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What behavioral therapies can help someone with autism and severe anxiety?
Today’s “Got Questions?” answer comes from clinical psychologist Jeffrey Wood, Ph.D., of the Center for Autism Research and Treatment at the University of California, Los Angeles. The recipient of three Autism Speaks grants, Wood has extensively studied anxiety in elementary school and adolescent children with autism.
Anxiety is common among children and adults with autism spectrum disorder (ASD). Research suggests that at least 30 percent of children withASDalso have an anxiety disorder such as social phobia, separation anxiety, excessive worry/rumination, obsessive compulsive disorder or a phobia such as extreme fear of spiders or loud noise. Indeed, many of the children involved in our ASD research suffer multiple anxiety disorders.
It’s important to remember that anxiety can range from fluctuating, mild and completely understandable to unremitting, severe and irrational. Most people experience some form of anxiety on a regular basis, and this generally involves some degree of physical discomfort as well as negative mood.
Moderate levels of anxiety can actually be a positive, motivating force to increase one’s level of effort and attention when working or socializing. However, research on how children adapt to different settings (academic, athletic, social, etc.) suggests that high levels of anxiety can interfere with academic and social success.
Several types of cognitive behavioral therapy (CBT) have been developed to address anxiety in children with ASD, with promising results from several clinical research centers. Techniques include challenging negative thoughts with logic, role-play and modeling courageous behavior, and hierarchical (step by step) exposure to feared situations.
We and others have developed programs using modified versions of CBT that was originally developed for typically developing youth. These directly address problematic levels of anxiety in children with ASD. Several of these programs incorporate “special interests” to motivate children to engage in treatment activities during weekly sessions. For example, the therapist may use favorite cartoon characters to model coping skills, or intersperse conversations about a child’s special interests throughout the treatment sessions to promote motivation and engagement.
Depending on the program, these treatment sessions usually last 60 to 90 minutes each and extend over a course of 6 to 16 weeks. Most treatment plans also require parent involvement and weekly homework assignments.
Results from our randomized clinical trial, case studies and related reports indicate that most children with ASD who complete such programs experience significant improvements in anxiety as well as some improvement in social communication skills and other daily living skills. 1-9
We and others continue to conduct research on these and related behavioral interventions for relieving anxiety. At present these intensive and scientifically studied treatment programs are available primarily at a small number of autism treatment centers. We hope that further research and dissemination efforts will make them become more accessible to families throughout North America and elsewhere.
References:
1. Wood JJ, Gadow KD. Exploring the nature and function of anxiety in youth with autism spectrum disorders. Clinical Psychology: Research and Practice. (In press)
2. Wood JJ, Drahota A, Sze K, Har K, Chiu A, Langer DA. Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: a randomized, controlled trial. Journal of Child Psychology and Psychiatry. 2009;50(3):224-34.
3. Sze KM, Wood JJ. Enhancing CBT for the treatment of autism spectrum disorders and concurrent anxiety: a case study. Behavioral and Cognitive Psychotherapy. 2008;36:403-9.
4. Chalfant AM, Rapee R, Carroll L. Treating anxiety disorders in children with high functioning autism spectrum disorders: a controlled trial. Journal of Autism and Developmental Disorders. 2007;37(10):1842-57.
5. Lang R, Regester A, Lauderdale S, Ashbaugh K, Haring S. Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review. Developmental Neurorehabilitation. 2010;13(1):53-63.
6. Reaven JA, Hepburn SL, Ross RG. Use of the ADOS and ADI-R in children with psychosis: importance of clinical judgment. Clinical Child Psychology and Psychiatry. 2008;13(1):81-94.
7. Scarpa A, Reyes NM. Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: a pilot study. Behavioural and Cognitive Psychotherapy. 2011;39(4):495-500.
8. White SW, Albano AM, Johnson CR, et al. Development of a cognitive-behavioral intervention program to treat anxiety and social deficits in teens with high-functioning autism. Clinical Child and Family Psychology Review. 2010;13(1):77-90.
9. Sofronoff K, Attwood T, Hinton S. A randomized controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatiry. 2005;46(11):1152-60.
Read more autism research news and perspective on the science page.
Autism – 2.23.12
All mental health disorders should get insurance coverage, not just autism, coalition says (Lansing, Mich.)
Legislation that would require insurers to cover autism treatments unfairly singles out one condition, says a coalition that wants coverage for all mental health issues. Read more.
‘Growing out of autism’ claim unfounded (Littlehampton Gazette)
Can some children simply “grow out” of autism? The Daily Mail certainly thinks so, and today reported that new research by a “prestigious American university” claims that “not only is this possible, it’s also common.” Read more.
Bill would require insurance coverage for autism (NECN)
The Alaska Senate has passed a bill requiring insurance coverage for autism spectrum disorders. Read more.
