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anxiety disorders in autistic young people - Coggle Diagram
anxiety disorders in autistic young people
diagnostic information
autism - neurodevelopmental difference characterised by social communication differences, restricted and repetitive behaviours and areas of interest, and hyper and hypo sensory differences
42% of autistic children are diagnosed with an anxiety disorder, compared to 3% of non-autistic children
29-57% of autistic young people have co-occurring SAD
alexithymia - common co-occurring condition - difficulty labelling and understanding emotions
applying models of social anxiety to autistic young people
additional risk factors
intolerance of uncertainty - unpredictability is particularly anxiety-provoking for autistic people
rigidity of thought - harder to break out of negative patterns of thoughts, cognitive inflexibility was found to be a risk factor for internalising and externalising symptoms
alexithymia - difficulty understanding your emotions and interpreting bodily experiences as emotions
atypical sensory function
social stigma/negative social experiences - more likely to have negative social experiences due to communication differences
autistic identity - relates to social stigma - having a positive sense of autistic identity can be a protective factor against SAD
safety behaviours vs. camouflaging
how do they differ conceptually
both involve heightened awareness of impression on other people and altering behaviours to manage this impression
camouflaging is associated with burnout
high degrees of masking were found in non-autistic people with high levels of SAD - possible that masking is mediated by social anxiety cognitions
masking is related to disguising social communication differences, safety behaviours are related to addressing self-perceived social inadequacy
Clark and Wells
assumes you have no social communication differences and come across as 'normal' if you drop safety behaviours
autistic people do not always come across well and make good impressions in social situations, especially without masking, and it's not helpful to ignore this
Rapee and Heimberg
more emphasis in this model in monitoring external indicators of negative evaluation
autistic individuals may struggle more with being able to do this - difficulty with reading social cues
could lead to increased risk of anxiety because it is harder for them to tell how they are being perceived - increased monitoring
could mean this is a less important mechanism of anxiety in autistic people as they are not concerned with reading other people's reactions to them anyway
treatments for social anxiety in autistic young people
safety behaviours vs. camouflaging
encouraging dropping safety behaviours is key to treatment for SAD
distinguishing between safety behaviours and camouflaging is hard
camouflaging may be a response to trauma and be important for keeping a person safe from negative social situations
optimising exposures
exposures may not be effective if anxiety-provoking situations are related to sensory sensitivities
e.g. if an autistic person avoids crowded places because they get overstimulated, exposure alone is unlikely to reduce anxiety
positive autistic identity
having a positive autistic identity is associated with improved mental health and wellbeing
support and acceptance from other people can be more important for fostering a positive autistic identity than internal factors
peer support groups can be important for fostering positive autistic identity
an individual psychological treatment may not be the best way of supporting autistic people with SAD and may be less effective alone
NICE guidelines for adaptations
placing greater emphasis on changing behaviour than changing cognitions
making rules explicit and explaining context
avoid excessive use of metaphors
more structured approach with written and visual information
incorporating regular breaks and special interests where possible/applicable
evaluation of these adaptations
may increase ability to access and engage in therapy
assume that underlying mechanisms of SAD are the same as neurotypicals
assumes that being autistic will affect the way you can engage with therapy, but not that it will affect your experience with SAD
evaluation of the literature
limitations
autistic people are often excluded from RCTs about efficacy of anxiety treatments so there is a lack of research about how effective they are for autistic individuals
unrepresentative - often white, male, without other intellectual disability
use of self-report measure
implications
importance of general education and acceptance of autism
just focusing on changing your own behaviours and thoughts is not always going to be enough
strengths
positive psychology approach
future research
different levels of autism/support needs should be represented
RCTs should include autistic people