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ANXIETY AND MANAGEMENT IN ASD

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Slide 1 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT ANXIETY AND MANAGEMENT IN ASD Dr Clodagh Doyle Consultant Clinical Psychologist NHSCT
Slide 2 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Aims of Session Definition of anxiety Prevalence of anxiety Anxiety and ASD Symptoms Strategies
Slide 3 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT ANXIETY What is anxiety? Anxiety is a NORMAL EMOTION – it helps us cope with difficult, challenging or dangerous situations. Anxiety is COMMON – there are times when we all feel worried, anxious, uptight or stressed. But anxiety becomes a PROBLEM WHEN IT STOPS YOUR child from enjoying normal life by affecting their school, work, family relationships, friendships or social life. This is when ANXIETY TAKES OVER and your child has lost control. (from Paul Stallard : Anxiety)
Slide 4 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Definitions Fear – reaction to real environmental threat that is focused on a specific object, individual or circumstance eg chased by a dog. It’s a normal emotional response essential for survival Worry – thoughts and beliefs about possible problems that may occur in the future ie focused upon distal events Anxiety – a general, frightened response to a source that is not readily identifiable and may be out of proportion to environmental threats –ie excessive worry re common life situations
Slide 5 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Prevalence in the general population Anxiety disorders represent the most common type of psychological distress in school-age children (eg Kashani & Orvaschel, 1990) 25.7% 8 yr olds meet diagnostic criteria for an anxiety disorder Anxiety in childhood is most common risk factor for depression in adolescence and early adulthood Anxious children are more likely to be anxious adults ie anxiety disorders have a persistent course
Slide 6 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Anxiety and ASD 84.1% of children with pervasive developmental disorder met the full criteria of at least one anxiety disorder Muris et al (1998) 35% of children with ASD met criteria for an anxiety disorder (Wood & Sze, 2007) 65% of young people in clinic presented with clinically significant levels of anxiety (Atwood, 2004)
Slide 7 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Anxiety and ASD Why? - rigidity of thought and behaviour - difficulties with change; transitions; social situations - communication and language difficulties - sensory difficulties - difficulty recognising signs of anxiety
Slide 8 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Anxiety and ASD Poor copings /resource strategies Hypervigilance to things/people in their environment Difficulty recognising and discriminating between others feelings Difficulty predicting outcomes
Slide 9 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Anxiety and ASD Risk factors: Awareness of difference High trait anxiety Family tension Bullying/victimisation Adverse life events (Tantam,2000)
Slide 10 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Anxiety and ASD Anxiety and fear are factors in behaviour difficulties and challenging behaviours. Anxiety more common in those with diagnosis of Aspergers Syndrome or High Functioning Autism (White et al,2009).
Slide 11 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Symptoms of Anxiety Exercise: think about what the symptoms of anxiety are.
Slide 12 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Symptoms
Slide 13 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Components of anxiety Affective – feelings of fear, panic, agitation, nervousness Cognitive – worry, negative thoughts, poor concentration, attentional biases Physiological – increased heart rate, stomach aches, muscle tension, perspiration, sleeping difficulties Behavioural – flight, fight, freeze, reassurance seeking
Slide 14 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Body cues for Anxiety Symptoms “FLIGHT–FIGHT” reaction: • shortness of breath • tight chest • dizziness or light-headedness • palpitations • muscle pain, especially head and neck pain • wanting to go to the toilet
Slide 15 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT • shakiness • sweating • dry mouth • difficulty swallowing • blurred vision • butterflies or feeling sick.
Slide 16 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT What do we do? Tool–box: promote self-regulation Relaxation Distraction Create predictability – visual schedules, visual cues/symbols Emotional education – teach about emotions; signs of anxiety Social stories CBT type approach Social skills training
Slide 17 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT TOOL BOX PHYSICAL ACTIVITY TOOLS RELAXATION TOOLS SOCIAL TOOLS THINKING TOOLS SOLITUDE SPECIAL INTERESTS
Slide 18 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Relaxation tools – slow release of emotional energy Breathing Relaxation training Repetitive action Lego/Drawing Music – listening/playing Sleep Reading
Slide 19 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Physical Activity Tools – quick release of physical energy Exercise – eg trampoline Sport Creative destructive Swing
Slide 20 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Social Tools Spend time with family member or friend Seek advice Solitude Be with a pet
Slide 21 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Thinking Tools Put event in perspective What would you like to do Flexible thinking eg •“It might have been an accident. I should check before I get angry” Social story
Slide 22 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT
Slide 23 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Relaxation Relaxation allows child to change their physiological arousal It counteracts the physical feelings of anxiety Taught to a child when they are feeling calm Individual and group exercises
Slide 24 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Types of relaxation Progressive muscular Visualisation/imaginative Breathing exercises Group exercises - relaxation - breathing
Slide 25 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Relaxation Group exercise
Slide 26 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Distraction Distractions are mental operations – typically mindless Goal is to engage mind in something simple or routine that the worry thoughts are prevented ie distraction helps to take your mind of the negative/worrying thoughts It helps you take control of your thoughts by thinking about something else
Slide 27 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Additional techniques Worry time Worry box/safe Therapeutic stories Talking back to worries Turning volume down on worry thoughts Turning the tape off.
Slide 28 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Cognitive Behaviour Therapy What is COGNITIVE BEHAVIOUR THERAPY? Cognitive Behaviour Therapy (CBT) is based on the idea that how we feel and what we do are due to the way we think. Focuses on relationship between Cognitions – what we think Affect – what we feel Behaviour – what we do
Slide 29 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT CBT ENVIRONMENT
Slide 30 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT CBT SCHOOL PLAYGROUND
Slide 31 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT CBT Monitoring and identification of thoughts, feelings an behaviour Psychoeducation Learning alternative ways to manage anxiety/unpleasant emotions Challenging the unhelpful thoughts
Slide 32 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT CBT Coping and positive self talk Learning new behaviours Coping plan/target setting Practice
Slide 33 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT CBT To summarise: STOP Plan S = pay attention to signs of anxiety T = pay attention to anxious thoughts O = think of other helpful thoughts P = praise and plan for next time.
Slide 34 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Modifications of CBT for Young people with ASD More concrete and visual: worksheets, pictures, social stories, thermometer, feelings diary Use of special interests Adapt to suit developmental level Include social skills training Use a written schedule Concrete language Creativity Questioning though use of role play or give choices/alternatives
Slide 35 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Summary Young people with ASD are vulnerable to anxiety Emotional education is key. Use “tool-box” for helping strategies CBT useful – requires modifications Parents have important role UNDERSTAND AND SUPPORT
Slide 36 - Dr Clodagh Doyle, Consultant Clinical Psychologist, NHSCT Thank you for listening