Treating Anxiety in Children and Teens with ASD
How to Desensitize Autistic Children
Many autistic children are born with significant sensory issues. They can be startling, upsetting, or even painful to the individual. This article explains how to methodically reduce sensitivities in vision, hearing, and touch using gradual exposure.
Assessment and Accommodation
Before beginning desensitization, it is important to understand how bad the sensitivity is, and if there is an easier way to deal with it.
Assess the child's sensitivities, to find out how severe they are.It's important to understand the problem before trying to help the child overcome it.
If the child can communicate, take the time to ask them about their sensitivities.What bothers them the most? Does anything hurt or startle them? What would they like help with?
- You will want to know more than what causes severe pain—also look for what causes discomfort or mild distress. You might want to start with a smaller goal: for example, help them feel comfortable in t-shirts before worrying about jeans or sweaters. This eases them into the process and keeps it from feeling too intimidating to them.
After the assessment and interview, make a list of the stimuli that upset the child.Consider how much each sensitivity impacts the child's success and comfort. This process works best for hearing, touch, and vision, so this article will focus on those.
- Hearing may include sudden sounds, loud sounds, or too many contrasting sounds.
- Touch may be specific to specific sensations such as heat, cold, or rough textures.
- Vision may include too many variables that are distracting, too much movement, bright lights, or sudden moves.
See if you can provide accommodations to get rid of any of the upsetting stimuli.Ask parents, the child, teachers and other adults, and autistic writers (many of whom post helpful articles online) for ideas.
- Visually sensitive children can sit up front, so other students do not distract them. Their desk might also be angled so that their vision to the hallway or window is blocked.
- Sometimes, earplugs and white noise are a good way to minimize distressing sound.
- If the child's tactile sensitivities are mild, it may not be worth the time—instead, the painfully itchy sweaters can be donated, and the child can help pick out softer clothes during the next shopping trip.
Talk to others about being considerate of the child's needs.For example, if a teacher regularly shouts to quiet a noisy class, ask the teacher if they could flicker the light switch instead.
Desensitization works best when the child feels comfortable and empowered. Sometimes, part of the aversion is psychological—they remember feeling pain or fear from similar stimuli, so anxiety worsens their reaction. Gently introducing the child can reduce or eliminate that anxiety.
Find the thing that upsets the child.Show it to the child, and explain how the desensitization process works. For example, if you are going to help them handle a school bell, then talk to them about how you'll help train their brain to feel less startled by it.
- Even if the child can't communicate well, it is important to explain what you are doing—the child probably can understand some or all of what you're saying. It also establishes trust, by showing that you care about them and want them to feel involved.
Allow the child to experience the object in a non-threatening way.For example, if you'll be using a flashlight, let them explore it and turn it on and off. If you're desensitizing them to wearing jeans, then let the child touch the buckle or stick their fingers in the legs, without needing to wear them.
- Model playing with the object— run your hand along the flashlight, and show them how the on/off button works (while being careful to point it away from the child). Then offer it to the child.
- Keep it fun and open-ended. If they want to stick their hands in the jeans and wave them about, let them. If they only feel comfortable with touching them with one finger, that's also okay. Encourage their play and congratulate them on doing well.
- This step is crucial to the child's comfort—when they can play with and explore the object on their own terms, they feel in control. If they can manipulate the object how they choose, it becomes much less frightening.
Listen to any concerns they have, and reassure them as best as you can.Let them know that they control the pace, and if something hurts, they can say "stop" and it'll stop. Offer to answer any questions they have about desensitization.
- If they instinctively withdraw from the object, remind them that they're in total control, and nothing unexpected will happen. Encourage them to engage with it a little (e.g. stroking it with one finger) and asking how they feel.
- If they're still afraid, take it away, and start with something smaller (e.g. a tiny flashlight instead of the big bright one), or work on a different stimuli altogether.
Stepping Up with Desensitization
Once the child feels comfortable at a certain step, it is time for a small and controlled escalation.
Talk to the child about the next step.For example, a school bell can be simulated using a phone's ringtone.
Offer a coping mechanism to the child.(If the child is old enough, these can be brainstormed together.) Explain it in a cause-and-effect manner: "When the school bell rings, you can squeeze the stress ball to help you feel calm."
- Coping mechanisms include stress balls, chew toys, deep breathing, deep pressure (e.g. squeezing hands), fidget toys, other stims, and more.
- Try running a simulation to prepare them. Tell the child that you're going to pretend to be a school bell, and you'll say "Ring!" (See if you can make them laugh.) When you say "Ring," they should squeeze the ball. Then give it a try, and congratulate them when they succeed.
Introduce the preparatory stimulus.For example, turn up the volume on the phone together. (If the child is old enough to do it by themselves, then let them choose the volume; otherwise, show them the phone as you turn up the volume.)
- After the first trial, ask them how it was. If they seem shaken, then you've pushed them too hard, and you should turn down the volume or take a break.
