Often Undiagnosed but Treatable: Case Vignettes and Clinical Considerations for Assessing Anxiety Disorders in Youth with Autism Spectrum Disorder and Intellectual Disability.

ABSTRACT Varying rates of anxiety have been reported in children with Autism Spectrum Disorder (ASD) and Intellectual Disability (ID). Recent reports, using an adapted semi-structured interview approach, suggest that the risk for anxiety in these children is equal to that found in those with ASD and average or above average IQ. This wide range in rates derives from the challenges associated with assessing anxiety in those with limited language/severe developmental delays. Three case vignettes are presented to illustrate an approach for conducting a developmentally sensitive parent interview in order to detect anxiety in those with ASD and ID. Since accurate assessment of anxiety is critical to the important goal of guiding appropriate mental health treatment, practical assessment considerations from our research and the literature are provided including: 1) considering whether a child with ASD and ID might have an anxiety disorder that is undiagnosed, 2) using semi-structured interviews validated for children with ASD with a focus on behavioral examples, 3) considering the Defense Cascade or 6Fs, 4) considering physical symptoms of anxiety, 5) differentiating anticipatory anxiety/fearful avoidance from other underlying emotions, 6) considering idiosyncratic coping methods, 7) considering whether “distinct” areas of anxiety are present, and 8) considering clinician training. A discussion of developmentally appropriate treatment options for the three cases is included. Limitations and future directions regarding clinician training are explored.