Case study on Anxiety

Background

B. is a fourteen year old girl and attends an autism unit within a mainstream school. She has a diagnosis of Asperger’s syndrome and experiences high levels of anxiety and repetitive negative thoughts, which have impacted on her self-esteem. Her strengths lie in her care for others and in her many talents, such as drawing. K.L frequently reflects negatively on herself, which can result in her viewing herself as a ‘bad person.’ She also has a tendency to focus on negative things that have happened in the past and finds it difficult to reflect positively on events. She finds it difficult to acknowledge and speak about her achievements and talents. When experiencing high levels of anxiety, B. will attempt to exit the room or will reflect negatively on herself and believes that she deserves to suffer. In the past she has engaged in self-injurious behaviour in response to anxiety.

Triggers

In consultation with teachers and parents the following triggers for behaviour were identified.

Being in noisy environments
An adult raising their voice
Changes in routine, such as a substitute teacher
Remembering negative experiences in previous placement settings, particularly bullying
Watching a film or advertisement with upsetting content
B. enjoys spending time with soft toys, however, she believes that these are not age appropriate and is very anxious about her peers finding out about these interests

Maintaining Factors

B. was unaware of strategies she could use to lower her anxiety level
She did not want to worry those around her, so she would keep negative thoughts to herself

Strategies

B. and her class were encouraged to complete “positive books” each day to help them to reflect positively on past experiences
She was given worry dolls to tell her worries to. These were used at night and then placed in a box
Use of strategies to support B. with labelling her emotions e.g. The 5 Point Scale, Emotional Toolbox, and she used emotional regulation loom bands. Three colours were used; red, orange and green. She wore the band which represented how she felt
Cognitive based strategies to help her identify her ‘poison’ thoughts, and choose and appropriate ‘antidote thought’
Using a visual representation B. was encouraged to decide if worries were within her control or outside her control
Take Ten visual breathing programme was used to teach deep breathing as a method of relaxation during times of anxiety
Delivering messages throughout the day to promote movement and sensory regulation
Access to a safe space for time out. Use of fidget toys, and relaxing activities in this space
In collaboration with school, B. was taught about autism and famous women with autism