'Anxiety Floods the Entire System': A Qualitative Study Exploring Teacher Perspectives Regarding How Anxiety Impacts Autistic Pupils with Co-Occurring Intellectual Disabilities
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| Title: | 'Anxiety Floods the Entire System': A Qualitative Study Exploring Teacher Perspectives Regarding How Anxiety Impacts Autistic Pupils with Co-Occurring Intellectual Disabilities |
|---|---|
| Language: | English |
| Authors: | Katie Giltinan, Craig Goodall (ORCID |
| Source: | Journal of Research in Special Educational Needs. 2025 25(4):849-861. |
| Availability: | Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us |
| Peer Reviewed: | Y |
| Page Count: | 13 |
| Publication Date: | 2025 |
| Document Type: | Journal Articles Reports - Research |
| Descriptors: | Autism Spectrum Disorders, Anxiety, Students with Disabilities, Intellectual Disability, Multiple Disabilities, Special Schools, Special Education, Special Education Teachers, Student Behavior, Environmental Influences, Sensory Experience, Disability Identification, Symptoms (Individual Disorders) |
| DOI: | 10.1111/1471-3802.70017 |
| ISSN: | 1471-3802 |
| Abstract: | This qualitative study investigates teachers' perspectives on anxiety among autistic learners with intellectual disabilities (ID) in special school settings. Research in this area remains limited, with existing studies often overlooking the distinct ways anxiety manifests and interacts with ID in this population. Semi-structured interviews with eight teachers explored their views on anxiety presentation, triggers and strategies for support. Reflexive thematic analysis provided nuanced insights into the findings. Teachers highlighted that anxiety often presents through behaviours misinterpreted as core features of autism, complicating identification and response to emotional needs. Environmental factors, including sensory stimuli, routine disruptions and limited spaces for sensory breaks, emerged as significant triggers. Unpredictable staffing and incompatible pupil groupings further exacerbated anxiety, contributing to social withdrawal and self-regulation challenges. To address these issues, teachers described using proactive strategies, such as transition planning, building trust or low-arousal environments. They emphasised the need for a whole-school, collaborative approach, alongside multidisciplinary support. However, teachers often felt overwhelmed due to limited access to external specialists or support. Participants advocated for neurodiversity-affirming practices focusing on environmental triggers and regulation. The study underscores the importance of increased teacher support, comprehensive planning, and integrating family and community resources to develop consistent anxiety management strategies. |
| Abstractor: | As Provided |
| Entry Date: | 2025 |
| Accession Number: | EJ1486557 |
| Database: | ERIC |
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| FullText | Links: – Type: pdflink Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwGuj6r7I7rZMyX0txdMZnShAAAA4zCB4AYJKoZIhvcNAQcGoIHSMIHPAgEAMIHJBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDOCgrEz_IFhKK5T0pwIBEICBmzzNALzZdvd2RNft9z9e1YCC6uqiBqCdbthpYUwGbY1MsCFmQFBbO_oPEY45T9icE0ek7Zt3ZgQc8kXLPXD2xW6yYhNaxY599NAA1i-wjZYd3K8e3IO7dbkm-Ox9FzwvcfuA_Ebqh_XHbUb1aDrRZXfAw_BdGrE5gW3ezlV-FESPnjvrAUbYvIopUOxADsC3v4cyFKDR7NwL0bSG Text: Availability: 1 Value: <anid>AN0188551863;0lc01oct.25;2025Oct13.03:34;v2.2.500</anid> <title id="AN0188551863-1">'Anxiety floods the entire system': A qualitative study exploring teacher perspectives regarding how anxiety impacts autistic pupils with co‐occurring intellectual disabilities </title> <p>This qualitative study investigates teachers' perspectives on anxiety among autistic learners with intellectual disabilities (ID) in special school settings. Research in this area remains limited, with existing studies often overlooking the distinct ways anxiety manifests and interacts with ID in this population. Semi‐structured interviews with eight teachers explored their views on anxiety presentation, triggers and strategies for support. Reflexive thematic analysis provided nuanced insights into the findings. Teachers highlighted that anxiety often presents through behaviours misinterpreted as core features of autism, complicating identification and response to emotional needs. Environmental factors, including sensory stimuli, routine disruptions and limited spaces for sensory breaks, emerged as significant triggers. Unpredictable staffing and incompatible pupil groupings further exacerbated anxiety, contributing to social withdrawal and self‐regulation challenges. To address these issues, teachers described using proactive strategies, such as transition planning, building trust or low‐arousal environments. They emphasised the need for a whole‐school, collaborative approach, alongside multidisciplinary support. However, teachers often felt overwhelmed due to limited access to external specialists or support. Participants advocated for neurodiversity‐affirming practices focusing on environmental triggers and regulation. The study underscores the importance of increased teacher support, comprehensive planning, and integrating family and community resources to develop consistent anxiety management strategies.</p> <p>Keywords: anxiety; autism; intellectual disability; special education; teachers</p> <p></p> <ulist> <item> Misinterpretation of behaviour: Participating teachers stressed that understanding and responding to anxiety among autistic pupils with co‐occurring intellectual disabilities can be challenging. Anxiety‐related behaviours were often mistaken for core autistic traits, complicating support. Teachers felt it was important to understand the experiences of anxiety to better understand and meet pupils' emotional needs.</item> <p></p> <item> Environmental triggers of anxiety: Teachers identified classroom and broader life factors—like sensory overload, unpredictable routines and limited regulating spaces—as significant anxiety triggers for autistic pupils with ID, highlighting the need to address these environmental stressors systematically.</item> <p></p> <item> Interactionist understanding of experience: Participants' insights reflected an interactionist view of autism, recognising that pupils' behaviours are shaped by dynamic interactions with their environments—not solely by internal traits—supporting neurodiversity‐affirming frameworks like Autistic SPACE.</item> <p></p> <item> Call for systemic change: Despite using proactive strategies, teachers reported systemic barriers, including limited support and involvement in decision‐making. They advocated for whole‐school, collaborative approaches that integrate specialist input and prioritise environmental fit.</item> </ulist> <p>Key points</p> <hd id="AN0188551863-2">BACKGROUND</hd> <p>Autism is a neurodevelopmental condition or difference formally characterised by a shared dyad of challenges in social communication and repetitive behaviours which may also include difficulties in social interaction and sensory processing. Often referred to as a 'spectrum', it is important to recognise the heterogeneity of autism as this dyad of challenges is experienced differently by each autistic individual (Goodall, [<reflink idref="bib24" id="ref1">24</reflink>]). The prevalence of autism varies. For example, up to recently 1.55% of the school population in the Republic of Ireland—where this study took place—were estimated to have a diagnosis (National Council for Special Education (NCSE), [<reflink idref="bib42" id="ref2">42</reflink>]), while in Northern Ireland 5% have a diagnosis (Rodgers &amp; McCluney, [<reflink idref="bib51" id="ref3">51</reflink>]). The prevalences within the UK also different from the above rates in Norther Ireland across Scotland, Wales and England. In four catchment areas in Ireland, Boilson et al. ([<reflink idref="bib9" id="ref4">9</reflink>]) identified 52% prevalence in special schools. In 2022–2023, 116 special schools operated in Ireland (NCSE, [<reflink idref="bib44" id="ref5">44</reflink>]) and between 2011 and 2019 teaching posts allocated for special education increased by 46% and Special Needs Assistant (SNA) posts increased by 51% (NCSE, [<reflink idref="bib43" id="ref6">43</reflink>]).