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Stress-Management for Children with High-Functioning Autism

"I need some stress management techniques to use on my very anxious daughter with autism (high functioning). Thanks in advance."

Children with High-Functioning Autism (HFA) are prone to greater stress in their daily lives than their “typical” peers. Social interaction – especially with more than one peer in which the HFA child has to identify, translate, and respond to social and emotional cues and cope with unexpected noise levels – inevitably increases stress to a point where his or her coping mechanisms may collapse.

A “stress assessment” (based on the knowledge of HFA) will help parents and teachers determine what are the natural and distinctive stressors for the child. Subsequently, an effective stress-management program can be designed.



When there are concerns about an HFA youngster’s stress level, a stress assessment can be conducted in order to better understand why the stress is occurring and to determine the most effective interventions to address it.  

The assessment process involves:
  • observing the child’s behavior while he or she is experiencing stress
  • identifying the context in which the stress-related behavior occurs
  • documenting actions that precede and follow the behavior
  • triggers and payoffs for the behavior
  • parent response
  • child reactions to the parent response
  • frequency of the behavior

The goal here is to gain greater clarity about the child’s distinctive stressors and the function of the stress-related behavior so that effective interventions can be put in place to address his or her individual needs.


==> Parenting Methods for Reducing Stress in Your "Special Needs" Child [audio segment from lecture by Mark Hutten, M.A.] 
 

Components of a stress-management program may include the following:

1. At school, one option for the HFA youngster who becomes stressed on the playground during recess, for example, is to be able to withdraw to the school library, or for the child who is anxious about socializing during lunch break to be able to complete a crossword puzzle or go for a walk in the gym.

2. Help your HFA child understand his routine each day. He wants to know what is going to happen next. He needs to hear it every day – even if he did the same thing yesterday! You might hear your child ask the same questions over and over again. Try not to get frustrated with him if this happens. This is his way of trying to understand or asking you to give him more information. Also, talk to your child if he gets upset about a change. Ask him why he is upset. He needs help putting his feelings into words. Sometimes he just doesn’t like to stop what he is doing, or sometimes he might be worried about what will happen next.

3. “Cue-controlled relaxation” (i.e., a combination of deep breathing and repetition of the word "relax") is also a useful component of a stress-management plan. One technique is for the HFA child to have an object in his or her pocket that symbolizes – or has been conditioned to elicit feelings of – relaxation. For instance, one AS teen was an avid reader of fiction, his favorite book being The Secret Garden. He kept a key in his pocket to metaphorically open the door to the secret garden (an imaginary place where he felt peaceful and content). A few moments touching or looking at the key helped him to contemplate a scene described in the book and to relax and achieve a more positive state of mind. Parents can have a special picture in their wallet (e.g., a photograph of a beach scene) which reminds their child of the solitude and tranquility of such a place.

4. Let your child know if there is going to be a change in her routine. She feels worried inside when she doesn’t know what is going to happen or if she doesn’t know what she needs to do. It really helps when you tell your child about her day when she wakes up in the morning. Also, keep her updated as the day moves forward. Also, it really helps your child do what she needs to do when you can give her a five minute warning before a change happens. Even if she complains and doesn’t like what is going to happen, she can still get ready and do well with your help, if YOU stay calm.




5. Environmental modification can significantly reduce stress. This can include having a safe area for periods of solitude to relax, minimizing distractions and reducing noise levels.

6. If the parent or teacher recognizes that a particular event is a major cause of stress, then it would be wise to consider whether the source of stress could be avoided altogether (e.g., recommending the temporary suspension of homework).

7. Practice new things with your child before she has to do them with others. If she is going to do something new, it helps her get ready and feel good about trying if she can practice with you first. Even if the practice is not exactly the same as what is going to happen, just pretending about something new or simply reading a book about it can help. When the new thing happens, your child will remember about practicing with you and will know what to do.

8. Help your HFA child know what to do when he misses you. Being away from you is hard for him, even when he is doing something fun or is with someone he likes. Sometimes it helps if you tell your child what the two of you will do together when you come back.

9. Traditional relaxation techniques using activities to encourage muscle relaxation and breathing exercises can be taught to children with HFA as a “counter-conditioning procedure,” but parents and teachers must also consider the circumstances in which the child is particularly prone to stress. Counter-conditioning is the conditioning of an unwanted behavior or response to a stimulus (e.g., nervousness) into a wanted behavior or response (e.g., calmness) by the association of positive actions with the stimulus. For instance, when conditioning a child who has a “startle response” to loud noises, the parent would create a positive response by massaging or hugging the child when he or she reacts anxiously or nervously to a loud noise. Thus, this will associate the positive response with the loud noise.

