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Recognizing and Responding to Anxiety and Depression

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by Richard Bromfield, PhD
Autism Asperger’s Digest
| September/October 2012

I hardly need to point out that life and Asperger’s Syndrome (AS) can be unfair. Having AS does not excuse children, or the adults they become, from the trials and hardship of life. If anything, it only makes coping with those realities tougher. And this is true for depression and anxiety as well. Though neither are criteria for the diagnosis of AS or high-functioning autism (American Psychiatric Association 2000), these children are vulnerable to both depression and anxiety. Whether this susceptibility to depression and anxiety represents a co-related disorder or follows from dealing with life on the spectrum is not yet understood. For this discussion, it does not matter. Here, we focus on ways to recognize depression and anxiety, whatever the cause, and ways to ease the child’s suffering and promote his being all he can be.

It’s about the Neurology
The neurology of AS makes a lot of life more demanding. How can the playground not pose a challenge? How can it not be frustrating to deal with others’ frequent, if not constant, misunderstandings or underwhelming appreciation for who the child is, what he is saying and doing, and so on? These children are often somewhat disconnected from what they themselves feel, leaving them a bit—or a lot—ill equipped to make sense of their daily experiences.
Moreover, the nature of their social and communication issues creates its own problems, mainly that these children are often deprived of the social rewards, support, and validation that neurotypical children know and take for granted, leading to yet greater frustration. In concrete terms, these children know constant rejection and criticism, which can translate into a harsh self-judgment that they are
failing others.
In my 30 years of experience, I have heard many such children talk of hating themselves, their self-rebuke a combination of social experience that threatens their esteem and an acute awareness of the ways that their neurotypical siblings and peers make their way through life seemingly more gracefully and successfully. This is too much for anyone to endure, no less a child who already tends to bear much of everything alone. Though it might prove to be that the same biology that causes AS causes depression and anxiety, we cannot overestimate the adverse powers that the burdens of AS place on the child’s shoulders and psyche. Nor can we put too much effort into understanding and empathizing with the child’s experience. So what can we do to help protect the child from depression and anxiety?

Look for the Signs
They are not so hidden or obscure. Watch for irritability and frustration that can’t be quelled, that rises fast and frequent. Stress can intensify tics and body tension, or cause behaviors and focus to grow more driven and rigid. A child’s losing interest in, or conversely going deeper into, an obsession can signal the blues. Heed self-derogatory remarks and self-injury, of course.
Beware of dismissing real evidence of depression or anxiety as the inevitable side effects of having AS. In younger children, it can look more like irritability, frustration, and aggression; in teens, more like the blues of adults. Children with AS deserve to have their suffering noticed and eased as much as any other child.

Validate Worry
Children with AS are often worriers with a capital W. Try not to criticize or show your own frustration over this worry. “That is something to worry about,” you might say, or “How can you not be fretting over your doctor’s appointment—wouldn’t anyone?”
Do not squelch or try to rationalize away the child’s worry, for when we dismiss a child’s feelings, we dismiss
the child. There is only one thing worse than worrying or feeling bad and that is suffering these experiences isolated
from another human being. Invite their expressions of hurt and worry with open arms. Such moments show the child how good and comforting human connection can feel, and how it can lighten an anxious or depressing load.

Seek Meaning
There has been a conventional assumption that the speech and behavior of children with AS hold less meaning than that of neurotypical children. I question this. Be careful not to take words or behaviors that you don’t understand as being empty, unintelligible, or as nothing more than neurological static. Strive to discover what the child is trying to convey or express. This teaches the child the inherent value of communication and empowers his being an agent in being understood by others, something he may want but feel incapable of.
The more clearly and directly the child can share what he feels, the less in the dark you will be, and the more data you will hold to guide your actions and interventions. Ultimately, shared meaning can only foster a closer relationship between you and the child, itself a powerful antidote against depression and anxiety.

Cool It
Feeling a parent’s or teacher’s stress can only intensify the child’s. Do not try to stop the child’s twitching or command the child to relax. Parents tend to do such things even though we know the futility of our ways. Nothing truly comforts a child more than being in the presence of someone who, to them, feels genuinely at ease, especially in the presence of the child’s distress. If what you are doing is stressing the child unduly, try to back off and speak more quietly, more slowly, or not at all. You can’t insulate the child from the stresses of life, but you can be a welcoming and dependably calm shelter from a world that moves too fast and too unresponsively.