</p> <p>Although being autistic does not definitively lead to anxiety, being autistic means one is at high risk of anxiety (Beardon, [<reflink idref="bib7" id="ref7">7</reflink>]). Teachers see autistic children interact and engage in different environments that are potentially anxiety‐provoking and are identified as key figures in understanding how anxiety affects them (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref8">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref9">2</reflink>]). There is, however, a dearth of literature relating to teachers' perspectives of autism and anxiety (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref10">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref11">2</reflink>]; Keen et al., [<reflink idref="bib33" id="ref12">33</reflink>]), and especially for those diagnosed with co‐occurring intellectual disability (ID) and autism (Gobrial &amp; Raghavan, [<reflink idref="bib23" id="ref13">23</reflink>]). With figures suggesting an increase in teaching posts in special schools, and with 50% of the autistic population presenting with ID (Kapp, Gillespie‐Lynch, et al., [<reflink idref="bib31" id="ref14">31</reflink>]; Kapp, Steward, et al., [<reflink idref="bib32" id="ref15">32</reflink>]), it appears that little attention has been given to the experiences and perspectives of special education teachers in special schools (Syriopoulou‐Delli et al., [<reflink idref="bib55" id="ref16">55</reflink>]). There is evidence suggesting that the observable behaviours in autistic people with ID—misperceived as challenging—are a result of anxiety (Tarver et al., [<reflink idref="bib56" id="ref17">56</reflink>]).</p> <p>The current study explores the perspectives of eight special education teachers on how anxiety affects their autistic pupils with ID, what the prime triggers of anxiety are from the teacher's lens, and acknowledges the multi‐faceted role of the special education teacher. The study focuses on what the barriers are to supporting autistic pupils in the school setting and how schools can best support these pupils in managing their anxiety.</p> <hd id="AN0188551863-3">Co‐occurrence of anxiety and autism: possible blurred lines</hd> <p>Anxiety is a co‐occurring condition commonly experienced by autistic individuals and has been identified as an overarching challenge in successfully assessing education for autistic children (Tarver et al., [<reflink idref="bib56" id="ref18">56</reflink>]; Van Steensel et al., [<reflink idref="bib59" id="ref19">59</reflink>]; Wijnhoven et al., [<reflink idref="bib61" id="ref20">61</reflink>]). Wijnhoven et al. ([<reflink idref="bib61" id="ref21">61</reflink>]) found that 66.5% of 172 autistic Dutch children aged between 8 and 15 years experienced significant anxiety. Similar figures are presented by Kerns et al. ([<reflink idref="bib35" id="ref22">35</reflink>]), who suggest that the rate of anxiety is 69% in autistic children and 8% for non‐autistic children. Anxiety is best conceptualised on a continuum, with many autistic children experiencing transient worry, stress or anxiety daily (Middletown Centre for Autism, [<reflink idref="bib39" id="ref23">39</reflink>]). However, due to overlapping characteristics, anxiety‐related behaviours are often misinterpreted (Rodgers et al., [<reflink idref="bib52" id="ref24">52</reflink>]).</p> <p>Increased levels of anxiety have been (negatively) associated with a greater presence of repetitive behaviours (for example, hand‐flapping and flicking switches) and narrow interests (for example, having things in a particular order) (Gotham et al., [<reflink idref="bib25" id="ref25">25</reflink>]). Moskowitz et al. ([<reflink idref="bib41" id="ref26">41</reflink>]) report that repetitive behaviours can exacerbate in intensity and in frequency when individuals are in anxiety‐provoking situations and at times, these 'stereotyped behaviours' may serve as a discriminative stimulus. As Kapp, Gillespie‐Lynch, et al. ([<reflink idref="bib31" id="ref27">31</reflink>]) and Kapp, Steward, et al. ([<reflink idref="bib32" id="ref28">32</reflink>]) purports, repetitive or self‐stimulatory (stimming) behaviours are used by the autistic person to self‐soothe, control excess emotion and regulate when experiencing anxiety—not being able to engage with self‐regulatory stimming activities, or knowing an environment will cause sensory overload, may lead to anxiety. Often, teachers (and parents) depend solely on these external patterns of behaviour, or predictable cues, as possible indicators of the autistic child's inner states and emotions (Tarver et al., [<reflink idref="bib56" id="ref29">56</reflink>]).</p> <p>Teachers are in a position to assess and observe anxiety in pupils with autism in environments parents are not (Fodstad, [<reflink idref="bib21" id="ref30">21</reflink>]). The Well‐being Policy and Framework for Practice 2018–2023 (Department of Education and Skills, [<reflink idref="bib15" id="ref31">15</reflink>]) places an emphasis on the importance of presenting an environment that nurtures the well‐being of all pupils and most importantly, for autistic pupils who have a heightened vulnerability to mental health difficulties, such as anxiety (Department of Education and Skills, [<reflink idref="bib16" id="ref32">16</reflink>], [<reflink idref="bib17" id="ref33">17</reflink>]). Beardon ([<reflink idref="bib6" id="ref34">6</reflink>], [<reflink idref="bib7" id="ref35">7</reflink>]) argues that the predominant neurotypical environment should accommodate for the diverse needs of autistic people, rather than altering the autistic person's behaviour to 'fit in' to the neurotypical construct. Beardon ([<reflink idref="bib7" id="ref36">7</reflink>]) speaks about the golden equation in relation to providing a supportive environment for autistic people: 'autism + environment = outcome'. The golden equation suggests that no matter what the outcome is, positive or negative, the autistic person remains the same, and it is the environment that determines whether the outcome is successful or not.</p> <p>This also aligns with the recently developed Autistic SPACE framework (Doherty et al., [<reflink idref="bib18" id="ref37">18</reflink>]: See Figure 1) which emphasises the importance of an accessible and tailored environment to support access for autistic people. This autistic‐led framework emphasises sensory and communicative features of the environment which support predictability for autistic people (Doherty et al., [<reflink idref="bib18" id="ref38">18</reflink>]). In addition, interpersonal factors among staff providing service and autistic people accessing services are also emphasised, aligning with Milton's ([<reflink idref="bib40" id="ref39">40</reflink>]) Double‐Empathy problem.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/0LC/01oct25/jrs370017-fig-0001.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jrs370017-fig-0001.jpg" title="1 Autistic SPACE Framework (Doherty et al., [18])." /> </p> <p></p> <p>Of particular relevance in education settings is the emphasis on the environment, such that sensory processing differences among autistic pupils are considered in educational planning and delivery. In addition, an ordered environment is also key in supporting predictability for autistic pupils, which is important in supporting self‐regulation, developing tolerance for demands, and managing anxiety.</p> <hd id="AN0188551863-5">How anxiety can affect autistic young people</hd> <p>Autism can be best understood as a disability of trust (Clark, [<reflink idref="bib13" id="ref40">13</reflink>]). When the person's trust in others, or when the environment does not account for an individual's sensory sensitivities, communication preferences and challenges with uncertainty, then anxiety can result (Neil, Olsson and Pellicano, [<reflink idref="bib45" id="ref41">45</reflink>]). Many autistic children and young people have high intolerance of uncertainty and can experience difficulty with managing change; this can be associated with repetitive worry and the tendency to become overwhelmed by the unexpected (Birrell et al., [<reflink idref="bib8" id="ref42">8</reflink>]; Fletcher‐Watson &amp; Happé, [<reflink idref="bib20" id="ref43">20</reflink>]).</p> <p>Anxiety can present in traditional ways or in more idiosyncratic 'distinct' ways in autistic individuals. For instance, unusual specific phobias (for example, fear of certain sensory stimuli or minor changes in environment or characteristics, such as beards) (Kerns et al., [<reflink idref="bib34" id="ref44">34</reflink>]; Klein et al., [<reflink idref="bib36" id="ref45">36</reflink>]), associated challenging and self‐injurious behaviours (Ozsivadjian et al., [<reflink idref="bib47" id="ref46">47</reflink>]), and repetitive behaviours that include repetitive movements and sounds, narrow interests and intolerance of uncertainty (Fletcher‐Watson &amp; Happé, [<reflink idref="bib20" id="ref47">20</reflink>]). There are different perspectives regarding these responses, however, a monotropic perspective emphasises that enabling autistic students to engage in their special interests can have a positive impact on pupil's motivation to engage in activities and learning (Wood, [<reflink idref="bib63" id="ref48">63</reflink>]), and help overcome anxiety (Gunn &amp; Delafield‐Butt, [<reflink idref="bib28" id="ref49">28</reflink>]). Disentangling anxiety symptoms and core autism features is a critical necessity, given the significant impact of anxiety on well‐being and quality of life (Postorino et al., [<reflink idref="bib49" id="ref50">49</reflink>]). And, crucially, as is understanding the purpose of observed behaviour beyond the pathologized lens.