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Common causes of anxiety for pupils with autism and how to address them

This case study is part of a bitesize CPD learning unit on anxiety.

In the following video case study, Helen Clarke, who runs a consultancy providing autism training to schools and organisations, discusses some common causes of anxiety for pupils with autism and outlines some steps that schools and teachers can take to avoid or address them.

The video is divided in to the following sections:

  1. Introduction (0.08)
  2. Minimising unfamiliarity (01.58)
  3. Supporting communication methods (03.59)
  4. Avoiding information overload (06.34)
  5. Supporting pupils to express thoughts and feelings (07.40)
  6. Implementing structure and routine to learning materials and the classroom environment (10.19)
  7. Adapting the school environment to prevent sensory overload (12.36)
  8. Reviewing and adjusting teacher expectations (16.16)
  9. Coping with phobias (17.32)
  10. Final thoughts (18.24)


You can jump to each section by using the toolbar on the video.

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Hi everyone. My name is Helen Clarke. I am an autistic teacher who’s worked with autistic children for over 20 years, currently working at a school in Lancashire. And we’re setting up a unit for children with speech and language, communication needs, and/or autism. 

So I’m going to talk to you today about supporting children who are autistic to feel less anxious and talk about the common causes. But before I do that, there’s just a few things to note about autism and anxiety. So the first is that all autistic children are unique. So they’ve all got their own strengths and needs and differences. So what works for one child may not work for another. So it’s all about listening to the child and doing what’s best for them. 

The second thing is that… anxiety shouldn’t be attributed to being autistic. So although there’s quite a number of autistic people who experience anxiety, it’s actually living in a world that is not inclusive that can cause difficulties for autistic children. And the last thing is that autistic children can show feelings very differently. So there’s really great variability. 

So some autistic children may be more inward with their feelings. So it may be not very noticeable that they’re feeling anxious. They may be very quiet. Whereas others may be really vocal about if they’re feeling overloaded or anxious. So it’s about working with the child, really, and recognising that they’re all different. 

Some of the common causes of anxiety that autistic children experience are being with new people or being in unfamiliar places or in unfamiliar situations. So it’s about making the unfamiliar more familiar to them. So the school that I’m working at, what we’ve done already is… to sort the transitions out, I’ve sent a picture of myself to the children that are coming to our school and some information to prepare them for my visit, really. And I’m going to see them in their setting. So they’re not coming to me first. 

And that helps them to feel more comfortable about being with me because I’m new, and I’m unfamiliar to them. So once I’ve done that visit, then they come to us in the new school. But before they even do that, we’ve created a booklet for them so that they can see the people that they might be working with, and their new classroom, where things are in that room, and pictures of the school. 

And, also, we’ve given them as much information as we can about all the different routines that we’ve got. And that can help them to feel safe and comfortable about coming to the new school and managing that transition. 

So other things we can do is to introduce new people gradually. So it might be that they just come for a transition for an hour or two hours and then extend that to a few more hours. But it really depends on the individual child and what works for them. 

Some will only manage an hour or a look around, whereas other people will be able to come for longer for a few hours. It’s a lot to manage. So having that information, as much information as they can, can really help autistic children to feel safe and to help them feel less anxious.

The second thing that causes a lot of autistic children anxiety is communication issues. So quite a lot of these issues stem from the differences between the way that nonautistic people and autistic people communicate. So for autistic people, it may take us longer to take in information and process it. We might process it differently to some nonautistic people. 

So we need to be given time to digest information and to think about it first and then respond. So we’ve got to give children enough time. And sometimes autistic children can be misunderstood or misperceived. 

So sometimes autistic children could be seen as being a little bit abrupt or a bit forward, but they actually don’t mean to be. It’s just a misunderstanding and a misperception. They may not have the same tone or volume as a nonautistic person might use. But they don’t mean offence. So it’s more about people trying to change the way they perceive autistic people and our differences. 

What we can do to help autistic children is to understand that autistic people communicate and think differently to nonautistic people, and it’s equally as valid. Be aware that autistic children have different communication preferences, and that these may vary in different situations, especially when the child’s in distress. 

So if you have a child that does speak… that’s autistic and speaks, we can’t assume that they may want to communicate through speech all the time. They may prefer to show it a different way. So they may prefer to show you a visual or to gesture something or to use some kind of method that you’ve organised in advance that you both understand. So we don’t always want to communicate through speech. 

