978-1572305441

Zachary 49
were part of his TV viewing and other interests. He had a worried look
on his face; he paced around the house asking his mother questions
over and over again; he was having trouble sleeping. He never spontaneously
said he was worried about death—one might expect that from a
more typical child—but nevertheless there was a feeling of anxiety
throughout the entire interview that was evident in Zachary’s actions.
Children with ASD find it difficult to talk about their feelings; that is,
after all, part of the disorder. Instead, anxiety is often signaled by certain
behaviors: repetitive questioning, disturbances in sleep, pacing, and an
increase in repetitive actions, such as finger flicking and rocking. It is
also often accompanied by a more intense preoccupation with the
child’s usual interests, so that getting his attention to turn to something
else (like coming for dinner or turning off the TV) can provoke aggression
and temper tantrums.
Little is known about how common these anxiety symptoms are in
ASD and how to treat them. One frequently encountered set of anxieties
are specific phobias of an unusual content. As mentioned in Chapter 3,
children with ASD can be terrified of bees or mosquitoes, rain or the
fog—things that don’t usually terrify typical children. For example, Stephen
would become distraught if one of his balloons made an unusual
sound when the air escaped. He was very afraid of the broken bits of
balloon flying around. In contrast, typical children may become phobic
about the dark, big dogs, or spiders, phobias that are more understandable.
Some adolescents with ASD have more generalized worries about
schoolwork, about being teased, about having girlfriends—but again,
often with an unusual twist. For example, Justin would become anxious
about being too close to people, about harming them, about his bodily
functions and how these might influence others. Typical children are
anxious instead about being separated from their parents, afraid
that something bad might happen to them, or else they are very selfconscious,
easily embarrassed about their appearance, their speaking
habits, and their clothes. Children with ASD seldom have such worries
and are rarely, if ever, embarrassed since this emotion requires a clear
understanding of how others might perceive them. Another important
difference is that typical children are able to articulate more clearly that
they are worried. These and other emotions are more apparent from
their facial expression and overall behavior than they might be with
children with ASD.
However, the most common anxiety among children with ASD is
about change. They will, as explained in the preceding chapter, try to