</p> <p>Behaviours of concern such as self‐injuring, biting, pinching and hitting may be viewed as manifestations of anxiety, however, these could also be the actions of a non‐speaking autistic child with ID, who is communicating pain and illness (Postorino et al., [<reflink idref="bib49" id="ref51">49</reflink>]). Anxiety is commonly linked to physical health problems such as breathing problems and gastrointestinal issues (Ng‐Cordell et al., [<reflink idref="bib46" id="ref52">46</reflink>]). Pain, illness and anxiety‐related physical health problems (for example, headaches and muscle aches) can often be expressed through self‐injurious or stress response behaviour and are often misinterpreted as 'misbehaviour' or autism‐related behaviour (Buie et al., [<reflink idref="bib12" id="ref53">12</reflink>]).</p> <p>Tarver et al. ([<reflink idref="bib56" id="ref54">56</reflink>]) explored parental experience in managing the anxiety of their child who speaks few or no words. Parents depend on the demeanour, frequency or intensity of their child's behaviours in order to identify whether they are experiencing anxiety. Parents rely on 'educated guesswork' and reported difficulty in recognising anxiety due to their child's limited communication skills and the frequency of misinterpreting their child's emotions as a result. These parents also reported their reliance on external behavioural manifestation and how it can be easily misinterpreted.</p> <p>While parents' perspectives are essential in gathering information on the topic of anxiety and autism, their knowledge of how anxiety impacts their child in the school setting may be limited (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref55">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref56">2</reflink>]). Although research is limited, it is suggested that the combination of autism and anxiety is likely to affect autistic pupils' educational experience and engagement in learning (Ashburner et al., [<reflink idref="bib3" id="ref57">3</reflink>]).</p> <hd id="AN0188551863-6">The perspectives of special education teachers and the school context</hd> <p>School environments can be increasingly anxiety‐provoking for autistic pupils. According to the Autism Good Practice Guidelines (Department of Education and Skills, [<reflink idref="bib16" id="ref58">16</reflink>], [<reflink idref="bib17" id="ref59">17</reflink>]), 'the promotion of emotional development should be located within a school's broader whole‐school plan to meet the well‐being, learning and participation of all students' (p. 96). However, for special education teachers of autistic pupils with ID and anxiety, this objective has proven to be difficult to achieve, due to associated physical health issues and behaviours of concern which naturally affects how pupils present in school (Ferguson et al., [<reflink idref="bib19" id="ref60">19</reflink>]).</p> <p>A key consideration is the impacts of environmental factors within the physical, sensory or interpersonal ecology of the school setting which impact the experiences of the autistic pupils (Beardon, [<reflink idref="bib7" id="ref61">7</reflink>]). This is likely to differ significantly in its impact across individual autistic pupils given the diversity of presentation within the autism spectrum and will be influenced by factors from the students home or other relevant contexts.</p> <p>'When anxiety is experienced as overwhelming and persistent, it becomes a barrier to wellbeing, participation and learning' (Department of Education and Skills, [<reflink idref="bib16" id="ref62">16</reflink>], [<reflink idref="bib17" id="ref63">17</reflink>], p. 190). Anxiety is a significant barrier that impedes autistic learners' ability to listen and retain information, follow instructions, ability to socialise and attend different activities throughout the school day (Wood &amp; Gadow, [<reflink idref="bib62" id="ref64">62</reflink>]). Within a growing body of autistic school experience research (see Horgan et al., [<reflink idref="bib29" id="ref65">29</reflink>]), the school context has been identified as a significant contributing factor to autistic pupils' stress and anxiety, particularly in relation to the school environment and structure, social isolation and relationships with teachers and peers (Pellegrini, [<reflink idref="bib48" id="ref66">48</reflink>]). And, compared to autistic children without a diagnosis of anxiety, those with anxiety have poorer health including gastronomical issues, sleep deprivation, and are at higher risk for depression and self‐injury (Ferguson et al., [<reflink idref="bib19" id="ref67">19</reflink>]) which naturally affects how they present in school.</p> <p>Despite significance within the autistic child's life (spending some 6 h daily in school), the perceptions of special education teachers remain a critical knowledge gap (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref68">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref69">2</reflink>]). Simpson et al. ([<reflink idref="bib54" id="ref70">54</reflink>]) further highlights the essentiality of obtaining the perspectives of teachers to better understand how anxiety affects autistic individuals in the school setting. Teachers observe them mix and socialise with both peers and staff in multi‐sensory environments, which can be potentially anxiety‐inducing and present greater social, cognitive and sensory demands (Goodall, [<reflink idref="bib24" id="ref71">24</reflink>]). While parental reports are significant in providing valuable information on their child's strengths, areas for development and apparent anxiety triggers in the home, how a pupil experiences anxiety in the school setting may differ significantly.</p> <hd id="AN0188551863-7">METHODOLOGY</hd> <p>To date, in the Irish context, there is limited research that explores the perspectives of special education teachers and minimal studies including autistic individuals with intellectual disabilities in research on anxiety. This study utilised a qualitative research design and employed face‐to‐face, semi‐structured interviews as the chosen source of data collection for exploring the perspectives of special education teachers in a special education school. Qualitative research (Denzin &amp; Lincoln, [<reflink idref="bib14" id="ref72">14</reflink>]) can elicit unquantifiable knowledge and information about individuals' beliefs and interpretations of a phenomenon, such as how anxiety impacts autistic pupils with ID and can contribute to gaps in the literature. The emphasis of this study is on identifying what the prime triggers of anxiety are for these pupils and how teachers can best support them in managing their anxiety.</p> <hd id="AN0188551863-8">Participants</hd> <p>This study took place in a special school setting for pupils with a dual diagnosis of autism and severe intellectual disability located in an urban area with participants recruited using a purposive convenience sampling approach. The school principal agreed to act as the gatekeeper and shared the project recruitment and information letters with the 43 staff in the school. Eight teachers agreed to participate, with six being female and two being male.</p> <p>All participants reviewed a project information letter outlining the purpose of the study, the expectations for participation and data protection procedures. They provided signed Informed Consent Form, and the researcher arranged to conduct an interview at a time and place of their preference. The participants were given the interview schedule via email 3 days before the interview, allowing them to prepare and familiarise themselves with the questions.</p> <hd id="AN0188551863-9">Procedures</hd> <p>Semi‐structured interviews enabled the interviewer to adjust questions flexibly and probe deeper where necessary (Robson, [<reflink idref="bib50" id="ref73">50</reflink>]). In advance of data collection, a pilot study was conducted with a non‐participating teacher to test the interview method as recommended by Baker ([<reflink idref="bib4" id="ref74">4</reflink>]). Feedback led the researcher to change interviewing approaches and simplify question forms to support interview flow, reduce interruptions and slow the pace during data collection interviews.