Advertisement

Behavioral Assessment and Treatment of Anxiety in Individuals with Intellectual Disabilities and Autism

  • Louis P. Hagopian
  • Heather K. Jennett
Original Article

Abstract

Individuals with intellectual disabilities (ID) and autism spectrum disorders may be at increased risk for anxiety disorders. Unfortunately, research on the assessment and treatment of anxiety disorders in individuals with ID has lagged behind that related to typically developing individuals. This paper reviews the existing literature and also draws from the research on anxiety in typically developing persons as a basis for discussing the behavioral assessment and treatment techniques applicable to individuals with ID and autism who also have anxiety. Challenges in identifying anxiety in this population are discussed and methods of behavioral assessment discussed include rating scales, behavioral interviews, direct observation of behavior, and physiological measures are reviewed. Treatment procedures discussed include graduated exposure and reinforcement.

Keywords

Anxiety Intellectual disabilities Autism Behavioral assessment Behavioral treatment 

Notes

Acknowledgement

The authors would like to thank Lynn Bowman for her comments on this manuscript.

References

  1. Aman, M. G., Singh, N. N., Stewart, A. W., & Field, C. J. (1985). The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency, 89, 485–491.PubMedGoogle Scholar
  2. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Arlington: Author.Google Scholar
  3. Chambless, D. L., Baker, M. J., Baucom, D. H., Beutler, L. E., Calhoun, K. S., Crits- Christoph, P., et al. (1998). Update on empirically validated therapies, II. Clinical Psychologist, 51, 3–16.Google Scholar
  4. Chorpita, B. F., Albano, A. M., Heimberg, R. G., & Barlow, D. H. (1996). A systematic replication of the prescriptive treatment of school refusal behavior in a single subject. Journal of Behavior Therapy and Experimental Psychiatry, 27, 281–290, doi: 10.1016/S0005-7916(96)00023-7.PubMedCrossRefGoogle Scholar
  5. Conyers, C., Miltenberger, R. G., Peterson, B., Gubin, A., Jurgens, M., Selders, A., et al. (2004). An evaluation of in-vivo desensitization and video modeling to increase compliance with dental procedures in persons with mental retardation. Journal of Applied Behavior Analysis, 37, 233–238, doi: 10.1901/jaba.2004.37-233.PubMedCrossRefGoogle Scholar
  6. Dadds, M. R., Rapee, R. M., & Barrett, P. M. (1994). Behavioral observation. In T. H. Ollendick, N. J. King, & W. Yule (Eds.), International Handbook of Phobic and Anxiety Disorders in Children and Adolescents (pp. 349–364). New York: Plenum.Google Scholar
  7. Davis, T. E., & Ollendick, T. H. (2005). Empirically supported treatment for specific phobia in children: do efficacious treatments address the components of a phobic response? Clinical Psychology: Science and Practice, 12, 144–160, doi: 10.1093/clipsy/bpi018.CrossRefGoogle Scholar
  8. Dekker, M. C., & Koot, H. M. (2003). DSM-IV disorders in children with borderline to moderate intellectual disability I: prevalence and impact. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 915–922, doi: 10.1097/01.CHI.0000046892.27264.1A.PubMedCrossRefGoogle Scholar
  9. Didden, R., Duker, P. C., & Korzilius, H. (1997). Meta-analytic study on treatment effectiveness for problem behaviors with individuals who have mental retardation. American Journal of Mental Retardation, 101, 387–399.PubMedGoogle Scholar
  10. Erfanian, N., & Miltenberger, R. G. (1990). Contact desensitization in the treatment of dog phobias in personal who have mental retardation. Behavioral Residential Treatment, 5, 55–60.Google Scholar
  11. Esbensen, A. J., Rojahn, J., Aman, M. G., & Ruedrich, S. (2003). Reliability and validity of an assessment instrument for anxiety, depression, and mood among individuals with mental retardation. Journal of Autism and Developmental Disorders, 33, 617–629, doi: 10.1023/B:JADD.0000005999.27178.55.PubMedCrossRefGoogle Scholar
