It’s not easy living with both autism and diabetes every day. Sometimes, the problems can cause anxiety. Stress can be a factor in hyperglycemia.
Here are the coping skills:
- Pay attention to your feelings. Almost everyone feels frustrated or stressed from time to time. Dealing with diabetes can add to these feelings and make you feel overwhelmed. Having these feelings for more than a week or two may signal that you need help coping with your diabetes so that you can feel better.
- Talk with your health care providers about your feelings. Let your doctor, nurse, diabetes educator, or psychologist know how you’ve been feeling. They can help you problem-solve your concerns about diabetes. They may also suggest that you speak with other health care providers to get help.
- Talk to your therapists and health care providers about negative reactions other people may have about your diabetes. Your therapists and health care providers can help you manage feelings of being judged by others because you have autism and diabetes. It is important not to feel that you have to hide your autism and diabetes from other people.
- Ask if help is available for the costs of diabetes medicines and supplies and autism-related stuff. If you are worried about the costs, talk with your pharmacist and other health care providers. They may know about government or other programs that can assist people with costs. You can also check with community health centers to see if they know about programs that help people get insulin, diabetes medicines, and supplies (test trips, syringes, etc.) or programs that help people with autism.
- Talk with your family and friends. Tell those closest to you how you feel about having autism and diabetes. Be honest about the problems you’re having in dealing with both conditions. Just telling others how you feel helps to relieve some of the stress. However, sometimes the people around you may add to your stress. Let them know how and when you need them to help you.
- Allow loved ones to help you take care of your diabetes and deal with autism. Those closest to you can help you in several ways. They can remind you to take your medicines, help monitor your blood sugar levels, join you in being physically active, prepare healthy meals, and deal with autism-related problems properly. They can also learn more about diabetes and go with you when you visit your doctor. Ask your loved ones to help with your autism and diabetes in ways that are useful to you.
- Talk to other people with autism and diabetes or people who have one condition or the other. Other people with one condition or the other or both understand some of the things you are going through. Ask them how they deal with their conditions and what works for them. They can help you feel less lonely and overwhelmed. Look for autism and diabetes support groups in your community or online or look up personal accounts online.
- Do one thing at a time. When you think about everything you need to do to manage your diabetes, it can be overwhelming. To deal with diabetes distress, make a list of all of the tasks you have to do to take care of yourself each day. Try to work on each task separately, one at a time.
- Pace yourself. As you work on your goals, like increasing physical activity, take it slowly. You don’t have to meet your goals immediately. Your goal may be to walk 10 minutes, three times a day each day of the week, but you can start by walking two times a day or every other day.
- Take time to do things you enjoy. Give yourself a break! Set aside time in your day to do something you really love; it could be calling a friend, playing games, or working on a fun project. Find out about activities near you that you can do with a friend.
- Scream into a pillow: If necessary, scream into a pillow in a private place, but make sure nobody hears you. Otherwise, they’ll call the police. Optionally, turn on the TV or music very loud, so nobody would hear you screaming.
- Keep a diary: To help someone understand anxiety, get them to understand the symptoms they display when they are anxious and to look at the causes of their anxiety. Keeping a diary in which they write about certain situations and how these make them feel may help them to understand their anxiety and manage it better. Use the diary also to think about the physical changes linked to anxiety. Use the diary to monitor this as well. Record the time and date, situation, how you felt, how anxious (1 to 10), etc.
- Meltdown prevention plan: Create an anxiety plan when someone is feeling positive about things. An anxiety plan is a list of things and situations that cause anxiety as well as solutions and strategies they can use to help them manage their anxiety levels. The plan can be adapted, depending upon how well someone understands anxiety. Remind yourself not to worry about hypo or hyperglycemia levels. It’s okay if you’re surprised once in a while, but don’t make a big deal out of it. Deal with them properly. Learn the lessons from your mistakes and move on. Take a few deep breaths if needed to.
Here’s an example of a prevention plan:
- Situation – going on the bus or having high blood sugar
- Anxiety symptoms – heart beats fast; sweat and feel sick
- Solution – have stress ball in pocket, squeeze the ball and take deep breaths, listen to music.
- Relaxation techniques: People with autism can sometimes find it very difficult to relax. Some have a particular interest or activity they like to do because it helps them relax. If they use these to relax, it may help to build them into their daily routine. However, this interest or activity can itself be the source of behavioural difficulties at times, especially if they’re unable to follow their interest or do the activity at a particular moment. Some people may need to be left alone for short periods of the day to help them unwind.
- Physical activity can also often help to manage anxiety and release tension. Using deep breathing exercises to relax can be helpful as can activities such as yoga and Pilates or ballet fitness, which focus on breathing to relax. Use a visual timetable or write a list to help remind the person when they need to practice relaxation.
