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Asperger Syndrome and Anxiety

by Meena Dasari, Ph.D.

Asperger Syndrome defined

Children with Asperger Syndrome (AS) have average intelligence, but have difficulty in grasping social interactions and in understanding emotional experiences. Asperger Syndrome affects about 2 in 10,000 children in the U.S. Early intervention and treatment programs that combine behavioral, social communication, and family interventions usually lead to a better quality of life for children with Asperger Syndrome.

Children with Asperger Syndrome and co-occurring anxiety

It is estimated that up to 80% of children with Asperger Syndrome also experience intense anxiety symptoms. Anxiety Disorders such as Obsessive Compulsive Disorder, Social Anxiety, and Generalized Anxiety Disorder commonly co-occur with Asperger Disorder. When anxiety symptoms are untreated, they can further interfere with a child's quality of life. Children with both Asperger Syndrome and Anxiety Disorders experience a more limited social world than children with only one disorder.. They may have difficulty in adapting at home and in school by avoiding opportunities to make friends, join social activities (e.g., joining a club), and break their usual rituals to try something new.

How anxiety symptoms are manifested in children with Asperger Syndrome

Although little is known about what anxiety symptoms look like in children with Asperger Syndrome, the following symptoms, which overlap with Anxiety Disorders, indicate anxiety:

  • Avoidance of new situations
  • Withdrawal from social situations
  • Irritability
  • Somatic complaints

Another set of anxiety symptoms may be seen and may be unique to children with Asperger Syndrome:

  • Increased insistence on routines and sameness
  • Increased preference for rules and rigidity
  • Increased repetitive behavior
  • Increased special interest
  • Becoming explosive easily (e.g., anger outbursts)
  • Becoming "silly"

Treatment of anxiety symptoms in children with Asperger Syndrome

Cognitive behavioral therapy, a time-limited approach designed to change thoughts, emotions, and behaviors, has been shown to be successful in treating Anxiety Disorders in children.

For children with both anxiety symptoms and Asperger Syndrome, an innovative group therapy program using cognitive behavioral therapy has been developed at the University of Colorado. 1 The program includes specific modifications for working with children with Asperger Syndrome and Anxiety Disorder and consists of both a child component and a parent component.

Modifications designed to address the cognitive, social, and emotional difficulties include:

  1. "Individualizing" anxiety symptoms—Children should be helped by the therapist to identify what their own anxiety symptoms look like as anxiety symptoms may present differently.

  2. More education on emotions—Activities such as feeling dictionaries (i.e., a list of different words for anxiety) and emotional charades (i.e, guessing people's emotions depending on faces) are helpful in developing emotional self-awareness.

  3. Combining visual and verbal materials—Use of worksheets, written schedules of therapy activities, and drawings can be added to increase structure in therapy sessions

  4. Games and fun physical activities are important to include in group therapy to promote social interactions.

  5. Behavioral management—Addition of a reward and consequence system maintains structure and prevents anger outbursts.

  6. Greater parent involvement—To build on the attachment between child and caregiver, it is important to have parents learn the techniques and coach children to use them at home.

There is some early evidence to suggest that cognitive behavioral group therapy with specific modifications can be successful in treating anxiety symptoms in children with Asperger Syndrome In a study involving children with both disorders most benefited from their participation in the group therapy program and showed fewer anxiety symptoms after 12-weeks of consistent attendance.2 Future research is being done to get stronger evidence for the effectiveness of the group therapy program.

References

1. Reaven, J., Hepburn, S., Nichols, S., Blakeley-Smith, A., Dasari, M. (2005). Coping Group: Fighting Worry and Facing Fear. Denver CO: University of Colorado Board of Regents. Manualized cognitive-behavioral treatment for children with Asperger Disorder and Anxiety Symptoms.

2. Reaven, J., Dasari, M., Hepburn, S. Nichols, S. (2004, October). Cognitive-Behavioral Group Therapy for High-Functioning Autism and Anxiety: A Pilot Study. Paper presented at the 21st Annual Conference of National Association for the Dually Diagnosed, Vancouver, Canada.

Related on AboutOurKids.org

Read more Asperger and Other Pervasive Developmental disorders here.

Read more about Anxiety disorders here.

About The Author

Meena Dasari, Ph. D., a psychologist, is a Post-doctoral Psychology Fellow at the NYU Child Study Center Institute for Anxiety and Mood Disorders. In addition to treatment of anxiety in children with Asperger Disorder and anxiety, Dr. Dasari has been active in research and treatment in the areas of emotion regulation, medical adherence in diabetic treatment, and brain imaging in schizophrenia. The results of her research have been published in several professional journals.