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Prakash Chandran (Host): Children on the autism spectrum are more likely to suffer from anxiety, and the impact on a child can be quite substantial, but what can parents do to help their autistic child who might be experiencing this? Let’s talk with Dr. Christopher Lynch, director of the pediatric behavioral medicine department at Goryeb Children’s Hospital. This is Building Healthier Communities the podcast with Atlantic Medical Group. I'm Prakash Chandran. So first of all Dr. Lynch, can you tell us about the connection between autism and anxiety?

Christopher Lynch PhD (Guest):   Sure. Well kids on the autism spectrum, like any other kid, could have anxiety for a variety of different reasons. Academic pressure, family issues, health issues. However, there are additional factors that increase the prevalence and the severity of anxiety in kids who are on the autism spectrum.

Host: Okay. So tell us about some of those other factors that contribute to that.

Dr. Lynch:   First there is cognitive processing factors. So kids on the autism spectrum tend to process information in a detail oriented way. This can be a wonderful strength at times, but it can also make it difficult when there’s unexpected change or when a child is required to make a transition. There are also sensory sensitivities as well. This is a huge factor. So kids who are on the autism spectrum are sensitive to noises, tactile sensations, etcetera. There are also social challenges for kids who are on the spectrum. Kids on the spectrum want to interact. However, they may have some difficulty with processing what the rules are and what the nuances of social situations are. This gets more complicated as the child gets older and as social situations become more complexed and nuanced and this can also create anxiety.

The fourth factor is language processing. Kids on the autism spectrum often have challenges with processing language. It could be expressive language, receptive language, and also pragmatic language, which is the understanding of the social application of language. So if there’s a lot of language going on, it’s not so much that the child can't understand it, but if there’s a lot going on within a relatively short period of time that can be overwhelming.

Then the final factor is what I call task frustration. So kids on the spectrum are fantastic at a range of different tasks and have a range of different abilities, but there are some areas that they may have some difficulty with. Fine motor skills being one. As they get a bit older and as some of the tasks at school become a bit more abstract, that’s another one. Writing is another one. It’s not that they can't improve at it, but very often when they're first learning or first coming into some challenges with those tasks, that is also an area of significant frustration. That frustration quickly leads to anxiety.

Host:   Got it. So what you're talking about here is those five prime suspects of what makes childhood anxiety actually happen. If I can recap them, it sounds like it’s if there’s any change in routine or schedule, things around social differences, the auditory senses, language processing, and task frustration. Is that correct?

Dr. Lynch:   Yeah, that’s right. Sensory sensitivities in general, not just auditory. It could also be, for example it could be lights, it could also be senses such as the sense of balance, internal sensations as well. Kids on the spectrum tend to have those sensitivities to a range of different sensory input and that’s very often a cause of anxiety. Across the board, but particularly in social situations because a lot of social situations do have a very high degree of sensory components. If you think about it, if you're at a birthday party it’s very loud, it’s very crowded. There’s often a lot going on with regard to the lighting and all of that can be overwhelming.

Host:   Yeah, certainly. So I'm wondering for parents how important is teaching stress management skills to their autistic children?

Dr. Lynch:   Well, it’s very important. My focus is first prevention is better than cure. So certainly for each of those factors there’s things that where the onus is on us to modify and to accommodate the environment to prevent anxiety from occurring in the first place. So, for example, preparing a child for change in transition. Helping them to be aware of what’s coming up next will help. Reducing those sensory factors. So if you can reduce noise, again, that can go a long way towards reducing anxiety. Supporting kids in social situations and making sure that they're in social situations that they feel confident in and accepted in. Providing those language supports and making sure that when our child is distressed that we’re giving them language at a pace that they can manage, and also accommodating their task frustrations.

So that would be my first step would really be my first step to really look at what factors are contributing to a child’s anxiety and first try to prevent through support and accommodation. However, no matter how much support and accommodation we provide, we will never be able to eliminate anxiety for any child. So I think it’s also important to teach stress and anxiety management strategies so that if a child does start to become overwhelmed, he or she can start implement them to prevent anxiety from escalating.

