The transition from primary school to secondary school brings with it many new challenges to contend with, including new buildings, new people and new routines. This transition is difficult for any child, but for children with an autism spectrum disorder (ASD) it can be a huge struggle for both them and their families. Unfortunately many children with ASD do not receive the support they need to successfully manage their secondary school years, which can have a lasting impact on their quality of life.
This became particularly apparent through my work at a psychological therapy service for adults with ASD where many of the clients I saw had been referred for treatment of anxiety (including generalised anxiety, obsessive compulsive disorder, and social anxiety), which they had developed in their secondary school years. Indeed, secondary school is a critical period during which children develop psychologically, emotionally and intellectually, in order to set themselves up for a positive transition into adulthood further down the line.
It is important to address how we can best support young people with ASD to manage the transition from primary to secondary school, to give them the best chance of reaching their social and occupational potentials.
So what exactly is ASD?
Autism spectrum disorder is a lifelong developmental disability that affects social interaction, communication, interests and behaviours (see Table A). It is a spectrum condition, meaning that although all people with autism share certain difficulties, they will be affected in different ways and with differing severity. Approximately 1% of the population have an autism spectrum disorder, and it is four times more common in males than females. Research suggests that several genetic and environmental factors may account for the particular changes in brain development that give rise to ASD. The main features of ASD typically start to develop in early childhood, although the impact of these may not be apparent until there is a significant change in the person’s life, such as a change of school. This is especially likely in high-functioning autism (also known as Asperger Syndrome) where normal language and intellectual development can mask a child’s ASD-related difficulties.
Table A: Diagnostic categories of ASD
|Reciprocal social interaction:
||Restricted repetitive and stereotyped patterns of behaviour, interests and activities:
In addition to the core triad of difficulties listed in Table A, many individuals with ASD will also have problems with motor coordination and with processing sensory information. All of these difficulties will make various aspects of school life much more challenging, especially at secondary level where there are greater demands academically and socially.
ASD and mental health
In comparison to their typically developing peers, children and adolescents with ASD are seven times more likely to have a co-occurring mental health problem (Simonoff et al., 2008). Anxiety is particularly common, with 40% of individuals with ASD having at least one anxiety disorder, compared with up to 15% in the general population (National Autistic Society). Both internal and external factors are likely to contribute to this increased risk.
Internal vulnerability factors:
Individuals with ASD have inherent difficulties in recognising, expressing and regulating emotions. In addition to this, they tend to have less flexible ways of thinking, which greatly impairs their ability to problem solve. This can make it difficult to cope in less predictable situations, and make them more vulnerable to feelings anxiety and frustration. Figure 1 illustrates how the three diagnostic areas of ASD are likely to contribute to the development of emotional difficulties.
Figure 1: The diagnostic triad and increased risk of emotional difficulties
External vulnerability factors:
A major external risk factor for young people with ASD is that they are very vulnerable to being bullied because they may behave in seemingly odd or inappropriate ways. Many of the adult clients I saw had experienced bullying during school, which had lasting effects on their self-esteem. Additionally, as they grow older, individuals with ASD often develop an increased awareness of being “different” to others, which can lead to negative beliefs about the self. Low self-esteem often goes hand-in-hand with a diminished sense of being able to cope in situations that are perceived to be difficult, which further fuels anxiety.
Alleviating anxiety within the school environment
Thankfully, as our understanding of ASD improves, we are increasingly able to put into place more effective means of support. Targeting this support within the school environment will help students with ASD develop the confidence and coping skills they need to carry them through in later life. Some of these key strategies are listed below.
1) Preparing for the transition
One of the biggest difficulties with starting secondary school for young people with ASD is managing so many huge changes to their routine. This includes a new journey to school, new teachers, new subjects and a new (often much larger) busy school environment. The more preparation that can be done in advance of the transition the better, including liaison between the primary and secondary schools about the child’s individual needs. Ideally, the child should have an opportunity to visit the school more than once, a chance to meet his or her new teacher, and, if possible, also meet some of their new classmates.
