This question came up after I did a reel on instagram and TikTok where I was talking about the research behind child anxiety treatment and someone said, and I quote, “Is this true with autism and adhd then too?”
I thought this was a great question so even though it isn’t anxiety specific, there is certainly enough overlap in these diagnoses that I thought it was worth discussing.
ADHD and autism are both a form of neurodiversity, meaning that we’re talking about kids whose brains work differently than the perceived norm. Anxiety may show up as part of a neurodiverse diagnosis — and it is super common in both ADHD and autism — but we’re not trying to cure them and although I bristle a bit at the word cure, we are trying to cure anxiety.
Ok let me back up here.
There are certain ways of being that make some kids more vulnerable to dysfunctional anxiety because remember anxiety itself, is a tool to keep us safe. Dysfunctional anxiety is that tool overreacting and limiting us and limiting our options and experiences. We don’t want to cure all anxiety but we do want to cure the dysfunction.
All of the research shows that in child anxiety the parents and/or caregivers unintentionally get stuck in pitfalls that perpetuate the anxiety instead of supporting their child’s functioning in the face of anxiety.
A super simple example would be a child who is afraid of driving over bridges — this is my daughter when she was small — and so the parents start planning their route to avoid driving over bridges. This limits the child’s chance to deal with their anxiety about bridges and disrupts the whole family’s functioning. But the parent is in charge of that and so the parent needs to understand what they’re doing, why it isn’t helping, and how to stop and deal with the fall out. And then the parent needs to take that information into all the other kinds of anxiety issues they are facing with their child.
Also the parent needs to know how to support their child’s growth in coping with anxiety so that eventually the child can handle these exposures on their own. Plan for them, deal with them, learn to recognize when they’re anxious avoiding and start confronting. Because the child is going to be an adult and will need to know how to do that.
When families do this, when parents get this help when parents go through a guided program, the research tells us that it’s much more effective than asking kids to do it. In fact there was one study that found that when parents had a two hour class and then six follow up check in phone sessions that 95% of the children no longer met criteria for an anxiety diagnosis. Compare this to a study that found that working exclusively with kids resulted in about just 60% no longer meeting criteria.*
Now with ADHD and Autism we’re obviously not trying to get to a place where neurodiverse children no longer meet criteria for their neurodiversity, right? But we certainly want to see them improve in functioning and yes, parental support and parent-led interventions do have a strong research base, which just makes sense. Parents control children’s environments and so if parents can learn to be more effective and create more welcoming and supportive environments then all to the good. I do think that the purpose is a bit different because anxiety can be perpetuated by parental behavior and obviously I don’t think that’s true of ADHD or autism but certainly we can all learn better how to support our kids who need something different than their neurotypical peers.
As far as anxiety as PART of an ADHD or autism diagnosis, the research shows that addressing parental behaviors works to address the anxiety IF the anxiety is the primary concern. That is to say, that if the ADHD or Autism is a greater challenge for the family then they should focus on that whether that’s learning strategies for the family or addressing issues through other interventions such as occupational therapy or working with a speech-language pathologist or getting some ADHD coaching or finding a social skills group.
Personally I advise parents to start with one step, whichever issue feels most pressing for the family, address that one first and then when they feel they have a handle on that — whether that’s seeing some improvement, or feeling like the family is coping fairly well — then take next steps.
It’s tempting to do everything all at once and in some cases early intervention in several areas can be part of the coordinated plan but it’s also ok to take things step by step. Otherwise everyone is going to get overwhelmed.
I also wanted to address a comment I got on TikTok where someone said, and again, I quote, “I really think if a child is in therapy then the parents need to be in therapy too.”
So let’s talk about that.
I don’t agree that every time a child is in therapy the parents should be, too. I think it can help. I think for parents who are struggling with whatever brought their child to therapy that can be a help. For example, if a child experienced a traumatic event that can certainly be traumatic for parents.
But sometimes I think it’s less about therapy and more about supports, or more about finding your village.
One of the things we know about anxiety, for example, is that parents do better when they don’t feel alone. And so an advantage to groups is that parents get to talk to other parents. When I was focusing more on one to one clinical work, that was a big frustration for me, to see how lonely it can be to parent and to not have more resources to share. It’s one of the things that inspired me to create Child Anxiety Support is that it allowed me to build it in a platform where people can talk to each other and not just me. I tried to do that in real life but it’s awfully hard to build momentum to get a parent group working. It’d seem like we’d figure it out and then soccer season would start and everyone’s schedules would blow up and the group would be back to square one.
Anyway. I don’t think everyone needs therapy but I do think everyone needs something when a child is struggling.
Especially if we’re talking about a teenager. I mean, sometimes that makes sense. Sometimes the family’s functioning is suffering, sometimes parents need help figuring out how to parent a teenager, sometimes family therapy makes sense. But other times, a child or teen just needs someone else. They just need someone else to talk to.
I think back to several kids I’ve seen with great parents and the kids were just struggling a little and part of the parents’ building the child’s resiliency and building their child’s toolbox was showing them that there are other adults they can trust and count on to support them. These parents valued counseling as a tool and so they felt comfortable saying to their child, “Hey, this person can be part of our toolbox.” Those parents didn’t need counseling but those parents valued counseling and valued creating and promoting a family culture where getting help is accepted and normalized.
Now I do think that parents and counselors should always be communicating to some extent. More so when kids are younger, less so when kids are teens but enough that the therapist has a rough idea of what’s going on with the family and the parents feel they can trust the therapist to communicate with them should the need arise. Obviously the child or teen needs to trust the therapist’s confidentiality and so the therapist always needs to clear and upfront about when and what they will share with parents. But that, my friends, is a whole different topic.
Dobham, V. E. (2012) Do anxiety-disordered children need to come into the clinic for efficacious treatment? Journal of Consulting and Clinical Psychology, 80, 465-476.
James, A. C., James, G., Cowdrey, F. A., Soler, A., & Choke, A. (2013). Cognitive behavioral therapy for anxiety disorders in children and adolescents. Cochrane Databse System Review, 6: CD004690.pub4.