Host:   Yeah so let’s talk about some of those strategies because I imagine that when a child becomes stressed or really anxious or overwhelmed, the parents kind of react in that same way. So let’s talk about maybe some of the prime methods that you teach parents to cope with this.

Dr. Lynch:   Sure. That’s an excellent point. I mean anxiety’s contagious. For any child, if our child is anxious or upset or if there is some kind of behavioral challenge, as parents we tend to get even more upset. Then we tend to use more language, for example, to try to guide them towards a different outcome. That, for kids on the spectrum, can often have the opposite effect. So if we are providing a lot of reprimands, if we’re providing a lot of redirection, and we’re using a lot of language when our child starts to get upset, that can actually make the anxiety get worse.

So I find that kids on the spectrum can learn and relaxation strategy that any other child can learn. So I use, for example, deep diaphragmatic breathing. I use something called progressive muscle relaxation where a child goes through the different body parts and learns what it feels like when their muscles are tense versus what it feels like when they're relaxed. I use imagery techniques. Whether that’s imagining some kind of visual that makes the child feel more relaxed. Mindfulness meditation. I find that kids on the spectrum, they see the value of the relaxation strategies and they can learn them.

I do find that it’s important when teaching these relaxation strategies to explain it in a way that makes sense. Things have to have a clear rationale for kids on the spectrum. I also find that using visual supports to teach strategies can also help, but, again, kids on the spectrum can learn any other relaxation strategy that any other child can. So it’s important to teach these, but it’s also important to prompt, remind, and to que our children when, where, and how to use them.

Host:   Yeah, you know, one thing I really like here is that you're giving them a framework not only to identify the suspects of what is causing the anxiety, but then giving them strategies and how to cope with them. When I'm hearing you talk about some of these things—like deep diaphragm breathing, muscle relaxation and tensing—they're something that we can all use. So certainly for parents as well. You know, I'm curious because I imagine that a lot of these parents might have caretakers or teachers that are working with their children. Is it worth also involving these people in creating these stress management techniques or bringing them into the fold with the strategies you're talking about?

Dr. Lynch:   It’s not only preferable. It’s absolutely crucial to involve anybody who is supporting a child who is on the spectrum throughout the day into the fold with regards to anxiety management. Kids spend a significant portion of their day in school. So school is a really important place to support the child in terms of anxiety management. So it’s important for the school to be aware of those prime suspects and to accommodate and to support the child in that regard. It’s also important for the school to be aware of any anxiety management strategy that the child knows so that school personnel can prompt, remind, and que the child before, during situations that may cause anxiety.

Host:   Yeah, that’s a fantastic answer. One of the last things I always like to ask is what do you wish that more parents with children on the spectrum knew before they came to see you.

Dr. Lynch:   Well, you know, parents often get a lot of behavioral advice. I certainly understand that, and certainly challenging behavior, by definition, is challenging. I think it’s very important to understand that very often it’s anxiety that’s driving that behavior. The behavior is not intentional. If the behavior is not intentional, not only is it not fair to work at the behavioral level in terms of consequences, but it’s also going to be ineffective. Because until you address that anxiety, you're not going to address the behavior. So it’s important to be aware of what factors are driving that behavior and to work to reduce those factors in addition to supporting the child with positive management strategies. It’s really important to first look at—Do a little bit of detective work, step back and look at the context of what is driving that behavior because that’s ultimately what's going to be the most effective approach.

Host:   Well, that’s fantastic advice for any parent, Dr. Lynch, and we really appreciate your time today. That’s Dr. Christopher Lynch, the director of the pediatric behavioral medicine department at Goryeb Children’s Hospital. Thanks for checking out this episode of Building Healthier Communities with Atlantic Medical Group. For more information on this topic and to access the resources that were mentioned, call 973-971-6305 or visit us on the web at findadoctor.atlantichealth.org. If you found this podcast helpful, please share it on your social media channels and be sure to check the entire podcast library of topics of interest to you. Thanks and we’ll see you next time.