My teen daughter has Asperger’s and extreme social anxiety. It started to get worse at 13, resulting in refusing school. It has progressed to hardly leaving the house at all and no education as such for 2 years. She is 15 now, and no one seems to be able to help. I am at a loss too. How do I get her through this?
This week’s “Got Questions?” answer comes from Jeffrey Wood, PhD, a psychologist at the University of California, Los Angeles. Three Autism Speaks research grants support Dr. Wood’s work on adapting cognitive behavioral treatments for children and teens with autism.
Editor’s note: The following information is not meant to diagnose or treat and should not take the place of personal consultation, as appropriate, with a qualified healthcare professional and/or behavioral therapist.
Thanks for the question. Unfortunately, anxiety – including social anxiety – is very common among children and teens on the autism spectrum. Many of these kids have a particular problem going to school. In fact, the problem is so common that we have a term for it: school phobia, or school refusal. Sometimes, school phobia involves the broader fear of leaving the house, also known as agoraphobia.
Sometimes these phobias stem from a specific fear such as a fear of having a panic attack in public. In other cases, it reflects more general social anxieties and fears around embarrassment or humiliation in public.
We’ve found great success easing both school phobia and agoraphobia with cognitive behavioral treatment (CBT) approaches, which I’ve described in previous posts to this column.
Cognitive behavioral therapy is a widely accepted psychological approach for breaking severe cycles of anxiety. Through extensive research, our group and others have shown that modified forms of cognitive-behavioral therapy can work particularly well with children and teens who have autism.
The first step in this process involves helping the child or teen identify the root of his or her fears. In second step involves taking small, incremental steps to approaching the feared situation and becoming more comfortable, or “habituated,”with the situation.
In your daughter’s case that would mean working with a cognitive behavioral therapist on gradually re-entering school. For instance, the therapist might begin by having your daughter simply step out the front door for a few minutes – or even seconds. In this way, your daughter would begin the process of habituation, and build up from there.
Next, the therapist might work with you and your daughter on briefly visiting the parking lot of the school, then the entryway of the school, the office and so on. Each small step in the right direction warrants praise and reward. Shaming is never a part of the process.
The therapist is likely to take the same or similar approach with social interactions: developing a list of easy to hard social situations and coaching your daughter through each until her anxiety is reduced to a reasonable level before moving to the next level.
Patience is important. After a long time out of public situations, most people are very cautious and avoidant. They need to take it slowly. A good cognitive-behavioral therapist can guide progress through this delicate early phase of treatment.
A good resource for finding a cognitive behavioral therapist is the Association for Behavioral and Cognitive Therapy. You can find local therapists through the associations “Therapist Finder” here.
You may be able to access these services free of charge through your local school system’s Individualized Education Plan (IEP) for your daughter. I would encourage you to work with the school system to evaluate your daughter’s needs and develop a comprehensive educational plan that supports her re-entry. What school placement, grade level and accommodations does she need? A qualified psychologist can perform the needed testing to guide you and the school on providing the appropriate educational environment to support a successful transition back to school.
Meanwhile, if you haven’t already, I encourage you to work with your school district to meet your daughter’s current educational needs, perhaps with in-home services.
In addition, your child’s physician and/or your health insurer may be able to provide a referral to an expert in child anxiety who practices cognitive behavioral therapy and is experienced working with children who have autism.
In other posts to this advice column, my colleagues and I have written extensively about anxiety and autism – particularly on the effectiveness of cognitive behavioral treatments. I think you’ll find them relevant to your issue:
Thanks again for your question. Please let us know how you and your daughter are doing by writing us again at email@example.com.