2) Practicalities (travel plans, timetables, diaries)
Reducing the chances of confusion or unpredictability during the school day will have a huge impact on the child’s anxiety levels. This would involve making sure that the child knows exactly what they are expected to do at each stage of the day. This will begin with planning in detail the journey to school (where to get the bus from, what to do if transport is delayed or cancelled, what to if they get lost etc.) as well as having a clear visual timetable of the school day, so that the child knows what is happening when. Additionally ensuring that the child is able to navigate around the school building (perhaps using a simple map with visual landmarks) will reduce a great deal of stress.
3) A place of refuge
Sensory sensitivities can make it very difficult for a young person with ASD to manage busy environments, leading to reluctance to be in large, noisy spaces, such as the canteen or the playground. Being in such environments can lead the young person to suffer from ‘sensory overload’ whereby they will struggle to process all the incoming information and they may go into a ‘fight or flight’ mode. Often in these moments the child may ‘act out’ and become aggressive with staff or other children. Many children with ASD will benefit from a ‘refuge’, a safe and quiet place in the school where they can relax and ideally get support from someone who can listen to them.
4) Using ‘special interests’
It can be helpful for teachers to know about a child’s particular special interest, if the child has one. This can serve as a major motivator within the classroom, especially as individuals with ASD respond less to praise from teachers, which is often the main motivator for their typically developing peers. Embedding these special interests into the curriculum can make learning more motivating for the student, and therefore more likely to do well.
5) Having a ‘buddy’
Due to the inherent difficulties in social interaction and communication, children with ASD will find it very difficult to make and keep friendships. A ‘buddy’ system can be a put in place whereby a small group of students in the class are made ‘buddies’ for a student with ASD. These ‘buddies’ are selected for their kindness and maturity and are asked to ensure that the student with ASD is included. Buddies also have the role of looking out for any bullying or exclusion and to generally be supportive to the student if they get stressed out or upset at break time or in class. This approach at the very least will reduce the likelihood that the student with ASD will be alone (and therefore becoming a target for bullies) and at it’s best can lead to genuine lasting friendships.
6) Social skills groups
As a young person with ASD enters secondary school, the social situations they encounter will become increasingly complex, placing greater demands on their compromised social skills. Their difficulties in understanding the views of others, picking up on social cues, as well as understanding and using pragmatic language, means that children with ASD are prone to do or say inappropriate things. Social skills groups can be a great way for the young person to learn more about what aspects of social interaction they find difficult, and practice skills, such as making conversation, in a friendly and supportive environment. It can also be a great opportunity for the young person to meet others who have an ASD diagnosis, which can serve to normalise the condition and reduce any feelings of shame.
7) Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is an evidence-based form of therapy that has been shown to be an effective treatment for anxiety in individuals with ASD (Lang. et al, 2010). The treatment can be adapted to suit an individual’s specific needs and can incorporate education about ASD, teaching of emotion language and emotion recognition, and building upon existing – as well as trying out new – emotion regulation skills. CBT tends to be a relatively short-term intervention (12-20 sessions) and is usually delivered one-to-one, although parental-involvement can be helpful. Often having a diagnosis of ASD can over-shadow other difficulties such as anxiety, which can and should be treated in their own right.
Hopefully through increased awareness and understanding of the disorder, parents and teachers will feel more able to help young people with ASD get the support they deserve, to lead happy and fulfilling lives.
National Autistic Society: Transition from Primary to Secondary School [Online] Available from: http://www.autism.org.uk/living-with-autism/education-and-transition/transition-from-primary-to-secondary-school.aspx.
National Autistic Society: Mental Health and Autism [Online] Available from:http://www.autism.org.uk/living-with-autism/understanding-behaviour/mental-health-and-autism.aspx.
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921-929.
Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K., & Haring, A. (2010). Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation, 13(1), 53-63.
About the author
Georgie Bremner is a Clinical Psychologist in training in London, who has worked with adults diagnosed with ASD who have mental health difficulties, using adapted Cognitive Behavioural Therapy. Georgie’s first degree was in Psychology, Physiology and Philosophy at Oxford University, where she was awarded the British Psychology Society undergraduate award for obtaining the highest mark in an accredited Psychology programme. Georgie’s main research interests are in the development and treatment of anxiety disorders, notably social anxiety disorder and post-traumatic stress disorder.