Autism & Anxiety: Parents seek help for extreme reaction to loud noise
2014年8月29日我们12岁的儿子患有自闭症，轻度的智力残疾和焦虑发作如此严重，以至于我们进入急诊室。大声的噪音是最糟糕的 - 例如，学校火灾警报器，雷暴，气球弹出，烟火。任何帮助将不胜感激。
This week’s “Got Questions?” answer is by Judy Reaven, a clinical psychologist and associate professor of psychiatry and pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado, in Denver. Dr. Reaven’s conducted research on the effectiveness of cognitive-behavioral therapy for anxiety in adolescents with autism, with the support of an新利luck娱乐在线Autism Speaks research grant。
编者注：以下信息并非旨在诊断或治疗，也不应与合格的医疗保健专业人员和/或行为治疗师一起享用个人咨询。
Thanks for the great question. It certainly sounds like your family is experiencing a very difficult situation. Anxiety symptoms and reactions are very common in individuals with autism spectrum disorder (ASD). They can interfere with functioning across home, community and school settings.
Although your son’s reaction sounds more severe than most, many people with autism struggle with a range of fears, phobias and worries. These can range from a debilitating fear of, say, spiders or the dark to chronic anxiety about making mistakes or being late.
Fortunately, recent research suggests that anxiety in children and adults who have autism is quite treatable. Often, these individuals are helped by the same or similar strategies that work well in treating anxiety in the general population.
这些方法包括认知行为疗法或CBT。认知行为方法是建立良好的基于证据的治疗方法，已成为焦虑症的心理社会治疗的黄金标准。我自己的研究和同事的研究证明了修改认知行为的方法，以满足患有自闭症的人的特殊需求。
在哪里开始？
您描述了可能与感觉敏感性有关的许多恐惧。我建议您首先咨询职业治疗师，他们可以评估您儿子对噪音的极端敏感性是否是更广泛的感官处理障碍的一部分。如果是这种情况，并且如果您的儿子的恐惧仅由感觉刺激引起，那么他的症状最好通过以感官为中心的干预来解决。许多专门从事自闭症的职业治疗师在该领域接受特殊培训。
患有ASD和焦虑的儿童对感官刺激变得极为恐惧是很常见的。也许 - 像许多自闭症患者一样，您的儿子也很难告诉您什么在吓到他。取而代之的是，他可能会极端避免局势表现出恐惧。
例如，他可能会在消防演习后拒绝上学。在被一个意外弹出的气球吓到生日聚会之后，他可能会害怕生日聚会。极端困扰的其他迹象可能包括大喊大叫，哭泣，紧贴和普遍搅动。因为您的儿子可能很难进行交流，因此重要的是要观察他的行为这些遇险迹象。这可以帮助您确定引发他的恐惧的原因。
Avoidance versus learning to cope
Many parents go to great pains to protect their children by avoiding agitating situations. This approach is sometimes appropriate and even necessary. However, it denies individuals the opportunity to learn how to manage anxiety-provoking situations on their own.
By helping your son learn to manage his fear, you can prepare him for an unpredictable world so that he can participate in it to the maximum extent possible.
考虑到您儿子的焦虑症状的严重性，我建议您除了这里提供的策略外寻求专业支持。孩子患有焦虑症状的家庭可以自己尝试这些策略 - 如果症状恶化，请寻求专业帮助。
一次解决一个恐惧
I suggest making a list of your child’s major fears and worries. Try to rank order them from mild to severe. To encourage success, I’d start with a mild-to-moderate fear before taking on his extreme reaction to loud noises.
认知行为方法的关键组成部分包括介绍应对策略，例如深呼吸和“有用的思想”，可以帮助一个人管理可怕的反应。
For example, you can teach your son to take deep slow breaths to help manage his body’s physical anxiety reactions.
“有用的想法”是您儿子面对使他感到焦虑的陈述。例如，您可以指导您的儿子说：“这是一个大声的噪音。我不喜欢它，但我可以处理。”
To help your son to learn these strategies, I suggest you model taking deep breaths while repeating a “helpful thought” out loud.
Graded exposure
最重要的一步是帮助您的儿子一次面对他的恐惧。我们称此为“分级暴露”。例如，向您的儿子解释一下，你们两个将听雷声的录音。第一次，您可能会以软音量播放录音，然后随着时间的推移逐渐增加音量
或者，您可能会尝试观看气球弹出的视频 - 也许是第一次卷。然后，他可以看着一个真正的气球弹出，同时站在距离之外。随着时间的流逝，他可以越来越靠近气球。
After such exercises, you can present him with small rewards for being brave and “facing fears.” Remember that even a small act of bravery – such as listening to a recording of thunder for 10 seconds – represents an important step toward handling fears. It deserves to be acknowledged.
尽管分级暴露似乎违反直觉，但研究表明该策略是单一的most effective strategy for getting over a particular fear。
I wish you and your son the very best. Please let us know how you’re doing with an email toGotQuestions@autismspeaks.org。
Editor’s note: Also see these related “Got Questions?” blog posts from our archives …
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