</p> <p>The interviews, guided by 10 core questions, lasted between 20 and 35 min (see framework in Appendix S1). Each interview was conducted at a time and in a setting of the participant's choice.</p> <p>Field notes were taken during and after the interviews to capture non‐verbal cues, the environment and the researcher's own thoughts and feelings. While challenging, the process of collecting these notes encouraged self‐reflection on interviewing skills and potential biases, consistent with the advice of Marshall and Rossman ([<reflink idref="bib38" id="ref75">38</reflink>]).</p> <hd id="AN0188551863-10">Data analysis</hd> <p>Data analysis was conducted using thematic analysis, a method that identifies patterns or themes in qualitative data (Braun &amp; Clarke, [<reflink idref="bib11" id="ref76">11</reflink>]). This approach provided a detailed account of the themes that were constructed from the interviews. The recordings were transcribed orthographically, including verbal hesitations, pauses and speech cut‐offs, though irrelevant utterances were excluded. The researcher followed Braun and Clarke's six‐step framework, which included familiarising with the data, generating initial codes and searching for themes.</p> <p>Themes were identified by grouping similar codes together under descriptive headings. These themes were then reviewed to ensure they accurately represented the data. Finally, the researcher defined and named the themes, identifying any sub‐themes. This methodical approach to data collection and analysis ensured that the themes developed were an accurate reflection of participants' experiences and the study's objectives.</p> <hd id="AN0188551863-11">Establishing trustworthiness</hd> <p>To ensure trustworthiness in this study, the criteria of credibility, transferability, dependability and reflexivity, as outlined by Lincoln and Guba ([<reflink idref="bib37" id="ref77">37</reflink>]) were considered. Credibility refers to the accuracy of the representation of participants' views (Guba &amp; Lincoln, [<reflink idref="bib27" id="ref78">27</reflink>]). To achieve credibility, the researcher retained awareness of their position as a practitioner‐researcher and bracketed potential biases. To mitigate biases, peer debriefing processes within the research team (Tracy, [<reflink idref="bib58" id="ref79">58</reflink>]) to support validity in the design of methodology and instruments. In addition, dependability (Tobin &amp; Begley, [<reflink idref="bib57" id="ref80">57</reflink>]) was also supported by this process, which was further addressed through the use of a pilot study to test interview processes and instruments. An audit trail (Tracy, [<reflink idref="bib58" id="ref81">58</reflink>]) of the research process was carefully documented to facilitate replication by other researchers, ensuring a logical and consistent approach (Goodall, [<reflink idref="bib24" id="ref82">24</reflink>]).</p> <p>Reflexivity involves reflecting on the research process and the researcher's role (Gallais, [<reflink idref="bib22" id="ref83">22</reflink>]). Member reflection processes where each transcript was shared with the participants (Robson, [<reflink idref="bib50" id="ref84">50</reflink>]) were also used to allow participants to clarify any misinterpretations and provide additional input.</p> <p>Rich and detailed descriptions of the research process, participants and context were used to support transferability, the extent to which the findings can be applied in other contexts (Lincoln &amp; Guba, [<reflink idref="bib37" id="ref85">37</reflink>]). Although this study focuses on special education teachers in Irish schools working with autistic pupils with intellectual disabilities, the detailed descriptions allow others to assess its applicability to their own contexts (Brantlinger et al., [<reflink idref="bib10" id="ref86">10</reflink>]).</p> <hd id="AN0188551863-12">Ethical considerations</hd> <p>Approval for this study was granted by the Dublin City University Research Ethics Committee (REC). Informed consent was obtained through a Plain Language Statement and an Informed Consent Form, outlining the study's purpose, data confidentiality and participant expectations. Pseudonyms were used to protect anonymity, although full anonymity could not be guaranteed. To minimise power imbalances, interviews were scheduled at convenient times and locations for participants. Researcher awareness of potential biases helped build trustworthiness and maintain the integrity of the research process.</p> <hd id="AN0188551863-13">Study limitations</hd> <p>This study's qualitative design and narrow focus may contribute toward a number of limitations. Specifically, this study's small sample size and single‐school setting limit its transferability and generalisability to other Irish special schools for autistic children with intellectual disabilities. However, the small sample was justified by the need for convenience, ease of access and the intent to positively impact practice within the school. This use of piloting of instruments, peer debriefing and member reflection processes contributed to rigour and care in design. However, it is possible that expanding the interview framework from 10 to 12 or 15 questions could have yielded more in‐depth data. While the study may not be broadly applicable, its dependability and transferability could support replication in similar contexts.</p> <hd id="AN0188551863-14">FINDINGS AND DISCUSSION</hd> <p>Anxiety in autistic pupils presents complex challenges that require a nuanced understanding from educators and support systems. The study aimed to address the following questions:</p> <p></p> <ulist> <item> How does anxiety impact autistic students with ID?</item> <p></p> <item> What do special school teachers identify as key triggers of anxiety in these students?</item> <p></p> <item> How can teachers best support autistic learners with ID in managing their anxiety?</item> </ulist> <p>This study highlights three interrelated themes and four associated sub‐themes, as well as the strategies for effective support. Findings are presented in Figure 2.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/0LC/01oct25/jrs370017-fig-0002.jpg?ephost1=dGJyMNXb4kSepq84yOvqOLCmsE6epq5Srqa4SK6WxWXS" alt="jrs370017-fig-0002.jpg" title="2 Main themes and sub‐themes." /> </p> <p></p> <hd id="AN0188551863-16">Teachers navigating the complexities of recognising anxiety in autistic pupils</hd> <p>Teachers shared their perspectives on recognising signs of anxiety in their autistic pupils, stressing the importance of understanding how it can present differently across individuals. Identifying anxiety in autistic pupils is nuanced and challenging due to overlapping traits of autism and anxiety. Many autistic pupils, particularly those who are non‐speaking or have co‐occurring intellectual disabilities, may find it difficult to express their internal states. The diversity among autistic individuals adds further complexity, with almost two‐thirds having an additional diagnosed condition and 41% having two or more comorbid diagnoses (Green et al., [<reflink idref="bib26" id="ref87">26</reflink>]).</p> <p>Teachers reported feeling that they must navigate a landscape where presentations of the features of anxiety are subtle, distinctive or easily mistaken for core features of autism. T3 noted, 'sometimes you just don't know.' Teachers rely heavily on observable behaviours, often balancing careful observation with their limited understanding, which can lead to diagnostic overshadowing and missed opportunities for support. One key challenge is that the bidirectional relationship between autism and anxiety can mask how anxiety presents, making it harder for teachers to detect anxiety in their pupils.</p> <p>His facial expression just changes suddenly... he becomes rigid... and immediately starts self‐injuring, all these behaviours happen together. (T8)</p> <p>T1 described how anxiety can escalate quickly into high‐risk behaviours: 'The vocalisation was getting higher and higher... he was beginning to move about in a forceful manner... then quickly went to a stage of aggression.' Although these behaviours may indicate anxiety, they do not always fully reflect the pupil's internal emotional state. Diagnostic overshadowing—where one condition overshadows another (White et al., [<reflink idref="bib60" id="ref88">60</reflink>])—adds to this challenge.