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AUTISM &

ANXIETYStacy L.Nonnemacher, PhD

Clinical Director

ODP/BAS

June 6, 2019

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>www.dpw.state.pa.us >www.dhs.pa.gov 2


• What is anxiety?

• What does anxiety look like for

people with autism?

• How can we support people with

autism who may be struggling with

anxiety?


Physical

Emotional Cognitive

Behavioral


• Generalized Anxiety: constant and intense feeling of

anxiety regarding anything

• Social Anxiety: intense fear of others judging them in

social or performance situations

• Panic Disorder: experiencing panic attacks that appear

out of nowhere and occur unexpectedly

DSM-V: Anxiety Sub Types


~40% of children/adolescents with

autism have a co-occurring

anxiety disorder

Is anxiety a condition that occurs in addition

to the autism OR is the anxiety one of the

many symptoms that contributes to autism?

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Unraveling anxiety & autism…

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Which brings us to treatment

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Wallace, et al (2016)

Issues in flexibility were associated with anxiety-related

symptoms.

• What is the real world application of this?

• What does this look like?

• How does it affect him/her physiologically, behaviorally,

emotionally, or cognitively?


Mattys, L., Noens, I., Evers, K., & Baeyens, D. (2017) &

Kerns, et al (2016)

Some individuals are worried about making a social

mistake or being seen as “not normal,” while others avoid

and dread social situations.






Maisel, et al (2016)

Individuals with autism often lack the ability to identify and

understand their emotions may prompt heightened

reactions to emotional experiences. This can impact higher

levels of anxiety.






Uljarević, Richdale, Evans, Cai, & Leekam (2017)

Insistence on sameness and ability to self-regulate are

related to anxiety.






COGNITIVE BEHAVIORAL THERAPY

Graduated Exposure

Cognitive Restructuring

Psycho-Education

Relaxation

Techniques


How do you adapt for autism?

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What does this look like for George?


Graduated exposure

Careful if behavior is harmful

to self, others, or destructive

to property

May need to be paired with

things that are highly

motivating

Graduated Exposure


Cognitive Restructuring &

Psycho Education

Make concrete

Lists & Social Stories:

– Use to educate: what is

adaptive anxiety and what is

not?

– Use to prepare: what can he

expect

Cognitive Restructuring

Psycho-Education

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Use Interests in treatment

During exposure, use as

something highly preferred for

motivation

Use a character or player to

emphasize social norms


Focus on social skills


Functional Communication

Training


Increased involvement in

all team members

Increases generalization

Reinforces


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