A presentation by Sarita Freedman, PhD 26540 Agoura Road, Suite 100 Calabasas, CA 91302 (818)...
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Transcript of A presentation by Sarita Freedman, PhD 26540 Agoura Road, Suite 100 Calabasas, CA 91302 (818)...
AUTISM ACROSS THE LIFE SPAN
ANXIETY & AUTISM
A presentation by
Sarita Freedman, PhD26540 Agoura Road, Suite 100
Calabasas, CA 91302(818) 999-9330
[email protected] www.saritafreedman.comwww.collegeonthespectrum.com
© 2012, Sarita Freedman, PhD
What is Anxiety?
Worry, nervousness, fear Biologically meant to be
protective Feelings arise in the “reptilian
brain” part of the emotion center of the brain (amygdala)
Fight or flight Can also be motivating
© 2012, Sarita Freedman, PhD
When is Anxiety a problem?
Everyone worries at one time or another!
Anxiety is a problem when:It interferes with doing your job
(school, work, chores)It makes you avoid thingsIt affects your family, friends, or
associates
© 2012, Sarita Freedman, PhD
What does Anxiety feel like?Physical
Fight or flight – you want to run away or you want to protect yourself by fighting back Heart palpitations Chest pain Sweating Heavy or difficult breathing/hyperventilation Stomach aches/nausea Dizziness Shaking or trembling
© 2012, Sarita Freedman, PhD
What does Anxiety feel like?Emotional & Behavioral
It can feel AWFUL…like you can’t stand being in your own skin
Difficulty sleeping, restlessness Fatigue and low endurance Tantrums and/or aggression Avoidance Repetitive thoughts/behaviors to avoid
worrying (OCD, different than “stimming”)
© 2012, Sarita Freedman, PhD
What does Anxiety feel like?Cognitive
Distractibility, unable to concentrate Confusion Poor problem solving (reptilian brain) Cognitive distortions
All or nothing thinking (black or white) Catastrophizing/minimizing Jumping to conclusions (making assumptions) Magical thinking “Should” statements
© 2012, Sarita Freedman, PhD
ASD can complicate anxiety
Difficulty understanding the world
Difficulty understanding emotions – own & others’
Difficulty taking another’s perspective
Social challenges Correlation between low social assertiveness
and high social anxiety© 2012, Sarita Freedman, PhD
Communication challenges
Difficulty asking/knowing when to ask for help
Learning and executive functioning challenges College students with ASD report higher anxiety
than non-ASD college students
© 2012, Sarita Freedman, PhD
Difficulty with transitions and shifting
Difficulty with emotion regulation
Narrow focus on preferred activities or topics (reduce anxiety; familiarity)
Need for sameness (reduce anxiety)
Sensory overload can trigger anxiety© 2012, Sarita Freedman, PhD
Managing Anxiety: General
Visual supports Calendars/Schedules Charts Pictures/written instructions Lists
Practice switching from preferred to non-preferred tasks Activity choice chart
© 2012, Sarita Freedman, PhD
Activity Choice Chart
Tasks Completed
CraftsBoard GamesReadingPlay OutsideWatch TVPlay with PetsComputer GamesHomeworkCookingListen to MusicPlay Video GamesArt (color, painting…)Make Believe PlayDress UpClean RoomCall a FriendBuild Stuff (legos, blocks…)Laundry
(excerpted from Developing College Skills in Students with Autism & Asperger’s Syndrome, Jessica Kingsley Publishers, 2010)
Managing Anxiety: Social
Social skills training (1:1 w/adult peer dyad peer groups) – school, home, community
Adult support faded Buddy or peer mentor (especially in
college) Theory of Mind
Perspective taking Intention/desire Social Thinking (Michelle Garcia-Winner)
© 2012, Sarita Freedman, PhD
Assertiveness training Learn when, how, and who to ask for
help Participation in activities with peers
Boy/Girl Scouts Acting classes, theater Clubs (especially in college)
© 2012, Sarita Freedman, PhD
Managing Anxiety: Behavioral
Feelings thermometer/scale (rates anxiety from 1 – 10) Offers a visual aid to see the intensity Good tool for student and parent/teacher to
compare their ratings of student’s anxiety (perspective)
Excellent way to monitor reduction in anxiety over time
Different ways to express anxiety/worries (talking, writing, drawing, reading, puppets)
© 2012, Sarita Freedman, PhD
Work with a professional to learn Relaxation strategies Deep breathing (4-4-4) Visualization Use of a worry box Increase self-awareness Learn to predict and prepare for stressful
situations (Social Stories/Comic Book Conversations by Carol Gray)
Other calming strategies (listen to music, rock, trampoline, time-limited video games, breaks, etc.)
© 2012, Sarita Freedman, PhD
Anxiety Tool Box Can include cue
cards containing all of the strategies that have worked.
Cards can be in picture format or written
Pictures, memories, music
Tool box can be actual or imaginary (doesn’t need to be a box, can be anything)
© 2012, Sarita Freedman, PhD
Cognitive Behavior Therapy (CBT)
Relationship between thoughts, emotions and actions
Identify cognitive distortions Learn to challenge cognitive
distortions Increase self-awareness Increase emotional awareness in self
and in others Learn coping statements/strategies (I
can do this; stress ball) © 2012, Sarita
Freedman, PhD
Anxiety: Medical Management
Get a physical to rule out medical conditions that can contribute to/cause anxiety High blood pressure Thyroid condition Other metabolic/medical conditions
Once medical causes ruled out, see a psychiatrist for a medication evaluation
© 2012, Sarita Freedman, PhD
Why a Psychiatrist vs. Internist?
PSYCHIATRIST INTERNIST
Knowledge base of a specialist vs. generalist
Tend to be covered by insurance because MD
Better monitoring of effectiveness/side effects
Especially with ASD, must know in’s & out’s
May be competent in prescribing psychotropic meds
Not specialists, so prescribing not as nuanced
Follow-up is not as thorough in most cases
ASD knowledge may be limited
© 2012, Sarita Freedman, PhD
Neurotransmitters & the Synaptic Space…a simplified explanation
Neurotransmitters = chemicals that regulate various functions, including mood
Stay in the synaptic space in order to be effective Current medications act as “reuptake inhibitors”
Spectrum of mood disorders now thought to be biochemical imbalances, much like diabetes or thyroid issues© 2012, Sarita Freedman, PhD
Societal Stigmas, Myths & Truths
Shame/embarrassment about “needing” medication or seeing psychiatrist
Medication is NOT A CRUTCH
Medication is used to balance out chemical imbalances in the brain – a medical problem
© 2012, Sarita Freedman, PhD
When managed correctly, no addiction
Some people may need a short course, many may need life long – so what?
Examine your pre- and mis-conceptions
You don’t have to suffer!!
© 2012, Sarita Freedman, PhD
Complimentary Treatments
EXERCISE!!! Natural endorphins Daily practice of relaxation strategies
& mindful meditation – these strategies will not work without consistent practice
Build both exercise and relaxation/meditation into daily routine (not just for ASD!)
Good “sleep hygiene” Develop an ethic of taking care of
yourself – commit to yourself!© 2012, Sarita Freedman, PhD