Post #11 Managing anxiety

We are most likely all feeling anxious  during this unsettling time. Feeling anxious in a situation like the one we currently find ourselves in is normal. Many of us will have ways we have learned that help us to manage our anxiety and ways to self-soothe or to stay calm. For autistic children and young people, anxious feelings occur frequently, anxiety is often heightened and associated feelings can be very intense.  This post includes strategies, resources and apps which may help you to find ways for your son or daughter to manage their anxiety.

There are many reasons for increased anxiety in our children and young people. Whilst each person is unique, there are some common reasons which are likely to cause anxiety at this time. This short article gives some reasons for high anxiety in autistic people: 5 reasons for anxiety

 We are all experiencing anxiety at this time, but anxiety levels may be elevated for your son or daughter. Imagine we all carry a bucket of anxiety, the level of anxiety in our bucket goes up and down throughout the day. However, the level of anxiety in your son's or daughter's bucket may be much higher than yours. 

The level of anxiety in the bucket is at risk of overflowing depending on multiple factors, for example change to routine, sensory issues in the environment and so on. 

Anxiety about Corona Virus and Pandemics Many individuals will be experiencing anxiety and worries about pandemics, Corona Virus and Co-vid 19. Adding anxiety about Corona Virus may cause the bucket to overflow. For some, their anxiety will be evident in their behaviours, for example asking repetitive questions about the topic. Importantly, some will not necessarily show outward signs of anxiety, but may well be internalising their worries which may lead to outbursts or 'meltdowns' for no obvious reason. My earlier post on this topic sign-posted some useful resources for sharing information with your son or daughter. Social Stories and Articles are one way of providing information in an 'autism-friendly' way - there are some examples in the earlier post. If this is an approach which is helpful for your son or daughter, you may wish to join 'Carol's Club', which is now free to join and where you will find helpful guidelines for writing Social Stories which need to be personalised for your child. Join Carol Gray's club
In addition, take a look at another example from Dr. Siobhan Timmins: Learning about the corona virus - Siobhan Timmins Siobhan's website includes more free Social Stories in the 'thoughts and news' section, as well as helpful information on how to personalise a Social Story: Siobhan Timmins' website

Change to routines often results in high levels of anxiety. This is particularly important given the current disruption to routines. School closures, or disruption to usual school routines where schools are open, are major changes and likely to generate considerable anxieties. Routines at home have also changed, as many homes have become a place for learning and completing 'school work'. Coupled with this is the unpredictability of the current situation, meaning we are unable to answer questions such as 'when will school re-open?' The most important first step in reducing anxiety is to add clarity and predictability for your son or daughter.

The use of visual schedules is particularly important during this time of change, see earlier posts on First Then, visual schedules and also making choices, for guidelines and examples.

Morning	Afternoon
Warm-up	Sensory play
Project with mum	Go for a walk with mum and Tom
Choose	Snack
Snack	Computer time
Garden with Tom	Relax: cosy corner or dream tent
Reading	Chores in the kitchen
Times-tables	Play in garden
Cosy corner	Dinner
Lunch & play	TV

If you decide to use visual schedules for home learning and for regular home routines, it is a good idea for the home learning schedule to be presented slightly differently so as to highlight the difference between 'home learning' time and normal home time. This could be as simply as presenting the schedules on different coloured backgrounds. Following a  schedule at home will develop a new routine, which will become reassuring as information about 'what is happening' and 'when it will happen' provides structure and predictability. Visual schedules are important in supporting independence and developing confidence, which in turn reduce anxiety. 

Communicating about anxiety Many children and young people find emotions difficult to understand and difficult to communicate (future post will focus more on emotions). Emotions are complex and difficult to navigate which leads to heightened levels of anxiety. Anxiety is a feeling that some individuals will not be able to explain to you, some will not like to talk about anxiety or worries and may even dislike hearing or using these words.