It may take several tries before they learn to use the coping mechanism on cue.If need be, use a visual or auditory prompt to help them learn.
- Only turn the volume of the phone up again when the child appears to have mastered using the stress ball as a release for the adrenaline caused by the sudden ringing phone.
When they succeed, congratulate them.Let them feel the success, and continue doing trials so that they gain mastery. [[
Once they feel comfortable and confident at a certain level, increase the stimulus.Ask the child if they're ready to move on, and if so, turn up the volume together.
Offer the next step up.For example, once the child has mastered the cell phone, they can move on to a handheld bell.
Recordings of a sound can also be useful, because it is easy to gradually increase the volume.
Know that bad days will happen.Some days, the child may be feeling more tired or overstimulated than usual, and may need to temporarily return to an earlier step. This is all right—some sensory days are worse than others, and respecting that will help the child feel safe. Continuing at an easier level will allow the child to practice comfortably, and you can return to the previous level tomorrow.
Throughout the process, keep a close eye on how they're doing, and if they're showing signs of distress.If they're getting upset, then they've been pushed too hard, and may need a break, or should go back to a lower level of stimulation. Pushing them harder may result in a meltdown, and if you ignore very obvious distress, you may undo all progress. Here are signs that they're overwhelmed:
- Withdrawing, communicating less, seeming anxious, or crying
- Easily upset
- Stimming a lot (e.g. rocking) paired with withdrawal or an unhappy expression
- Pushing away the object, or refusing to interact with it (e.g. covering ears)
- Trying to leave or ignoring you
Transitioning to the Real Thing
Once the child has mastered the stimulus in therapy, it is time to encounter it in everyday life. Introducing this can be friendly and playful, to ease the transition.
Help the child predict when they will encounter the stimulus.If they are going to handle a school bell, try giving them a timer or watch so that they know when it will happen. If they'll encounter pots and pans, explain when their parents usually cook, and what signs show that cooking will happen.
Place them in the situation where the stimulus will occur.Continue the therapy version (instead of the real version) for a while longer, to keep the transition from being too abrupt.
Keep notes.When the child is close to meeting the goal (e.g. wearing jeans for most of the day or playing the bell sound at almost full volume), it's time to try completing the goal. Ask them if they think they're ready to try the real thing. If they say yes, decide when they'll try, and if they say no, ask again in a few days.
Attempt to complete the goal.Give the child extra support (e.g. a verbal warning shortly before the bell will ring, or extra time in their quiet corner with a weighted blanket).
The experience may be somewhat unpleasant for the child.They might feel startled by the school bell because it is so loud, or they may want to take off their jeans before the end of the day.
- If they can't meet the goal on the first day, that's okay. Let them have a break. Return to where they were before, and they can try again in a day or two.
- The experience should not be too negative for them. If it is, then they were not prepared enough, and it'll take a while before they can handle it again.
- Never force a child to continue engaging with an upsetting or painful stimuli. If they say they need a break, respect that.
Continue supporting them.Give them positive feedback when they do well, and check up with them to make sure that they're comfortable. Make it clear that if they feel uncomfortable at any time, they can come to you.
Continue taking notes on the process.When the child shows no obvious signs of distress, and requires only moderate amounts of stimming to cope, then they have been successfully desensitized.
Congratulate the child.Tell them that you're proud of them for working hard, and never giving up. Express your happiness that they feel more comfortable now.
Even after the process is complete, continue checking up with the child.They may have bad days, or experience a relapse and need for the program to be briefly re-implemented. Always make sure that they feel comfortable and safe.
- Desensitizing moves in planned and methodical steps, but the timetable is not strict. It's important to move at the pace that the child can handle.
- In some cases, the team may feel that small rewards will help the process.
- Use no more than one or two desensitization plans at a time. Anxiety can escalate exponentially, and even if the child appears to be doing well, it's important to give them plenty of downtime. Targeting too many senses at one time can overwhelm them.
- If the child has a team of specialists, work with them. Keep them up to date, and coordinate so that they never have too many programs (psychological, desensitization, occupational therapy, schoolwork) running at the same time.
- The team may be the Individual Education Planning team, or the equivalent if the student is not in special education, but is in a 504 plan, or supported education for most of the day.
- Never take control of a child's body (e.g. grabbing their face or holding down their hands). At best, they will feel upset and wary of you. At worst, they will develop Post-Traumatic Stress Disorder, lose all trust in adults, and stop believing that a "no" will and should be respected.
- Pushing a child too hard rarely works (if ever). If the child is showing signs of stress, discuss it with the team.
- Remember that disabled children are often on many programs for overcoming challenge at home, one the bus, in classes, in the hallways, etc. It is better to attempt less at any given time and succeed than to be overzealous and cause the student to fail.
- It's very important to keep the child aware of what's going to happen. It helps them to feel valued, and reduces any element of surprise.
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