Handbook of Autism and Anxiety

266 Pages·2014·3.577 MB·English

by  Thompson E. Davis III, Susan W. White, Thomas H. Ollendick (eds.)

Autism and Child Psychopathology
Series
Editor
Johnny L. Matson
Baton Rouge, Louisiana, USA
More information about this series at http://www.springer.com/series/8665
Thompson E. Davis III • Susan W. White
Thomas H. Ollendick
Editors
Handbook of
Autism and Anxiety
2123
Editors
Thompson E. Davis III Thomas H. Ollendick
Department of Psychology Department of Psychology
Louisiana State University Child Study Center
Baton Rouge Virginia Tech
Louisiana Blacksburg
USA Virginia
USA
Susan W. White
Department of Psychology
Child Study Center
Virginia Tech
Blacksburg
Virginia
USA
ISSN 2192-922X ISSN 2192-9238 (electronic)
ISBN 978-3-319-06795-7 ISBN 978-3-319-06796-4 (eBook)
DOI 10.1007/978-3-319-06796-4
Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014939564
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To Allison, who is not only my wife but also my best friend. Her
constant patience, kindness, encouragement, and love have
been the key to my success professionally and personally.
Thompson E. Davis III
To my husband Brad White, who is always my biggest
supporter, and my sons Alden and Calvin for providing
perspective and unconditional love.
Susan W. White
To Mary, my wife, daughters Laurie and Katie, sons-in-law
David and Billy, and grandchildren, Braden, Ethan, Calvin,
Addison, Victoria, and William. Without them, life would be
much less meaningful and enjoyable.
Thomas H. Ollendick
Foreword
Thompson Davis III, Susan White, and Thomas Ollendick are to be con-
gratulated for having produced an important edited volume which brings
together the clinical and research aspects of two conditions: autism and
anxiety disorders. These two conditions are given scholarly attention sepa-
rately and together. Different contributors to this novel collection consider
the diagnostic overlap between these two conditions, whether the tradi-
tional treatment methods for anxiety disorders apply to autism, and what
may account for the considerable comorbidity between autism and anxi-
ety disorders. The issue of anxiety has for 70 years been neglected within
autism spectrum conditions (ASC), and in this new book it is brought into
central focus.
ASC is also referred to as ASD (autism spectrum disorders) but some
authors prefer the more neutral term “condition” to the more value-laden term
“disorder.” ASC is a neurodevelopmental condition affecting social cognition
alongside unusually narrow interest and difficulties in coping with change/a
need for sameness. It is commonly accepted clinically that if you put a person
with ASC (whether they have classic autism or Asperger Syndrome) into
social situations that are unpredictable and unfamiliar, they will experience
high levels of social anxiety. And as far as is known, this is true from the earli-
est age and remains the case across the lifespan.
This may be secondary to the social-cognitive deficits they have, since they
report difficulties in “reading” other people’s behavior and show impairments
on “theory of mind” tests. Such difficulties mean that interpreting and predicting
other people’s behavior may be challenging for them and lead to confusion,
and to social avoidance. Their anxiety may also be secondary to their difficulties
in dealing with unpredictability and change more generally, separate to the social
world, even if it is the case that most unexpected change comes from the social
world.
This book will push clinicians to ask some new questions. If one has
a very anxious patient, could this be undiagnosed autism? To answer this
would entail an assessment of domains (such as obsessional interests and
social skills) that might otherwise be overlooked. Equally, if one has a patient
with autism, might their anxiety be treated using methods such as systematic
desensitization or cognitive behavioral therapy, or do such approaches need
vii
viii Foreword
to be modified to be useful to a person with autism? Finally, what is the
relationship between autism and anxiety, and do they co-occur because of
a common neural substrate, for example, in amygdala dysfunction? This
book will be of great value both clinician-scientists in both the autism and
anxiety fields, and will do what any valuable book should do, which is
to make connections that open up new questions, hopefully lead to new
knowledge, and improved clinical practice.
Autism Research Centre Simon Baron-Cohen
Cambridge University
Cambridge
UK
Preface
It is currently an exciting, but turbulent, time for those studying, assessing,
treating, and researching autism spectrum disorder (ASD). It is also a chal-
lenging time for individuals with ASD and their families, as they grapple with
the upshots of the recent changes in the DSM and what the diagnostic labels
mean to them both personally and with respect to service procurement. For
the last several decades, estimates of the prevalence of ASD have increasingly
indicated the disorder is becoming more and more common, with rates of 1
in 1000 children in 1980, to 1 in 150 children in 2000 to 1 in 88 children as
of 2008 (Centers for Disease Control and Prevention [CDC] 2013). As more
research has been conducted, it has become clear that ASD is also a disorder
that does not occur in isolation. Comorbidity with other psychopathologies
has become the rule rather than the exception for those with ASD (Matson
and Nebel-Schwalm 2007). Piggybacking the relative explosion in research
on ASD has been the subsequent development and ongoing refinement of