Sally Bercow: ‘My son has autism, and I’m very proud of him’ – video (UK)
Labour activist Sally Bercow talks to disability campaigner Nicola Clark about her eldest child Oliver, who’s autistic. She tells of how she found out about her son’s condition and how it has affected her life, and why she supports TreeHouse school in north London, Ambitious About Autism’s flagship project that educates autistic children. Read more.
Manchin visits Autism Training Center (The Parthenon)
United States Senator Joe Manchin visited the Autism Training Center on Tuesday at Marshall University. The Autism Training Center at Marshall provides students who are underneath the autism spectrum with support in academic and social situations. It serves individuals at Marshall and at statewide level. Read more.
Autism Speaks’ daily blog “Autism in the News” is a mix of top news stories of the day. Autism Speaks does not vet the stories and the views contained therein do not necessarily reflect Autism Speaks beliefs or point of view.
Autism Journal Offers New Podcast on Gender Differences
The international journal Autism released a new podcast in its Autism Matters series. Sven Bölte, Ph.D., director of Sweden’s Karolinska Institute Center for Neurodevelopmental Disorders, discusses his research on gender differences in cognitive function among high-functioning persons with autism spectrum disorder. Autism Matters podcasts are hosted by University of London psychologist Laura Crane, Ph.D.
The series is designed for a broad audience and aims to showcase the latest research published in the journal with an emphasis on real-world relevance.
Lorri Unumb to Host “My Child Has Autism: How Do I Get Insurance?” Webchat
Please join us Monday February 27th for our first webchat featuring the Government Relations team: “My Child Has Autism: How Do I Get Insurance?” The webchat will be hosted by Lorri Unumb, Esq., our Vice President for State Government Affairs.
Held at 8 p.m. Eastern (7 Central/6 Mountain/5 Pacific), this “office hour” will connect families looking for answers about their health insurance with Ms. Unumb, who is regarded as one of the nation’s pre-eminent experts on health insurance and coverage for the diagnosis and treatment of autism. Ms. Unumb wrote groundbreaking autism insurance reform legislation enacted in her home state of South Carolina in 2007 and has since led the way for the enactment of similar laws in 27 other states. Her most recent honor was the 2012 Leadership in Advocacy Award presented by the California Association for Behavior Analysis.
Ms. Unumb welcomes your questions about how autism insurance coverage works in your state, understanding self-insured policies and the impact of the new federal health care law on autism coverage. However, the guidance provided on the webchat is not meant to substitute for the information provided by your employer’s human resources department, your insurance agent or attorney.
Autism Speaks Kicks off “Light It Up Blue”
In celebration of World Autism Awareness Day on April 2, Autism Speaks will again seek to turn the world blue. Our third annual Light It Up Blue initiative is fully underway with over 350 buildings already committed to turning blue.
Among the landmarks that will be turning blue on April 2, 2012 are Rockefeller Center, Top of the Rock Observation Deck and Madison Square Garden in New York City, Hôtel de Ville in Paris, France, the famous Tokyo Tower in Japan and Canada’s CN Tower, the Sydney Opera House in Australia and Michigan’s Mackinac Bridge.
Check out LightItUpBlue.org to register your events and see a full list of participating buildings.
Last year we had over 2000 buildings and landmarks turn blue. With your help, in 2012 we will more than double that number!!
Autism in the News – 2.22.12
Expression and Attention in Shriver Center Autism Research Studies (Disability Info)
Over the past month in our 4-part series “Getting Involved in Shriver Center Research,” a common theme has emerged — the notion of “giving back.” For Joyce, the mother of a 16-year-old daughter with Asperger Syndrome (AS), giving back influenced her decision to enroll her daughter in “Express Yourself” (EY) and “Look Who’s Talking” (LWT), two studies on expression and attention in teens with AS and high functioning autism (HFA). In addition, the “Detection Study” and “Focus of Attention” are two more great studies that explore attention and autism in children and teens. Read more.
Autism Detection Is Delayed in Minorities (Psych Central)
A new study suggests the symptoms of autism in toddlers from a minority background are more significant than those noted in age-equivalent Caucasian children. Read more.
Autism Awareness art show to feature talent, provide resources (Iowa City, Iowa)
Lisa Burns’ son, Peyton, has hundreds of characteristics. He funny, he’s sweet. He’s silly, he’s naughty. “He’s all of these things, but the minute you say ‘autism,’ that’s all people see,” Burns says. Read more.
Parents of autistic children give the thumbs-up to new course (Halifax Courier)
Parents of children with autism were given a helping hand on an innovative new course in Calderdale. Read more.
Police question brother in shooting of autistic boy, 14 (Chicago Sun-Times)
A 14-year-old boy was shot to death on the South Side Tuesday afternoon, and investigators were questioning one of his brothers, police said. Read more.
Autism Speaks’ daily blog “Autism in the News” is a mix of top news stories of the day. Autism Speaks does not vet the stories and the views contained therein do not necessarily reflect Autism Speaks beliefs or point of view.
