Intervention for Anxiety and Problem Behavior in Children with Autism Spectrum Disorder and Intellectual Disability

Abstract

There is little research on the functional assessment and treatment of anxiety and related problem behavior in children with autism spectrum disorder (ASD), particularly those with intellectual and developmental disability (IDD). In a recent study, we evaluated a multimethod strategy for assessing anxiety in children with ASD and IDD (Am J Intellect Dev Disabil 118:419-434, 2013). In the present study, we developed treatments for the anxiety and associated problem behavior in these same children. A multiple baseline design was used to evaluate the effectiveness of a multicomponent intervention package, incorporating individualized strategies from Positive Behavior Support and Cognitive Behavioral Therapy. During intervention, all three participants showed substantial decreases in anxiety and problem behavior and significant increases in respiratory sinus arrhythmia in the situations that had previously been identified as anxiety-provoking.

Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour

“…The current results are in line with previous reports of anxiety in ASD and ID being associated with SIB (Oliver et al 2017, Soke et al 2017, Kerns et al 2015, and the results from Moskowitz et al (2017b) where problem behaviours decreased as anxiety markers decreased in children with ASD and ID. These findings highlight the importance of conducting thorough psychiatric assessment in cases involving ASD, ID and "challenging" behaviours such as SIB.…”

“…If Philip seemed more agitated, tactile sensory diversions were introduced, such as caregivers taking initiative to kick a ball and get Philip to throw or kick it back, offering Philip a snack or a drink. These strategies are similar to those described as "exposure paired with anti-anxiety stimuli" or "counterconditioning" by Moskowitz et al (2017b) and "anxiety relief" or "grounding" by Bakken et al (2014). "Grounding" in trauma treatment may refer to any technique that aids the patient in re-establishing an awareness of the present (Kennerley, 1996).…”

“…Also for treatment, most research on anxiety disorder in individuals with ASD has focussed on individuals with average to above average IQs (Appleton et al 2019, Postorino et al 2017. Current knowledge regarding treatment for anxiety disorder in ASD and mild/ moderate ID seems to be limited to case studies (Moskowitz et al 2017b, Chok et al 2010, while in severe/profound ID the published case studies have primarily focussed on behavioural treatment of problematic avoidance (Rosen et al 2016), targeting phobic avoidance of specific situations or stimuli. In spite of previous studies identifying associations between anxiety disorders and SIB in youth with ASD (Kerns et al, 2015), treatments targeting more complex manifestations of anxiety have been sparsely described in individuals with ASD and severe levels of ID.…”

Anxiety and Emotional-Behavioral Problems of Adolescents in China: Evidence for A Serial Mediation Model of Alexithymia and Dependency

“…This study explored the relationship between multidimensional anxiety, alexithymia, dependence and emotional-behavioral problems in adolescents. Consistent with previous studies, adolescents with anxiety symptoms have shown increased emotional-behavioral problems [45][46][47][48], and multidimensional anxiety. Negative personalities are positive predictors of adolescent emotional-behavioral problems [22].…”

Perceptive- Cognitive Functional Learning Model Based on The Self-Management of Students with Autistic Spectrum Disorder: A Comparative Analysis

“…In other studies were researched functional treatments of anxiety processes Moskowitz et al [6], which, likewise, they start from previous competence development, evaluated from a multiple strategy, as well as, from theoretical base of behaviors as part of the associated global behavior, thoughtful as a multicomponent process, as soon as include different strategies, both individualized positive behavior support skills and cognitive behavioral therapies, encouraging, likewise, as they also affirm Clarke, Hill & Charman [7], the participation of all social factors involved in educational process of children with ASD. These studies move over field of intervention, concluding that exclusively clinical environments must to be replaced for cultural contexts adapted to individual needs, becoming applied programs based on the school and in right context, which allow seeming improvements to happen where exclusively clinical environments don´t find them Drmic, Aljunied & Reaven [8].…”