So, this past week I got an official diagnosis of generalized anxiety disorder (GAD). I’m gonna be honest, guys; though it was validating to hear it officially, I realized that I had GAD years ago. As a result, this isn’t going to be a post about self-discovery. Instead, this is a reminder, particularly for those of you who are caregivers of kids on the spectrum, to be aware of and look for anxiety disorders even in children.
I’ll explain. Anxiety disorders are highly common in people on the spectrum, the second most commonly diagnosed disorder for people on the spectrum to also get diagnosed with. They also can, and for many people certainly do, begin in childhood. Anxiety disorders come in many different forms – generalized anxiety disorder, as Caley and I have; panic disorder, as Caley has and I had; social anxiety disorder; and phobias, as Caley and I have both struggled with. If you’re not familiar with these disorders, it can be really easy to miss the signs of them, especially in children.
When Caley was growing up, dealing with both panic attacks and generalized anxiety, none of the members of our family had any clue what it was like for her. We knew she was anxious, sure, and got her medication for anxiety. But we didn’t know what it meant. We didn’t know how she felt, didn’t take her fears seriously because WE DIDN’T REALIZE. We didn’t know that her anxiety went beyond mere worry into actual disorders which fundamentally altered how she sees the world. This is a girl who has no difficulties with spoken communication, unless she’s under stress, and yet I never understood what she was going through until I developed my own anxiety disorders, despite her efforts to explain. For kids on the spectrum who DO have difficulty with spoken communication, then, it must be even harder to communicate what it’s like. And if you don’t know what you’re looking for, as my family found out the hard way, you have little chance of understanding what your child is trying to communicate. So here’s a crash course:
Generalized Anxiety Disorder
Constant, exaggerated worry. Unlike a phobia, there is no one stimulus which is associated with fear. Instead, regular worries are amped up. For example, if you haven’t heard from or seen your mother in a somewhat longer than average period, you might believe that something terrible has happened to her. If you notice it’s windier than normal, you might worry that there’s going to be a tornado. It’s constant ‘what if’ scenarios, but ones which feel absolutely real and are different for everyone. When GAD is milder, you can ‘push through’ the anxiety. When it’s bad, doing even basic every-day things can be too much. (As I discussed in an earlier post, On Anxiety and the Effort It Takes to Climb a Mountain and Make a Phone Call:http://www.autismspectrumexplained.com/our-blog/on-anxiety-and-the-effort-it-takes-to-climb-a-mountain-and-make-a-phone-call )
Learn more about GAD here: http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Panic Disorder
Panic disorder is characterized, unsurprisingly, by panic attacks. These involve an intense feeling of fear and last for several minutes or even longer. Panic attacks are associated with very physical symptoms - fast heartbeat, trouble breathing, dizziness, chest/stomach pain, sweating, and more. People with panic disorder may also grow afraid of and avoid being in places where they’d previously experienced panic attacks.
Another thing I’d like to point out is that panic attacks can also occur during sleep. For about a year growing up, I would wake up absolutely TERRIFIED at 3 AM in the morning, almost on the dot. I was certain something terrible was happening, and I had all the physical symptoms of panic attacks. Not knowing what was happening, I would move into my mother’s room whenever they occurred, seeking comfort. It got to the point that I was going into her room almost nightly and I was afraid to go to sleep. It never occurred to either of us that they were panic attacks, because, like most people, we didn't know that you could have panic attacks in your sleep. This is definitely something to look out for in your own children as well, as panic disorder is highly treatable and had we known I’m sure my mother would have gotten me help.
Read more about the signs of panic disorder in children and adolescents (which are different than those in adults!) here:
http://www2.massgeneral.org/schoolpsychiatry/info_panicdisorder.asp
Social Anxiety Disorder
Social anxiety disorder involves an intense fear of being judged by others. This fear is what sets it apart from the social difficulties inherent for people on the spectrum. Fear of criticism and humiliation, to the point for some of being afraid of speaking in public or being afraid of going to school, is the hallmark of this disorder. This is another disorder dominated by what if’s, ie. “What if I say something stupid?” or “What if they laugh at me?” There are physical symtoms associated with this, as well, such as sweating or shaking in the feared situation (and even beforehand).