Dr. Beth Ann Malow, MD, Sleep Chat Transcript
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A Trip to the Dentist Can Be a Positive Experience
Posted by Elizabeth Shick, DDS, MPH, assistant professor at Children’s Hospital Colorado and the University of Colorado School of Dental Medicine, one of 17 Autism Speaks Autism Treatment Network (ATN) sites across North America.
As a dentist, I can only hope that when I say “open wide,” that’s exactly what the person sitting in my dental chair does. When I see children in my practice, I know I won’t get my wish every time. Many children with autism spectrum disorder (ASD) have difficulty following directions during routine dental cleanings. Nonetheless, I love working with these kids and their families. So I’ve adapted my practice so that everyone involved with these wonderful patients gets the most out of each visit.
A few years ago, for example, I had a visit I will never forget. The family had not one but two sons with autism. My receptionist greeted the family and after consulting with the parents, we decided it would be best for me to see the six year old first, and then see his eight-year-old brother. He came into my small examination room with his mom and immediately began pacing and staring at the floor as if looking for something he had lost. I asked him to sit in the chair. He didn’t respond or look up. It was clear that the bag of tricks I learned in dental school wasn’t going to get him to cooperate.
To coax him into my examination chair, I asked his mom to hold his hand and help steer him into the chair. She continued to hold his hand during the entire visit. I made sure not to rush through with my typical routine. Instead, I showed him the mirror and toothbrush I was going to use and explained to him, each step of the way, what I was going to do next.
After a while, he began to make eye contact with me. He even smiled. He didn’t do everything I asked, and he struggled through certain parts of the appointment, sometimes trying to sit up or jump off the chair. But we got done what we needed to—a dental cleaning, a thorough dental exam, and a fluoride application. Then his dad came in with his older brother, and we did it all again.
During dental school, few students practice treating patients with ASD. For this reason, many dentists may feel uncomfortable when caring for patients with autism, and it can be difficult for families to find a dentist who understands their child’s needs.
I have been fortunate to work with some wonderful autism specialists here at Children’s Hospital Colorado. With support from Autism Speaks’ Autism Treatment Network (ATN), we created Treating Children with Autism Spectrum Disorders: A Tool Kit for Dental Professionals. It is designed to help dental professionals like myself understand autism and work with parents to help make office visits successful. I often use the recommendations in the tool kit in my own practice.
With autism on the rise, it’s becoming more and more important that dental providers—including dental hygienists, dental assistants and even front desk staff—have the most current information about autism and know how to interact with families affected by it. It is our sincere wish that more dentists will be empowered by our tool kit to welcome these children into their practice and help make their visits a positive experience. We hope you will share the new Dentist Tool Kit with your dental care providers. You can download for free, here. Also see Autism Speaks Dental Tool Kit for families, here.
Build-A-Bear Workshop Accepting Nominations for Huggable Heroes
Build-A-Bear Workshop, one of our wonderful corporate sponsors, is accepting nominations for its ninth annual Huggable Heroes program that recognizes young heroes in local communities.
Nominations will be accepted through Feb. 27 throughout the country. Build-A-Bear is looking for kids who provide extraordinary service to their communities.
Candidates must be between the ages of eight and 18. Ten kids will be selected as Huggable Heroes and earn a trip to Build-A-Bear Workshop World Bearquarters in St. Louis.
Each Huggable Heroe also receives a $7,500 scholarship and $2,500 to donate to a charity of their choice.
To nominate someone for the Huggable Heroes program, go to buildabear.com/huggableheroes or pick up an entry form at Build-A-Bear Workshop stores.
Autism in the News – 02.21.12
A Life With Autism: Summit Hill Junior High Student Expresses Himself Through His Art (Frankfort Patch)
Last week, we wrote about Mokena teen Alex Joss, whose art was recently featured as part of a larger children’s show in Frankfort. The Joss family—Jay, Laurel, Alex, 13, and Tyler, 9—let us meet with Alex for a quick snapshot of their lives. Read more.
Autistic students deserve the best of education (Canada)
I read with interest the article published by the Times (Feb. 16), “Parents, educators frustrated. Little accountability when it comes to autism.” Read more.
Taking a puppy away from an autistic girl (MyNorthWest.com)
Faith Creighton of Silverdale, Washington has a lot to deal with. The eight-year-old girl has mild Cerebral Palsy, Autism, multiple life-threatening allergies, left ventricle hardening of her heart, reduced kidney function, and Familial Mediterranean Fever Syndrome. Read more.
Teen falls to death down trash chute in Gold Coast (Red Eye Chicago)
A 16-year-old boy with autism and Down syndrome fell to his death down a trash chute at a Gold Coast highrise, authorities said this morning. Read more.
Arundel folk gives voice to Worthing mum’s loving message (UK)
Arundel folk club organiser Chris Davis is helping to stage a special concert, with a mother’s song for her autistic son certain to be among the highlights. Read more.
Autism Speaks’ daily blog “Autism in the News” is a mix of top news stories of the day. Autism Speaks does not vet the stories and the views contained therein do not necessarily reflect Autism Speaks beliefs or point of view.






