Post #17 Wellbeing (4) Emotional aspects of wellbeing

Life during lockdown is an emotional roller coaster for us all. For many autistic children and young people, the emotions they are experiencing may be intense and confusing. In this post I share some of my experiences and thoughts on ways to support emotional wellbeing at home. 

The confusion and unpredictability of the current situation, and when/how  we will eventually exit lockdown, is causing a good deal of anxiety for everyone. Awareness of the risks to emotional wellbeing for autistic children and young people is an important first step to supporting their wellbeing at this time. An earlier post focused upon increased anxiety which of course risks emotional wellbeing. Other widely recognised factors also impact emotional wellbeing for our children including: difficulties in communicating about feelings, barriers to interaction, differences in ways of thinking - such as lack of flexibility, sensory processing differences, difficulties with asking for help, lack of resilience due to prior experiences. Major disruption to routines will also be impacting your child's emotional wellbeing, including feelings of isolation from those they see daily in school or college and fear and uncertainty about what is happening now and what will happen in the future. There are many resources available to help with supporting emotional wellbeing, links to some can be found in earlier posts (managing anxiety and resources). However, my main focus for this post is to reflect upon some of the important issues regarding emotional wellbeing for your children.

Communicate about emotions & feelings
Sensory communication

Many autistic children and young people are non-verbal and face significant challenges in communicating with others. For many, the only means by which they can communicate about how they are feeling is through their behaviour. Careful observations of your son's or daughter's actions and behaviours are the best way to gain insights into how they may be feeling. You know your child best and so are likely to notice any differences in behaviours which may suggest signs of how they are feeling. For example, they may be missing their usual routine, feeling isolated from peers at school or college, missing out on the range of activities which they enjoy on a daily basis. Lack of ability to communicate about the way they feel may result in more intense withdrawal at home and/or more intense behaviours such as self-injurious behaviours and perhaps for some, meltdowns. All of these behaviours may be signs of anxiety, confusion and/or fear and put emotional wellbeing at risk. It may well be that your son or daughter usually struggles in these areas on a daily basis, be aware that the current situation may intensify their feelings and subsequent behaviours and actions. Supporting your child's emotional wellbeing will most likely require the use of sensory soothing strategies (see posts on sensory ideas, sensory strategies & resources). Don't be afraid of allowing your child to self-stimulate (as long as it is safe) if this helps them to calm and relax, they may well need to engage in these behaviours more frequently than usual. The intensity of feelings will impact your child and you, so do what you need to do in order to maintain a calm environment. Use music if this relaxes your child or gives them good feelings - watch this film of a music therapist giving tips on calming strategies:

Try sensory activities such as massage, identify aromas which calm your child, some children relax in a bubble bath, some feel good if they engage in repetitive activities - there is no right or wrong. The situation we are in is challenging and so don't feel bad if you are not using all the activities school may have suggested  - but do communicate with school to discuss how you and your child are getting on.  

Visual supports for communicating about feelings

Many children and young people use alternative communication systems at school and sometimes at home. Visual communication strategies and tools can be very effective for helping youngsters to communicate wants and needs, express choices and preferences and so on. If your child is using a specific strategy at school, such as the Picture Exchange Communication System (PECS), consider how you might use this at home. Talk to your child's teacher for guidance. Other visual supports may be helpful for your child, see: Visual supports & resources for examples. Again, talk to your child's teacher about what is used in school, what is most effective and what you might introduce at home if this is appropriate. Enhancing opportunities, and providing an effective strategy, for your child to communicate about needs and wants is an important step in supporting their emotional wellbeing. Visual supports are also often used to try to teach youngsters to communicate about feelings, although a word of warning as these may be too abstract. For example, a smiley/sad face such as the one below may not be meaningful in representing the feelings of happy and sad.  

If you are keen to try a visual tool at home for your child to express if they are happy or sad, try taking photos of family members with happy and sad faces - these may be much more meaningful to your child. You can mount these on to a board or use a keychain tool. 

Know your normal
Many of your children are able to communicate successfully verbally. However,  communicating about feelings and emotions is one of the most abstract of communication topics, which results in what may feel like insurmountable barriers for both the young person and their communication partners. It may well be that while your child feels ok, they are able to express themselves easily. However, as feelings become intense, such as anxiety or frustration, their ability to communicate drops and they may start to show their feelings through their behaviours. One first step to support communication about how a young person feels is 'know your normal'. Helping your son or daughter to identify what is 'their normal' can then help them to communicate when things change. 

Know your normal toolkit includes many useful resources, explained as:

"The ‘know your normal’ tool allows you to describe what your normal looks like, things such as how much sleep you get, how much time you spend on your interests and hobbies and how this makes you feel, so that if this changes, it’s easier to explain to people who may not understand your autism that something feels different".

When emotions change
During this period of extreme change, we should expect that our children's emotions will be more intense and may cause an increased number of outbursts. Visual supports can be a tool which your child will benefit from, especially to support their communication about how they are feeling. As language about emotions is abstract, visual supports provide a visual hook or cue to associate with emotions/feelings words and make communicating more successful. So, how best to support your child to communicate about their emotions?

