Behavioral Treatments for Anxiety in Minimally Verbal Children with ASD

Determining the presence of anxiety in minimally verbal children with ASD can be especially challenging given their limited ability to self-report coupled with the overlapping features of anxiety and ASD. In contrast to verbal individuals, for whom the verbal/cognitive and subjective response domains are customarily assessed, assessment in this population is often limited to the behavioral domain. We use the term anxious avoidance to refer to avoidant behavior associated with traditional indicators of anxiety (e.g., fearful affect); and simple avoidance to refer to avoidance of nonpreferred situations not associated with apparent anxiety. Behavioral assessment should include the use of parent report measures, naturalistic and structured observations, analysis of parent-child interactions that may reinforce anxiety and avoidant behavior, and evaluation of parental anxiety. Graduated exposure and related interventions demonstrated to be effective with typically developing children appear applicable to individuals with ASD-though minimally verbal children will likely be unable participate in cognitive-behavioral therapies.