Assessing and Treating Anxiety in Individuals with Autism.
Define anxiety as visible behavior and treat it with DRA plus stimulus fading even when the client talks very little.
01Research in Context
What this study did
Channell et al. (2022) worked with four autistic clients who spoke only a few words.
The team first watched each client in scary situations. They wrote a clear definition of what anxiety looked like for that person.
Next they built a simple DRA plan. The client could escape or get a treat for staying calm. They slowly made the scary part longer or louder. This is called stimulus fading.
What they found
All four clients showed fewer signs of anxiety. The behavior dropped right away and stayed low.
The clients also used their calm behavior more often. Parents and aides said life felt easier.
How this fits with other research
Perihan et al. (2020) pooled 23 studies and found CBT helps high-functioning autistic kids. Keira shows you can help even when the child talks very little.
Taylor et al. (2017) mixed PBS and CBT for kids with both autism and ID. Keira kept the package simple: just DRA plus fading. Both teams got big drops in worry and problem behavior.
Brown et al. (2022) used one-minute timings of positive thoughts for a teen girl. Keira used escape and treats instead of self-talk. Both single-case studies cut anxiety in 2022, showing two roads to the same goal.
Vause et al. (2020) ran an RCT with functional CBT for obsessive rituals. Keira used the same functional idea but for anxiety and with a single-case design.
Why it matters
You now have a low-language option. Define anxiety as observable movement or freezing. Pick a reinforcer the child already loves. Let them earn it for calm behavior while you slowly raise the scary part. No fancy talk therapy needed. Try it next time a client covers their ears, paces, or hits to escape new places.
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02At a glance
03Original 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.
Behavior modification, 2022 · doi:10.1177/01454455211051678