</p> <p>Understanding interoception, or the awareness of internal bodily sensations, is crucial in supporting autistic pupils. Many autistic individuals have difficulty recognising internal states, making it harder for them to convey emotions. Fletcher‐Watson and Happé ([<reflink idref="bib20" id="ref89">20</reflink>]) noted that interoceptive challenges exacerbate difficulties in recognising internal emotional triggers. Teachers in this study found it challenging to identify the causes of anxiety, particularly when they arose from imperceptible internal triggers like pain, hunger or frustration. T4 observed, 'Frequently, when I have worked with children with anxiety, we would have a list of triggers, but always on that list is 'unknown'.</p> <p>Adding to the complexity is the issue of overlapping symptoms caused by medication side effects or physical health problems. T8 recounted how a pupil's anxiety seemed to increase after receiving medication for constipation: I see major anxieties after they receive medication... I presume they are cramping... these signs overlap with anxiety.' This example illustrates how medical conditions and their treatments can further blur the lines between anxiety and autism, making it difficult for teachers to determine the root cause of a pupil's distress.</p> <p>The overlap between expressions of anxiety and expressions associated with being autistic adds further complexity. Teachers expressed uncertainty in distinguishing potential causal factors leading to their pupils becoming agitated, unhappy or dysregulated. The interaction between environmental factors and autism‐associated preferences, such as intense sensory experiences or preferences for predictability/ritualistic patterns, made it difficult for teachers to interpret how to respond in certain situations. However, T5 described how one pupil's repetitive movements intensified as his anxiety about going home grew. These behaviours, serving as coping mechanisms, complicate identifying whether they are manifestations of anxiety or autism. Kapp, Gillespie‐Lynch, et al. ([<reflink idref="bib31" id="ref90">31</reflink>]) and Kapp, Steward, et al. ([<reflink idref="bib32" id="ref91">32</reflink>]) similarly found that repetitive behaviours serve a self‐regulatory purpose for many autistic individuals, often in response to other factors linked to the social or sensory environment. Beardon ([<reflink idref="bib7" id="ref92">7</reflink>]) would suggest that the interaction between the person's experiences and their surrounding environment is an ongoing and dynamic process, suggesting that teachers might need to develop a profile of sensory or environmental considerations for their students as a part of their assessment processes to guide lesson planning or profiling. In addition, the development of strong communication links with other key stakeholders to collect information regarding all aspects of the students' day or life circumstances would also be a useful source of information to inform profiling and planning in the school setting.</p> <p>Given these challenges, there is a need for greater teacher support and training. Teachers in this study often felt ill‐equipped to address anxiety in their autistic pupils, particularly when it involved interoceptive difficulties and overlapping autism traits. The lack of multidisciplinary support was a common theme, with teachers seeking more input from experts in fields like psychology and occupational therapy. Increased education on interoception and the ways it affects autistic pupils could help teachers better understand the internal experiences of their students and provide more targeted support.</p> <hd id="AN0188551863-17">'The school environment can exacerbate anxiety'</hd> <p>The school environment often exacerbates anxiety for autistic pupils due to sensory processing differences, inappropriate groupings and unpredictable changes. As outlined in the Autistic SPACE Framework (Doherty et al., [<reflink idref="bib18" id="ref93">18</reflink>]) the planning for a sympathetic sensory environment is a key factor in supporting engagement for autistic individuals. Building work, ongoing in some schools, creates excessive noise, which exacerbates sensory sensitivities. Other triggers, such as interactions with other pupils, insufficient space to escape these triggers and staff availability, are largely outside teachers' control. Taken together, these factors suggest schools are often experienced as sensorially challenging settings that are largely unpredictable and unstructured.</p> <p>The Well‐being Policy and Framework for Practice 2018–2023 (Department of Education and Skills, [<reflink idref="bib15" id="ref94">15</reflink>]) stresses the importance of a nurturing school environment for all pupils, especially autistic children, who are more vulnerable to mental health challenges issues (Department of Education and Skills, [<reflink idref="bib16" id="ref95">16</reflink>], [<reflink idref="bib17" id="ref96">17</reflink>]). The structure and environment of the school are key factors contributing to anxiety in autistic pupils. Classroom dynamics also play a role; inappropriate groupings of pupils with contrasting sensory needs can escalate anxiety. T8 remarked, 'He is triggered by sudden movement or loud vocals from other pupils.... I have one pupil who is very hyperactive, and the other pupil... he can't cope'. Another teacher voiced their concern:</p> <p>If you have a noise‐sensitive pupil in the same class as a pupil who vocalises all day... it doesn't work. Teachers' input should be asked for in relation to what pupils get on well with one another. We know best as their teachers. (T2)</p> <p>Adams, MacDonald, and Keen ([<reflink idref="bib1" id="ref97">1</reflink>]) and Adams, Young, and Keen ([<reflink idref="bib2" id="ref98">2</reflink>]) support the idea that teachers' insights are vital for effective planning. Space was another issue, with limited indoor areas for pupils to retreat when overwhelmed. One teacher shared how they adapted their environment to meet pupils' needs: 'In the corridor, we have set up a space where he can chill... there's a couch... we bring his weighted blanket and mat as well (T8).</p> <p>Unpredictability, such as staff changes, also increases anxiety. Howlin ([<reflink idref="bib30" id="ref99">30</reflink>]) noted that routine helps reduce fear caused by chaotic environments, a point echoed by Doherty et al. ([<reflink idref="bib18" id="ref100">18</reflink>]). Consistent staff provide comfort, but several teachers reported that changes in staff increased anxiety and self‐injury in their pupils. T7 observed,</p> <p>We've had some changes this year with staff and it affected the pupils... trust building takes time... new staff find it hard to build relationships with them... it definitely caused more behaviours. I saw one boy's self‐injury increase when we had two SNAs out for a while. It was the only way he could control his anxiety. I suppose for pupils, it's a way of controlling the uncontrollable. (T7)</p> <p>Disruptions to routines further heighten anxiety, with pupils often developing personal coping strategies to manage change. T2 described how a pupil's day could be derailed by even minor changes, such as a different bus escort: That one pupil relies so much on order and predictability...He needs to be the last person out of the class....and always to see where everyone else is and what they are doing. He has developed these routines for himself as a coping tool...If disrupted, he is hysterical (T2).</p> <hd id="AN0188551863-18">'Anxiety floods the entire system'—The impact of anxiety on cognitive and social functioning</hd> <p>Educators working with autistic pupils who have co‐occurring intellectual disabilities frequently face challenges linked to anxiety. Many students experience emotional struggles that often go unaddressed due to a lack of adequate clinical assessments. Fodstad ([<reflink idref="bib21" id="ref101">21</reflink>]) highlights how existing tools for identifying anxiety in autistic individuals are insufficient, leaving many pupils without necessary support. Consequently, their cognitive, social and emotional well‐being can be negatively impacted.</p> <p>Teachers commonly report that anxiety affects pupils' ability to engage in learning. It disrupts concentration, complicates following instructions and impedes social interactions, limiting classroom participation. This aligns with Wood and Gadow's ([<reflink idref="bib62" id="ref102">62</reflink>]) research, which shows that anxiety can disrupt cognitive functions such as attention, memory and task management, thereby becoming a barrier to learning. Educators express concern about these barriers, which can prevent pupils from reaching their full potential.