Anxiety in Children and Adolescents with Autism Spectrum Disorder

Evidence-Based Assessment and Treatment

Connor M. Kerns, Patricia Renno, Eric A. Storch, Philip C. Kendall, Jeffrey J Wood

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128052679
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

Anxiety in Children and Adolescents with Autism Spectrum Disorder: Evidence-Based Assessment and Treatment begins with a general overview of the history of research on anxiety in ASD and the path towards evidence-based assessment and treatment methods. Thereafter, chapters focus on the nature of ASD and anxiety comorbidity, the assessment of anxiety in ASD, and its treatment. Later chapters are devoted to future directions for research on this topic, including a discussion of anxiety assessment and treatment for adults and minimally verbal individuals.

Anxiety disorders in children with autism spectrum disorder (ASD) can cause substantial distress and impairment over and above that caused by ASD alone. Emerging research on genetic, psychological, psychophysiological, and psychometric aspects of ASD establish anxiety as a valid and necessary treatment target in this population.

This book is designed to help a broad array of providers who work with children with ASD understand cutting-edge, empirically supported treatments for anxiety, including specific treatment plans and strategies.

• Presents a balanced discussion of the scientific literature on anxiety in ASD
• Provides a pragmatic, clinically applied focus that gives readers a 'how-to' guide for the treatment of anxiety in ASD
• Considers the distinct ways in which anxiety presents in children and adolescents with ASD and the challenges this presents to assessment and treatment
• Examines emerging areas of anxiety assessment and treatment research in ASD

Chapter 1

Introduction

Connor M. Kerns¹, Patricia Renno², Eric A. Storch³, Philip C. Kendall⁴ and Jeffrey J. Wood²,    ¹Drexel University, Philadelphia, PA, United States,    ²University of California, Los Angeles, CA, United States,    ³University of South Florida, Tampa, FL, United States,    ⁴Temple University, Philadelphia, PA, United States

Abstract

This book covers broad ground and targets the scientist, the clinician, and those who combine these disciplines in their daily work. It provides reviews of literature, covering topics such as the prevalence, etiology, presentation, and assessment of anxiety in ASD with chapters submitted from leaders in the field. This compilation combines scientific richness and evidence with clinical “how to’s” and practical illustrations and suggestions. The chapters cover newly developing areas and areas of important future research and clinical practice. There should be something in this book for all those who support individuals with ASD in their lives and careers and who wonder about the essential nature of social development and cognition and its connectedness with mental health, quality of life, and well-being. Further, we see this book as a medium to deliver the scientific literature to those outside academia who nonetheless want to know as much as they can know, know what has been tested, and offer treatments and approaches that can be expected to have an impact on the lives of individuals with ASD.

Keywords

Anxiety; functional impairment; autism; etiology; autism spectrum disorder; Diagnostic and Statistical Manual

Anxiety has been discussed within the context of autism spectrum disorder (ASD) since Kanner and Asperger’s initial accounts of autism, in the descriptions of ASD in the Diagnostic and Statistical Manual (DSM), and in the burgeoning research on the prevalence, presentation, and treatment of ASD that has emerged over the last decade. Kanner (1943) noted high levels of anxiety in several of his case studies. For example, he described one child as being “very timid, fearful of various and changing things, wind, large animals, etc.” (p. 228). Another child displayed “…a good deal of ‘worrying.’ He frets when the bread is put in the oven to be made into toast, and is afraid it will get burned and be hurt…” (p. 233). Criteria for ASD in the DSM over the last several editions have included symptoms that often overlap with anxiety (e.g., adherence to rituals, difficulties with minor changes in routine). Recent research provides evidence that anxiety disorders affect approximately 40–50% of children with ASD (van Steensel et al., 2011) and cause substantial distress and impairment over and above that caused by ASD alone (Bellini, 2004; Chang et al., 2012; Sukhodolsky et al., 2008).

Although anxiety has been consistently noted in ASD, efforts to understand and explain the role and significance of this cooccurrence are more recent. Cooccurrence of psychological disorders is common and yet there is something particular about the relationship of anxiety in ASD. Anxiety is more prevalent in ASD than other developmental and learning disorders. Further, anxiety is both independent and distinguishable from core ASD deficits and also influenced by and influential to them (Kerns and Kendall, 2012). The relationship of ASD and anxiety may thus teach us much about the underlying etiology and maintenance of these psychological conditions and the increased functional impairments related to their cooccurence. The study of anxiety in ASD may demonstrate neurobiological and behavioral patterns associated with comorbidity generally but also elucidate patterns specific to the cooccurrence of these particular symptoms. Further, recent research has indicated that anxiety is a valid treatment target among children with ASD based on emerging genetic, psychophysiological, and psychometric evidence. As a result of the increased awareness of the prevalence and impact of anxiety on individuals with ASD, several interventions have been developed and tested and found to be efficacious in treating anxiety in ASD.

This book begins with chapters focusing on the nature of ASD and anxiety cooccurrence. Authors delve into the current literature on the prevalence, presentation, and underlying mechanisms of anxiety in ASD. These chapters highlight classical presentations of anxiety in youth with ASD, as well as, more ambiguous presentations, the correct diagnostic classification of which is unclear. Additional chapters discuss recent research findings on neurobiological mechanisms underlying anxiety in ASD.

Chapters are then devoted to discussion of assessment and treatment of anxiety in ASD, with several chapters on evidence-based practices. Basic cognitive behavioral therapy principles are introduced as well as how this treatment approach can be applied to children and youth with ASD. Authors review the existing literature on the efficacy of individual and group CBT therapies for anxiety in ASD. Further, authors describe individual and group CBT approaches that have been employed in successful treatment programs and provide case studies to exemplify how these types of interventions can be implemented by clinicians to treat anxiety in youth with ASD. Chapters detailing psychosocial treatment have a pragmatic flavor to them allowing the reader to apply skills and techniques immediately. Particular attention is also given to treatment considerations for symptoms related to anxiety in ASD that can complicate case conceptualization, treatment planning, and implementation.

