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

Three kids with autism and intellectual disability took part. Each child got a custom mix of PBS and CBT tools. The team taught coping statements, deep breathing, and reward charts. They used a multiple-baseline design to show the package worked.

Sessions happened where each child usually felt anxious — loud cafeteria, crowded hallway, or gym. Staff tracked heart rate and counted problem behavior minute-by-minute.

All three children calmed down fast. Problem behavior dropped by at least a large share in every case. Heart rate fell from ‘flight-or-fight’ to normal range within five minutes.

Parents said meltdowns at home also shrank. Gains lasted the full six-week follow-up.

Strydom et al. (2020) looks like the opposite story. Their adult RCT found PBS added nothing over usual care. The key gap is age: kids’ brains are more flexible, so teaching coping skills sticks better.

Eldevik et al. (2006) tried low-intensity ABA for the same dual-diagnosis group. They saw only tiny gains. Adding CBT-style coping tools, as J et al. did, may explain the jump from small to large effects.

Eikeseth et al. (2002) already showed big school-based ABA gains twenty years ago. The new study extends that work by targeting anxiety, not just academics.

You now have a rapid, low-cost option for anxiety-driven meltdowns in ASD+IDD. Pick the setting that triggers the child, script two coping lines, add a reinforcer, and collect heart-rate or latency data. You should see change in one to three sessions, just like the study team.