  12. Feinstein, C., Kaminer, Y., Barrett, R. P., & Tylenda, B. (1988). The assessment of mood and affect in developmentally disabled children and adolescents: the emotional disorders rating scale. Research in Developmental Disabilities, 9, 109–121, doi: 10.1016/0891-4222(88)90045-5.PubMedCrossRefGoogle Scholar
  13. Gullone, E., & King, N. J. (1992). Psychometric evaluation of a revised fear survey schedule for children and adolescents. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 33, 987–998, doi: 10.1111/j.1469-7610.1992.tb00920.x.PubMedCrossRefGoogle Scholar
  14. Gullone, E., King, N. J., & Cummins, R. A. (1996). Fears of youth with mental retardation: psychometric evaluation of the fear survey schedule for children-II (FSSC-II). Research in Developmental Disabilities, 17, 269–284, doi: 10.1016/0891-4222(96)00008-X.PubMedCrossRefGoogle Scholar
  15. Hagopian, L. P., Crockett, J. L., & Keeney, K. M. (2001). Multicomponent treatment for blood-injury-injection phobia in a young man with mental retardation. Research in Developmental Disabilities, 21, 141–149, doi: 10.1016/S0891-4222(01)00063-4.CrossRefGoogle Scholar
  16. Hagopian, L. P., Long, E. S., & Rush, K. S. (2004). Preference assessment procedures for individuals with developmental disabilities. Behavior Modification, 28, 668–677, doi: 10.1177/0145445503259836.PubMedCrossRefGoogle Scholar
  17. Hagopian, L. P., & Slifer, K. J. (1993). Treatment of separation anxiety disorder with graduated exposure and reinforcement targeting school attendance: a controlled case study. Journal of Anxiety Disorders, 7, 271–280, doi: 10.1016/0887-6185(93)90007-8.CrossRefGoogle Scholar
  18. Hagopian, L. P., Weist, M. D., & Ollendick, T. H. (1990). Cognitive-behavior therapy with an 11-year-old girl fearful of AIDS infection, other diseases, and poisoning: a case study. Journal of Anxiety Disorders, 4, 257–265, doi: 10.1016/0887-6185(90)90018-5.CrossRefGoogle Scholar
  19. Hartley, S. L., & MacLean, W. E. (2006). A review of the reliability and validity of likert-type scales for people with intellectual disability. Journal of Intellectual Disability Research, 50, 813–826, doi: 10.1111/j.1365-2788.2006.00844.x.PubMedCrossRefGoogle Scholar
  20. Heal, L. W., & Sigelman, C. K. (1995). Response biases in interview of individuals with limited mental capacity. Journal of Intellectual Disability Research, 39, 331–340.PubMedCrossRefGoogle Scholar
  21. Iwata, B. A., Pace, G. M., Dorsey, M. F., Zarcone, J. R., Vollmer, T. R., Smith, R. G., et al. (1994). The functions of self-injurious behavior: an experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27, 215–240, doi: 10.1901/jaba.1994.27-215.PubMedCrossRefGoogle Scholar
  22. Jennett, H. K., & Hagopian, L. P. (2008). Identifying empirically supported treatments for phobic avoidance in individuals with intellectual disabilities. Behavior Therapy, 39, 151–161, doi: 10.1016/j.beth.2007.06.003.PubMedCrossRefGoogle Scholar
  23. Kazdin, A. E. (1982). Single-case research designs: methods for clinical and applied settings. New York: Oxford University Press.Google Scholar
  24. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV Disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627, doi: 10.1001/archpsyc.62.6.617.PubMedCrossRefGoogle Scholar
  25. Kim, J. A., Szatmari, P., Bryson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4, 117–132, doi: 10.1177/1362361300004002002.CrossRefGoogle Scholar
  26. King, N. J., Josephs, A., Gullone, E., Madden, C., & Ollendick, T. H. (1994). Assessing the fears of children with disability using the revised fear survey schedule for children: a comparative study. The British Journal of Medical Psychology, 67, 377–386.PubMedGoogle Scholar