Further chapters include preliminary findings and future research directions related to the treatment of anxiety in individuals with ASD. These sections are devoted to the assessment and treatment of anxiety in adults and minimally verbal children. There is also a chapter on school-related issues that are relevant for youth with anxiety and ASD. Topics include how anxiety can manifest and interfere in the school setting and discussion of accommodations and supports that can be employed in the school for anxious children on the spectrum. Lastly, there is a chapter on the use of evidence-based psychosocial treatments for anxiety in youth with ASD in the community. It discusses current efforts to disseminate psychosocial approaches and future directions for implementing psychosocial treatments to treat anxiety and related conditions in children and youth with ASD in the community.

This edited book covers broad ground and targets the scientist, the clinician, and those who combine these disciplines in their daily work. It provides reviews of literature, covering topics such as the prevalence, etiology, presentation, and assessment of anxiety in ASD with chapters submitted from leaders in the field. This compilation combines scientific richness and evidence with clinical “how to’s” and practical illustrations and suggestions. The chapters cover newly developing areas and areas of important future research and clinical practice. There should be something in this book for all those who support individuals with ASD in their lives and careers and who wonder about the essential nature of social development and cognition and its connectedness with mental health, quality of life and well-being. Further, we see this book as a medium to deliver the scientific literature to those outside of academia who nonetheless want to know as much as they can know, know what has been tested, and offer treatments and approaches that can be expected to have an impact on the lives of individuals with ASD.

This edited book provides the current state of knowledge of the presentation, assessment, and treatment of anxiety in ASD, but there are future research directions that the authors note in their chapters. Of considerable importance is the need for further research in the assessment and treatment of anxiety in under-represented subpopulations on the autism spectrum, including individuals who are minimally verbal, individuals with intellectual disability and adults. The majority of the current assessment and treatment research has been conducted in school-age children with average intellectual abilities. Additionally, with research demonstrating the efficacy of individual and group treatment approaches for anxiety in ASD, further research on how these treatments can be successfully disseminated and implemented in the community is needed.

Anxiety disorders in children and adolescents with ASD have been rigorously studied over the last decade and continue to receive considerable attention. Explicit studies of anxiety in ASD have increased our knowledge of the prevalence, presentation, assessment and treatment of these constructs and their connectedness. Further, this research suggests that regardless of how it is conceptualized or what it is called, anxiety plays a role in the long-term development, functioning and well-being of individuals with ASD and their families. Moreover, it may provide a gateway to global improvements for individuals and their families.

References

1. Bellini S. Social skill deficits and anxiety in high-functioning adolescents with autism spectrum disorders. Focus Autism Other Dev Disabil. 2004;19:78–86 http://dx.doi.org/10.1177/10883576040190020201.

2. Chang Y, Quan J, Wood JJ. Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders. J Dev Phys Disabil. 2012;24:235–245 http://dx.doi.org/10.1007/s10882-012-9268-2.

3. Kanner L. Autistic disturbances of affective contact. Pathology 1943;217–250.

4. Kerns CM, Kendall PC. The presentation and classification of anxiety in autism spectrum disorder. Clin Psychol. 2012;19(4):323–347 http://dx.doi.org/10.1111/cpsp.12009.

5. Sukhodolsky DG, Scahill L, Gadow KD, et al. Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. J Abnorm Child Psychol. 2008;36:117 117. doi:10.1007/s10802-007-9165-9.

6. van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14:302–317 http://dx.doi.org/10.1007/s10567-011-0097-0.

Chapter 2

Prevalence of Anxiety in Autism Spectrum Disorders

Rachel Kent and Emily Simonoff, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom

Abstract

This chapter reviews the current knowledge about the prevalence of and risk factors associated with anxiety disorders in individuals with autism spectrum disorder (ASD). Prevalence rates for a diagnosis of an anxiety disorder are considered only from studies that use clinical diagnostic interviews. We report that anxiety disorders are common in individuals with ASD and overall prevalence rates for anxiety disorders as an aggregate group range between 42% and 79%. The prevalence rates for individual anxiety disorders are variable. Specific phobia, obsessive compulsive disorder, and social anxiety disorder are the most common but the rate and type of anxiety disorders may vary across age and ability level. Challenges in measuring anxiety in ASD and factors that may contribute to variation in overall rates and those for specific disorders are discussed. The objective of summarizing the research literature on anxiety in ASD to...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• List of Contributors
• Chapter 1. Introduction
• Chapter 2. Prevalence of Anxiety in Autism Spectrum Disorders
• Chapter 3. Phenomenology and Presentation of Anxiety in Autism Spectrum Disorder
• Chapter 4. Neurobiological Mechanisms of Anxiety in ASD
• Chapter 5. Assessment of Anxiety in Youth With Autism Spectrum Disorder
• Chapter 6. Cognitive-Behavioral Principles and Their Applications Within Autism Spectrum Disorder
• Chapter 7. Individual CBT for Anxiety and Related Symptoms in Children With Autism Spectrum Disorders
• Chapter 8. Group Cognitive Behavior Therapy for Children and Adolescents With Anxiety and Autism Spectrum Disorders
• Chapter 9. Behavioral Treatments for Anxiety in Adults With Autism Spectrum Disorder
• Chapter 10. Behavioral Treatments for Anxiety in Minimally Verbal Children With ASD
• Chapter 11. Anxiety and ASD in Schools: School-Related Issues and Individualized Education Programs
• Chapter 12. Dissemination and Implementation of Behavioral Treatments for Anxiety in ASD
• Index