- Any other activities that are pleasant and calming such as taking a bath, listening to relaxing music, aromatherapy, playing on a computer may also help reduce anxiety. Some people may find lights particularly soothing, especially those of a repetitive nature, such as spinning lights or bubble tubes.
- Talking about anxiety: Some people find direct confrontation difficult. They may therefore be unable to say they don’t like certain things or situations, which will raise their anxiety levels. If they identify they are anxious, they could use a card system to let family or friends around them know how they are feeling. At first, you may need to tell them when to use the card and prompt them to use it when they do become anxious. They could also carry a card around with them to remind themselves of what they need to do if they start getting anxious. You could also give them a stress scale that they can use whenever they find something particularly stressful.
- It may help them to buy our Autism Alert card, which is the size of a credit card. They can use the card to let members of the public know that they are autistic.
- Stop and Think! method: Stop and think to yourself, ‘Is it worth it to worry over this?’ For example, a person with autism checks his or her blood sugar. The result is 300. He or she takes a deep breath and thinks, ‘I gotta deal with this properly. I don’t wanna get upset over this!’ Two hours after dinner of a low-carb meal and a proper amount of insulin, he or she rechecks the glucose levels. The result was 150. Another example is that he or she waits in long line at the movies or a grocery store and thinks, ‘Nothing to worry about. Everything’s fine. No big deal. I don’t want high levels later.’
Remember that it’s important to pay attention to your feelings. If you notice that you’re feeling frustrated, tired, and unable to make decisions, take action. Tell your family, friends, counselors, and health care providers. They can help you get the support you need. Make sure you don’t end up in the hospital.
*Same blog on Life With Diabetes site
- Socially Avoidant
- Socially Indifferent
- Socially Awkward
- Minimal interaction
- Turning or walking away
- Fear of unexpected touch
- May be hypersensitive to another’s voice or smells
- Doesn’t seek interaction with others
- Interaction increases when “wants and needs” are necessary
- Will initiate rather than respond
- Most common category
- Want to experience social engagement but lack the skills
- History of being excluded or left out
- Lack reciprocity in social interaction
- Poor conversation skills
Social Emotional Issue #1:
- Unsafe use of playground equipment
- “Aggressive” with peers
- Disrupts others’ games
Why is this occurring?
- Sensory seeking
- Difficulty controlling body movements
- Poor modulation
- Lack of social skills for play
- Practice safe use of equipment
- Provide and review a written list of playground rules
- Pair student with a peer model
- Review playground performance and offer immediate feedback
- Alert the playground supervisor of the student with special needs
- Be aware of signs and signals of over-arousal
- Student may need additional adult supervision
Social-Emotional Issue #2
BEHAVIOR: Making rude or inappropriate comments
Why is this occurring?
- Decreased perspective taking
- Deficits in verbal communication (receptive and expressive)
- Difficulty with social pragmatics
- Challenges reading nonverbal signals from others
- Prepare other students for their reaction (ignore or model appropriate behavior)
- Identify pattern and be prepared to help the student
- Make your immediate feedback and be specific
- Practice the social interaction
Social-Emotional Issue #3
BEHAVIOR: Difficulty accepting criticism or help
Why does this happen?
- Concrete thinking interferes
- Anxiety increases
- Maintain a calm, quiet voice
- Avoid “black and white” words such as “wrong”
- Use qualifiers (“very close” or “almost”)
- Try writing your corrections or assistance rather than talking
- Prepare peers to expect such behavior and disregard or encourage if appropriate
Routine & Academics Issue #1
BEHAVIOR: Messy desk and losing homework
Why is this occurring? Planning deficits, visual processing problems, & poor motor skills
- Give entire class an organizational review
- In the AM, take time to walk student through process of getting materials out of backpack, handing in homework, etc. then fade your prompts
- Have a peer buddy help father materials at the end of the day
- Consider using accordion file folder rather than 3-ring
- Copy teacher’s transparencies
- Takes teacher/parent communication
Routine & Academics Issue #2
BEHAVIOR: Inattentive/off-task or not following directions in and out of class
Why is this occurring?
- Too much verbal information
- Difficulty terminating and transitioning
- Auditory and visual distractions
- Daydreaming or shut-down due to sensory overload or fatigue
- Visual supports
- Hand fidgets
- Oral strategies
- Seat near the teacher or away from distractions
- Alert student that directions are forthcoming
- Check to ensure student is starting assignment, art, or PE activity correctly
- Keep language simple and concrete
- Allow time for processing
Routine & Academics Issue #3
BEHAVIOR: Problems Riding on the Bus or in the Car
- Student leaves his or her seat
- Can be disruptive
- Refuses to get on/off the bus or in/out of the car
- Allow plenty of time in the morning for student to engage in his/her routine
- Provide something familiar to occupy the child (iPod, book, toy) for the ride to and from school
- Give him or her a closed-ended task/game to play during the ride
- Seat near the bus driver
- Bring a friend to meet him or her or walk to the bus
- Bring a favorite item to carry back to the classroom upon arrival
- Take something special home to “show and tell” to parents—don’t just put it in his or her backpack
Avoidance and Retreat
- Over-responsive to sensation
- May respond to touch with aggression or fear
- May appear anxious and unwilling to take chances
- Avoids crowded areas
- Can be picky eaters
- Decreased peer and social relations
Avoidance and Retreat Issue #1
BEHAVIOR: Covering Ears
Why is this occurring?
