The month of April is globally recognized as Autism Awareness Month, including “World Autism Awareness Day” on Friday, April 2, 2021. This year’s observance will be unlike any other, as it will run just two weeks after the one-year anniversary of the start of the Covid 19 pandemic. The anniversary of Covid 19 is accompanied by a diverse range of solemn reflections, as every aspect of society has been directly affected by the pandemic (some, more than others). Parents who have children with special needs are well-aware of the challenges faced, of migrating their child’s education to an online environment. While these transitions have had their own set of unique challenges and frustrations, the online migration has resulted in an “accidental” and welcome discovery – children with social anxiety are finding tremendous benefit from virtual interactions.
In part 1 of our series for Autism Awareness Month, we will take a look at an overview of anxiety and how it relates to children across Autism’s diverse spectrum. Then, we will explore a few welcome positive strategies for treating children with social anxieties in the not-so-social age of Covid 19.
WHY IT MATTERS – RATES OF AUTISM ARE RISING.
The prevalence rates of autism spectrum disorders (ASDs) have risen dramatically over the past several decades. In the United States, research suggests that one in every 91 children (one in 58 boys) is affected by Autism Spectrum Disorder. Research suggests that these prevalence rates are similar across the globe.
ANXIETY PLAYS A MAJOR ROLE IN AUTISM SPECTRUM DISORDERS.
As noted by The National Center for Biotechnology Information:
One factor linked to increased impairment beyond core ASD symptoms is the presence of anxiety [
8].
Up to 80% of children with ASDs experience clinically significant anxiety [
9–
11], with high comorbidity rates for
social phobia,
generalized anxiety disorder (GAD),
obsessive-compulsive disorder (OCD) and
separation anxiety disorder (SAD) having been observed (30, 35, 37 and 38%, respectively) [
9,
10,
12,
13]. The presence of clinically significant anxiety is associated with compounded functional impairment beyond a single ASD diagnosis [
14]. Anxiety comorbidity is associated with greater ASD symptom severity and concomitant impairments in psychosocial functioning [
15–
19]. For example, patients with ASDs and comorbid anxiety are at increased risk for displaying
externalizing behavior problems [
20],
social avoidance [
16,
18–
20],
difficulties establishing/maintaining peer relationships,
sleep problems and
disruptions in family functioning [
21,
22]. Among youths with ASDs and anxiety, these problems are also present in school settings, with studies reporting
increased disruptive behavior,
noncompliance with teacher demands, and
disengagement from peer-centered activities [
23–
27].
Or, more simply put, the presence of anxiety serves as a trigger in the large majority of children with an Autism Spectrum disorder. This anxiety oftentimes serves as the “root” cause for more complex and specific dysfunctions – resulting in more than one impairment. Plus, the tendency for multiple anxiety disorders leads to greater severity of symptoms. Anxiety begets anxiety, making the diagnosis more difficult. When anxiety is present in conjunction with autism spectrum disorders, it is linked to increased psychosocial, familial, behavioral, and academic impairment beyond the core autism symptoms.
SOCIAL ANXIETY DISORDER – AN OVERVIEW:
STATISTICS:
Approximately
15 million Americans suffer from social anxiety disorder. Recent estimates indicate that 6 % of children and 12.1% of adolescents meet the criteria for this diagnosis. Social anxiety disorder starts as early as age 5 and peaks around age 12. When untreated, it runs a chronic course into adolescence and eventually adulthood. Children with the disorder tend to start noticing symptoms between the ages of 8 and 15, but if they hide how they are feeling, parents might not realize anything is wrong for some time.
THE SIGNS:
Children with social anxiety disorder are extremely self-conscious about how they appear to others.
There are two main types of social anxiety disorder. The first focuses on performance, with kids worrying about things like speaking in public or trying out for a team. The second type involves social situations in general — not just situations when a child is in the spotlight. Kids with this type of social anxiety may fear things like going to school, eating in public, using public restrooms, meeting new people, and even having conversations. Most people with more general social anxiety also experience anxiety about performing.
The defining feature of social anxiety disorder includes marked fear or anxiety about one or more social situations in which the person might be subject to possible scrutiny by others. Examples include social interactions, being observed by others, and performing in front of others.
Other symptoms of social anxiety disorder include the following:
- The person feels that he or she will act in a way or show anxiety symptoms that will be negatively evaluated
- The social situations always trigger fear or anxiety (in children this can manifest as tantrums, clinging, crying, freezing up, or failure to speak)
- Social situations are avoided or endured with intense feelings of fear and anxiety
- The fear or anxiety is out of proportion to the actual threat
- The fear, anxiety, and avoidance lasts for 6 months or more
- Causes clinically significant distress in social, occupational (school), or other areas of functioning
- Dread of social events that can occur weeks in advance
- Excessive clinging to familiar people
- Tantrums when faced with anxiety-provoking social situations
- Blaming others for perceived social failures
- Physical symptoms: Blushing, racing heart, shaky voice, trembling, nausea, difficulty speaking
Social anxiety disorder has many effects on the body and mind, causing physical, emotional, and behavioral symptoms.
