Reducing Anxiety #3 Make the world more understandable! In the first part of the series, we discussed making sure that we first meet the needs of the nervous system (calm and organize) in order to reduce anxiety. In the second part of the series we focused attention on changing or modifying the environment demands (sensory, cognitive, and social) to better match the child’s processing needs. In this article we will look at reducing “uncertainty”, providing structure, predictability, and understanding to reduce anxiety. When your world is very chaotic and confusing, there is a lot of uncertainty, which leads to strong insecurity and anxiety. People on the spectrum require a very concrete, literal, and predictable world to feel secure. Unfortunately our world is filled with many unwritten, invisible rules, which fluctuate based on situational context. Something can have a specific meaning in one situation, and mean something totally different in another situation. A given action can be acceptable in one situation, and be rude or unacceptable in another situation. It is hard to be confident in your actions, if you cannot accurately read the expectations. The world is just too vague, relative, and unreliable for many on the spectrum. This “uncertainty” creates ongoing anxiety. For this reason, many children on the spectrum have a strong need to control all activity and interaction around them. To help deal with this insecurity and anxiety, we have to decrease the “uncertainty” in their lives. The following strategies can help do that: 1. Build structure to daily routine: The more structured, and predictable, the daily routine is, the less uncertainty there is for the child. When he knows what is coming up next, and how his day is going to flow, there is less anxiety. Unfortunately, many of our family lives are very scattered and disorganized, with little predictable pattern to it. This can cause severe anxiety for children on the spectrum. Using visual strategies like written checklists and picture schedules can help make the world more clear and predictable. 2. Routine “habits” use less energy! Keeping familiar routines throughout the day, also allows us to skate smoothing through our daily activities without much “cognitive effort.” We do many routine activities without “thinking about them.” We do these daily tasks “out of habit” with little effort. This frees up our mental energy for more important matters. The same is for our children on the spectrum. Since the world is often chaotic and confusing for them, keeping the simple routines consistent allows children to know what to expect, and perform them with minimal effort. This helps reduce both uncertainty and cognitive effort. This adds predictability and certainty to their world. 3. “Define a path to provide a map!” Many kids on the spectrum go through the day essentially lost, with little concrete direction to lead the way. Since they cannot read the invisible rules that help us make sense of our world, they often do not know what to expect, or why they are doing what they are doing. Like all of us, if we do not know how to navigate in our immediate world, we feel anxious. If possible provide visual (pictures, written) schedules so the kids can “see” what is coming up next, and what they are doing. It provides predictable order to their day. These visual schedules provide the child a nice detailed path to follow. It lets them know what to expect and when to expect it. This alone can drastically reduce anxiety. 4. “Prepare by Previewing!” We often lead children into tremendous, unnecessary “uncertainty” by not previewing for them what is going to happen. We move them from one event to another without much preparation. To reduce “uncertainty” it is important that we prepare the children before entering events, by previewing (1) what they can expect, (2) what is expected of them, (3) how long it is going to last, and (4) what is coming up next (afterwards). Lay things out very concretely so the child clearly understands what they are walking into. This helps to reduce uncertainty and anxiety. 5. “Describe as you do!” Since the children often do not understand the invisible rules, and especially the thoughts, feelings and perspectives of others, it is important for us to describe what is happening (what they don’t see) as you are go through the day. Increase understanding, by filling in the empty holes from what the children miss. Give the information to complete the understanding. If we are walking through a foreign country, it helps to be with someone who can describe and interpret for us. So, when doing something together, verbally describe what is happening, why it is happening, and highlight what is invisible. Be the social interpreter for your child. 6. “Don’t assume; clarify and verify!” We often assume; since we know, they know! Or, since the child is bright and verbal, he automatically understands. This is bad mistake to make. They often cannot read the invisible assumptions we make. To maximize understanding, first clarify very literally what to expect, and then verify that they understand. 7. ”Ease transitions, prepare for change!” For many children, their brains have difficulty rapidly shifting gears. They do much better if we make out a concrete schedule for what is coming up, and they have warnings, or reminders, when the one activity is ending and another is beginning, especially if the current activity is a strongly preferred activity. To ease transition difficulties try to (1) ensure that the child always knows what will be coming up next (watch TV, then bath), and (2) give the child 5,3, and one minute reminders that the current activity is going to end (watching TV), and he will move to the next activity (bath). At few minutes before the end of the TV show, “Johnny, remember once the movie ends we are taking your bath.” This way the brain is prepared for what is coming up next, and the reminders help bridge the transition. 8. “Have a Plan B!” When a favorite activity abruptly is cancelled the child can explode. For activities, especially preferred activities, that may be cancelled or postponed, discuss a plan B. “If it rains and we cannot go swimming, then we can go bowling instead”. This way the child already is prepare for what may happen, and what will happen instead. This works well for common activities that are dependent on weather or factors that you cannot control. In summary, help reduce anxiety by decreasing the “uncertainty” in their lives. Provide predictability to their daily routines, use visual strategies (schedules, directions, etc.) to define a path to follow, prepare them by previewing ahead of time, provide information as you go, verify that they understand, and prepare for change! It may exhaust you, but it will drastically reduce their anxiety. In all seriousness, these strategies may seem overwhelming at first. Do not try and learn these strategies all at once. Use one strategy at a time until it becomes “habit” for you (remember habits use little energy, because you do them without thinking about it). Build in one strategy at a time until the whole sequence you do out of habit, without thinking about it! Don’t worry, when you forget, your child’s reactions will remind you.
Posted on: Thu, 10 Jul 2014 10:20:19 +0000
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