So other ways that children manage that is that they may write things down instead, or they may use something that’s colour-coded to be ‘yes, thanks’ or ‘no, thanks’. And giving them options as well gives them ownership, if they want to take part in something, or they don’t want to, that they don’t feel that they’re forced to take part. Or even that they’re put on the spot to communicate, it all adds to the pressure, really. So if we can take that pressure off, it’s really helpful.

Autistic children can also experience difficulties with too much information. So when I go to visit lots of schools, I notice that the staff can sometimes talk a lot. And for autistic students, that can be very overloading, especially when they’ve got other things to manage in the environment, like the overwhelm of all the displays of the classroom. Sometimes that can be a sensory overload. 

And then they’ve got all this information that’s piled on the top as well to process as well as relationships to manage with friends. So as well as expectations of academic achievement. So it all can get on top of them and can be a bit overloading. So we’ve got to find ways to help autistic children to manage the school day better and provide things like brain breaks or sensory activities to do, depending on the child. 

The next thing I want to talk about is discussing feelings, really. Autistic children, we’ve already said, will express their feelings in a different way to nonautistic people sometimes, and that’s OK. So some children will find it really difficult to understand and describe feelings in words. And that’s known as alexithymia. 

So we shouldn’t assume that just because children are in mainstream schools, that they’ll be able to express their feelings in the same way as the nonautistic pupils. And we’ve got to help them to be able to express themselves in a way that works for them. 

So to help them, we need to be aware that autistic children express themselves in their own unique way. We can provide visuals for some children to show how they’re feeling. We can work on extending their vocabulary around emotions, so starting off quite basic and then moving on to more complex feelings and more complex vocabulary. 

We can listen to them and explore with them what might work. And for children that don’t really know what works for them, we can provide them with options. So for some children, we might say, you could try this or try that, and give them two options. 

But really encourage that child to tell you what works for them and encourage them to be honest with you, even if the things that you’ve suggested are no good. That’s OK. It’s all about doing what’s best for the child. 

So we’ve also got to teach safe ways to express negative feelings as well. And that really helps with behaviour. And we can do things like providing charts for children to show us how things are escalating for them. 

So it might be an anxiety scale of 1 to 5, so 1 being – I’m a little bit anxious, to 5 being – I’m very anxious and I’m overloaded and I need some help now. And we can provide alongside that the visuals to help them so they know what to do to de-escalate the anxiety. 

Intense interests. Quite a lot of autistic children have intense interests. And these really help them through the difficult times. So being able to do things that you really love with a passion is such a nice thing. And it absolutely helps autistic children improve their wellbeing. 

So we need to focus on the strengths that autistic children have and their interests. And try and build them into what we’re doing every day. So they’re getting all these lovely sensory experiences and being able to do all the things that make them happy and feel relaxed. 

So the other thing that causes a lot of anxiety is lack of structure and routine. So this is variable as well. So some autistic children will really struggle with managing change and can be very, very anxious and stressed if they haven’t got enough of a routine and they don’t know what they’re doing. So we’ve got to provide structure in the tasks that we’re giving them and also structure in the environment that they’re in. 

So in a classroom, structure might look like different zones that have been labelled out for them so they know what’s going to take place and where, having a little relaxation zone in the classroom, like we’ve just set up. We’ve set up two different zones for relaxing, one inside the classroom and one outside the classroom. 

And in that zone, you could have things like comfortable seats, beanbags, mats for them to put over their laps to help them calm down that are weighted, and sensory toys, things like that, things like lighting that’s very calming, and things like visuals on keyrings to help remind them what to do when they’re feeling overly stressed and anxious. So having different zones in the classroom is really helpful. 

And providing a routine in the classroom, you could just do things like provide a schedule, a visual and written schedule of what’s going to take place in that lesson and when it’s going to happen so that they know exactly what’s going to happen in that lesson, and they’ve got routine. So children really need routine to feel safe and comfortable. They need structure in the task. They need us to be clear and concise with information. They need us to provide visuals and examples of what we expect. 

Some children really like now and next boards, but they don’t work for everybody. So that helps them to know what they’re doing now and then what’s going to happen after and for how long. And then you can just keep using different ones. And keeping a structure and a routine in lessons is all really helpful. 

