Autistic Anxiety: Hidden Triggers

A few days ago, I received a call from a parent of one consumer who lives in our residential program. She was concerned about the antecedent of her son’s last mild self-injurious behavior with anxiety-like symptoms. When our team reviewed the case, we did not find a clear and contingent antecedent of this challenging behavior.

In Dr. Kanner’s 1943 report on autism – one of the first ever studies to be published - he accentuated the role of anxiety in autistic children. I think that autistic anxiety should be understood as an emotional response evoked when an autistic individual perceives an external situation as threatening or fearful even in the presence or absence of the direct stressors. The autistic anxiety may be caused by a chronic or acute “fight or flight” response to feeling trapped by “exposure” to some aversive external stimuli or social situations. Possibly, this situation will result in involuntary avoidance, diversion, fear, depression, retaliation responses and defensive strategies which involve compulsive responses to the overt counter tactics of others and confusion that may result from being unable to "make sense" of the world in a routine way. Based on this definition of autistic anxiety, I have the hypothesis that autistic individuals occasionally respond to a variety of environmental stressors with prolonged latency than the normal population [hidden triggers]. In addition, autistic individuals show “a lack of fear in response to real dangers, and excessive fearfulness in response to harmless situations” (APA, 1994).

Several studies emphasize that common events (e.g. closeness of others, staffing change, over-prompting, special demands, etc) may become a stressor evoking fear or threatening events. Since the autistic individual wants to escape or avoid this situation and has not learned the adaptive coping mechanism to respond to this situation, he or she may behave in a maladaptive manner (e.g. self-injurious behaviors, destruction of property or aggression). In my experience, the identification of the external stimuli that trigger the maladaptive behavior has been very difficult for staff because occasionally the challenging behaviors are apparently dissociated from the original stimuli. However, the contingency relationship between the antecedent stimuli and behavioral response may still be associated.

Recent studies suggest that anxiety is a common feature in autism spectrum disorder (ASD). Morris et al. reviewed the comorbility of autism and anxiety symptoms and they found that 84.1% of the individuals studied met the criteria for anxiety disorder (Weisbrot et. al. 2005). Several studies have provided evidence from brain imaging (fMRI) that the hippocampus and the amygdala by be responsible for the emotional dysregulation in autistic individuals (Gray, & McNaughton, 1982, 2000; Davidson et. al. 1999; Kalin et. al. 2004.)

There are several multi-modal approaches to address the autistic anxiety such as medication, applied behavioral analysis, cognitive behavioral therapy, play therapy, self calming and relaxation techniques, counseling. However, the specific therapy approach depends on the particular case (Chalfant, et. al. 2006). Normally, we can combine medication with another alternative therapy approach (Miller, et. al. 1995). Learning what are the hidden triggers and stressors, and strategies to improve consumer attitudes and behaviors would help to reduce the incidence of anxiety symptoms that would result in maladaptive behaviors.