Help Your Child on the Spectrum Conquer Their Fears

On October 31st, many Americans will celebrate Halloween. A holiday built around scaring people through creepy costumes, spooky decorations, haunted houses, horror movies, and much more. I have suffered from generalized anxiety disorder most of my life. Just thinking about Halloween brings many of my fears and phobias top of mind.

Just like me, many people experience anxiety associated with distinct fears and phobias. This type of anxiety occurs at much higher rates in individuals with Autism Spectrum Disorder (ASD). Several studies have shown that nearly 40% of individuals diagnosed with ASD are also diagnosed with anxiety disorder, usually accompanied by specific phobias (van Steensel, Bogels, and Perrin, 2011).

In this blog post, I will focus on several approaches that parents and educators can use to help their anxious children or students address their fears. These techniques are founded on the scientifically proven elements of cognitive-behavioral therapy (CBT).

The Problem with Phobias

Healthy fear is flexible. As a matter of fact, many children with ASD never encounter enough healthy fear responses in certain circumstances, which may result in unsafe behaviors such as eloping. Fear is seen as—a phobia—when a child’s fear is excessive, disproportionate to the circumstance (commonly cited as irrational), and/or hinders the child's behavior. Listed below are several examples of possible phobias:

o The child nervously anticipates a fire drill because he heard a fire engine drive by the school;

o The child panics when his class sings the "Happy Birthday" song to a peer;

o The child screams and runs away every time he sees a certain peer walking towards him;

o The child frets about school parties and experiences insomnia for days prior to the event;

o The child is so afraid of making an error that he won't complete his schoolwork;

o The child is so concerned about losing, that she won't play games with her classmates.

How do Children Develop Phobias?

In general, the child encounters a situation that scares, surprises, or feels distressing to them. These situations may even become fear triggers later on. For example, a child gets startled by thunder during a storm or is extremely upset when eating any food with texture such as beans or peas because they feel like they are choking. These unpleasant events trigger the child’s fear reaction any time the child finds himself in that same situation or a similar situation in the future. As a general rule, the child will broaden his fear of things connected to the original situation. For example, if the child was first frightened by a balloon popping at a birthday party, that fear may evolve into a fear of clowns because a clown was holding the balloon when it popped. This is known as anticipatory anxiety or “fear of fear.”

To address this chain of events, parents or educators may try their best to keep a child or student away from fear-inducing situations. This may be the preferred course of action, as long as it does not seriously hamper the child’s or family’s lifestyle; In reality, it's not possible to avoid every fear-inducing situation a child will encounter. For example, if a child is afraid of the dentist or doctor, they will eventually have to go in for dental or medical care. Even when evasion is possible, it can keep the child from participating in rewarding and enjoyable activities.

Another strategy parents and educators use to prevent a child from experiencing anticipatory anxiety is they don't tell the child about a fear-inducing event, ahead of time. This approach is ineffective at reducing the child's anxiety during the actual event, and the child will continue to connect it with fear. Additionally, this strategy can induce even more anxiety, because the child may constantly worry that the event will happen unexpectedly.

If the child gets proper therapy, the anticipatory anxiety preceding fear-inducing events can be reduced and the amount of anxiety the child feels during the actual event can also be reduced. "In other words, while shots still hurt; sounds still startle or hurt; and losing is less fun than winning, by reducing the degree of anxiety before and during events, these experiences can often become much more manageable for children"(Levine, 2013).

Treatment Strategies for Phobias at Home or School

According to Dr. Karen Levine, PH.D. Psychologist and Developmental Specialist, parents, and educators must develop a plan to purposefully and progressively expose the child to tolerable amounts of the fear-inducing trigger event followed up with exposure to strategies that will help the child decrease their anxiety. This can be accomplished by using the three-step process below:

1. Dissect the child's fears and identify everything that scares the child about a particular situation. In certain situations, the child may only be afraid of one thing, however, as time passes most fears contain multiple “bundled” elements as described above (e.g., fear of clowns in regards to their connection to popping balloons at a birthday party). It's possible that your child or student has fears that are trickier and have several bundled anxiety-triggering elements at the outset. For example, a child who is afraid of eating textured foods may also be afraid of eating lunch in the cafeteria on days those foods are served and the sensory elements related to noises and smells in the cafeteria. Consequently, sensual, psychological, and associative elements of fear-inducing situations can trigger anxiety for the child. You may be unable to identify all of the child's fears related to a specific phobia but do your best to discover as many as you can, because dissecting fear-inducing situations into separate parts, and weakening the child's fear response to each one, will result in more favorable outcomes.

2. Establish which self-regulation or co-regulation techniques will work best for your child or student during the fear-inducing exposure sessions. There is no one size fits all calming strategy so you will have to determine which particular methods will work best for your child or student in their particular situation. "Many children respond well to co-regulating strategies (those that involve another person, such as sharing humor with a favorite adult or peer, especially if the humor involves components of the feared event (e.g., the child pretends to give the adult “100 shots” while the adult yelps playfully), or adult-guided relaxation strategies" (Levine,2013). Self-regulating techniques include going for a walk, yoga poses, deep breathing, swinging on a swing, coloring a picture, drawing, listening to music, ripping up paper, watching TV, playing with a fidget toy, etc. These techniques may help your child cope with low levels of exposure to the feared situation. It is fine to combine self- and co- regulating techniques as needed.

3. Identify the methods you will use to dull your child or student's fear response and then follow up with anxiety-reduction activities. Deciding which fear-dulling methods to use may feel overwhelming initially. The main objective is to develop a plan of action to where you can introduce your child or student to the fear-inducing item(s) or situation bit by bit in a way that is not overwhelming and could even be appealing to the child. With this in mind, it is absolutely essential that the child’s responses to the methods you choose are closely observed so you can adapt your approach to optimize the child's interest and keep their fear to a minimum.

Methods and Measures for Progressively Desensitizing A child to Scary

Situations or Events

The book, Replays: Using Play to Enhance Emotional and Behavioral Development for Children with Autism Spectrum Disorders (Levine and Chedd, 2009) gives detailed role-plays and pretend play scenarios that parents and educators can use to desensitize their child or student to fearful situations and events.

YouTube has a video for almost any situation your child might find scary (e.g., fire drills, medical appointments, insects, or birthday celebrations). There are also Internet sites such as Soundsnap where sounds that scare your child like a toilet flushing, a vacuum, or loud laughter can be found. These video and audio resources can be useful in gradually introducing your child to the sights and sounds of places or situations they fear. There are several smartphone apps designed to address some of the most widespread phobias in an amusing, kid-friendly way. Some of these include the Toca Boca series and My Playhome.

Source: Levine, K., 2013. Treating Fears And Phobias In Children With ASD. [PDF] UC Davis MINDS Institute, pp.8-10. Available at: <http://drkarenlevine.com/wp-content/uploads/2016/02/LevineASQ36Summer2013-1.pdf> [Accessed 19 October 2020].