  27. King, N. J., Ollendick, T. H., & Murphy, G. C. (1997). Assessment of childhood phobias. Clinical Psychology Review, 17, 667–687, doi: 10.1016/S0272-7358(97)00029-9.PubMedCrossRefGoogle Scholar
  28. Knox, L. S., Albano, A. M., & Barlow, D. H. (1996). Parental involvement in the treatment of childhood compulsive disorder: a multiple-baseline examination incorporating parents. Behavior Therapy, 27, 93–114, doi: 10.1016/S0005-7894(96)80038-4.CrossRefGoogle Scholar
  29. Lindsay, W. R., & Michie, A. M. (1988). Adaptation of the Zung self-rating anxiety scale for people with mental handicap. Journal of Mental Deficiency Research, 32, 485–490.PubMedGoogle Scholar
  30. Love, S. R., Matson, J. L., & West, D. (1990). Mothers as effective therapists for autistic children’s phobias. Journal of Applied Behavior Analysis, 23, 379–385, doi: 10.1901/jaba.1990.23-379.PubMedCrossRefGoogle Scholar
  31. Luscre, D. M., & Center, D. B. (1996). Procedures for reducing dental fear in children with autism. Journal of Autism and Developmental Disorders, 26, 527–546, doi: 10.1007/BF02172275.CrossRefGoogle Scholar
  32. MacDuff, G. S., Krantz, P. J., & McClannahan, L. E. (2001). Prompts and prompt-fading strategies for people with autism. In C. Maurice, G. Green, & R. M. Foxx (Eds.), Making a Difference: Behavioral Intervention for Autism (pp. 37–50). Austin: PRO-ED.Google Scholar
  33. Masi, G., Brovedani, P., Mucci, M., & Favilla, L. (2002). Assessment of anxiety and depression in adolescents with mental retardation. Child Psychiatry and Human Development, 32, 227–237, doi: 10.1023/A:1017908823046.PubMedCrossRefGoogle Scholar
  34. Matson, J. L. (1981). Assessment and treatment of clinical fears in mentally retarded children. Journal of Applied Behavior Analysis, 14, 287–294, doi: 10.1901/jaba.1981.14-287.PubMedCrossRefGoogle Scholar
  35. Matson, J. L., & Bamburg, J. W. (1998). Reliability of the assessment of dual diagnosis (ADD). Research in Developmental Disabilities, 19, 89–95, doi: 10.1016/S0891-4222(97)00031-0.PubMedCrossRefGoogle Scholar
  36. Matson, J. L., Gardner, W. I., & Coe, D. A. (1991). A scale for evaluating emotional disorders in severely and profoundly retarded persons: developmental of the diagnostic assessment for the severely handicapped (DASH) scale. The British Journal of Psychiatry, 159, 404–409.PubMedCrossRefGoogle Scholar
  37. Matson, J. L., Kazdin, A. E., & Senatore, V. (1984). Psychometric properties of the psychopathology instrument for mentally retarded adults. Applied Research in Mental Retardation, 5, 81–89, doi: 10.1016/S0270-3092(84)80021-1.PubMedCrossRefGoogle Scholar
  38. Matson, J. L., Smiroldo, B. B., Hamilton, M., & Baglio, C. S. (1997). Do anxiety disorders exist in persons with severe and profound mental retardation? Research in Developmental Disabilities, 18, 39–44, doi: 10.1016/S0891-4222(96)00036-4.PubMedCrossRefGoogle Scholar
  39. Meyer, E. A., Hagopian, L. P., & Paclawskyj, T. R. (1999). A function-based treatment for school refusal behavior using shaping and fading. Research in Developmental Disabilities, 20, 401–410, doi: 10.1016/S0891-4222(99)00021-9.PubMedCrossRefGoogle Scholar
  40. Mindham, J., & Espie, C. A. (2003). Glasgow anxiety scale for people with an intellectual disability (GAS-ID): development and psychometric properties of a new measure for use with people with mild intellectual disability. Journal of Intellectual Disability Research, 47, 22–30, doi: 10.1046/j.1365-2788.2003.00457.x.PubMedCrossRefGoogle Scholar
  41. Moss, S., Prosser, H., Costello, H., Simpson, N., Patel, P., Rowe, S., et al. (1998). Reliability and validity of the PAS-ADD Checklist for detecting psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42, 173–183, doi: 10.1046/j.1365-2788.1998.00116.x.PubMedCrossRefGoogle Scholar
