Autism, nightmares and anxiety

Dr. Cindy Ariel & Dr. Robert Naseef

Question: Autism, Anxiety and Nightmares
My 13-year old daughter was has recently diagnosed with mild retardation and autism. She has suffered from nightmares, but they disappeared with medication. Now in the past month, the nightmares have returned. I'm at a loss as to what to do. Her anxiety is making me sick at my stomach with worry because I don't know how to fix it! Are nightmares common with autism? What do you suggest I try next?

Answer: From Dr. Robert Naseef:
You sound overwhelmed and understandably so with trying to help your daughter and being the best mother you can be. It is important to understand that anxiety is virtually part and parcel of having autism. Tony Atwood, Ph.D., an internationally renowned expert, is fond of saying “Autism is anxiety looking for a target.” That makes sense when you think about it. If you have a neurological disorder which affects speech and language, relating and communicating, and which includes repetitive behaviors and sensory dysfunction, then there is plenty to be confused and befuddled by in the “neurotypical” world.

Your next step is actually fairly straightforward. The right medication will certainly help, and it will invariably be even much more effective when coupled with an effective psychotherapy. Your child needs the help of a psychologist or psychotherapist who is experienced in treating the anxiety of children diagnosed with autism. The best form of therapy for anxiety is cognitive behavioral therapy (CBT). As for how you yourself can be involved, you might want to take a look at “Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries, and Phobias” by Tamar E. Chansky or “Exploring Feelings: Cognitive Behaviour Therapy to Manage Anxiety” by Tony Attwood.

As for how to find someone qualified and experienced to do the job, start with asking the psychologist who tested your daughter. Gradually parents of children with autism can build a network of professionals who they can rely upon. You could also ask your local chapter of the Autism Society of America.

While nightmares are common with all children, children with autism have frequent sleep problems and have a much harder time calming themselves and regulating their emotional state. While you can’t fix it, you can certainly help your child with autism and help your other children to understand and live with a sibling who has autism.

You have taken many positive steps, so give yourself credit. I hope this information will help you to take a few more steps that will yield positive results.

From Dr. Cindy Ariel:
Nightmares are common among everyone and can occur at any age though certain risk factors increase the possibility of their occurrence. While nightmares are not a symptom of autism, they are certainly increased by anxiety which often does go hand in hand with autism.

You may want to find out from your daughter if she is having nightmares or night terrors. The difference is that with nightmares she will remember the bad dream that scares her whereas with night terrors she will wake up sweating and extremely frightened but without recollection of a dream provoking this. Talking about the nightmares may help to shed some light on specific anxiety or stress that your daughter is experiencing. Some medications are actually known to increase nightmares. In either case, nightmares or night terrors are not illnesses in themselves. They don’t have long term effects. It is the anxiety and stress that must be attended to.

Usually, no specific treatment is needed for nightmares. Your daughter with autism and mental retardation however needs extra help in understanding and dealing with all of the anxiety and stressful things going on within and around her. An effective combination of medication and psychotherapy may work best for your daughter.

Due to your daughter’s specific needs, it would be most helpful to find a psychiatrist familiar with autism and its many facets. Some of your daughter’s anxiety may be the way she is ‘wired’ and it could very well be made even stronger by the stress and anxiety she faces everyday in trying to understand and live in the world around her. She needs a great deal of patience and understanding.

Robert Naseef, Ph.D., and Cindy Ariel, Ph.D., are the co-editors of "Voices from the Spectrum: Parents, Grandparents, Siblings, People With Autism, and Professionals Share Their Wisdom" (2006). On the web at

Courtesy of About a NYTimes Company

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