Managing anxiety in children with autism

This resource includes a variety of strategies and tips that will help further your understanding of anxiety.

Diary

Using a diary can help to organise thoughts and relieve stress. A diary has no limits, allowing your child to express themselves freely.

Imagining a bucket of water

Anxiety UK suggest imagining anxiety as a bucket of water. It is a build-up of small everyday stresses, or something very stressful, that will fill up the bucket or even make it overflow.

It is important to take time to figure out the causes of anxiety and finding strategies to reduce or relieve feelings of anxiety. It may help to make a diary to take note of any incidents of behaviours such as anger outbursts, withdrawal, increased self-stimulatory behaviour and general indicators of anxiety and to think about the events leading up to such behaviours.

Routines and visuals

Changes to routine can be a cause of anxiety.

Make the world easier to understand and build structure to daily routine. Use visual strategies, picture schedules and written checklists.

Routine habits use less energy. Keep simple routines consistent, this allows children to know what to expect.

Ease transitions and prepare them for change. Children with autism do much better with concrete schedules. To ease transitions always make sure that the child knows what is coming next and give the child 5 minute, 3 minute and 1 minute reminders, or use the traffic light system. It can show them that the current activity is going to end and that they will be moving onto the next activity.

Strategies

It is usually best to stick to a few techniques that your child can learn and feel confident and comfortable using.

Some strategies may work better in some situations than others. At home, exercise and deep pressure stimulation may be helpful strategies. In the heat of the moment, fidget toys, finger compressions and deep palm squeezes can help.

Often children will have their own favourite sensory break that they go to when they are stressed.

Young people may not be able to do the calming strategies themselves and may need an adult to help them.

Always start with the child’s preferred interest built into the coping strategies. They are more likely to use an activity they enjoy.

When someone is exposed to the stressful situation, using their favourite activity can help them to tolerate it until the event is over.

Coping skills and self-calming strategies

Common techniques for regulating stress and anxiety:

Self stimulation (stimming) is any repetitive rhythmic sensory stimulation used to block out overwhelming stimulation.

These may include:

• rocking
• hand flapping
• hand wringing
• pacing
• bouncing
• humming
• chanting
• singing
• repetitive vocal noises

Many people with autism find using small sensory objects to fidget with helps with anxiety. This can include having items to squeeze such as pieces of fabric or blue tack. Depending on their sensory needs, some children find chewing helps,  including chewing gum or chewellery (rubber necklaces or wrist bands).

Deep pressure and proprioception

Deep pressure stimulation calms the nervous system and proprioception (tension to joints and tendons) releases stress chemicals.

Examples of deep pressure stimulation include deep massages or squeezing.

Examples of self calming include:

• deep pressure
• massaging the palms of the hands together
• self-hug squeezes
• rubbing the tops of the thighs

Proprioception means they can provide tension to the joints and tendons themselves.

Common strategies include:

• knee tapping
• chewing gum
• muscle squeezes. Tense the whole body like a rock and hold the position for 10 seconds. Then release with “no muscles”. Repeat this technique 3 times.
• Hand clenches. Squeeze the hands into fists and hold them for 10 seconds. Release and repeat 3 times.

Videos with good examples:

Benefits of deep pressure and calming movement by Flaghouse Sensory

Simple Massage for Children – Occupational Therapy with TherapySPOT – YouTube

Calming Deep Pressure Touch – YouTube

Ep 109 | Proprioceptive activities to calm your child | Sensory diet to improve focus | Reena Singh – YouTube

Sensory Play at Home: Proprioceptive Games – YouTube

At-Home Gross Motor Activities for Children Using an Exercise Ball – YouTube

Sensory Brushing Programme – YouTube

Some children might find toys or items around the house useful:

• Fidget toys
• Stress ball. Try this homemade stress ball or a store bought one
• Punch a pillow

Exercise-based coping strategies

• run in place
• run on the spot
• bend head down with deep breaths

Oral-based coping strategies

• Chewing Strategies for Sensory Seeking Kids | SPD – YouTube
• suck a lollipop
• blow up a balloon
• deep belly breaths and blowing out through “duck lips”
• hum low and “under your breath”

Smell-based coping strategies

• smell calming scents
• peppermint, basil, lemon, and cinnamon are linked to mental alertness
• lavender, chamomile, orange, and rose are linked to relaxation and calmness

Touch-based coping strategies

• Tactile fidget toys
• Sensory touch bar for desks
• Sticky back velcro is a great cost-effective version of this strategy
• Calming waterbead sensory play

Vision-based coping strategies

• Lava lamp for kids

Physical activity

• going for a walk
• push ups
• jumping jacks
• full body stretches
• trampolines

Deep breathing and muscle relaxation

Learning deep breathing and muscle relaxation can be a great help in staying calm. Some videos with examples are below:

Progressive Muscle Relaxation for Kids – YouTube

Progressive Muscle Relaxation for kids – YouTube

Relaxation for Kids – The Koeppen Technique (Part 1) – YouTube

Relaxation for Kids – The Koeppen Technique (Part 2) – YouTube

Some children may find yoga helpful.