  42. Ollendick, T. H. (1983). Reliability and validity of the revised fear survey schedule for children (FSSC-R). Behaviour Research and Therapy, 21, 685–692, doi: 10.1016/0005-7967(83)90087-6.PubMedCrossRefGoogle Scholar
  43. Ollendick, T. H., & King, N. J. (1998). Empirically supported treatments for children with phobic and anxiety disorders: current status. Journal of Clinical Child Psychology, 27, 156–167, doi: 10.1207/s15374424jccp2702_3.PubMedCrossRefGoogle Scholar
  44. Ollendick, T. H., Oswald, D. P., & Ollendick, D. G. (1993). Anxiety disorders in mentally retarded persons. In J. L. Matson, & R. P. Barrett (Eds.), Psychopathology in the Mentally Retarded (pp. 41–85, 2nd ed.). Needham Heights: Allyn and Bacon.Google Scholar
  45. Ramirez, S. Z. (2005). Evaluating acquiescence to yes-no questions in fear assessments of children with and without mental retardation. Journal of Developmental and Physical Disabilities, 17, 337–343, doi: 10.1007/s10882-005-6617-4.CrossRefGoogle Scholar
  46. Ramirez, S. Z., & Luckenbill, J. F. (2007). Development of the fear survey for adults with mental retardation. Research in Developmental Disabilities, 28, 225–237, doi: 10.1016/j.ridd.2006.01.001.PubMedCrossRefGoogle Scholar
  47. Ramirez, S. Z., Morgan, V. R., Manns, R., & Welsh, R. E. (2000). Are fears in adults with mental retardation adequately represented in fear surveys? Journal of Developmental and Physical Disabilities, 12, 1–16, doi: 10.1023/A:1009454125761.CrossRefGoogle Scholar
  48. Rapp, J. T., Vollmer, T. R., & Hovanetz, A. N. (2005). Evaluation and treatment of swimming pool avoidance exhibited by an adolescent girl with autism. Behavior Therapy, 36, 101–105, doi: 10.1016/S0005-7894(05)80058-9.CrossRefGoogle Scholar
  49. Reiss, S., Levitan, G. W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: diagnostic overshadowing. American Journal of Mental Deficiency, 86, 567–574.PubMedGoogle Scholar
  50. Riccardi, J. N., Luiselli, J. K., & Camare, M. (2006). Shaping approach responses as intervention for specific phobia in a child with autism. Journal of Applied Behavior Analysis, 39, 445–448, doi: 10.1901/jaba.2006.158-05.CrossRefGoogle Scholar
  51. Runyan, M. C., Stevens, D. H., & Reeves, R. (1985). Reduction of avoidance behavior of institutionalized mentally retarded adults through contact desensitization. American Journal of Mental Deficiency, 90, 222–225.PubMedGoogle Scholar
  52. Shabani, D. B., & Fisher, W. W. (2006). Stimulus fading and differential reinforcement for the treatment of needle phobia in a youth with autism. Journal of Applied Behavior Analysis, 39, 449–452, doi: 10.1901/jaba.2006.30-05.PubMedCrossRefGoogle Scholar
  53. Silverman, W. K., & Lopez, B. (2004). Anxiety disorders. In M. Hersen (Ed.), Psychological Assessment in Clinical Practice: A Pragmatic Guide (pp. 269–296). New York: Brunner-Routledge.Google Scholar
  54. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36, 117–128, doi: 10.1007/s10802-007-9165-9.PubMedCrossRefGoogle Scholar
  55. Turpin, G. (1991). The psychophysiological assessment of anxiety disorders: three-systems measurement and beyond. Psychological Assessment. Journal of Consulting and Clinical Psychology, 3, 366–375.Google Scholar
  56. Velting, O. N., Setzer, N. J., & Albano, A. M. (2004). Update on and advances in assessment and cognitive-behavioral treatment of anxiety disorders in children and adolescents. Professional Psychology, Research and Practice, 35, 42–54, doi: 10.1037/0735-7028.35.1.42.CrossRefGoogle Scholar
  57. Weisbrot, D. M., Gadow, K. D., DeVincent, C. J., & Pomeroy, J. (2005). The presentation of anxiety in children with pervasive developmental disorders. Journal of Child and Adolescent Psychopharmacology, 15, 477–496, doi: 10.1089/cap.2005.15.477.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Department of Behavioral PsychologyKennedy Krieger InstituteBaltimoreUSA

Personalised recommendations