Anxiety Disorders in Persons with Developmental Disabilities: Empirically Informed Diagnosis and Treatment

Abstract

Anxiety disorders are common in individuals with developmental disabilities (DDs), although they may not be diagnosed and treated as often as they are in patients without DDs. Patients with mental retardation, autism, and other pervasive developmental disorders may exhibit comorbid anxiety disorders, such as generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), phobias, and other anxiety symptoms at much higher rates than in the general population, but identification of these comorbid anxiety disorders may be made more difficult by the presence of the DD and concurrent difficulties with communication, other behavior problems, the lack of standardized assessments specific to diagnosing patients with DDs and psychiatric comorbidities, and the need for greater collateral sources of assessment information. In addition, systematic study of the treatment of anxiety in patients with DD is limited to a relatively small number of empirical studies done specifically in these patients along with case reports and theoretical reviews on the extension and modification of more well-studied treatments used for anxiety in patients without DDs. The present article reviews the literature on the prevalence, features, assessment and diagnosis of anxiety disorders in individuals with DDs, and also reviews empirical studies of pharmacological and psychological treatment of patients with comorbid anxiety and DD and summarizes the findings. Recommendations are made to guide treatment and further research in this area.

Differentiating High-Functioning Autism and Social Phobia

“…Although preliminary evidence supports the fact that SP does present at higher rates in those with ASDs compared to the general population, identification of SP in individuals with ASD can be difficult due to impairments in communication and introspective thinking, behavior problems, and a lack of standardized assessments for psychiatric co-morbidity specific to the autism population (Davis et al 2008). Problems with language and intellectual functioning may also hinder accurate reporting of symptoms.…”

“…Problems with language and intellectual functioning may also hinder accurate reporting of symptoms. Including behavioral observation, as well as input of family members, teachers, and other caregivers in assessment and treatment planning may help to aid against limitations in self-reporting (Davis et al 2008). Modified assessment instruments, such as the ACI-PL, a modified version of the K-SADS-PL (Kaufman et al 1997), are promising possibilities in this domain (Leyfer et al 2006).…”

“…Applying versions of ASD-specific social skills interventions for patients with SP may also prove successful. In both disorders, psychopharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) has met with some success in ameliorating symptoms, though more so in SP than in HFA (Compton et al 2010;Davis et al 2008). As our understanding of the behavioral aspects of both disorders increases, and as we understand risk and protective factors in each disorder, our ability to tailor these interventions to both SP and HFA will improve.…”

Therapeutic Strategies in Fragile X Syndrome: Dysregulated mGluR Signaling and Beyond

“…Therefore, therapeutic strategies to treat these disorders are not usually designed to target the underlying pathological mechanisms. Rather, treatments are mostly limited to behavioral interventions or drug therapies that ameliorate comorbid symptoms, such as anxiety, aggression, or epilepsy (Davis et al, 2008;Depositario-Cabacar and Zelleke, 2010;Brosnan and Healy, 2011). Fragile X Syndrome (FXS) is the most common inherited form of intellectual disability (ID) and the most common known monogenic cause of autism spectrum disorders (ASD).…”

Intellectual Disabilities and Mental Health: United States–Based Research

“…Davis, Saeed, and Antonacci (2008) reviewed literature regarding anxiety in individuals with developmental disabilities including ID and ASD and found a number of investigations directed at increasing recognition of its occurrence and variations in clinical presentation. Limited controlled investigations of pharmacologic treatment were identified.…”