10. Some stress is “good” stress, and some stress is “bad” stress. Not all stress is bad. Learning to do new things can be stressful for your child, but you can help her take a break if she needs to, or you can help her feel good about trying. 

Resources for parents of children and teens on the autism spectrum:
 
 
 
More articles for parents of children and teens on the autism spectrum:
 
Social rejection has devastating effects in many areas of functioning. Because the ASD child tends to internalize how others treat him, rejection damages self-esteem and often causes anxiety and depression. As the child feels worse about himself and becomes more anxious and depressed – he performs worse, socially and intellectually.

Click here to read the full article…

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Meltdowns are not a pretty sight. They are somewhat like overblown temper tantrums, but unlike tantrums, meltdowns can last anywhere from ten minutes to over an hour. When it starts, the Asperger's or HFA child is totally out-of-control. When it ends, both you and your child are totally exhausted. But... don’t breathe a sigh of relief yet. At the least provocation, for the remainder of that day -- and sometimes into the next - the meltdown can return in full force.

Click here for the full article...

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Although Aspergers [high-functioning autism] is at the milder end of the autism spectrum, the challenges parents face when disciplining a teenager on the spectrum are more difficult than they would be with an average teen. Complicated by defiant behavior, the teen is at risk for even greater difficulties on multiple levels – unless the parents’ disciplinary techniques are tailored to their child's special needs.

Click here to read the full article…

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Your older teenager or young “adult child” isn’t sure what to do, and he is asking you for money every few days. How do you cut the purse strings and teach him to be independent? Parents of teens with ASD face many problems that other parents do not. Time is running out for teaching their adolescent how to become an independent adult. As one mother put it, "There's so little time, yet so much left to do."

Click here to read the full article…

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Two traits often found in kids with High-Functioning Autism are “mind-blindness” (i.e., the inability to predict the beliefs and intentions of others) and “alexithymia” (i.e., the inability to identify and interpret emotional signals in others). These two traits reduce the youngster’s ability to empathize with peers. As a result, he or she may be perceived by adults and other children as selfish, insensitive and uncaring.

Click here to read the full article...

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Become an expert in helping your child cope with his or her “out-of-control” emotions, inability to make and keep friends, stress, anger, thinking errors, and resistance to change.

Click here for the full article...
 
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A child with High-Functioning Autism (HFA) can have difficulty in school because, since he fits in so well, many adults may miss the fact that he has a diagnosis. When these children display symptoms of their disorder, they may be seen as defiant or disruptive.

Click here for the full article...
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Part 4: Teaching Strategies for Students with Asperger’s and High-Functioning Autism – Problems with Generalizing



Many students with Asperger’s (AS) and High-Functioning Autism (HFA) are unable to generalize the skills that they learn. For instance, the teacher may inform the student how to respectfully address a teacher. Normally this skill would then be generalized to any adult in a position of authority. However, a student with AS or HFA is likely to only apply the skill to the individual initially used as the target of respect in the learning process. The student will probably not apply this behavior to a principal, dean, or police officer.

The inability to generalize can also pose a problem in classroom assignments. For example, giving the direction to open a math book to a certain page does not communicate to additionally begin solving the problems. Thus, teachers should verbally give all the steps necessary to complete an assignment rather than assuming the AS or HFA student will know what comes next.



There are additional techniques that have been used in assisting “special needs” students to learn to generalize. Modes of instruction such as "scope and sequence" can be useful in equipping these students with the skills that assist in social and academic learning as well as generalization. Scope and sequence training involves teaching the student about the basics prior to expecting the generalized rules to be learned. For example, it would be best to (1) teach the student that “the tone of a person's voice sends a message” BEFORE (2) teaching the student he should “use a tone that is respectful to others.” Due to the difficulty AS and HFA students have with generalization, failing to teach the basics will further enhance their inability to generalize.

The IDEA Act is clear in its declaration that students must be placed in the least restrictive environment possible in an effort to provide them with the best education possible. This can only be achieved by means of evaluation by teachers as to the effectiveness of their chosen teaching strategies and a willingness on the part of teachers to continue to learn new techniques of instruction. Every AS and HFA youngster needs to (a) be evaluated, (b) have a plan established addressing areas of weakness, and most importantly (c) have a teacher that believes in the student and expects her to reach appropriate grade level requirements.