Read more about social anxiety disorder here:http://www.childmind.org/en/health/disorder-guide/social-anxiety-disorder
Phobias
This is the anxiety disorder that most people have the greatest familiarity with, perhaps because it’s so pinpointed. A phobia is an intense and disproportionate fear of one specific thing, and its subsequent avoidance. That can be an event (flying – as Caley and I have struggled with), a place (heights), an animal (snakes or spiders, for instance), or any number of other things. You can, of course, have multiple phobias. They can develop quickly, and be for things a person wasn’t previously afraid of. Even if the person is aware they aren’t logical, they can still have a phobia of a stimulus. So, for example, Caley and I weren’t afraid of flying until we had one really turbulent flight when she was in middle school. Afterwards…instant phobia. Caley was absolutely terrified for the next leg of the flight that we had to get on not even an hour later, and during our visit in she tried to be as nice as possible to everyone, as she knew she was going to be forced to fly again to go home and she was going to die. I, too, developed a fear of flying from this incident, though I know it isn't rational (and, because of my fear, probably know far more about just how safe planes are than most people do).
The interesting thing about phobias is that many people think they can be cured without the help of the therapist, by simply forcing the person to confront the feared stimulus over and over. Please, please don’t try this with someone else on your own. Get a therapist to help your child to overcome their fear – as an untrained person, you risk making the fear even greater by trying it on your own and exposing your child to terror for no gain.
Read more about phobias here: http://www.childmind.org/en/health/disorder-guide/specific-phobias
BEHAVIOR IS COMMUNICATION
This a critical key to not only understanding people on the spectrum in general, but also detecting these anxiety disorders in them. If a person has trouble communicating by speech, a tantrum or melt-down may be their way of saying “I’m afraid of this!” It’s no less important to listen to their communication in that mode than any other.
Moving Forward
I’ll explain. Anxiety disorders are highly common in people on the spectrum, the second most commonly diagnosed disorder for people on the spectrum to also get diagnosed with. They also can, and for many people certainly do, begin in childhood. Anxiety disorders come in many different forms – generalized anxiety disorder, as Caley and I have; panic disorder, as Caley has and I had; social anxiety disorder; and phobias, as Caley and I have both struggled with. If you’re not familiar with these disorders, it can be really easy to miss the signs of them, especially in children.
When Caley was growing up, dealing with both panic attacks and generalized anxiety, none of the members of our family had any clue what it was like for her. We knew she was anxious, sure, and got her medication for anxiety. But we didn’t know what it meant. We didn’t know how she felt, didn’t take her fears seriously because WE DIDN’T REALIZE. We didn’t know that her anxiety went beyond mere worry into actual disorders which fundamentally altered how she sees the world. This is a girl who has no difficulties with spoken communication, unless she’s under stress, and yet I never understood what she was going through until I developed my own anxiety disorders, despite her efforts to explain. For kids on the spectrum who DO have difficulty with spoken communication, then, it must be even harder to communicate what it’s like. And if you don’t know what you’re looking for, as my family found out the hard way, you have little chance of understanding what your child is trying to communicate. So here’s a crash course:
Generalized Anxiety Disorder
Constant, exaggerated worry. Unlike a phobia, there is no one stimulus which is associated with fear. Instead, regular worries are amped up. For example, if you haven’t heard from or seen your mother in a somewhat longer than average period, you might believe that something terrible has happened to her. If you notice it’s windier than normal, you might worry that there’s going to be a tornado. It’s constant ‘what if’ scenarios, but ones which feel absolutely real and are different for everyone. When GAD is milder, you can ‘push through’ the anxiety. When it’s bad, doing even basic every-day things can be too much. (As I discussed in an earlier post, On Anxiety and the Effort It Takes to Climb a Mountain and Make a Phone Call:http://www.autismspectrumexplained.com/our-blog/on-anxiety-and-the-effort-it-takes-to-climb-a-mountain-and-make-a-phone-call )
Learn more about GAD here: http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad
Panic Disorder
Panic disorder is characterized, unsurprisingly, by panic attacks. These involve an intense feeling of fear and last for several minutes or even longer. Panic attacks are associated with very physical symptoms - fast heartbeat, trouble breathing, dizziness, chest/stomach pain, sweating, and more. People with panic disorder may also grow afraid of and avoid being in places where they’d previously experienced panic attacks.
