Dear Dr. Peters,
We would like to thank you for addressing such an important but often overlooked issue of the increased rates of anxiety in individuals with autism spectrum disorder (ASD). Recent research suggests that anxiety-related concerns are among the most common presenting problems for children and adolescents with ASD (White, Oswald, Ollendick, & Scahill, 2009).
You made some helpful recommendations for ways to address anxiety in persons with ASD. We would like to expand upon a few of those recommendations to clarify the amount of evidence (or lack thereof) that currently exists for them:
- Children with autism spectrum disorder should stick to routines, “…honoring their need for structure and predictability is key.” While this teaching method has its merits, and while maintaining structure and predictability are commonly used practices in working with individuals with ASD, it is also important to add that there is evidence-based research that shows how behavioral procedures have been used to reduce behaviors considered to indicate anxiety in individuals with developmental disabilities (e.g., Erfanian & Miltenberger, 1990; Ricciardi, Luiselli, & Camare, 2006). Such studies would suggest that individuals with anxiety can modify their behavior in order to address a situation that had previously caused them to emit anxiety-related behaviors. However, there clearly is a need for additional research on all types of potential interventions for addressing anxiety in individuals with autism spectrum disorder.
- Individuals with autism spectrum disorder benefit from visual schedules. It should be noted that using visual schedules could also possibly aid in teaching individuals how to be more flexible (e.g., by changing the typical order of pictures on the schedule to encourage flexibility).
- Teach yoga and deep breathing to address anxiety. One of the commenters on the article recommended transcendental meditation. These particular interventions at this time have no empirical support for their use in addressing anxiety with individuals with ASD.
We must be cautious when recommending interventions for which the efficacy has not yet been clearly determined. Often parents of children with ASD spend countless hours and dollars implementing treatments that seem attractive but have not been shown to be grounded in science. It is our hope that additional time will be devoted by researchers to establishing an evidence base that supports the efficacy of using various interventions for addressing anxiety and other concerns in individuals with ASD.
Christopher E. Smith, Ph.D., BCBA-D and Mary E. McDonald, Ph.D., BCBA-D
Association for Science in Autism Treatment
References
Erfanian, N., & Miltenberger, R. G. (1990). Brief report: Contact desensitization in the treatment of dog phobias in persons who have mental retardation. Behavioral Residential Treatment, 5, 55-60.
Ricciardi, 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.
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29, 216–229.