So the next thing I’m going to talk about is the environment and how the environment can be either overstimulating, or it can be used to help the child to feel less anxious. So if we think about autistic children being hypersensitive, which is overly sensitive, or hyposensitive, which is under-sensitive, we’ll understand better what we can do to adapt the environment to help children to feel less stressed. 

So some children really struggle with noise. So it could be noises outside the classroom. They may not be able to filter that out and listen to the teacher at the same time. 

So if we can keep the noise levels quite low, this will help children to feel relaxed and not feel that they’re being overwhelmed, because they have so much to deal with already. They’ve got relationships to manage at break times. They’ve got the expectations of their teachers and academic achievements and the sensory environment as well – all the smells and the lights and the noises. So we’ve got to take all of this into consideration. 

So it can be quite overloading for some children to be at school. So it’s really important that when they get home, that they have time to recharge the batteries and relax so that they can manage the next day at school. 

Other changes that are difficult and cause stress is having to move around from one classroom to another. So in mainstream schools, autistic children expect to be able to organise themselves for so many different lessons very quickly. And this is really difficult for some children. 

Being able to organise yourself is something that they will struggle with, not just as children, but for their whole lives. And it’s part of them being autistic. So they’re not being lazy, and they’re not doing it on purpose. It’s just the way that their brain functions. And that’s the way they are, and we’ve got to accept them for that. 

So there’s lots of things we can do to support them, with things like visual sequences to remember things. But they can really struggle with moving from one classroom to another because they also meet other teachers… Obviously, there’s different environments, and there’s a crowded corridor. But there’s also things like different teachers who have different rules and different ways of doing things. So if you can keep to being consistent in rules, that really helps autistic children to know where they stand and to feel less anxious. 

So what we can do in the classroom environment, we can help to keep it uncluttered so it’s nice and calm and orderly. We can keep visual displays to a minimum, keep them in borders so there’s not things hanging from ceilings and so much visual distraction that stops them from listening to the teacher because they’re focusing on all the visual things in the room. Keep things to a minimum. 

We can also prepare children for changes to the environment. So if you’re taking displays down, try to pre-warn the children that there’s change going to happen and maybe involve them in the new displays going up so that they feel there’s some ownership there. And, also, provide areas for autistic children to go to at lunch break and break times, so at times, when it’s unstructured, because they may need a quiet area to go to. But, obviously, that doesn’t apply to all children. 

OK, the next thing I want to talk about is expectations. And this is more about teachers’ expectations of children. And it’s not having high expectations of children, because autistic children should be able to achieve. It’s more about us as professionals adapting our expectations of the child rather than the child adapting themselves. 

So this also applies to, again, things like homework. If we realise how much effort it takes for a child to manage a school day for six hours and all that learning, then we can’t really expect that all autistic children will be able to manage several hours of homework once they’ve got home because, obviously, their brains will still be processing all that from the school day. And they may need that whole evening to relax, to help them manage the next day. 

So it’s about being flexible. And all these one-size-fits-all rules not really applying to autistic children, because in some ways, it discriminates. And every child is different and needs different things. 

Very quickly – phobias. Quite a lot of children that I’ve worked with have phobias. Sometimes they can seem quite unusual to some people. But to that child, it’s a very big issue. So we’ve got to involve the child in how they want to manage those phobias. 

Quite often, these relate to sensory issues. So it sometimes can be things like dogs or unexpected noises or things to do with smells. So exposing them to those is not a great idea. So it’s more about working with the child and getting them to help tell you what helps them what they want to do if they come into contact with that phobia, what is the best way to manage it, and maybe put that on risk assessments for them as well. 

So, finally, I just would like to say that we need to be thinking about the link between autism and anxiety differently. If we can change policies and practices and our approaches to working with autistic children, and change the environment as well to make it more inclusive, then we’re definitely going to have a positive impact on autistic children’s mental health. 

And we know that autistic children have told us through surveys that the biggest thing that can help them is working with people who understand them really well. So I’m really grateful for you listening today. Thank you.

    1. Clarke H (2022) Supporting Spectacular Girls. London: Jessica Kingsley Publishers.
    2. Purkis J, Goodall E and Nugent J (2016) The Guide to Good Mental Health on the Autism Spectrum. London: Jessica Kingsley Publishers.
    3. Wood R (2019) Inclusive Education for Autistic Children in Mainstream Schools: Helping Young People to Flourish and Learn in the Classroom. London: Jessica Kingsley Publishers.
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