Another thing I’d like to point out is that panic attacks can also occur during sleep. For about a year growing up, I would wake up absolutely TERRIFIED at 3 AM in the morning, almost on the dot. I was certain something terrible was happening, and I had all the physical symptoms of panic attacks. Not knowing what was happening, I would move into my mother’s room whenever they occurred, seeking comfort. It got to the point that I was going into her room almost nightly and I was afraid to go to sleep. It never occurred to either of us that they were panic attacks, because, like most people, we didn't know that you could have panic attacks in your sleep. This is definitely something to look out for in your own children as well, as panic disorder is highly treatable and had we known I’m sure my mother would have gotten me help.
Read more about the signs of panic disorder in children and adolescents (which are different than those in adults!) here:
http://www2.massgeneral.org/schoolpsychiatry/info_panicdisorder.asp
Social Anxiety Disorder
Social anxiety disorder involves an intense fear of being judged by others. This fear is what sets it apart from the social difficulties inherent for people on the spectrum. Fear of criticism and humiliation, to the point for some of being afraid of speaking in public or being afraid of going to school, is the hallmark of this disorder. This is another disorder dominated by what if’s, ie. “What if I say something stupid?” or “What if they laugh at me?” There are physical symtoms associated with this, as well, such as sweating or shaking in the feared situation (and even beforehand).
Read more about social anxiety disorder here:http://www.childmind.org/en/health/disorder-guide/social-anxiety-disorder
Phobias
This is the anxiety disorder that most people have the greatest familiarity with, perhaps because it’s so pinpointed. A phobia is an intense and disproportionate fear of one specific thing, and its subsequent avoidance. That can be an event (flying – as Caley and I have struggled with), a place (heights), an animal (snakes or spiders, for instance), or any number of other things. You can, of course, have multiple phobias. They can develop quickly, and be for things a person wasn’t previously afraid of. Even if the person is aware they aren’t logical, they can still have a phobia of a stimulus. So, for example, Caley and I weren’t afraid of flying until we had one really turbulent flight when she was in middle school. Afterwards…instant phobia. Caley was absolutely terrified for the next leg of the flight that we had to get on not even an hour later, and during our visit in she tried to be as nice as possible to everyone, as she knew she was going to be forced to fly again to go home and she was going to die. I, too, developed a fear of flying from this incident, though I know it isn't rational (and, because of my fear, probably know far more about just how safe planes are than most people do).
The interesting thing about phobias is that many people think they can be cured without the help of the therapist, by simply forcing the person to confront the feared stimulus over and over. Please, please don’t try this with someone else on your own. Get a therapist to help your child to overcome their fear – as an untrained person, you risk making the fear even greater by trying it on your own and exposing your child to terror for no gain.
Read more about phobias here: http://www.childmind.org/en/health/disorder-guide/specific-phobias
BEHAVIOR IS COMMUNICATION
This a critical key to not only understanding people on the spectrum in general, but also detecting these anxiety disorders in them. If a person has trouble communicating by speech, a tantrum or melt-down may be their way of saying “I’m afraid of this!” It’s no less important to listen to their communication in that mode than any other.
Moving Forward
When I asked Caley to describe when she could first remember having disorder-level anxiety, she immediately said that it was when she was about four, which is about how old she is in this photo of the two of us pretending to be snakes. Four years later, when she was about eight, we recognized that she was struggling with anxiety and got her into treatment. My anxiety disorders didn't develop until later, my guess for the development of GAD would be about middle school for myself, and I didn't recognize it was a disorder until a few years ago...and even as recently as a few months ago I wasn't getting treatment.
Our hope is that by sharing our experiences you all can better recognize the signs of anxiety disorders in yourselves and your own children. And if you missed them, don't feel bad. Like I said, unless you know what you're looking for, it's incredibly hard to tell. Caley and I have great, loving, and attentive parents, and they couldn't tell. Heck, it took me getting my bachelor's in psychology to figure it out for myself, and chances are you don't have that background. The important thing is what you do with the information now that you have it.
I hope this post helped you understand a bit more about anxiety disorders. If you have any questions, leave them in the comments! And remember, I’m not a professional, so if you suspect an anxiety disorder in yourself or your children, please get professional help. All of these disorders are treatable, and the impact of treating them on the quality of a person’s life is immeasurable.
- Creigh
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