Behavioral Assessment and Treatment for Anxiety for Those with Autism Spectrum Disorder

Abstract

Anxiety is a prominent associated feature in autism spectrum disorder (ASD); however, determining the presence of anxiety in this population can be especially challenging for several reasons. Overlapping features between anxiety and ASD (e.g., social avoidance and repetitive and compulsive-like behavior) can make it difficult to determine if these behaviors are due to anxiety or a component of the autism. In addition, persons with ASD have limited communication skills and social impairments that limit self-report; and are at increased risk for engaging in problem behavior (e.g., aggression, self-injury, and property destruction)—some of which is known to occur to avoid or escape certain situations. Caution should be taken to not assume the presence of anxiety (or dismiss it) based on how the presenting complaint is labeled by care providers (or even by the individual him or herself). Rather, multimodal, multi-informant behavioral assessment should be initiated upon encountering individuals with avoidant and seemingly anxious behavior. Review of the existing literature suggests that many of the behavioral assessment strategies traditionally employed with non-ASD populations are applicable to individuals with ASD. Treatment should be individualized based on the characteristics and functioning level of the individual. The core components of behavioral treatment procedures include graduated exposure and reinforcement, but these are often supplemented with other components. Despite significant gaps in the literature, the existing research is sufficient to guide clinicians on how to proceed with assessment and treatment of anxiety in individuals with ASD.