Anxiety in Children and Adolescents with Autism Spectrum Disorder. Evidence-Based Assessment and Treatment

260 Pages·2017·2.93 MB·English

by  Connor M. Kerns

ANXIETY IN CHILDREN
AND ADOLESCENTS
WITH AUTISM
SPECTRUM DISORDER
ANXIETY IN CHILDREN
AND ADOLESCENTS
WITH AUTISM
SPECTRUM DISORDER
Evidence-Based Assessment
and Treatment
Edited by
CONNOR M. KERNS
Drexel University, Philadelphia, PA, United States
PATRICIA RENNO
Universityof California, Los Angeles,CA, United States
ERIC A. STORCH
Universityof South Florida, Tampa,FL, United States
PHILIP C. KENDALL
Temple University, Philadelphia, PA,UnitedStates
JEFFREY J. WOOD
Universityof California, Los Angeles,CA, United States
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To Mike, Finn, Rebecca and Graham
Connor M. Kerns
To Sue and Paul Renno
Patricia Renno
With love to Maya, Noah, Ellie, and Jill
Eric A. Storch
For all of the youth and their families who have
contributed to our knowledge and our ability to
provide improved services through their
participation in research
Philip C. Kendall
This book is dedicated to my two sons,
Jonah and Elliott, the two sweetest boys
I could ever have imagined
Jeffrey J. Wood
LIST OF CONTRIBUTORS
MaryBaker-Ericze´n
Child &AdolescentServices ResearchCenter,San Diego, CA, United States;
Rady Children’s Hospital, San Diego, CA, United States
LaurenBrookman-Frazee
Child &AdolescentServices ResearchCenter,San Diego, CA, United States;
Universityof California,San Diego, CA, United States
ColbyChlebowski
Child &AdolescentServices ResearchCenter,San Diego, CA, United States;
Universityof California,San Diego, CA, United States
CaitlinM.Conner
Universityof Colorado School of Medicine,Aurora, CO,United States
JohnDanial
Universityof California,Los Angeles, CA, United States
ThompsonE.Davis
Louisiana State University, Baton Rouge, LA, United States
JamesP.Donnelly
Institute for Autism Research, Canisius College, Buffalo,NY,UnitedStates
AmyDrahota
Michigan State University, East Lansing, MI, United States; Child &Adolescent
Services Research Center, San Diego,CA, United States
CoriFujii
Universityof California,Los Angeles, CA, United States
LouisP.Hagopian
Kennedy Krieger Institute, Baltimore, MD,UnitedStates; Johns Hopkins
UniversitySchool of Medicine, Baltimore, MD,United States
JohnD.Herrington
The Children’s Hospital of Philadelphia, Philadelphia,PA,United States;
Universityof Pennsylvania, Philadelphia, PA, United States
MaysaM.Kaskas
Louisiana State University, Baton Rouge, LA, United States
PhilipC.Kendall
Temple University, Philadelphia, PA,United States
RachelKent
Institute of Psychiatry, Psychology &Neuroscience, London, United Kingdom
ConnorM.Kerns
Drexel University,Philadelphia, PA, United States
xiii
xiv ListofContributors
SamiKlebanoff
Universityof California, LosAngeles, CA, United States
MatthewD.Lerner
Stony Brook University, StonyBrook, NY, United States
KarenLevine
HarvardMedical School, Lexington, MA, United States
MeganLilly
Louisiana State University, Baton Rouge, LA, United States
ChristopherLopata
Institute for Autism Research,CanisiusCollege,Buffalo, NY,UnitedStates
BrennaB.Maddox
The Children’s Hospital of Philadelphia, Philadelphia,PA,UnitedStates
IlianaMagiati
National Universityof Singapore, Singapore
JudithS.Miller
The Children’s Hospital of Philadelphia, Philadelphia,PA,UnitedStates;
Universityof Pennsylvania, Philadelphia, PA, United States
LaurenJ.Moskowitz
St. John’s University,Queens,NY, United States
AnnOzsivadjian
Guy’s and St. Thomas Foundation Trust, London,UnitedKingdom
ValentinaParma
Scuola InternazionaleSuperiorediStudi Avanzati, Trieste,Italy
JudyReaven
Universityof Colorado AnschutzMedical CampusSchool of Medicine, Aurora,
CO, United States; Children’s HospitalColorado, Aurora,CO,United States
PatriciaRenno
Universityof California, LosAngeles, CA, United States
TamaraRosen
Stony Brook University, StonyBrook, NY, United States
PaigeM.Ryan
Louisiana State University, Baton Rouge, LA, United States
EmilySimonoff
Institute of Psychiatry,Psychology&Neuroscience,London, United Kingdom
NicoleStadnick
Child &Adolescent Services ResearchCenter,San Diego, CA, United States;
Universityof California, San Diego,CA, UnitedStates
ListofContributors xv
EricA.Storch
Universityof South Florida, Tampa, FL, United States
MarcusL.Thomeer
Institute for Autism Research, Canisius College, Buffalo,NY,UnitedStates
SusanW.White
Virginia Tech, Blacksburg, VA, United States
KirstenWillar
Universityof Colorado AnschutzMedicalCampusSchool of Medicine, Aurora,
CO,United States; Children’s Hospital Colorado,Aurora, CO,UnitedStates
JeffreyJ.Wood
Universityof California,Los Angeles, CA, United States
CHAPTER 1
Introduction
Connor M. Kerns1, Patricia Renno2, Eric A. Storch3,
Philip C. Kendall4 and Jeffrey J. Wood2
1DrexelUniversity,Philadelphia,PA,UnitedStates
2UniversityofCalifornia,LosAngeles,CA,UnitedStates
3UniversityofSouthFlorida,Tampa,FL,UnitedStates
4TempleUniversity,Philadelphia,PA,UnitedStates
Anxiety has been discussed within the context of autism spectrum disor-
der (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, diffi-
culties with minor changes in routine). Recent research provides evidence
that anxiety disorders affect approximately 40(cid:1)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; Sukhodolskyet 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 psycho-
logical conditions and the increased functional impairments related to
AnxietyinChildrenandAdolescentswithAutismSpectrumDisorder. ©2017ElsevierInc.
1
DOI:http://dx.doi.org/10.1016/B978-0-12-805122-1.00001-6 Allrightsreserved.
2 AnxietyinChildrenandAdolescentswithAutismSpectrumDisorder
their cooccurence. The study of anxiety in ASD may demonstrate neuro-
biological 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 indivi-
duals 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 suc-
cessful 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 compli-
cate 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
Introduction 3
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 psycho-
social 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 some-
thing 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 nonethe-
less 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 pre-
sentation, assessment, and treatment of anxiety in ASD, but there are
future research directions that the authors note in their chapters. Of con-
siderable 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 assess-
ment and treatment research has been conducted in school-age children
with average intellectual abilities. Additionally, with research demonstrat-
ing the efficacy of individual and group treatment approaches for anxiety
in ASD, further research on how these treatments can be successfully dis-
seminated 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 consider-
able 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