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

Background: Despite the increased risk for anxiety disorders in youth with autism spectrum disorders (ASD), there is a lack of research on the functional assessment and treatment of anxiety and related problem behavior in children with ASD, particularly for those with an intellectual disability (ID).

Objectives: (1) To evaluate a multimethod strategy for the assessment of anxiety and problem behavior in children with ASD and ID; (2) To examine a multicomponent intervention plan to treat anxiety and related problem behavior in children with ASD and ID.

Methods: In Study 1 (the Assessment study), for three children with ASD and ID, anxiety was operationally defined using: (1) behavioral data from anxious behaviors, (2) affective/contextual data from parent-report and blind observer ratings of appearance of anxiety, and (3) physiological data (heart rate and respiratory sinus arrhythmia). A functional assessment of problem behavior during High- and Low-Anxiety conditions was conducted. In Study 2, we then developed treatments for the anxiety and associated problem behavior in these same three children. A multiple baseline design was used to evaluate the effectiveness of a multicomponent intervention package, incorporating individualized strategies from Applied Behavior Analysis (ABA), Positive Behavior Support (PBS), and Cognitive Behavioral Therapy (CBT).

Results: In Study 1, higher levels of problem behavior and heart rate, and lower levels of respiratory sinus arrhythmia, were found in the High-Anxiety than Low-Anxiety conditions (Moskowitz, Mulder, Walsh, McLaughlin, Zarcone, Proudfit, & Carr, 2013). In Study 2, following intervention, all three participants showed substantial decreases in anxiety and associated problem behavior in the situations that had previously been identified as anxiety-provoking (Moskowitz, Walsh, Mulder, Zarcone, McLaughlin, Proudfit, & Carr, in preparation). Additionally, the children showed changes in physiological arousal during intervention, suggesting parallel processes of improved coping and habituation (Moskowitz, Walsh, et al., in preparation).

Conclusions: Implications for the assessment and treatment of anxiety in this population using a multimethod approach are discussed.