</p> <p>Some teachers describe how anxiety can overwhelm pupils, making it difficult for them to engage with lessons. One teacher, T1, used the metaphor of a 'flooded system' to describe how anxiety overtakes a pupil, leaving them unable to process or interact with their surroundings. This can manifest as a student being physically present but disengaged, unable to focus on ongoing lessons. Teachers also observed that anxiety often leads to physical health challenges, causing pupils to miss school and reducing learning opportunities. Adams, MacDonald, and Keen ([<reflink idref="bib1" id="ref103">1</reflink>]) and Adams, Young, and Keen ([<reflink idref="bib2" id="ref104">2</reflink>]) suggest that the intersection of autism, intellectual disabilities, and anxiety hampers pupils' ability to cope with academic and social expectations, posing significant threats to their overall development and quality of life.</p> <p>Teachers noted that many students experience difficulties with tasks like transitioning between activities or managing sensory inputs. For some pupils, anxiety is so pervasive that merely attending school is considered an achievement. T5 explained that on particularly challenging days, the focus shifts from academic learning to ensuring the pupil's emotional well‐being, acknowledging that when anxiety becomes overwhelming, traditional academic goals must be set aside. 'If they just come in and survive the day... not even participate in class activities, but just be here...', said T5, highlighting the need for flexibility in meeting pupils' needs. This reflects a broader, school‐wide understanding that well‐being and emotional regulation must be prioritised over traditional academic objectives.</p> <hd id="AN0188551863-19">Social withdrawal</hd> <p>Anxiety also impacts social interactions, often leading to social withdrawal. Teachers observed that anxious students may seek space away from their peers and prefer quiet areas to manage sensory overload or avoid unexpected social interactions. This withdrawal can limit their participation in social activities and further isolate them. T6 shared that anxiety not only affects the individual pupil but can also influence the overall classroom environment, as pupils may need to be removed from group activities to self‐regulate. This separation can exacerbate feelings of exclusion and disrupt social connections.</p> <p>Teachers also expressed concerns about the long‐term effects of untreated anxiety. T5 recalled a former pupil whose severe anxiety evolved into Obsessive‐Compulsive Disorder (OCD), leading to social withdrawal, isolation from school and emotional distress. This highlights the importance of addressing anxiety early to prevent it from negatively impacting pupils' mental health and social well‐being.</p> <p>Anxiety can also leave autistic pupils in a heightened state of alertness, or hyper‐vigilance, where they constantly anticipate changes in their environment. This hyper‐vigilant state can lead to fatigue and further withdrawal from learning and social activities. T5 described a pupil who was always 'waiting for an uncertain movement,' eventually leading to exhaustion. These experiences reflect the need for low‐arousal, predictable environments, as advocated by the Autistic SPACE framework (Doherty et al., [<reflink idref="bib18" id="ref105">18</reflink>]) and the SPELL framework (Beadle‐Brown &amp; Mills, [<reflink idref="bib5" id="ref106">5</reflink>]). Selles et al. ([<reflink idref="bib53" id="ref107">53</reflink>]) also highlight how social communication challenges increase anxiety, especially when pupils struggle with social norms and expectations.</p> <hd id="AN0188551863-20">Behavioural manifestations of anxiety</hd> <p>Teachers also observed that anxiety often leads to behaviours such as self‐injury or aggressive outbursts. These actions are not indicative of misconduct but rather a form of communication or self‐regulation in response to overwhelming emotions. Moskowitz et al. ([<reflink idref="bib41" id="ref108">41</reflink>]) note that factors such as pain, illness or sensory overload can increase anxiety, making it more likely for pupils to express their distress through these behaviours.</p> <p>Teachers shared similar insights, recognising that anxiety can serve as a 'setting event' for such behaviours, increasing their likelihood. In some cases, these behaviours provide temporary relief from anxiety. T2 described how one pupil would head‐bang against the wall to 'compress their anxiety.' While harmful, this behaviour offered short‐term relief. T2 also gave an example of a pupil who would undress in front of classmates due to anxiety about being dressed in public, which increased when redirected, highlighting the sensory processing challenges many autistic individuals face.</p> <p>Teachers emphasised the importance of understanding each pupil's individual needs to interpret these behaviours accurately. T6 recounted a situation where she initially misinterpreted a pupil's actions as misbehaviour, only later realising that the pupil was attempting to manage their anxiety.</p> <p>It's only when you are working closely with him, that you understand... before I did realise what it was, it just looked... like misbehaviour... but it was him trying to overcome his anxiety.</p> <p>Despite training in behaviour management, many teachers feel overwhelmed by the responsibility of managing anxiety‐related crises. The constant need to assess triggers, manage responses and ensure pupils' well‐being can lead to burnout. Teachers also noted that while additional staff can help manage behaviours, a larger adult presence can increase anxiety, exacerbating distressing behaviours.</p> <p>Overall, teachers stressed the need for more specialised support and resources to address the complex relationship between autism, intellectual disabilities and anxiety. Despite multiple referrals for external support, improvements have been minimal, highlighting the need for more effective multidisciplinary approaches to address sensory and emotional needs. Without adequate support, anxiety will continue to create barriers to learning and personal development, limiting pupils' ability to reach their full potential.</p> <hd id="AN0188551863-21">Empowering through understanding: Strategies for supporting autistic pupils</hd> <p>Participants in this study identified several key strategies for how special education teachers can effectively support autistic pupils experiencing anxiety. Central to these strategies are the importance of building trust with pupils, acknowledging and understanding their anxiety and utilising individualised approaches tailored to each student's needs. According to the Autism Good Practice Guidelines (Department of Education and Skills, [<reflink idref="bib16" id="ref109">16</reflink>]), 'there is a risk that interventions may prioritise modifying anxiety‐related behaviours over understanding and addressing the triggers behind the anxiety'. Teachers in this study emphasised the need for personalised supports based on the pupil's immediate circumstances, rather than solely relying on established research or theoretical frameworks. As T3 expressed, 'My instinct is not to look at research or a document...it's to say 'look at the child, the room, what can I do in this moment to support them?</p> <p>A foundational aspect of supporting autistic pupils is establishing trust and rapport through a multi‐component approach that is individualised to the pupil. Teachers stressed the importance of truly knowing each pupil—gathering information about their likes, dislikes, anxiety triggers and preferred modes of communication. As stated by one teacher, T4, the documentation created by previous teachers, parents and professionals, including the pupil's Behaviour Support Plan and Communication Passport, is 'vital' in fostering a comprehensive understanding of each child's unique needs.</p> <p></p> <ulist> <item> Choice and autonomy: Teachers highlighted the significance of offering choices and promoting autonomy. T8 noted that providing 'freedom of choice fosters self‐determination and trust between teachers and pupils'. A pupil‐centred approach, allowing students to lead their learning based on their interests, naturally reduces anxiety. Supporting pupils in exploring multi‐sensory environments enables them to identify self‐regulating strategies that work for them. T3 illustrated how a child‐led approach helps build trust:</item> </ulist> <p>I have to earn their trust through Intensive Interaction and giving them lots of choices... they lead us toward self‐regulating activities.'