Children with social anxiety may experience physical symptoms such as shaking, sweating, flushing, and shortness of breath. They may express their anxiety by asking, “What if I do something stupid?” or “What if I say the wrong thing?” Young children sometimes throw tantrums and cry when confronted with a situation that terrifies them. Children may experience anxiety symptoms well in advance of the situation they are worried about.
In children, the symptoms appear in interactions with both adults and peers. Their feelings of anxiety might appear as:
- crying
- throwing tantrums
- freezing
- clinging to a parent or caregiver
- shrinking
- not speaking in social situations
Social Anxiety Disorder – Treatment
Cognitive-behavioral therapy is a widely accepted psychological approach for breaking severe cycles of anxiety.
However, research into anxiety treatments for children and adults on the spectrum is limited. There are no major clinical trials or proven methods to guide patients, families, or doctors as to which medications work best, for which symptoms, and in which patients who have autism.
How Virtual Therapy is helping children with ASD and Social Anxiety in the Age of Covid.
Orna Kemplar-Azulay, Founder and CEO of
RemoteSpeech.com,
Abington Speech Pathology, and
VirtualTx has been managing treatment programs for children across the diverse spectrum of autism and social anxiety disorders for decades. In 2015, she launched
RemoteSpeech.com to respond to the growing demand for therapeutic services for speech-language pathology and to combat the shortage of licensed professionals available to provide treatment. As Azulay notes, the covid pandemic lead to some positive observations.
“I’ve observed a number of advantages from virtual therapy among children on the spectrum,” says Azulay. At the launch of
RemoteSpeech.com, Azulay learned that children were far more responsive to therapy delivered in a virtual environment. “We received a great response from children receiving therapy through RemoteSpeech. Pre-Covid, our therapists would reserve the last 10 minutes of therapy for games on the computer or tablet. Children often associated the desktop or tablet with ‘fun’ which quickly changed their perception of therapy to be a ‘reward,’” notes Azulay. Now that all facets of education and therapy are reserved for a virtual environment, we are seeing kids address therapy in more positive ways. It completely changed their perception, motivation, and engagement.”
The Covid 19 pandemic provided an additional “hurdle” that previously went unexplored in the treatment of children on the spectrum. Suddenly, children of all ages were receiving the entirety of their education through an online environment. While speech-language pathology had been “virtually established,” a new opportunity slowly drifted to the surface – treating children with social anxiety disorder.
“We are noticing that children that suffer from social anxiety disorder feel less restricted when engaging with their peers online,” says Azulay. “All of the symptoms that are often present with social anxiety disorder can be mitigated and are much easier to control in online interactions. Previously, children would be slowly introduced to social interactions. But now we are learning that in virtual environments, the perceived consequences are no longer present, and the anxiety is dramatically reduced.”
While we are just one year into the Covid pandemic, Azulay shares cautious optimism. “Although there is such little research on the treatment of social anxiety disorder amongst adolescents across the spectrum of Autism, the correlation between the two disorders is well-established. Our therapists are well-versed in the signs to help to diagnose our patients across the spectrum. Technology has dramatically reshaped the way we treat children on the spectrum, and I have no doubt that there are still many innovations for treatment yet to be discovered.”
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The response to the COVID-19 virus is unprecedented. Because of our unique role in children’s K-12 education, we feel a responsibility to do what we can to assist schools, therapists, and students with this transition to online learning and seclusion. To ensure that our clients remain engaged and supported, our therapists will be providing complimentary “Support Sessions” to the country’s youth. We will also be assisting schools by training therapists for remote therapy.
Click here to schedule a complimentary consultation with an Executive Member of our Team.
Abington Speech Pathology and RemoteSpeech.com are uniquely prepared to provide assistance for parents of children with Speech-Language Pathology.
About Abington Speech Pathology
Abington Speech Pathology is managed and owned by a licensed speech-langauge pathologist. All of the company’s directors are licensed and remain clinical to better direct and support both the company’s clients and the clinical staff.
Through the years the company’s client base continues to grow and remains loyal. ASPS, INC has expanded its services to include Physical therapy, Occupational therapy, Teachers of the visually and hearing impaired, and School psychologists. ASPS, INC. now operates two offices. The corporate office is in eastern PA and services all 5 major counties surrounding the metro Philadelphia area. The Southern CA office services the Los Angeles and Orange County metro areas and at this point only offers speech pathology services to all settings.
The company offers the professional staff a lending library of materials. In PA, there are 2-3 continuing educational seminars to assist on clinical growth and state and national mandated continuing education requirements.
About RemoteSpeech.com
RemoteSpeech is a subsidiary of
Abington Speech Pathology Services, a multi-faceted Rehab company that has provided Speech Staffing and support throughout the country for more than 20 years. RemoteSpeech combines crystal clear voice with the sharpest video to provide next-generation video calling and high-definition video delivery.
Prior to the Covid 19 pandemic, Orna Kempler-Azulay, President of RemoteSpeech, says the demand for speech-language therapists was outpacing the supply in some cities. RemoteSpeech is here to meet the demand. With its live, face-to-face interaction, RemoteSpeech is
not the next best thing to being there in person — it’s just as good, and, in some cases, even better. With advanced state-of-the-art games, activities, and interactive screen sharing, students and adults will actually look forward to their therapy sessions.