1. Find out which words your child currently uses and understands, what is their emotions vocabulary? You may find that a starting point will require you to teach key words, perhaps beginning with the most basic emotions such as happy, sad, angry. You could make an emotions/feelings bingo game and play with your autistic child and siblings, or play charades using emotions words. Make a point of describing how family members are feeling at every opportunity - in so doing you are teaching word labels for feelings. 
2. If your child has a vocabulary of emotions/feelings do bear in mind that, for some children, emotions words make them feel uncomfortable and they may need to substitute certain words with their own label (e.g., instead of happy, they may prefer jolly). 
3. You may want to try a strategy to help your son or daughter to use their emotions vocabulary to communicate about how they are feeling. There are many visual tools which are used to support individuals to communicate about how they are feeling. It's a good idea to check with your child's teacher as there may be tools in use at school which you could introduce at home. Many of these tools use pictures and symbols to support vocabulary In addition, colours can be used to represent specific emotions. Be aware though that for some children it is a good idea for them to select which colours to use to represent specific emotions. Feelings, and the colours we may associate with those feelings, can be very personal so do not feel you have to stick with the colours used in marketed products. You might make an emotions/feelings dictionary with your child to help them to develop their vocabulary - use words, symbols/pictures and colours as the visual images will help your child to recall each word and it's meaning.
    
   
   
4. Develop emotional regulation - this is the ability to separate an emotional response to a situation from the ability to think through what to do. For example, a student may feel a strong emotional response when they receive a 'fail' grade, but then decide to ask the teacher about why they failed and what they need to do to resit the assignment. Many autistic children and young people struggle with emotional regulation. Their emotional response may feel very intense, blocking them being able to organise their thinking in order to decide what they need to do. A child or young person with poor emotional regulation may:
   
   
   • Overreact to situations when compared to same-age peers.
   • Experience negative emotions for a longer amount of time than same-age peers.
   • Have a short temper and engage in emotional outbursts.
   • Have mood swings.
   So an autistic student who fails an assignment may have an outburst, or may withdraw, and are unable to manage their emotional response so that they can figure out what to do about the situation. For many youngsters who experience intense emotions, they are constantly in a situation where they might 'explode' or 'retreat' as their roller coaster of emotions triggers intense and immediate responses, but does not allow them to think through what to do to about the situation or solve a problem. There are many tools which make use of visual supports and colours, for example emotions wheels, fans, thermometers, as a means of supporting emotional regulation. Watch these films for an explanation & examples of how they are used:
   
   
   
   
   
   
   The post 'managing anxiety' provided an example of the use of the '5-point scale' which is a visual system for working through challenging situations. The first step is to identify a problem area, that is a situation in which your child has a strong emotional response such as an outburst. An example might be 'losing a game'. This is then broken down into 5 stages - for each stage discussion with the young person identifies what this looks like, feels like and what can be done. The strategy is often used in schools to help a child or young person to learn to manage their emotional response to a situation. If you are interested, see: 5-point scale For further information and a variation of the 5-point scale, see: How to improve emotional regulation.
    
   
   Key to any approach to teaching your child to self-regulate their emotions is their own unique perspective - so do not be afraid to adapt an approach to make it more meaningful for your child. For example, I have used the concept of the numbered scale but adapted it for some children who found it difficult to identify with 5 stages. In addition, I would suggest that you try to help your child to identify their 'good feelings' (see wellbeing post 1) and use these to identify ways to cope, for example: 
   
   

   These things give me good feelings.
   Learning these things gives me good feelings	Maths – my favourite J Science topics Learning dances from You Tube
   Activities at home that give me good feelings	Watching my favourite show on TV Cooking with mum Playing my music in my room Bubble bath
   Things I like to play that give me good feelings	Football with Tom Organising my Pokémon cards Lego
   Food that gives me good feelings	Pizza Crunchy food Cucumber and strawberries
   Exercise that give me good feelings	Jo Wicks PE Jumping on trampette Relaxation exercise
   Remember these good feelings if I start to get upset.  Remember good feelings return again another time J

   
   

   		I feel like this when…	I could do this… Choose from my good feelings list
   3	Angry	I lose a game	Play music in my room Relaxation exercise
   2	Getting upset, or worried or frustrated	I have to do English homework	Ask mum for help and think - I can do maths next.
   1	Happy & cheerful	I can watch my favourite show over and over again J I can play with Lego	Enjoy the good feelings I have J

Learning to self-regulate emotions can also be part of 'fun games', for examples of ideas: 

In conclusion, supporting your child's wellbeing will at times be challenging. Do talk to school or college to discuss ways to support your child at home. Do not feel guilty if you are not able to implement strategies that you feel you ought to. Take some time for a physical and mental break yourself.

Key points:
Find ways to communicate about emotions & feelings.
Use sensory & relaxation strategies.
Use visual supports.
Consider emotional regulation strategies.

Further resources: 
Know your normal
NAS resources 
Autistica resources
CAMHS resources