One approach that can help with communicating about anxiety is Kari Dunn Buron's five-point scale which is a visual strategy that helps to organise a person's 'emotions thinking' at times which are difficult. Watch the film for an illustration of different ways a five point scale can be used:

An 'anxiety five point scale' helps to identify how a person feels, ranging for example from calm to extremely anxious. Here is an example:

	I feel…	What I can do…
5	I am panicking. I am extremely anxious and worried.	Go to my ‘calm place’. Listen to relaxation music. Squeeze my fluffy cushion.
4	I am really anxious. I am upset. I am hot and I feel sick. I can feel my heart beating.	Tell mum. Neck massage. Use my soothers.
3	I feel wobbly. My tummy hurts a little bit. Worried, anxious.	Breathe. Use my soothers.
2	I am ok but I feel a bit warm. I am a little worried.	Take a short break. Open a window for some fresh air. Have a sip of my drink.
1	I feel ok. I am calm.	Keep calm and carry on J

There are lots of examples of five point scales on the internet which give ideas of how to present them. Before you make the scale you need to discuss it with your son or daughter, use vocabulary they are familiar with, get their ideas about what they can do at each level, personalise with pictures, drawings, symbols.

Kari has provided some freely downloadable scales and examples: Downloadable scales and also some tips which may also be helpful: Kari Dunn Buron tips

Strategies to help reduce anxiety

Relaxation strategies are important for managing anxiety. You may need to do some detective work to find out what works best for your son or daughter. Here are some suggestions:
Create a 'calm place'	Try to find a space which your son or daughter can use to self-manage their anxiety and to calm. For example, you could create a 'cosy corner', ‘pillow place’ or ‘dreamy den’ which includes items that are calming for your child. This might include sensory soothers such as: soft fabrics, cushion or pillow, weighted blanket, lava lamp, favourite book or photos, squishy toys, relaxation app on Smart phone, calming music. Some individuals could use sensory strategies to calm, for example sensory apps, sensory bag or box – see sensory ideas. The most important point is to create a calm place which your child can use to self-calm when they are anxious, so choose items which your child prefers (not too many so as not to overload). Teach to use the calm place - Include times for using the calm place on a visual schedule, this would enable your child to practise using the space when they are feeling relaxed and hopefully to enjoy the space. Then when they are anxious it is a space they are familiar with and which they have experience of relaxing in. If you are using a five point scale for managing anxiety, discuss with your child adding the calm place to the scale and at what level this could be as the ‘go to’ place. Finally, use a timer to indicate how long to use the space – this will really depend on your child and his or her needs, check in with them after the allotted time and if they are still anxious reset the timer for extra time. If they have calmed, use the schedule to move on to an activity.
Breathing exercises	Use visual images to guide breathing. For example, ‘smell the flowers, blow out the candle’ – this can be done at a concrete level with real objects, at picture or symbol level. Picturing a favourite place whilst doing breathing exercises can also be calming; again this can be supported with photos or pictures. Watch this short film for a simple breathing technique: Breathing exercise for calming Here is an autistic adult giving useful guidance on breathing exercises: Breathing exercises for autistic anxiety This film shows a yoga session for a child with autism: https://www.youtube.com/watch?v=0CWOYMu9_p4
Guided  imagery & meditation	Some children and young people might enjoy guided imagery or meditation exercises. You may find information on this website helpful: mindfulmazing  or see this brief explanation of guided imagery from Headspace  You can try headspace for free – it may be helpful for your son or daughter, or even for yourself to relax. Watch these You Tube films for examples of guided meditation and imagery which can be used to self-calm when anxious or to relax before sleeping:

Special interests - planning time for pursuing special interests can help to reduce anxiety, however this may become a bit of a balancing act as some individuals can experience heightened anxiety when engaging in activities of special interest. See my next post Wellbeing, Happiness and Good Feelings for further information about using special interests to reduce anxiety.

Resources:

Molehill Mountain App Autistica: Anxiety tool

Young people may prefer using technology to manage their anxiety. Autistica and King's College London have developed the first evidence-led smartphone app for autistic people to understand and manage their emotions. 
See: Molehill Mountain app

This app. is available on the App store and for androids and is free to download.

SAM Anxiety app - Developed by the University of the West of England, Bristol as a self-help app for managing anxiety. Available free from the App store and for Androids. See this short explanation: 

Other apps which may help to calm: 7 apps for calming

Resources for autism is a registered charity which provides a useful list of resources for mental health and wellbeing: Wellbeing resources

Childline has lots of great activities and tools for helping to stay calm: Calm zone. You can find breathing exercises, yoga videos, games and more. These have not been specifically designed for autistic young people, but may still be helpful. They are fun and engaging.

South London and Maudsley NHS Foundation Trust the National Autistic Society have created guidance about Managing anxiety in children and young people on the autism spectrum: Managing anxiety in children and young people on the autistic spectrum.

Watch out for future posts on wellbeing, happiness and good feelings.