Absenteeism - Module 4

2. STRATEGIES AND TECHNIQUES

2.2. ANXIETY

When people are anxious, they usually engage in very shallow breathing which does little to oxygenate the body. People who are anxious tend to do more breath holding (they usually keep their lips closed as they breathe out; or appear tight lipped when working). Others may take short, fast breaths (this is letting carbon dioxide out but not much oxygen in). This does not help the body or mind to feel calm and relaxed. 


Guidelines for managing anxiety especially when the student is afraid of certain contexts, subjects or situations

Below we specify some guidelines to be able to deal with anxiety, it is not necessary to wait for overwhelming situations to occur in which it is difficult to handle anxiety or stress, sometimes it is useful to anticipate those situations that by observation we have appreciated that they can generate anxiety situations. That is why it is important to teach and practice relaxation skills:

  • Controlled breathing: teach and model-controlled breathing (4 seconds of inhalations through the mouth and 7 seconds of exhalations). Ask the child to sit or lie down and issue the following instructions to them:

    • Place one hand high up on your chest and the other lower down just above your belly button/around your diaphragm. 

    • Take a deep breath in gently through your nose allowing your body to react naturally and then let the air slowly out of your mouth. 

    • Notice what is happening to your hands. Is your lower hand moving in? Good this shows that you are breathing and filling all your lungs. If you are doing shallow breaths, there will be little movement. 

    • You should be seeing both hands moving: the rear hand should move towards your back as you breathe in and out as you exhale. The top handhold rises as you breathe in and fall as you breathe out. 

    • If you are struggling to get movement, try taking deeper breaths and letting your stomach push out slightly as you breathe out. 

    • Practice this several times 

    • Breath in slowly, gently making the in breath a continuous movement

    • Pause briefly 

    • Before slowly exhaling/breathing out 

    • Pause again and just take a short while to feel the pressure of your hands on your body (this calms the body down and stops any panting action). 

  • Visualization techniques: 

Imagination is very powerful. It is about thinking in images clearly, seeing ourself experiencing those desired situations and sensations.

An example of a student with ASD who is afraid to walk down the hall of the school, because there are too many people and feels pressure to feel observed, is to accompany him/her in imagination.

    • Relating a situation in a very specific way in which he feels more and more strength and power so as not to feel embarrassed because there are people around. 
    • Look at details to look for distraction, such as the colour of people’s shoes.
    • Observe that the rest of the people in the hall are talking without noticing you.


  • Listening to music: 

Singing a song or listening to music help to reduce anxiety. In case of fearful or evasive about a subject, this can generate positive emotions that can be associated with that subject. It is necessary to take into account and observe if what we expect occurs, since for some boys with ASD it is necessary to control the volume of the music or the tones (sometimes too high) since they can have acoustic hypersensitivity


  • Emotive imagery:

It can be helpful for children who have problems with relaxation. An example would be to have the child sing songs with themes that emphasise courage and strength. It also works drawing situations in which he positively and courageously faces situations that scare him/her.


  • Modelling:

This strategy is very useful when the student is afraid of certain contexts, situations or materials

    • Filmed modelling: record a person of a similar age to the student in which the “movie” is later seen in which that person performs that action or that activity that causes fear (approaches or interacts with the feared object or situations)  
    • Participant modelling: this is live modelling coupled with a school mentor or peer physically guiding the student and accompanies him to carry out that activity, or to approach those feared object or situation.


  • Systematic desensitisation is the most commonly used method in treating children’s fears. 

    • Make a list with the student, ordering from things that cause a small worry to those causing major distress. For example, if you are afraid to go out into the yard and not find anyone you know: 

      • ‘You go out into the school yard and meet your class far from where you are’

      • ‘You go out into the school yard and you find your class busy talking to some boys you know’

      • ‘You go out to the school yard and you find your class busy talking with some boys you don't know’

      • ‘You go out to the school yard and you only see one person from your class’

      • ‘You go out to the school yard and you can't find your class and you get nervous because you don't know what to do’

    • Help the child to relax and then discuss their fears in order from things that cause a small worry.

    • Seek supervision before attempting this approach 

    • Use a drawing scale where they can indicate the level of stress or satisfaction in each situation, it might be useful (an example is the Buron and Curtis Incredible 5-point Scale).


It is common for the students with ASD to be in a constant state of worry, a kind of perpetual state of alert. From problems associated with sensory interpretation (noise, temperatures, tactile sensations, smells…) which can disturb or saturate their senses, to the correct interpretation of commonly accepted social roles (from sarcasm, corporal expression, literalities or double meanings, in short, something that for most people is something learned from childhood, for these people it is something not only difficult to understand, it generates a state of continuous stiffness levels). And this continuous tension generates emotional states that lead to anxiety attacks, depression, frustration, parasomnias and somatization, among others.

Somatoform disorders are characterized by the chronic presence of physical symptoms, which are not explained by any physical disease. All somatoform disorder subtypes share one common feature; predominance and persistence of unexplained somatic symptoms associated with significant distress and impairment.

It is important to take into account this disorder, present sometimes at the beginning of the absentee behaviours of students with ASD, with the presentation of physical symptoms, such as: stomach aches, headaches, allergies ... Knowing this disorder, action strategies can be proposed:

  • Treatments or techniques to reduce anxiety and stress, such as those we have previously discussed.

  • Positive suggestion: Somatic symptoms improve with “positive” suggestion about the definite diagnosis, as compared to “negative” suggestion of uncertainty of diagnosis and outcome.

  • Initially provide biomedical explanations for symptoms and initiate psychosocial talk when cued by the student

  • Reattribution therapy:  to elicit physical symptoms, psychosocial problems, mood state, beliefs about the problem, relevant examination and tests; to summarize physical and psychosocial findings and negotiate; and explanation relating the physical symptom to psychosocial problem based on timing or physiology

  • Guided imagery: Construct an image representing a symptom in their mind and then they change it to become “how it should be” (specially for gastrointestinal disorders)