Condone Down Time
When it comes to children on the spectrum, down time has gotten a bad rap. It is easy to understand why. We do not want our children spending every moment tethered to some electronic device, cut off from human contact. And yet, given how challenging and stressful the world can be, why wouldn’t the child adore the steady, quiet, self-regulated, unthreatening control of his computer, books, or room? He deserves a place of respite that he can count on. Strive not to ignore the child’s true need for restorative down time, maybe even preemptively suggesting at times that he run off to his preferred retreat.

Be Emotionally Available
It can be hard to empathize with a child’s feelings. This is particularly difficult if he is having self-hating and pervasively negative thoughts, and perhaps is not so pleased with us. And yet, what other choice do we have? If the parent does not try to get into that space, where does that leave the child but in a vacuum of thinking and feeling that can be dark, scary, and hopeless.
Affirm what the child feels. “You are so happy, your body is jumping up and down.” “You didn’t like my being mad at you, and now you feel so, so bad.” How do you know you have gotten it right and are with the child where he is emotionally? — If your words, actions, or mere presence calm his body, slow his tics, expand his focus, [fill in the blank]. No one knows your child like you do, and you will learn to sense when you have emotionally connected with him.

Take Feelings Seriously
Adults often take their own feelings seriously but are prone to see the children’s as, dare I say, childish or to be somehow fixed and put to rest. But a child is just like an adult, only younger and maybe shorter. He may be expressing worry just about his miniature car collection or the population of Buenos Aires. Whatever the content, he is nonetheless worried. “You can’t rest until you find out how many people live in Brazil?” “You are so upset that the web page is down.” “Seeing me in bed with the flu makes you scared and angry.” By helping to contain and label the child’s feelings, you package them into a shape and form that is more manageable and tolerable, something he can begin to digest and integrate as his own.

Use Words and Intellect
Though not always, many children with AS have strong if not formidable vocabularies. Likewise, I have seen many socially awkward children who, in my waiting room, eagerly pick up adult books on parenting, relationships, and other aspects of human relatedness. The child’s intellect is always an ally in aiding us to help him understand himself. Try out various ways of conversing. Your child may enjoy and benefit from less emotionally tinged and more intellectually grown-up discussions about the more abstract aspects of people and how they get along with each other. Parenting is hardly an inert, one-trick enterprise. It is an ever-moving opportunity for experimenting and re-experimenting to find better ways of raising our children.

Face Depression
A child’s dark mood can be frightening, just as can his self-injurious words or behaviors. And yet, the reality is what it is. The facts and demands of having AS are stressful and can invite feelings of despair, hopelessness, and self-disregard. Don’t let your fear keep you at bay or leave your child alone with his distress. Do not shy away from the outside world, isolating yourself as the child isolates himself. If your child’s mood concerns you, seek professional help—be it for counseling, assessment, or medication.

Raising a child with AS is a lifelong endeavor, not to be accomplished in a single night or lone dramatic discussion. Helping your child fend off and deal with depression and anxiety is a process that proceeds in, we hope, a positive direction. Whatever else you do, stay connected in whatever way you and your child can muster and bear. “Keep in mind, at the very top of your list, in capital and bold letters, that every molecule of connection you forge with the child helps to protect him from the toxicity of isolation, self-hatred, despair, and depression” (Bromfield 2011, p. 109).

Richard Bromfield, PhD, is a psychologist on the faculty of Harvard Medical School and author of Embracing Asperger’s and Doing Therapy with Children and Adolescents with Asperger Syndrome.
(See www.RichardBromfield.com for more information.)

References
American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: DSM-IV-TR. Washington, DC: American Psychiatric Association.

Bromfield, R. 2010. Doing Therapy with Children and Adolescents with Asperger Syndrome. Hoboken, NJ: Wiley & Sons.

Bromfield, R. 2011. Embracing Asperger’s: A Primer for Parents and Professionals. London: Jessica Kingsley Publishers.

 

 

Copyright © Autism Asperger’s Digest. 2012. All Rights Reserved. Distribution via print is prohibited without written permission of publisher.


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