Clinical Supervision Series: Tips for social workers working with ASD
Considerations regarding generalized anxiety
There is a much higher prevalence of generalized anxiety amongst autistic folks therefore I wanted to present some tips/tools to address some factors that may be contributing to the higher anxiety rates in some of our autistic clients.
Here are some interventions you can use to directly work on GAD:
Support and validate the client in discovering the experiences in their life which may have forced their mind to have a very active fear response
Help to unpack/differentiate between helpful and unhelpful worry
Support the client in problem solving helpful worry and building a positive relationship with helpful worry thoughts
Support the client in refocusing to the present moment when they notice their mind is in unhelpful worry
Support the client in processing feelings as they arise and reducing cognitive avoidance
Support the client in learning the beliefs they have about worry and anxiety and the false benefits to worry which may be maintaining worry.
Gently support the client with compassion in learning what processes may have been put in place that offer them temporary relief from their anxiety but may also be maintaining their worry / anxiety (avoidance, reassurance seeking, pre-planning excessively for events that may never happen etc.) A note here, some pre-planning and reassurance seeking/ excessive structure may be ASD related and necessary for them to be able to regulate and feel safe. We want to check in with the client and determine if they find these strategies helpful or harmful to them, they decide which ones they want to let go of.
Beyond the typical GAD interventions, here are some ASD specific considerations:
Sensory sensitivity : help the client integrate ways of reducing sensory input. Sometimes this may require physical objects, other times we may need to help the client work through beliefs that may get in the way, or with setting boundaries with partners and family regarding alone time.
Masking : support the client to determine the risk of unmasking in various situations. Unfortunately, in our current society, at times there are real risks for autistic folks when they unmask in certain situations. I like to help clients learn to consciously decide when it feels safe and worth it for them to let down their mask in order to free up their energy and live authentically.
Demands/energy : How many demands are they facing? What kind of load are they carrying ? Support the client in finding resources which may help lower the demands and the load they are carrying. Have they considered a meal prep service? Cleaning support? Accommodations that are available to them at work and school? Outsourcing certain tasks to partners, friends and family? Community supports can also be considered.
Meltdowns: My favorite tool for understanding meltdowns unique to each person is to use a chain analysis. This can be helpful to increase awareness around thoughts, sensations and feelings which may indicate signs that a meltdown is coming and how we can respond to and take care of ourself in these moments. We also want to look at aftercare if a meltdown does occur - helping the client to integrate self compassion, rest and self- care.
I hope you found this helpful and this empowers you to work with ASD + GAD.
Tara McRae, MSW RSW
Registered Social Worker, Psychotherapist