assessment and treatment methodologies. Amidst all of these changes, a great
reorienting of the clinical compass also occurred in May 2013 with the release
of the Diagnostic and Statistical Manual for Mental Disorders—5th edition
( DSM-5) and its changes in diagnostic criteria (e.g., collapsing the various
Pervasive Developmental Disorders into one disorder) and with pronounce-
ments from the National Institute of Mental Health (NIMH) with its strong
endorsement of Research Domain Criteria (RDoC). This latter development
has resulted in an increased movement away from research based solely on
DSM-5 diagnostic research.
In addition, ASD was not the only diagnosis to emerge as a changeling from
the DSM-5 work groups: many longstanding diagnoses and diagnostic catego-
ries were revised, including a number of anxiety disorders. Importantly, anxiety
disorders have been found to be one of the most common comorbid conditions
experienced by those with ASD. Beginning with the earliest observations of
ASD, there appeared to be a connection between the constellation of social,
communicative, and behavioral symptoms and fear and anxiety. Kanner (1943)
recorded one mother’s description of her son as being “afraid of mechanical
things; he runs from them. He used to be afraid of my egg beater, is perfectly
petrified of my vacuum cleaner. Elevators are simply a terrifying experience to
him. He is afraid of spinning toys” (pp. 222–223). White, Oswald, Ollendick,
and Scahill (2009) have noted that the rate of anxiety disorders and symptoms
in those with ASD is as high as 84 %. Previous guidelines, especially as applied
to the assessment and treatment of children and adolescents (e.g., Davis et al.
ix
x Preface
2011; Silverman and Ollendick 2005) in those with anxiety disorders provided
a rough vision for what might work and be modified to help those with ASD
(Moree and Davis 2010). Moreover, recent reviews and discussions of ASD,
anxiety, and how the two might be intertwined have proven influential (Davis
2012; Kerns and Kendall 2012; Ollendick and White 2012) and pushed the
field beyond mere downward and lateral iterations of anxiety in otherwise
typically developing individuals to work specifically focused on the intersec-
tion of ASD and anxiety (Davis 2012). As a result, decades of research and
myriad recent changes to our definitions and understanding of ASD make this
an opportune time to evaluate the current state of the literature, elucidate and
reinforce best practices, and speculate about the future of these two distinct, but
oft intertwined psychopathologies. Seven decades after Kanner’s observations,
the time seems right to begin to summarize all of these findings in light of new
diagnostic and research guidelines.
This volume has emerged largely by standing on the shoulders of those
researchers and clinicians who have tirelessly worked to better understand
and help those with ASD. We are pleased to have been able to secure contri-
butions from many leaders in the field. Even so, in both editing and writing
portions of this book, we have tried to create a volume that would be useful
to clinical and academic professionals alike. This book has been organized to
be a resource for researchers and educators (e.g., as a training volume) and
for practitioners serving clients (e.g., to better understand current issues with
anxiety comorbidity). To these ends, we have divided the volume into four
broad parts. Part I focuses on laying the groundwork for understanding ASD
and anxiety. The volume begins with an historical review of ASD from the
past to the present, and then proceeds with chapters devoted to variability
in ASD presentation. Anxiety disorders in those with and without ASD and
other comorbidities are then introduced and subsequent chapters deal with
the increasingly difficult job of disentangling ASD and anxiety—or if they
should or even can be disentangled. Part I concludes with a chapter on where
we believe the future of ASD and anxiety research lies, in understanding the
complex etiologic and transdiagnostic processes involved in the ASD and
anxiety interplay. Part II of the volume then introduces specific anxiety diag-
noses for consideration alongside ASD symptoms. For example, the common
quandaries of whether symptoms are consistent with ASD or obsessive-
compulsive disorder, or social anxiety disorder, or phobia are discussed. Part
III tackles common issues of ASD and anxiety assessment and treatment, as
well as implementation issues within clinics and schools. Finally, we are very
pleased to have three diverse perspectives represented in Part IV where we
turn to commentaries on the new DSM-5 criteria and RDoC recommenda-
tions. The future of ASD research and practice is highlighted in these final
chapters.
Thompson E. Davis III
Susan W. White
Thomas H. Ollendick
Preface xi
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental
Disorders (5th ed.). Arlington: American Psychiatric Publishing.
Centers for Disease Control and Prevention. (June 27, 2013). Autism spectrum disorders
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Davis III, T. E. (2012). Where to from here for ASD and anxiety? Lessons learned from
child anxiety and the issue of DSM-5. Clinical Psychology: Science and Practice, 19,
358–363.
Davis III, T. E., May, A. C., & Whiting, S. E. (2011). Evidence-based treatment of anxiety
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Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217–250.
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