</p> <p></p> <ulist> <item> Acknowledgement and respect: Teachers acknowledged the importance of validating pupils' emotions. According to T6, 'recognising and respecting a pupil's anxiety helps develop self‐awareness and interoceptive skills'. By modelling appropriate emotional responses, teachers can support pupils in understanding their feelings and enhance their ability to cope with anxiety. T6 remarked on the need for understanding that, for some students, simply managing a school day is a significant challenge.</item> <p></p> <item> Avoidance and exposure: While some teachers shared strategies that involved removing anxiety‐inducing stimuli, such as avoiding loud environments, others emphasised the importance of gradual exposure. T2 articulated the need to offer alternative choices during anxiety‐inducing situations without forcing the pupil into discomfort. For instance, allowing a pupil to look out the window rather than immediately exposing them to the outdoor environment during seasonal changes helps build resilience gradually.</item> <p></p> <item> Proactive and reactive strategies: Teachers reported utilising short‐term, in‐the‐moment strategies to support pupils with anxiety. Creating low‐arousal environments—by dimming lights or minimising noise—was identified as effective in helping pupils regulate their emotions. T1 emphasised felt that 'Space is actually a huge one...allowing time helps'. Many teachers expressed the importance of allowing pupils time and space to decompress, echoing sentiments that such strategies are often undervalued.</item> </ulist> <p>In striving to meet the needs for a diverse population of learners and shifting from a in‐child deficit 'one size fits all' mentality, one teacher explained how they had to creatively adapt their limited space to meet the emotional needs of pupils:</p> <p>We don't expect him to adapt to our environment if it's not suiting... in the corridor, we have set up a space, where he can chill... there's a couch there, we bring his weighted blanket and mat as well... it's not the greatest but we do what we can with the limited space that we have. (T8)</p> <p></p> <ulist> <item> Preparation for change: Change is often a significant trigger for anxiety among autistic pupils. To support students through transitions, teachers utilised visual schedules, verbal explanations and Social Stories. T2 emphasised the need for consistent exposure to these strategies to enhance pupils' understanding and responses when changes occur. For instance, informing a pupil in advance about a different bus escort helps them prepare for transitions and reduces anxiety about unforeseen changes.</item> </ulist> <hd id="AN0188551863-22">Integrated support and collaboration</hd> <p>Teachers unanimously agreed on the necessity of a whole‐school approach to support autistic pupils. This approach involves creating a shared understanding of how anxiety manifests in these students. T2 suggested that training and discussions among staff could enhance awareness and help develop strategies to manage anxiety collectively. A whole‐school communication system is also vital, ensuring that all staff members understand individual pupils' anxiety triggers and early signs of distress. T3 highlighted the importance of knowing which pupils require additional support during transitions to minimise anxiety. Sharing resources and expertise among teachers is also essential to alleviating the pressure many feel to address anxiety independently. Teachers expressed a desire for collaboration, emphasising that learning from one another's experiences could strengthen their collective capability to support pupils with anxiety.</p> <p>Unfortunately, the findings also highlighted significant barriers teachers face in supporting their autistic pupils. A lack of multidisciplinary support often leaves teachers feeling overwhelmed, frustrated and drained. When asked about the barriers to supporting their autistic pupils with anxiety, T1 described his experience of working in a different country and his admiration for multidisciplinary teams working together around a table and the need for this approach in Ireland.</p> <p>I know in other countries I've worked in; I've seen a big push on everyone working around a table... the Multi‐D team. It's not on all of the teachers to be doing the therapies...</p> <p>Many teachers reported feeling unsupported when addressing their pupils' sensory needs and co‐occurring conditions, which can exacerbate anxiety. They expressed that without proper input from specialists, they often must take on roles beyond their training, such as acting as Speech and Language therapists or Occupational Therapists. T5 expressed her frustrations about poor professional guidance being provided to parents from mental health services, and how alone parents can feel as a result:</p> <p>Our students here have complex needs. It's really hard to figure out the issue... I had a parent who said it is difficult...children with an ASD diagnosis are often turned away from somewhere like CAMHS, because they're like 'oh it's their autism'... But I feel like screaming 'They have no one else!'</p> <p>T5 also highlighted an additional frustration among teachers: the challenge of engaging parents in collaborative efforts to manage their child's behaviours when they are young. She noted that it becomes much harder to teach coping strategies during the teenage years and expressed her frustration when parents do not support school practices. T5 emphasised that inconsistent approaches between home and school hinder effective anxiety management and that introducing coping strategies early in a child's development is essential. Collaboration with parents is crucial for establishing consistent methods for managing anxiety.</p> <p>Close links between parents and school staff are a key consideration given the interaction between a range of environmental, social and routine disruption factors that may cause the pupils to experience anxiety. Communication and sharing of information will be key to developing both an understanding of current circumstances for each pupil. Given the dynamic nature of such profiles (given changing ecological, temporal and social circumstances) it will be key that such ongoing close networks of collaboration can support monitoring of changes as a key input in understanding the behaviour or support needs in an optimal (and empathetic) manner. Indeed, such processes may be key to supporting relationships between pupils and teachers in a functional manner.</p> <hd id="AN0188551863-23">CONCLUSION</hd> <p>This study addressed the under‐researched area of teachers' perspectives regarding autism and anxiety among autistic pupils in special school settings who have a co‐occurring diagnosis of intellectual disability (ID) and autism (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref110">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref111">2</reflink>]; Gobrial &amp; Raghavan, [<reflink idref="bib23" id="ref112">23</reflink>]; Keen et al., [<reflink idref="bib33" id="ref113">33</reflink>]). The findings document the perspectives, thoughts and experiences of eight special education teachers teaching autistic pupils with ID who experience anxiety in a special school in Ireland. Given the prevalence of elevated levels of anxiety among autistic pupils (Beardon, [<reflink idref="bib7" id="ref114">7</reflink>]), teachers are often key figures in understanding how anxiety affects them (Adams, MacDonald, &amp; Keen, [<reflink idref="bib1" id="ref115">1</reflink>]; Adams, Young, &amp; Keen, [<reflink idref="bib2" id="ref116">2</reflink>]).</p> <p>Participants shared their experiences related to how anxiety affects autistic pupils with ID and identified prime triggers of anxiety in these pupils. They offered a range of neurodiversity‐affirming practices that focus on understanding environmental triggers and supporting regulation to best support autistic pupils in managing their anxiety.</p> <p>A key conclusion was the participating teacher's recognition of the interaction between their pupils' experience and behaviour and factors in the environment that surround them across their lives. This perspective aligns with the interactionist understandings of autistic experience proposed within the neurodiversity paradigm (Fletcher‐Watson &amp; Happé, [<reflink idref="bib20" id="ref117">20</reflink>]; Kapp, Gillespie‐Lynch, et al., [<reflink idref="bib31" id="ref118">31</reflink>]). Beardon ([<reflink idref="bib7" id="ref119">7</reflink>]) also emphasises the importance of considering environmental factors when interpreting the behaviour or responses of autistic individuals, a view that seems particularly pertinent for the current cohort of participants. Autistic designed frameworks, such as the Autistic SPACE framework (Doherty et al., [<reflink idref="bib18" id="ref120">18</reflink>]) provide accessible guidance to educators in considering how to adapt or fit the learning environment to the needs of individual pupils in their classes.