A Review of Behavioral Interventions for Anxiety‐Related Behaviors in Lower‐Functioning Individuals with Autism
Tiny, reinforced steps still beat anxiety in kids with autism who speak little or score low on IQ tests.
01Research in Context
What this study did
Rosen et al. (2016) hunted for papers that used ABA methods to calm anxiety in kids with autism who have limited speech or IQ under 70.
They kept only seven studies. Every study used gradual exposure, praise, or tokens to replace fear with calm.
What they found
All seven papers said the same thing: desensitization plus reinforcement drops anxious meltdowns.
Kids learned to stay in the room, touch the feared object, or finish the routine without screaming.
How this fits with other research
Cowell et al. (2023) later showed the same recipe—graded exposure and tokens—helps autistic clients wear face masks.
Pui Cai et al. (2024) looked at dental fear and found weaker, shakier gains. The difference? Dental studies mixed many tricks at once and rushed the steps.
Together the reviews draw a clear line: move in tiny steps, pick one reinforcer, and stay consistent.
Why it matters
You now have a simple map for anxiety in lower-functioning clients. Pick the scary thing, break it into five-second slices, and deliver a favorite edible for each calm breath. No fancy talk therapy needed.
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02At a glance
03Original abstract
Anxiety is highly prevalent in persons with autism and affects individuals with higher‐functioning autism (HFA) and lower‐functioning autism (LFA). Although there is emerging support for the efficacy of cognitive‐behavioral therapy (CBT) in treating anxiety in autism, these findings are largely based on HFA samples. Moreover, CBT may be inappropriate for individuals with LFA who may struggle to grasp the cognitive components of the therapy because of their more limited verbal abilities. Behavior analytic interventions may be better suited to treat anxiety in this population; however, the quantity and quality of the extant literature have yet to be reviewed. Toward this end, the extant behavioral intervention literature was reviewed. Seven studies met the inclusion criteria and were evaluated against quality indicators for within‐subject design research. Next, the efficacy of each treatment component was assessed using established criteria for defining empirically supported therapies. Results revealed behavioral interventions to be efficacious, with desensitization and reinforcement emerging as efficacious treatment components, while prompting, modeling, and antianxiety stimuli were established as possibly efficacious. However, given that some of the quality indicators were not met, these results should be interpreted with some caution. Additional research is needed to form a more conclusive evidence base for the treatment of anxiety in individuals with LFA. Copyright © 2016 John Wiley & Sons, Ltd.
Behavioral Interventions, 2016 · doi:10.1002/bin.1442