Towards a Treatment for Intolerance of Uncertainty for Autistic Adults: A Single Case Experimental Design Study

Rodgers, Jacqui; Herrema, Renske; Honey, Emma; Freeston, Mark H.

doi:10.1007/s10803-018-3550-9

Cited by 41 publications

(35 citation statements)

References 60 publications

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“…The slow but increasing recognition of the obligation on researchers and professionals to reduce reliance on researcher‐created questionnaires and to develop and use different means of gaining the views of all participants to supplement standardized questionnaires, regardless of their age or abilities [Fayette & Bond, ], have resulted in studies beginning to use alternative approaches to further the available knowledge about the nature of anxiety and to provide important insights from individuals on the autism spectrum. Some examples of such approaches include Joyce, Honey, Leekam, Barrett, and Rodgers [] who triangulated standardized questionnaires with interviews and drawings of experiences, and Rodgers, Herrema, Honey, and Freeston [] who used daily diary templates alongside standardized questionnaires. This would seem particularly important in the area of anxiety and mental health, where developing methods of self‐report will not only extend the research literature but will also give parents and therapists a greater understanding of the child's experiences and needs.…”

Section: Introductionmentioning

confidence: 99%

Exploring Anxiety at Home, School, and in the Community Through Self‐Report From Children on the Autism Spectrum

2019

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Research investigating anxiety in children on the autism spectrum usually reports caregiver rather than self‐report perspectives. This study aimed to document children's own descriptions of their anxiety symptomatology by combining profiles on a standardized autism‐specific self‐report measure of anxiety (ASC‐ASD‐C) with the answers from closed‐ and open‐answer questions about anxiety across home, school, and community settings. Across the sample of 113 children on the spectrum aged 6–14 years, the two most frequently endorsed items on the ASC‐ASD‐C were from the Uncertainty and Performance Anxiety subscales, and the least endorsed were both from the Anxious Arousal subscale. Almost all (96.5%) of the children on the spectrum reported experiencing anxiety in at least one setting, with 40.7% reporting anxiety in all three contexts (home, school, and community). Approximately half of the sample felt their anxiety goes unrecognized by others at school and almost 60% felt it was unrecognized by others when out in the community. The proportion of children reporting having someone to help reduce their anxiety differed across home (86%), school (76%), and community (45%) settings. This highlights the importance of understanding anxiety and its impact, not only within the context of autism but also for each particular child. Autism Res 2020, 13: 603–614. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay summary There has been a lot of research focusing on anxiety and autism, but most of it has used parent reports, rather than asking the child themselves. This study summarizes data from 113 children on the autism spectrum, aged 6–14 years. It reports the symptoms of anxiety that these children most and least commonly experience. The results suggest only 40–50% of children feel that others are able to recognize their anxiety at school and when out in the community, suggesting that more training is needed to help adults in these settings to recognize and support anxiety.

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Section: Introductionmentioning

confidence: 99%

Exploring Anxiety at Home, School, and in the Community Through Self‐Report From Children on the Autism Spectrum

2019

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“…that caregivers changed their behaviours to reduce the patient's anxiety, which in the anxiety treatment literature is frequently viewed as enhancing rather than mitigating anxiety (Frank et al 2020, Kagan et al 2017, Lebowitz et al 2013. Also the interventions developed by Rodgers et al (2018Rodgers et al ( , 2017 aim to increase flexibility in children and adults with ASD rather than reducing uncertainty. However, it is a basic tenet of anxiety treatments aiming to increase flexibility or tolerance of uncertainty through gradual exposure or similar, that the level of anxiety is tolerable and manageable for the individual concerned (Lebowitz et al 2013).…”

Section: Discussionmentioning

confidence: 99%

“…(7) Intolerance of uncertainty seems to contribute in the development of anxiety disorder in individuals with ASD as well as in others (Joyce et al 2017, Boulter et al 2014, Keen et al 2019, Baribeau et al 2020, and has been the target for recently developed interventions for anxiety in ASD (Rodgers et al 2018(Rodgers et al , 2017. Intolerance of uncertainty has also been reported by individuals with ASD/ID themselves to contribute to "challenging" behaviours (Wolkorte et al 2019).…”

