EBSA and Autism Spectrum Condition (ASC)

Page Updated: 5th November 2020

There is a new EBSA and Autism leaflet available to read that has been produced by the West Sussex: Educational Psychology Service, SENDIAS Service and the Autism Social Communication Team.

It is well documented that anxiety and poor stress management are common in children with autism and that anxiety may worsen during adolescence, as young people face increasingly complex social interactions and often become more aware of their differences and interpersonal difficulties. As yet, there is little research into the prevalence of those with ASC and EBSA but evidence and experience suggests that due to the anxieties that the children with ASC experience they are at increased risk of EBSA.

The factors which influence levels of anxiety in those with ASC, as with any child, are multiple and often complex; associated with context blindness, executive functioning, limited theory of mind, difficulties processing language, focus on detail, sensory processing differences (Ozsivadjian and Knott 2016; Gaus 2011; McLeod et al 2015; Ting and Weiss 2017). Recent research also considers intolerance of uncertainty (IU) as a key contributing factor to anxiety in children with ASC.

Schools will be aware that they are complex social environments that children with autism can find exhausting; they are spending cognitive energy managing this social experience and can become overloaded. Indeed, their anxiety may become ‘overflowing’ as depicted below and place them at risk of EBSA.

picture of bucket over flowing with water, surrounded by phases of things that can cause anxiety

Given the increased risk of a child with ASC experiencing high levels of anxiety that may lead to EBSA it is essential that there is early attention and intervention given to developing the child’s social skills, emotional literacy, resilience and their ability to self- regulate. Steps to address these are set out below.

Working with the child

Evidence and experience demonstrates that anxiety levels in children with ASC can be reduced by adopting good practice approaches that are individualised to the child’s specific needs including visual supports, structure, managing change and generally increasing the certainty of the school day. Further details of good practice strategies can be found in Appendix 6 – Strategies for Young people with ASC and should include all adults working with a child being made aware of the affect their communication style can have.

All adults working with the child:

  • Use child’s name before delivering any instructions so that they cue into you speaking to them and recognise the instructions applies to them.
  • Allow additional time for the child to process verbal information and instructions (at least 10 seconds) and avoid repeating verbally within this time.
  • If repetition of the information/instruction is necessary use exactly the same wording as initially used.
  • Use explicit, concise language when addressing the child as this is likely to enable them to process the information correctly.
  • Use short simple instructions. Give them in order that they are to be completed. Check for understanding. Ask the child to repeat them back to you

    Steps to Support Reducing Anxiety

    Step One

    Ensure that all adults working with the child have an understanding of ASC and communicate appropriately and that adults have implemented general autism ‘good practice’ strategies e.g. the child uses and is engaged with a visual timetable, relevant visual supports, calm space – see Appendix for further suggestions.

    Step Two

    Key to the effectiveness of any intervention is having a sound understanding of the child’s needs and how ASC specifically affects the child. Consider using a tool such as;

  • Pupil Progression tool - Autism Education Trust (AET 2017):
  • Autism from Diagnostic Pathway to Intervention by Kate Ripley

    Step Three Plan and implement individualised, strategies to develop the emotional and social skills identified in step two. These may include those identified for children in previous chapters of the guidance or more specific strategies such as those included in the resources section.

    Step Four

    Review the impact of the interventions using the Pupil Progression Tool (AET) or similar. It may be that, despite the good practice and interventions, the child’s anxiety continues to increase placing them at risk of EBSA and additional interventions will require implementation.

    Please note that the advice in previous chapters regarding Action Planning are also relevant here and should be followed.

    If there are indications that the child is at risk of EBSA it will be important to build up a clear picture of exactly what elements of attending school are increasing their anxiety in order that best endeavours can be made to alleviate the anxiety. It is recommended that the tools in Autism from Diagnostic Pathway to Intervention by Kate Ripley are used. In particular, Mapping the Landscape of Fear and planning solutions.

    Schools should also consider incorporating supports based on modified cognitive behaviour therapy (CBT). CBT is based on the notion that our thoughts mediate our emotional and behavioural response, implying that it is not external events such as people or situations that cause our responses, but rather our thoughts about those events. NICE (2013) recommend that CBT is considered for children and young people with autism anxiety who have the verbal and cognitive ability to engage and there is emerging and growing evidence that CBT could reduce anxiety in children with ‘high-functioning’ ASD.

    Schools could consider using resources such as:

  • The Homunculi Approach to Social and Emotional Wellbeing: A Flexible CBT Programme for Young People on the Autism Spectrum or with Emotional and Behavioural Difficulties by Anne Greig
  • Starving the Anxiety Gremlin by Kate Collins-Donnelly

    It may also be appropriate to seek specialist, outside agency support such as The Autism and Social Communication Team.

    Working with Parents

    Recent studies, (Reaven et al 2012; Steensel, Zeger and Bogels 2017, Ting and Weiss 2017) emphasise the importance of the relationship between parental anxiety and anxiety in children and young people. Many parents of children with autism report that they notice their own emotions have an impact on their child’s emotions and vice versa. Therefore, it important to emphasise the need for school to build a collaborative partnership with parents in the best interest of the child, as described previously.

    Parents may have received minimal guidance regarding strategies to support their child and schools should consider training courses that may be available to parents e.g. EarlyBird Plus and AScSURE. In addition, the transactional nature of anxiety highlights the need for parents and carers to pay attention to their own mental health needs and parent support programmes such as the Early Bird Healthy Minds Programme teaches parents to take care of themselves, in order to be in the best physical and mental health to help their child, whilst also teaching them strategies to develop their child’s emotional resilience. Further details available from the Autism and Social Communication Team.