Case study: identification of anxiety and subsequent intervention in an adolescent male with autism, severe intellectual disability and self-injurious behaviour.
Even non-verbal teens with severe ID can show anxiety-driven SIB that drops when you treat the anxiety.
01Research in Context
What this study did
AHand et al. (2020) worked with one non-speaking teen. He had autism, severe intellectual disability, and daily self-hitting.
The team asked: can we spot anxiety without words? They watched triggers, body cues, and behavior patterns.
They added anxiety care to his plan. This meant meds, sensory breaks, and trauma-wise therapy. They tracked his SIB before, during, and after.
What they found
Self-hitting dropped once anxiety care started. The lower rate held until discharge.
The teen could not say "I am anxious," but his body showed it. Treating the hidden anxiety cut the visible injury.
How this fits with other research
Soto et al. (2024) later tested 50 non-speaking youth with ASD and ID. Higher anxiety scores lined up with more SIB and repetitive acts. The case result now shows up in a group.
Schaaf et al. (2015) mapped SIB risk in teens with ASD. They said lower IQ and poor speech raise risk. AN’s case proves risk can still be lowered if you treat anxiety, even when both factors are present.
Rodgers et al. (2012) first saw that more repetitive behaviors predict higher anxiety in autism. AN flipped the arrow: cut anxiety, and repetitive SIB falls.
Why it matters
You can’t wait for words. If a client has ASD, ID, and SIB, run an anxiety check list that uses behavior and body cues. Add sensory breaks, safe spaces, or consult psychiatry. One teen stopped hurting himself once his anxiety was seen and treated. Start looking for the same clues in your clients.
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02At a glance
03Original abstract
<b>Introduction</b>: 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. <b>Materials and methods</b>: Case study including multimodal, psychiatric assessment and subsequent intervention. <b>Results</b>: 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. <b>Conclusions</b>: 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.
, 2020 · doi:10.1080/20473869.2020.1850160