Opinion — 06 April 2012

Mental health issues such as anxiety, depression in children are under-diagnosed all over the world. What if the child has autism, but can’t express himself properly? The chance of diagnosing this co-morbidity is very slim.

Why would they develop these problems? Do they have emotions like others? Yes, they have emotions like any other person. Not only simple emotions such as happiness and sadness, but also complex emotions like guilt. It was established recently by Professor Francesca Happe that people with autism, besides recognising their own emotions, can also recognise emotions of others. These special people, although they don’t make appropriate eye contact, can read others’ tones, gestures and facial expressions.

Dr. Wendy Lawson, a renowned Australian psychologist who herself has autism, said that it is impossible to fool people with autism. However, we usually make comments about autistic people in front them without thinking that the comments might be harmful because they can recognise our emotions through our voice and gestures. Many of them can also understand simple phrases.

Imagine yourself in the same situation, you have problems in expressing yourself, but you can understand that you are always scrutinised and/or criticised by people around you. Ultimately, you would develop low self esteem, anxiety, depression and other mental health problems. This is the situation for persons with autism.

Any behaviour that is different from what others expect is labeled as problematic. Therefore, signs of anxiety or depression are often not recognised among them. These symptoms are dealt with in the way that others want to deal with them; they are always asked to get over any difficulties, no matter how hard it is for them. They are often told that they are the only ones to develop this fear, so they should get over it as soon as they can.

According to research findings, 30-35% children with autism, after getting early intervention, can integrate with typically developing peer group with or without support. Bringing a child to this level needs relentless work by the family and the special schools or centres providing intervention to these children. When the child is ready to go with his typically developing peer group, he goes to the mainstream setup with the diagnosis of autism.

Anything different from his peer group is labeled as problematic, and parents often receive complaints about the different behaviour of their children. The child can feel that what he is doing is not accepted by others. Moreover, there is a chance of being bullied by his peer group as children are often very good at picking up on the differences in their friends. As a result the child may develop associated social anxiety.

People with social anxiety are fearful of social situations, they do not have enough confidence to get into a social situation. What happens when a child with autism develops social anxiety? He will not get into a group. How will we deal with these situations as caregivers? Is it autism or autism with social anxiety?

It does not matter whether the child does or doesn’t have this associated anxiety, we should support him in socialising with his peer group gradually. The common myth is, only because the child has autism, he will not benefit from this socialisation.

This is a real challenge faced by these special children who are developing mental health problems due to lack of proper integration. Many children who only had one diagnosis while leaving their special setups can later develop dual problems like autism with social anxiety and/or depression. Autism Spectrum Disorder (ASD) is a big spectrum, and children who are on the edge can often survive independently if they get proper support at an early stage. But the associated anxiety can hold them back from integrating independently into the society.

What can we do as care givers? Normalisation can give some relief to these fears. Rather than labeling these children as “different,” we can give them the idea that it is normal to get fearful at times. It can be done through stories and pictures too. We can also teach them to rate their emotions on a scale, be it happiness, sadness or anger. Of course, this should be introduced when the child is calm.

The physical feelings of anxiety can be described to them through pictures as well. They can be taught about their negative and positive thoughts through simple games. I often give the example of Mr. Worry and Mr. Norry, sometimes with the help of pictures, where Mr. Worry (bad thoughts) is presented as a character that the child obviously dislikes and Mr. Norry (good thoughts) is drawn as a favourite character of the child. Then the child is taught how he can defeat Mr. Worry with Mr. Norry’s help. This often helps to teach the child that his thoughts and emotions are under her/his own control and her/his thoughts don’t control him.

They can be encouraged to play with others about what they can do in fearful situations. Then parents and teachers can help them to get the exposure in peer groups in a gradual way, which will sensitise them over time. Mainstream schools can also educate the typically developing peer group about how to behave with their special friend.

Schools can play an important role in desensitisation. Schools and parents, rather than teaching the child to hide or get over her/his emotions, can encourage her/him to express her/his thoughts and emotions. Instead of assuming what is happening in her/his mind, we can actually ask them what situations are difficult for her/him and why. These open discussions about feelings and thoughts can minimise the fears a lot. Regular rating of her/his emotions can reflect her/his improvement and help to build up her/his confidence.

Awareness about autism also means the society’s responsibility to give these children the opportunity to grow up with other children in an accepting environment. We all have a responsibility towards lighting up the small hearts of these younger special citizens.

The writer is Nusrat Y. Ahmed, Director, Hope Autism Center. E-mail: ahmednydr@yahoo.com

As first appeared in The Daily Star, April 6, 2012

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