</p> <p>The study also examined how teachers recognise anxiety in their pupils, and how difficult it can be to detect due to overlapping characteristics and imperceptible triggers such as interoception difficulties. The study also explored teachers' perspectives on how anxiety affects their pupils in the school context, and the associated consequences that include cognitive overload, social withdrawal and behaviours of concern. Individualised and empirical strategies that are approached from a whole‐school are required for support and strategies to be successful in supporting autistic pupils with ID, in managing their anxiety. Lack of teacher's involvement in the planning of class groupings at the end of each year is a significant limitation identified by teachers in this study in addition to an absence of multi‐disciplinary support. Although based on the perspectives of eight teachers from one special school setting, the findings discussed in this exploratory research are of importance in identifying, understanding and managing anxiety experienced by autistic pupils with co‐occurring ID in settings beyond this one school.</p> <hd id="AN0188551863-24">ACKNOWLEDGEMENTS</hd> <p>This study was funded by Dubin City University Educational Trust under the Kerley Autism Education Scholarship scheme, which supported the tuition fees of the first author.</p> <hd id="AN0188551863-25">CONFLICT OF INTEREST STATEMENT</hd> <p>No potential conflict of interest is reported by the authors.</p> <hd id="AN0188551863-26">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p> <hd id="AN0188551863-27">ETHICS STATEMENT</hd> <p>This paper is the original work of the authors and is not under consideration or published elsewhere. The paper reflects the authors' own research and analysis in a truthful and complete manner.</p> <p>GRAPH: Appendix S1.</p> <ref id="AN0188551863-28"> <title> REFERENCES </title> <blist> <bibl id="bib1" idref="ref8" type="bt">1</bibl> <bibtext> Adams, D., MacDonald, L. &amp; Keen, D. (2019) Teacher responses to anxiety‐related behaviours in students on the autism spectrum. Research in Developmental Disabilities, 86, 11 – 19. Available from: https://doi.org/10.1016/j.ridd.2018.12.009</bibtext> </blist> <blist> <bibl id="bib2" idref="ref9" type="bt">2</bibl> <bibtext> Adams, D., Young, K. &amp; Keen, D. (2019) Anxiety in children with autism at school: a systematic review. Review Journal of Autism and Developmental Disorders, 6 (3), 274 – 288. 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| Items | – Name: Title Label: Title Group: Ti Data: 'Anxiety Floods the Entire System': A Qualitative Study Exploring Teacher Perspectives Regarding How Anxiety Impacts Autistic Pupils with Co-Occurring Intellectual Disabilities – Name: Language Label: Language Group: Lang Data: English – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Katie+Giltinan%22">Katie Giltinan</searchLink><br /><searchLink fieldCode="AR" term="%22Craig+Goodall%22">Craig Goodall</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-5713-9009">0000-0002-5713-9009</externalLink>)<br /><searchLink fieldCode="AR" term="%22Neil+Kenny%22">Neil Kenny</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-2340-6586">0000-0002-2340-6586</externalLink>) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="SO" term="%22Journal+of+Research+in+Special+Educational+Needs%22"><i>Journal of Research in Special Educational Needs</i></searchLink>. 2025 25(4):849-861. – Name: Avail Label: Availability Group: Avail Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us – Name: PeerReviewed Label: Peer Reviewed Group: SrcInfo Data: Y – Name: Pages Label: Page Count Group: Src Data: 13 – Name: DatePubCY Label: Publication Date Group: Date Data: 2025 – Name: TypeDocument Label: Document Type Group: TypDoc Data: Journal Articles<br />Reports - Research – Name: Subject Label: Descriptors Group: Su Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Multiple+Disabilities%22">Multiple Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Schools%22">Special Schools</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education%22">Special Education</searchLink><br /><searchLink fieldCode="DE" term="%22Special+Education+Teachers%22">Special Education Teachers</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Behavior%22">Student Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Environmental+Influences%22">Environmental Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Sensory+Experience%22">Sensory Experience</searchLink><br /><searchLink fieldCode="DE" term="%22Disability+Identification%22">Disability Identification</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink> – Name: DOI Label: DOI Group: ID Data: 10.1111/1471-3802.70017 – Name: ISSN Label: ISSN Group: ISSN Data: 1471-3802 – Name: Abstract Label: Abstract Group: Ab Data: This qualitative study investigates teachers' perspectives on anxiety among autistic learners with intellectual disabilities (ID) in special school settings. Research in this area remains limited, with existing studies often overlooking the distinct ways anxiety manifests and interacts with ID in this population. Semi-structured interviews with eight teachers explored their views on anxiety presentation, triggers and strategies for support. Reflexive thematic analysis provided nuanced insights into the findings. Teachers highlighted that anxiety often presents through behaviours misinterpreted as core features of autism, complicating identification and response to emotional needs. Environmental factors, including sensory stimuli, routine disruptions and limited spaces for sensory breaks, emerged as significant triggers. Unpredictable staffing and incompatible pupil groupings further exacerbated anxiety, contributing to social withdrawal and self-regulation challenges. To address these issues, teachers described using proactive strategies, such as transition planning, building trust or low-arousal environments. They emphasised the need for a whole-school, collaborative approach, alongside multidisciplinary support. However, teachers often felt overwhelmed due to limited access to external specialists or support. Participants advocated for neurodiversity-affirming practices focusing on environmental triggers and regulation. The study underscores the importance of increased teacher support, comprehensive planning, and integrating family and community resources to develop consistent anxiety management strategies. – Name: AbstractInfo Label: Abstractor Group: Ab Data: As Provided – Name: DateEntry Label: Entry Date Group: Date Data: 2025 – Name: AN Label: Accession Number Group: ID Data: EJ1486557 |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1111/1471-3802.70017 Languages: – Text: English PhysicalDescription: Pagination: PageCount: 13 StartPage: 849 Subjects: – SubjectFull: Autism Spectrum Disorders Type: general – SubjectFull: Anxiety Type: general – SubjectFull: Students with Disabilities Type: general – SubjectFull: Intellectual Disability Type: general – SubjectFull: Multiple Disabilities Type: general – SubjectFull: Special Schools Type: general – SubjectFull: Special Education Type: general – SubjectFull: Special Education Teachers Type: general – SubjectFull: Student Behavior Type: general – SubjectFull: Environmental Influences Type: general – SubjectFull: Sensory Experience Type: general – SubjectFull: Disability Identification Type: general – SubjectFull: Symptoms (Individual Disorders) Type: general Titles: – TitleFull: 'Anxiety Floods the Entire System': A Qualitative Study Exploring Teacher Perspectives Regarding How Anxiety Impacts Autistic Pupils with Co-Occurring Intellectual Disabilities Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Katie Giltinan – PersonEntity: Name: NameFull: Craig Goodall – PersonEntity: Name: NameFull: Neil Kenny IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 10 Type: published Y: 2025 Identifiers: – Type: issn-electronic Value: 1471-3802 Numbering: – Type: volume Value: 25 – Type: issue Value: 4 Titles: – TitleFull: Journal of Research in Special Educational Needs Type: main |
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