Children who have an Autism Spectrum Disorder (ASD) appear to be vulnerable to feeling anxious for much of their day at home and at school, often experiencing extreme anxiety in anticipation of, or in response to, specific events--such as the sound of a dog barking, making a mistake, or a change in the schedule of activities for the day. Sometimes, the level of anxiety may be perceived by parents and teachers as actually more disabling than the diagnostic characteristics of ASD.All types of anxiety disorder are more frequent in children with ASD in comparison with typical children; they include specific phobias, Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder (SAD), Generalized Anxiety Disorder (GAD), and Separation Anxiety (Van Steensel et al. 2011). However, there can be qualitative differences in the presentation of anxiety in children with ASD when compared with typical children. Phobias may develop as a response to sensory sensitivity. For example, to particular sounds--such as vacuum cleaners, electric hand dryers, or thunder (Mayes et al. 2013)--which may elicit painful responses with a resultant phobia of these sounds and situations where they can occur.

An assessment of the circumstances associated with heightened levels of anxiety can indicate an intolerance of uncertainty (Wigham et al. 2015), as well as a fear of making an error, or performance anxiety (Attwood 2006). There can also be a fear of being targeted for bullying, teasing, rejection, humiliation, and anxiety associated with changes in routine or expectations (Attwood 2006). Socializing with peers is perhaps the greatest source of anxiety.Anxiety can frequently be associated with specific social situations, such as those circumstances where there are no apparent or previously experienced social rules, or where the social codes or conventions are being deliberately broken by other children. There can be anxiety associated with complex and possibly novel social situations, such as birthday parties, and performance anxiety in terms of being able to apply learned social responses and behavior in real life social settings. The high level of anxiety experienced in social situations, such as the classroom or playground, may result in the child''s use of coping strategies that lead to a diagnosis of Separation Anxiety, where the child genuinely needs guidance and reassurance from a parent; and Selective Mutism (in terms of the flight, fight, and freeze response to anxiety), where the child "freezes" and is unable to speak in the classroom, but is verbally fluent when relaxed at home.The extensive research on Theory of Mind skills and autism confirms that children with autism have considerable difficulty identifying and conceptualizing the thoughts and feelings of both other people and themselves.

The interpersonal and inner world of emotions appears to be uncharted territory for children who have autism. This program provides guidance in exploring emotions and is designed to improve the child''s ability to monitor and manage anxiety throughout their day. Another characteristic associated with autism is alexithymia, namely a diminished vocabulary of words to describe emotions; this includes one''s own emotions as well as the emotions of other people (Berthoz and Hill 2005; Hill et al. 2004; Samson et al. 2012). Research suggests that the child with autism can identify having an increased level of emotional arousal, but has great difficulty labelling and eloquently describing the level of emotion (Ketelaars et al. 2016). When asked how they are feeling at a particular time or during a particular event, the child with ASD may reply, "I don''t know," which means, "I don''t know how to tell you.

" The child may therefore have difficulty telling a teacher or parent how anxious they feel and why they are anxious. However, it may be possible to identify specific behaviors, actions, and thoughts that serve as a behavioral "code" or "clue" for a particular feeling and the depth of that feeling.The teacher or parent must be a detective or scientist observing, collecting, and analyzing the data regarding which situations and events can precipitate intense anxiety. A new way of exploring and discovering the various levels of anxiety during the day, and the level of anxiety in response to a particular situation, can be sports technology. That is, devices worn on the wrist to measure heart rate, which can be used to record general anxiety levels throughout the day and the level of response to specific situations. The devices can also be used to encourage the ability to relax, using a relaxation strategy such as breath control, where the child is able to observe and respond to the gradual reduction in his or her heart rate. Deeper levels of relaxation can be achieved using the many different meditation techniques. In Western cultures, there is a growing awareness and appreciation of the value of activities such as yoga in encouraging a general sense of well-being and providing an antidote to anxiety.

We now have yoga activities specifically developed for children with ASD to use at school and home (Betts and Betts 2006; Bolls and Sewell 2013; Mitchell 2014; Hardy 2015), and some teachers are now using classroom and individual meditation activities to encourage relaxation and enhanced attention for the whole class. Mindfulness is also being used for children with ASD in school settings to regulate attention toward the present moment, to let an emotion pass and encouraging an attitude of openness and acceptance using imagery, meditation, and yoga (De Bruin et al. 2015).The original Exploring Feelings program for anxiety was published in 2004, and we have learned so much since then. This new training manual provides a valuable review and update to further explore and manage anxiety for children with Autism Spectrum Disorder. Dr. Tony Attwood, author Exploring Feelings: Anxiety: Cognitive Behaviour Therapy to Manage Anxiety Exploring Feelings: Anger: Cognitive Behaviour Therapy to Manage Anger.