child pursue outside of school that cause her to miss school?
What specific social situations at school are avoided?
What specific school-related stimuli are provoking her concern about going to school?
What specific problematic behaviors are present in the morning before school?
What is her degree of anxiety or misbehavior upon entering school?
What is her academic and social status? (This would include a review of academic records, formal evaluation reports, attendance records, and IEP or 504 plans.)
What family disruption or conflict has occurred as a result of her school-refusal?
What comorbid conditions (e.g., anxiety, depression, sensory sensitivities, etc.) occur with her school-refusal?
What are her specific forms of absenteeism, and how do these forms change daily?
Is her school-refusal relatively acute or chronic in nature?
Is her refusal to attend school legitimate or understandable in some way (e.g., due to a school-based threat, bullying, inadequate school environment, etc.)?
Is she willing to attend school if you accompany her?
Is she willing to attend school if incentives are provided for attendance?
How did her school-refusal develop over time?
Have recent or traumatic home or school events influenced her school-refusal?
Are there any non-school situations where anxiety or attention-seeking behavior occurs?
Are symptoms of school-refusal evident on weekends and holidays?
3. Put a picture of you, the parent, in your youngster's notebook, or place a special note in his lunch box (e.g., “Mommy loves you”). These “little things” aren’t so little, and will help your child feel more comfortable at school (especially if he is coping with separation anxiety).
4. Discuss the daily plans with your child so that everyone is informed and knows what to expect. Make sure your youngster is aware of everything, including who will be at the bus stop or who will be picking her up at school (this is especially important if you carpool).
5. Emphasize the positives of school. Frequently discuss how much fun school can be and all the new friends your child can meet. If your AS or HFA youngster has an older sibling in school, have that sister or brother talk to your “special needs” child about recess and all the fun that is had during the school day.
6. Meet with the school guidance counselor. This visit will make you and your child more relaxed about school. If you keep your youngster’s anxiety in the open with the counselor, he or she will likely check in on your child more often.
7. Lastly, if your youngster’s anxiety continues to grow, or you feel you can’t help her resolve her fears about school, it is time to see the doctor. Your doctor can consult with you and the entire family in order to decide if a therapist is needed.
Resources for parents of children and teens on the autism spectrum:
• Anonymous said… Even with the IEP it's still about conforming. • Anonymous said… Great article. My daughter has always shown signs of anxiety, but it ballooned once she started high school and resulted in severe depression, cognitive decline, and school refusal. It was not until age 16 that she was diagnosed with Asperger's. Her diagnosis came as both a surprise and a relief to us. She flew under the radar for so long, developing her own coping strategies along the way... but it finally became too much for her to handle. It has helped her and us to have a better understanding of her behaviour and sensory triggers. She is now back in school but on a reduced schedule of 2 in-school classes and 1 online class this semester. Our school has been very helpful and accommodating. She knows it will take her longer to complete high school with this schedule and she's fine with that. We still have our daily challenges but, with the right medication and removing the pressure to attend a full day of school, we've seen a positive change. • Anonymous said… I am done with school systems. After my son being bullied and called a loser by the school psychologist, that was the last straw. My ASD Spectrum son is 16. I dropped him out and homeschooling him. He'll take the Hi-Set (new GED) and go at his own pace until he's ready to take the Hi-Set. • Anonymous said… I am raising a child who is struggling in school.She doesn't have servers but has learning disabilities. You are right, it might look good on paper but the schools don't understand anxiety or learning pace. • Anonymous said… I am so sorry your son was bullied. No one deserves that. • Anonymous said… I can only speak from my own experience. The schools in our area really have nothing for Aspergers kids. My son is expected to be neurotypical and this has caused so much heartache for us. Inclusion without real support is rough. My hope is that there are schools out there who have more than what we've been given. • Anonymous said… Inclusion without support is not inclusion...it has been my experience that schools think they're being inclusive when really they are working towards integration...trying to make a neurodiverse student indistinguishable from their peers...the pressure to conform causes significant anxiety... this was one reason we recently moved schools...there are good schools out there striving for a truly inclusive culture... we are feeling positive about our new school....it's small and has a great part time program • Anonymous said… It is a real shame that schools don't work with kids with aspergers the way they should. Oh they go through the motions but they don't seem to do all that they can! It is very difficult for kids to sit in a classroom for a whole period and concentrate on the lesson....is that so hard to understand! • Anonymous said… my son gets stressed out at school feeling hes being bullied because other kids are trying to tell him what hes supose to do, then they ignor his requests knowing he will loose it and will get into trouble when they tell the teacher, all innocent, that he was yelling at them. • Anonymous said… my son is in first grade and I'm exhausted. We changed schools to give him something better. Looking ahead is hard. The thought of middle school worries me as well. • Anonymous said… We are in elementary school have problems with it too. I am very worried about middle school. • Anonymous said… You can ask for a IEP Which gives aspergers children a easier time. my son also has aspergers and makes his school day rough but he has learned to cope thank goodness also do you have any charter schools in your area they are also more prepared and willing to work with aspergers children.