It is important that the teacher understands what AS and HFA is – and how it hinders students. Without a clear understanding of this disorder, actions that are clearly a part of the syndrome can be confused with behavioral issues and dealt with inappropriately.

==> Teaching Students with Aspergers and HFA
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Does Your "Obsessive" Child on the Autism Spectrum Have OCD?

"My child (with HFA) does obsess about certain things, but how can I tell if he has full-blown obsessive compulsive disorder?"

Obsessive compulsive disorder (OCD) is described as a condition characterized by recurring, obsessive thoughts and compulsive actions. Obsessive thoughts are ideas, pictures of thoughts or impulses that repeatedly enter the mind, while compulsive actions and rituals are behaviors that are repeated over and over again.

The obsessions seen in kids with Asperger’s (AS) and High-Functioning Autism (HFA) differ from the youngster with obsessive compulsive disorder. The youngster with AS or HFA does not have the ability to put things into perspective. Although terminology implies that certain behaviors in AS and HFA are similar to those seen in obsessive compulsive disorder, these behaviors fail to meet the definition of either obsessions or compulsions.

They are not invasive, undesired or annoying, which is a prerequisite for a diagnosis of obsessive compulsive disorder. The reason for this is that children with severe autism are unable to contemplate or talk about their own mental states. However, obsessive compulsive disorder does appear to coincide with AS and HFA.



Szatmari et al (1989) studied a group of 24 kids. He discovered that 8% of the kids with AS and 10% of the kids with HFA were diagnosed with obsessive compulsive disorder. This compared to 5% of the control group of kids without autism, but with social problems. Thomsen el at (1994) found that in the kids he studied, obsessive compulsive disorder continued into adulthood.

  • become preoccupied with whether something could be harmful, dangerous, wrong, or dirty
  • experience a need for symmetry, order and precision
  • experience intrusive sounds or thoughts
  • feel like they must perform the task or dwell on the thought
  • feel strong urges to do certain things repeatedly (i.e., rituals or compulsions) in order to banish the scary thoughts or ward off something dreaded
  • have a difficult time explaining a reason for their rituals
  • have a fear of contamination
  • have a fear of illness or harm coming to oneself or relatives
  • have a strong belief in lucky and unlucky numbers
  • have an "overactive alarm system" 
  • have upsetting or scary thoughts or images that pop into their minds that are hard to shake
  • may have preoccupation with body wastes
  • may have religious obsessions
  • may have sexual or aggressive thoughts
  • realize that they really don't have to repeat the behaviors, but the anxiety can be so great that they feel that repetition is "required" to neutralize uncomfortable emotions
  • try to relieve anxiety via the use of obsessions and compulsions
  • want to feel absolutely certain that something bad won't happen 
  • worry about losing things, sometimes feeling the need to collect these items, even though the items may seem useless to others
  • worry about things not being "in order" or "just right"

Compulsions that are most common include: 
  • cleaning rituals
  • counting rituals
  • grooming rituals
  • hoarding and collecting things of no apparent value
  • ordering or arranging objects
  • repeatedly checking homework
  • repeating rituals (e.g., going in and out of doorways, needing to move through spaces in a special way, rereading, erasing, rewriting, etc.)
  • rituals to prevent harming self or others
  • rituals to undo contact with a "contaminated" person or object
  • touching rituals

Moms and dads can look for the following possible signs of obsessive compulsive disorder in their AS or HFA child: 
  • a continual fear that something terrible will happen to someone
  • a dramatic increase in laundry
  • a persistent fear of illness
  • a sudden drop in test grades
  • an exceptionally long amount of time spent getting ready for bed
  • constant checks of the health of family members
  •  high, unexplained utility bills
  • holes erased through test papers and homework
  • raw, chapped hands from constant washing
  • reluctance to leave the house
  • requests for family members to repeat strange phrases or keep answering the same question
  • unproductive hours spent doing homework
  • unusually high rate of soap or paper towel usage

 ==> "OCD: What To Look For" - Excerpt from Mark Hutten's Lectures


If your AS or HFA youngster shows signs of obsessive compulsive disorder, talk to your physician. In screening for obsessive compulsive disorder, the physician will ask your youngster about obsessions and compulsions in language that he or she will understand, for example:
  • Are there things you have to do before you go to bed?
  • Do things have to be "just so"?
  • Do you collect things that others might throw away (e.g., hair, fingernail clippings, dead batteries, etc.)?
  • Do you count to a certain number or do things a certain number of times?
  • Do you have to check things over and over again?
  • Do you have to wash your hands a lot?
  • Do you have worries, thoughts, images, feelings, or ideas that bother you?

