Assessing and Treating Anxiety in Individuals with Autism

Abstract

Anxiety is a cluster of responses that can involve both operant and respondent behavior, which can be both public and/or private in nature, and occurs when an upcoming aversive stimulus is signaled. Despite the reported high comorbidity of autism and anxiety, there has been very limited research on how to directly assess and treat anxiety, especially with individuals who have limited communication skills. In Study 1, anxiety was assessed in five individuals with autism, ranging in age from 10 to 19 years old. Anxiety was assessed by measuring behavior during (1) a baseline (with no putative anxiety-provoking stimuli present), (2) signals for an upcoming aversive event, and (3) exposure to that aversive event. Anxiety presented in several different ways, as both conditioned activation and suppression, and both with and without problem behavior during the aversive event. In Study 2, individualized treatments involving differential reinforcement of alternative responses and stimulus fading were used to successfully reduce anxious responding in all four participants who displayed anxiety. These studies demonstrated a potentially useful means of assessing anxiety in individuals with autism which may not only help to measure anxious behavior and identify anxiety-provoking events, but may also lead to effective treatment.

An Interdisciplinary Approach to Treating Severe Behavior in a Juvenile Justice Facility: Teaching Behavioral Self-Management via Telehealth

“…4.5 (range, 4-5) You would recommend this to another person that would like to work on their anger. 4.5 (range, 4-5) literature on private events as precursors to challenging behavior and how to incorporate these events when teaching self-managed responses (Anderson et al, 1997;Moore et al, 2022). Further, we found participants' behavior generalized by stating they would use alternative behaviors in response to precursors not introduced during teaching.…”

“…Results of the focused self-management intervention indicate that BST delivered via telehealth was effective for teaching four adolescent males in a juvenile justice facility to identify precursors for challenging behavior and replace with appropriate alternative behaviors during simulated contexts. This adds to behavior analytic literature on private events as precursors to challenging behavior and how to incorporate these events when teaching self-managed responses (Anderson et al, 1997 ; Moore et al, 2022 ). Further, we found participants’ behavior generalized by stating they would use alternative behaviors in response to precursors not introduced during teaching.…”

“…Anderson et al ( 1997 ) explained that private events fall into one of four classes: (a) emotions, (b) thoughts, (c) perceptions, and (d) interoceptive and proprioceptive stimuli. As a related example, Moore et al ( 2022 ) taught three individuals diagnosed with autism spectrum disorder to engage in relaxation responses when they emitted overt behaviors in the presence of specific events (e.g., loud noises) that were indicative of anxiety (an internal event). Although participants’ private events were not observable to a therapist, those events directly or indirectly evoked challenging behavior.…”