- Noise in the environment is perceived as painful, irritating, or confusing
- Student has difficulty screening out extraneous information and is overwhelmed
- Can be a “passive” resistive behavior to refuse work
- Give student a “heads-up” to alarms, bells, etc.
- Allow the use of headphones in class, during assemblies, on the bus, or on playground
- Provide quiet space for “noise break”
- Help student label his emotional reaction
- Use a positive reinforcement strategy
Avoidance and Retreat #2
BEHAVIOR: Putting head down, “shutting down,” or running away in class, during PE, or at recess
Why is this occurring?
- Anticipating his or her over-reactivity to sensation, he becomes avoidant and doesn’t participate in academics and social opportunities
- Unaware of the rules of the games
- Aware that motor skills are hard for him—becomes avoidant
- Prepare the student for the activity (social story)
- Positively reinforce participation in a stimulating activity
- Give student time to collect himself
- “Front-load” the student–practice the games and activities for PE and recess
- Allow an “approach/avoid” pattern—it’s OK to take a break and return to the activity
Difficulty with Routine and Academics
- Lacking adequate skills
- Not understanding
- Fear of being teased, left out, misunderstood
- Change in the physical environment
- Change in routine
- Having to wait too long
- Environmental Confusion: crowds & excessive visual/auditory clutter
- Organizational Concerns: desk, backpack, & homework
- Sensory Issues: may impact ability to focus on academic, PE, play
What does sensory processing have to do with learning and behavior at school? Necessary for systems to work together in an organized manner or major traffic jam!
Sensory Processing Dysfunction
- Sensory Modulation Disorders (SMD)
- Sensory Over-Responsive (SOR)
- Sensory Under-Responsive (SUR)
- Sensory Seeking (SS)
- Sensory Discrimination Disorders
- Sensory Based Movement Disorders: Dyspraxia and Postural
Not all children with a sensory processing disorder has autism, but all children with autism have sensory issues.
How Can We Best Categorize The Concerning Behaviors?
- Movement Issues
- Avoidance and Retreat Behaviors
- Difficulty with Routine and Academics
Where do we see these behaviors?
- Inside the classroom
- Outside the classroom—arriving, in line, leaving school
- PE and Playground
- Art, Music, Assemblies
- Pull-Out Services
- Lunchtime and Snack
- Student appears to be under-aware of his body and environmental stimuli
- Student may be defensive to touch
- Student appears to be hyperactive, or a “sensory seeker”
- May be labeled as “aggressive” with peers
Movement Issue #1:
- Out of seat
Why is occuring?
- Student craves movement
- May be attempt to maintain arousal state
- Movement breaks
- Allow student to stand at the desk
- Hand fidgets
- Seat cushion device
- Oral strategies
- “Calm Down Breathing”
Movement Issue #2
- Breaking pencils or canyons
- Extremely dark lettering
- Messy dark
- Can’t keep up with written work
What is the cause?
- Touch and force systems are under-aware
- Attempt to self-regulate by drawing and writing darkly
- Poor fine motor skills lead to frustration
- Use heavier writing utensils that won’t break
- Use heavier stock paper
- Use a mechanical pencil
- Try keyboarding
- Peer scribe
- Supply handouts, use highlighter
Movement Issue #3
- Doesn’t line up in time
- Wanders away from group
- Pokes or pushes other students
- “Aggressive” during PE and on playground
Why is this occurring?
- Challenges with waiting
- Lack of awareness of environmental cues
- Student is sensory seeking
- Reduce waiting time/limit turn taking
- Assign a consistent place in line
- Have motor restless child act as door holder
- Give the student something to hold in his hands while standing and walking in line
- Practice walking to various locations on campus to build a visual memory map
- Review the play and line rules
- Provide positive reinforcement for appropriate behavior
Movement Breaks in Class
- Move ‘n Sit cushion
- Semi-inflated beach ball
- Classroom helper
- Chair lifts
- Wall push-ups
Movement Breaks Out of Class
- Playground activities
- Custodial helper
Some Ideas for Hand Fidgets
- Squeeze balls
- Koosh balls
- Rubber bands
- Hair bands
- Textured fabric
- Stretchy bracelets
- Jolly Ranchers
- Spicy, crunchy, chewy snacks
- Stir sticks
- Water bottle with thin or long straw