Treatment—

The most successful treatments for AS and HFA children with obsessive compulsive disorder are cognitive-behavioral therapy (CBT) and medication. CBT helps these “special needs” children learn to change thoughts and feelings by first changing behavior. The therapy involves gradually exposing children to their fears, with the agreement that they will not perform rituals in order to help them recognize that their anxiety will eventually decrease and that no disastrous outcome will occur.

Just talking about the rituals and fears have not been shown to help obsessive compulsive disorder, and may actually make it worse by reinforcing the fears and prompting extra rituals. Thus, for CBT to be successful, it must be combined with “response prevention,” in which the youngster's rituals or avoidance behaviors are blocked (e.g., a youngster who fears dirt must not only stay in contact with the dirty object, but also must not be allowed to wash repeatedly).

Many children can do well with CBT alone, while others will need therapy and medication. Selective serotonin reuptake inhibitors (SSRIs) often can reduce the impulse to perform rituals. Once a youngster is in treatment, it's important for moms and dads to participate, to learn more about obsessive compulsive disorder, and to modify expectations and be supportive.

AS and HFA kids with obsessive compulsive disorder get better at different rates, so parents should try to avoid any day-to-day comparisons and recognize and praise any small improvements. Also, try to keep family routines as normal as possible.



More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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Part 3: Teaching Strategies for Students with Asperger’s and High-Functioning Autism – The “Hidden Curriculum”

Curriculum education is not the only education an Asperger’s (AS) or High-Functioning Autistic ((HFA) student encounters in the public school system. Social behaviors are not only necessary for successful playground interaction, they are necessary for successful acquisition of educational curriculum.

The “hidden curriculum” consists of important social skills that everyone knows, but no one is taught. This includes assumed rules, student expectations, idioms and metaphors. Understanding the hidden curriculum is difficult for all kids, but it is especially so for young people with AS and HFA who have deficits in social interactions.



The following example illustrates the difficulty children on the autism spectrum have understanding the hidden curriculum:

Michael was a popular ninth-grader, despite his social awkwardness. His classmates accepted him and were understanding of his disorder. One day Michael was hanging out with his peers in the hallway before class when his friend Jamie began swearing in disappointment about his D in math. Michael picked up on the swearing and associated it with disappointment. The bell rang and Michael went on to his next class. As he sat down, Michael realized that he left his history book in his locker. His teacher, Mr. Williams, would not let him go back to his locker, and immediately Michael got mad and began using cuss words. Mr. Williams sent Michael to the dean’s office, leaving Michael mystified about what he did wrong. He thought it was acceptable to cuss when he was disappointed at school. Michael did not understand the hidden curriculum – swearing may be acceptable around peers, but you should never curse when a teacher is present.

The hidden curriculum suggests an aspect of learning that is not obvious to students with AS and HFA. This aspect of learning includes the basic how-to's of daily functioning. These are things that other students seem to just know. The social know-how that tells “typical” students what is inappropriate subject matter may be foreign to an AS or HFA student. Thus, teachers should instruct students struggling in this realm through the use of acting lessons, direct instruction, scope and sequence, self-esteem building, and social stories. Social stories and acting lessons give examples of proper behaviors in various public settings.

More information on creating social stories can be found here: How To Write Social Stories

==> Teaching Students with Aspergers and HFA
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Catatonia in Children and Teens on the Autism Spectrum

Catatonia is a complex disorder covering a range of abnormalities of movement, posture, speech and behavior associated with under-activity as well as over-activity. Research and clinical evidence reveals that some children with Autism Spectrum Disorders (ASD), including Asperger’s and High Functioning Autism, develop a complication characterized by catatonic and Parkinsonian features.

In children with ASD, catatonia is shown by the onset of any of the following traits:
  • increased slowness affecting movements and/or verbal responses
  • increased reliance on physical or verbal prompting by others
  • increased passivity and apparent lack of motivation
  • Parkinsonian features (e.g., freezing, excitement and agitation, a marked increase in repetitive and ritualistic behavior)
  • difficulty in initiating, completing, and inhibiting actions



Behavioral and functional deterioration in the teenage years is common among young people with ASD. When parents notice a deterioration or an onset of new behaviors, it is important to consider the possibility of catatonia as an underlying cause. Early recognition of problems and accurate diagnosis are important, because it is easiest to manage and reverse the condition in the early stages.

Catatonia is a serious condition that can become more severe. This risk increases the longer the condition is left untreated, and it becomes more difficult to reverse the more severe it becomes. Catatonia is distressing for the ASD child, which can cause additional behavioral disturbances.

