Comorbid Anxiety Disorders in Autism Spectrum Disorder

Anxiety disorders are one of the most important comorbid psychiatric symptoms that researchers have found at a very high rate in Autism Spectrum Disorder (ASD) (Davis, Munson & Tarzca, 2009; Kashani & Orvaschel, 1990; Kessler, Berglund, et al., 2005; Kessler, Chiu, Demler, & Walters, 2005). In two studies using parent diagnostic interviews, anxiety disorder were more common than other psychiatric disorders in children with autism, and almost one-half of these children met criteria for an anxiety disorder (Ghaziuddin et al., 1998; Leyfer at al. 2006). Another study by Muris (1998) found 84% of individuals with autism met the criteria for an anxiety disorder (McNally Keehn, 2011).

Anxiety disorders are characterized by a disproportionate fear reaction to environmental stimuli. Typically, the anxiety symptoms have an early onset and they can become chronic and continue into adulthood if treatment is not initiated early (Albano et al., 2003; Spence, Rapee, McDonald, & Ingram, 2001). The problem is that if symptoms of anxiety are not identified and treated early in life, then these symptoms may not only continue into adulthood, but may become more severe (David, Ollendick & Nebel-Schwalm, 2008; Kendall, 1994).

From the Applied Behavior Analysis point of view, anxiety symptoms in autistic individuals can be described as escaping or avoidance behaviors, irritability, aggressive outbursts, self-abusive behaviors, or elopement from the producing situation stimuli or maintained behaviors. The physiological reactions (internal stimuli) of anxiety are difficult to observe. These physiological reactions include but are not limited to acceleration of heart and lung action, paling or flushing, constriction of blood vessels, liberation of fat and glucose for muscular action, dilation of blood vessels for muscles, inhibition of lacrimal gland and salivation, dilation of pupil (mydriasis), loss of hearing, loss of peripheral vision, hyperreflexia, and shaking.

Paradoxical the maladaptive behaviors and the internal effects of anxiety are contingently reinforced by escaping from anxiety. For instance, contingent upon the presentation of anxiety symptoms, the direct care staff may remove the autistic individual from the perceived cause of anxiety (removing the aversive demands, stimuli, or social difficult situation). In this situation, the effective treatment decision depends on the function of the behaviors associated with the anxiety.

Due to the complexity of the anxiety symptoms of individuals with autism, the assessment should be conducted using multiple informants and modalities. The interventions to reduce anxiety symptoms and mood deregulation disorder in individuals with Autism Spectrum Disorder (ASD) should focus upon improving social problem-solving skills. Depending of the comprehensive assessment and functional behavioral analysis (FBA), the autistic individuals could be trained in a variety of coping behaviors or replacement behaviors to help them manage their anxiety symptoms. Then, we can use Cognitive Behavioral Therapy (CBT) in conjunction with the Applied Behavior Analysis (ABA) procedures to improve compliance during the treatment. We particularly teach them social skills with visual aids as coping mechanisms with reinforcement.