Anxiety in Young People with a Learning Disability
We all experience anxiety at some point in our lives (e.g. during exams or when trying something for the first time). However, children and young people with a learning disability and/or autism are more likely to experience anxiety than other children. In fact, anxiety is thought to be one of the most common forms of psychological distress for people with learning disabilities and/or autism.
Anxiety can be understood as a psychological and biological state underpinned by a situation, thoughts about a situation, physical sensations and behaviour.
These characteristics interact and contribute to an unpleasant feeling associated with fear and worry. Sometimes anxiety is generalised across situations, and at other times it may be related to something specific (e.g. a phobia of dogs or spiders). In order to understand the cause and maintenance of anxiety it is useful to consider the key characteristics and their interaction (see the diagram below).
What is actually happening.
What we feel in our body (e.g. breathlessness, feeling hot, increased heart rate, shaky, feeling ‘butterflies’ in your stomach, needing to go to the toilet more than usual).
What we think about the situation or about how our body is feeling (e.g. ‘something terrible is going to happen’ or ‘I’m going to collapse’).
What we do (e.g. avoiding feared object or situation, moving away from situation/object).
Common causes of anxiety
Sometimes when a child with learning disabilities is challenging, others interpret their challenging behaviour as being intentional and the child is seen as difficult and awkward. However, children with learning disabilities may be struggling to communicate their feelings of anxiety and instead may present with changes in behaviour, such as aggression, self injury, withdrawal, crying, disturbed sleep patterns, or screaming.
Causes of anxiety for children with a learning disability and/or autism include:
A change in routine.
Sudden or lots of changes.
Over-stimulating environment (e.g. very bright or noisy).
Traumatic experiences (e.g. injury or bereavement).
What can you do as a parent/carer?
Often, children with learning disabilities and/or autism need routines in order to understand situations and structure their time. Having regular routines for everyday activities helps them to know what is happening and alleviates any uncertainty and anxiety caused by not knowing what’s coming next. Visual timetables are often helpful for communicating the routine. You might want to take a look at our advice on Introducing Routines.
HELPING WITH UNDERSTANDING
Helping children to understand situations can enable them to cope better and to be less anxious. For example, there are books and games that can help children with learning disabilities and autism understand about illness, separation and bereavement.
It's helpful to prepare your child as much as possible for what is expected of them and also for any changes in routine which may be happening, whether these expectations or changes are small (e.g. shower then get dressed) or large (e.g. moving to a new home). Often symbols and social stories are useful.
PROVIDE CALM AND REASSURANCE
Showing (modelling) to your child that the feared situation/object is OK, and providing reassurance of this, may help to alleviate some of their anxiety as they observe others coping well with it.
What treatments are available?
BEHAVIOURAL AND COGNITIVE BEHAVIOURAL INTERVENTIONS
Behavioural and cognitive behavioural approaches are commonly used for treating anxiety in children with learning disabilities. These require a specialist to observe and spend time with the child, to help identify the possible triggers and maintaining factors contributing to the anxiety.
Possible interventions could be:
Teaching the child relaxation skills (e.g. progressive muscle relaxation).
Graded exposure, where the child is exposed to the feared situation/object in a graded manner (gradually increasing the exposure over time). This is often combined with relaxation and aims for the child to learn that the feared situation is ok and that they can cope with it.
Some older children may benefit from anti-anxiety medications. A qualified Psychiatrist would be able to provide you with more information.
When to consider asking for more specialist help
CONSIDER SEEKING HELP:
If you are struggling to cope with your child’s anxiety problems and any related behaviour changes.
If your child is struggling with their anxiety and this is impacting upon their daily life (e.g. struggling to access the community).
If your child’s anxiety is seriously affecting their mental wellbeing, personal relationships or quality of life.
Please talk to your Paediatrician, Social Worker, or School about a referral to the LD-CAMHS team.
Further support, advice and self-help
The National Autistic Society provides information and support for people with Autism and their families and for professionals. They are a very active organisation and offer some really useful information about strategies and approaches for supporting people with Autism.
The British Institute of Learning Disabilities also have some useful information and further advice about a variety of common issues.
Local Offer is a Derbyshire-specific site which allows you to search for lots of different services, including parenting support groups, in the local area.