Autism-related catatonia looks quite different from classic catatonia. It occurs across a spectrum from mild to severe. In mild and moderate cases, moms and dads often describe their ASD teenagers as “slowing down” or appearing depressed. Sometimes, these teens become stuck when trying to initiate a movement (e.g., he or she may walk up to a doorway and then freeze before stepping over the threshold). Severe cases of autism-related catatonia look a lot like classic catatonia, with the youngster almost completely shutting down.

Autism-related catatonia also produces changes in movement patterns, which can include a brief “freeze” during actions, bursts of hyperactivity, difficulty coming to a stop, incontinence, marked reduction in speech, odd gait, and stiff posture.

One of the reasons autism-related catatonia went unrecognized for so long is because many of its symptoms overlap with those of autism. Thus, the “red flag” for moms and dads is a “marked change in behavior.” What’s lost is the ability to turn intentions into action.

There is little information on the cause or effective treatment of catatonia. In one study of referrals who had ASD, it was found that 17% of all those aged 15 and over had catatonic and Parkinsonian characteristics of sufficient degree to severely limit their mobility, use of speech, and ability to carrying out daily activities. It was more common in those with mild or severe learning disabilities, but did occur in some who were high-functioning.

Autism-related catatonia appears to result from a depression in the GABA neurotransmitter system. GABA is a brain neurotransmitter (i.e., it enables nerves in the brain to send messages to one another). One medication used to treat autism-related catatonia is the GABA-stimulating medicine called lorazepam (trade name Ativan).

With true autism-related catatonia, positive response to such treatment are often seen within an hour or so. This lasts for up to several hours. Thus, a positive response (with the ASD child showing improved spontaneous movement) helps confirm the diagnosis. For many of these kids, this type of medicine is also an effective long-term treatment. For severe cases, treatment options include electroconvulsive therapy, which seems to act like a “brain reboot” that helps get the child moving and eating again.

Given the scarcity of information in the literature, as well as the potential adverse side effects of medical treatments, it is important to recognize and diagnose catatonia as early as possible so that environmental, cognitive and behavioral methods of the management of symptoms and underlying causes can be implemented. Detailed psychological assessment of ASD children, their lifestyle, environment, circumstances, pattern of deterioration and catatonia are needed to design an individual program of management.

When evaluating for catatonia, the doctor needs to understand what the child was like before concerns arose. How smooth were his movements? What were his interests and abilities? How did they change?

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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Understanding the Behavior of an Autistic Student: Michael's Story

Asperger's/High-functioning Autistic students can present a challenge for the most experienced teacher. These kids can also contribute a lot to the classroom, because they can be extremely creative and see things from a unique perspective. Teachers can learn a lot when they have a child like Michael in their class, but they may experience some very challenging days too. Here are some tips for teachers to consider: 



More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

 ==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

 ==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

 ==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book
==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism





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Part 2: Teaching Strategies for Students with Asperger’s and High-Functioning Autism – Creating the Right Environment

We continue our series on Teaching Strategies for Students with Asperger’s and High Functioning Autism:

Environmental Noise—

In creating the right environment, one problem to be considered is that of sounds. Think of the example of nails scratching on a chalk board. Just imagining it can send a chill down your spine. To a youngster with Asperger’s (AS) or High-Functioning Autism (HFA), every day sounds can have a similar affect. Thus, teachers should take an inventory to determine sounds difficult for the AS or HFA student to listen to. Also, teachers may want to consider allowing the student to listen to soft music with headsets during class times when there is excessive noise. Earplugs are another option as well.



Transitions—

Minimizing the stress AS and HFA students face is critical to education, and minimizing transitions and insuring the environment is predictable may be one of the best ways to reduce stress. Frequent changes in routines make it difficult for the student to focus on the curriculum due to preoccupation concerning what will come next in the day. When there are changes in the routine, the student should be prepped ahead of time in order to avoid excessive anxiety.

Transition Planning—

A public school is not a static environment. AS and HFA students, like all others, change teachers each year. In addition, there is the requirement of moving from elementary to middle to high school. Thus, a "transition-planning meeting" can be scheduled prior to such transitions. This meeting allows the previous teacher to educate the incoming teacher on successful techniques as well as provide general education on the traits of AS and HFA. The “special needs” student should be orientated as well. Allowing him or her extra time to become familiar with a new environment will prevent unnecessary stress during transition.

==> Teaching Students with Aspergers and HFA
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