Books

Frogs Breathtaking speech: How children (and frogs) can use yoga breathing to deal with anxiety, anger and tension. By Michael Chissich and Sarah Peacock.

Online videos

Autism Calming Strategies – YouTube

Body Scan Meditation for Children with Autism & Special Needs – YouTube

Relaxing Mindfulness Exercise for Kids with Special Needs – YouTube

Visual Guided Color Meditation for Kids with Autism / Special Needs – 10 minutes – YouTube

Toddler Yoga: Animal Poses! – YouTube

Yoga and Movement Under the Sea – YouTube

Yoga for Kids! – YouTube

YOGA for kids – The cobra pose – Yoga practice tutorial – YouTube

YOGA for kids – The dog pose – Yoga practice tutorial – YouTube

Yoga for kids – Yoga animal poses – Yoga practice tutorial – Yoga class for children – YouTube

YOGA FOR KIDS – Sun Salutation and Animal Poses – Compilation Video – YouTube

Yoga For Beginners | 20 Minute Kids Yoga Class with Yoga Ed. | Ages 9-10 – YouTube

Books on anxiety

‘The Panicosaurus’ managing anxiety in children including those with Asperger Syndrome by K.I. Al-Ghani.

‘What to do when you worry too much’ a young person’s guide to overcoming anxiety using cognitive behaviour techniques by Dawn Huebner.

‘When my worries get too big’ for children about how to cope with worries by relaxing by Kari Dunn Buron.

‘Overcoming your child’s fears and worries’ a self-help guide for parents using cognitive behavioural techniques by Cathy Creswell and Lucy Willetts.

‘I feel frightened’ a story book about common fears to read with a child by Brian Moses.

‘I’m worried’ a story book about having worries to read with a child by Brian Moses.

‘Starving the anger gremlin’ anger management workbook for young people using cognitive behavioural techniques by Kate Collins-Donnelly.

‘Think good, feel good’ a guide to using cognitive behavioural approaches to improve mood (includes activities and worksheets) by Paul Stallard.

Books on stress and relaxation

‘Focussing and calming games for children; mindfulness strategies and activities to help children relax, concentrate and take control’ is a good introduction to theory about mindfulness and practical activities by Deborah Plummer.

‘Meditation for Aspies’ everyday activities to help people with autism take control and improve their lives by Ulrike Bolls.

Books on managing strong emotions

‘A 5 is against the law! Social boundaries: straight up!’ understanding rules around social boundaries for teenagers and young adults by Kari Dunn Buron.

‘The incredible 5-point scale’ understanding social interactions and controlling emotional responses by Kari Dunn Buron and Mitzi Curits.

Books on social stories

‘The new social story book’ how to write social stories with lots of example stories by Carol Grey.

Mindfulness activities

Mindful breathing

Taking deep breaths is important in relaxation as it brings awareness to your body. There are many different ways to teach children to take deep breaths and then blow out:

• using a pinwheel
• blowing bubbles
• blowing out candles
• picturing a balloon opening and closing with breath
• having your child breathe in while you count to 5 and then breathe out

Body scan

• have your child lay on their back
• tell them to tense up all their muscles from their head to their toes and hold for 10 to 15 seconds
• have them release and relax, ask them how they feel

This exercise helps kids to recognise how their body is feeling in a tense and in a calm state.

Visualization and guided imagery

This is a relaxation technique that is used to promote positive mental images. You can find guided imagery scripts online. Start by having your child close their eyes, while seated or lying down. Slowly read the script and have them visualise the image in their minds. Then have them draw a picture of that place and keep it in their desk or at home as a reference to a calm place for them.

Take a walk

Being outside and taking a walk is a great way for your child to be present in the moment. Point out the different sounds heard from birds chirping to leaves rustling. Notice the smell of the fresh cut grass or flowers. Feel the different textures of sand and rocks. Notice the sun, wind and clouds. Bring a blanket and lay on the grass, look up at the trees, look at the clouds. Walk over to a pond and listen for frogs, look for fish and throw rocks in to make a splash.

Stretching and yoga

Taking deep breaths and stretching can be very calming and teaches you to be aware of how your body is feeling. Turn the lights down, put on relaxing music and help guide your child through bedtime relaxation stretches for children.

Mindfulness for Kids YouTube Videos – The OT Toolbox

Websites for anxiety in children with autism

Anxiety UK

National Autistic Society

YoungMinds