Isla never had separation anxiety when she was younger. Unlike her sisters who would need to be peeled off me every morning while dropping them at daycare, Isla was happy to run off to kindy without a second glance. At the end of the day she wouldn’t really be that excited to see me either. I didn’t take this personally at the time. In hindsight this was another indicator of development that wasn’t going according to plan. Interestingly enough extreme clinginess in young children can be a sign of autism but this is not how it presented with Isla.
When out in public this lack of self awareness, coupled with a lack of impulse control, would cause Isla to run off. Her unpredictable nature, drive for sensory feedback and exploration was worrying. She just didn’t seem to care about her wellbeing like a normal child.
Over the years Isla’s development has rallied resulting in her being more “in the world”. This has meant her carefree nature has been replaced by fear, uncertainty and anxiety. Of course we welcome this progress and are relishing this new interest in us but is a bit of an adjustment. We went from having a child who generally enjoys being by herself and not being aware of those around her, to one who constantly seeks reassurance and our presence.
Isla has developed separation anxiety over the last month. Originally I thought it was because Santa’s impending visit was making her feel anxious. With Christmas having come and gone and the anxiety still being very much present, I now think it is a developmental stage that is here to stay. Isla will call out every 5 minutes or so “Mum, just checking you’re there?”. Every time Gareth or I leave the room she asks where we are going. If she doesn’t get an answer she will run to find us frantically. She will also ask if I’m there when standing right next to her. This is where the anxiety borders a little on the OCD.
Isla’s anxiety had definitely been increasing last term. It seemed to be triggered by an incident when there was no one in her classroom when she arrived (that she could see). We must have been a little early (for once) and although she wasn’t left alone for long she seemed to be traumatised by this. Being in a protected environment Isla doesn’t often get to practice problem solving. With poor executive functioning skills has trouble thinking what the next step should be. We had worked so hard the previous year to get her to walk to class on her own. This became difficult for her again but we persevered. I really didn’t want her to lose this little independence she had found.
Parenting a child with autism is tricky at times. Our children are very literal. Saying something you may say to other children like “hurry up and get ready or you’ll be left behind” in an attempt to get them moving in the morning can create ongoing anxiety. As I found out this throw away comment can become very real to our kids. No matter how much I reassure her it remains which adds to her anxiety.
On the positive side, with this new self awareness has also come the ability to articulate other emotions she is feeling. For example when she refuses to go into a new situation, which I previously thought was just because she didn’t want to try something new, she can now explain is because she is scared. Crying because she didn’t get her own way is because she is feeling jealous.
I am sure being more connected to her emotions is due to the huge amount of work that happens at school and at her different therapy activities. A lot of effort goes into helping match what she is feeling to a word with the use of visuals and talking through emotions. As she is getting older she finds it easier not to overreact to certain triggers. She often needs help talking through the situation but can move on a lot quicker than she used to.
So is anxiety part of autism?
Autism increases the risk of having anxiety. Anxiety disorders (such as obsessive-compulsive disorder, generalised anxiety disorder, and separation anxiety disorder) affect an estimated 11 to 40 percent of children and teens on the autism spectrum.
Apparently an anxiety disorder is completely separate from autism. It looks exactly the same in people with autism as it does in others. However for those with autism, anxiety and autism symptoms overlap. The need for sameness as a form of control to make sense of a world that is too unpredictable and frightening is driven by anxiety.
In addition if you do not know how to socialise in a normal way this could cause social anxiety or social indifference. The lack of ability to make decisions and problem solve (Executive Function Disorder) must cause a fair share of anxiety too. You can see how children like Isla who learn how to behave through experience would get anxious coming up against situations where they haven’t learnt what to do.
So what can you do ?
Isla is already on a SSRI called Fluoxetine that helps anxiety. Her brain’s way of reacting to traumatic experiences was to trigger a seizure. Her fear of ice, that I believe stemmed from disliking the feel of ice packs when she was younger, was one of the main culprits. Interestingly since we have started a small dose of this medication Isla hasn’t had another seizure. Like everything is hard to know if this is just coincidence with her perhaps growing out of seizures. At the moment it does seem like the addition of an SSRI, along with her anti-epileptic meds, have helped stabilise her enough not to have break through seizures. However time will tell.
I am reluctant to increase her meds to mask this new anxiety though. I think it is something she needs to work through to gain the skills to cope with these new feelings.
She seems to feel more secure with the knowledge of a schedule and routine. When she knows what is coming up and our plans for the day she feels safe. Even if I go out to the washing line I tell her and she is happy to follow me outside.
We have been encouraging her dog Bo to stay by her side. Hopefully this will help her feel safe during the day and at night time.
There are various therapies that can help with separation anxiety. With children like Isla it is a bit more difficult with her impaired cognitive function. Play therapy is perhaps something we could look into if this persists. Getting access to this type of therapy however continues to be challenging.
Have you got any tips to help with anxiety or separation anxiety with your children??