Section: Interventionmentioning

confidence: 99%

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

Kildahl

Bakken

Matre

et al. 2020

International Journal of Developmental Disabilities

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Introduction : Anxiety disorders are highly prevalent in individuals with autism spectrum disorder (ASD), but knowledge is limited regarding identification and treatment of these disorders in individuals with ASD and more severe levels of intellectual disability (ID). The current case study aims to explore and describe the inpatient, psychiatric assessment in an adolescent male with ASD, severe ID and self-injurious behaviour (SIB) who was diagnosed with a co-occurring anxiety disorder. The study further aims to explore the implications of this diagnosis for subsequent intervention and care, including management of SIB. Materials and methods : Case study including multimodal, psychiatric assessment and subsequent intervention. Results : Following changes in care strategies attempting to incorporate the understanding of anxiety/trauma as contributing to SIB, a reduction of SIB was observed, and this reduced frequency was maintained when the patient was discharged from the inpatient setting. Conclusions : Though no causal inferences are possible, these experiences indicate that further research is needed regarding possible associations between SIB and anxiety in individuals with ASD, including implications for treatment. Experiences from the current case further indicate that it is possible to recognize and diagnose anxiety disorder in complex cases involving ASD, severe ID, limited verbal language skills, and severe SIB.

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“…Coping with Uncertainty in Everyday Situations (CUES-A©) Intolerance of Uncertainty (IU) has been proposed as an important trans-diagnostic mechanism in the development of anxiety in autistic adults [22]. The focus of the CUES-A© intervention programme [40,44] is to support participants to develop their awareness, gain confidence in their ability to recognise and manage their own IU through collaborative CBT strategies.…”

confidence: 99%

“…Other trials of CBT for autistic adults similarly aim to improve emotional regulation and functioning as opposed to working specifically with anxiety-based presentations. Given the growing evidence that difficulty in tolerating uncertainty is associated with the development and maintenance of clinically significant anxiety in autistic adults [36][37][38][39], interventions aimed at increasing the ability to cope with uncertainty have been piloted for feasibility and have demonstrated promise as a treatment option [40].…”

Section: Introductionmentioning

confidence: 99%

Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment–Autism (PAT-A©) pilot randomised controlled feasibility trial

Parr

Brice

Welsh

et al. 2020

Trials

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Background: Anxiety is common in autistic adults and significantly limits everyday opportunities and quality of life. Evidence-based psychological therapies offered by mental health services often fail to meet the needs of autistic adults. The development of appropriate treatments for mental health conditions and, in particular, anxiety has been identified as a key priority by the autism community. The Personalised Anxiety Treatment-Autism (PAT-A©) trial aims to address this need by investigating the feasibility and acceptability of delivering an individualised psychological treatment for anxiety experienced by autistic adults. Methods/design: This is a pilot randomised controlled feasibility trial. Up to 40 autistic adults with clinically diagnosed anxiety will be randomised into one of two groups (either the PAT-A© intervention or Current Clinical Services Plus two emotional literacy skills sessions). Before randomisation, participants will receive a detailed clinical assessment to inform formulation and guide anxiety treatment. As part of the baseline assessment participants will also identify two personally important 'target situations' that cause significant anxiety and impact upon their daily life. Based upon the formulation and identified target situations, participants randomised to the PAT-A© intervention will receive up to 12 individualised, one-to-one therapy sessions. Initial emotional literacy training sessions will be followed by a bespoke, modular, needs-based treatment approach utilising one or more of the following approaches: Mindfulness, Coping with Uncertainty in Everyday Situations (CUES), social anxiety and graded exposure within Virtual Reality Environments. Participants in the control arm will receive two psychoeducational sessions focussing on understanding and describing emotions and be signposted to healthcare provision as required. Data will be collected through quantitative and qualitative methods. Discussion: This feasibility pilot trial serves as the first stage in the development and evaluation of a manualised personalised, evidence-based psychological therapy treatment for anxiety in autistic adults. Study outcomes will be used to inform an application for a fully powered multi-site intervention trial of adults and young people.

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Towards a Treatment for Intolerance of Uncertainty for Autistic Adults: A Single Case Experimental Design Study

Cited by 41 publications

References 60 publications

Exploring Anxiety at Home, School, and in the Community Through Self‐Report From Children on the Autism Spectrum

Exploring Anxiety at Home, School, and in the Community Through Self‐Report From Children on the Autism Spectrum

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

Treating anxiety in autistic adults: study protocol for the Personalised Anxiety Treatment–Autism (PAT-A©) pilot randomised controlled feasibility trial

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