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AUTISM &

ANXIETYStacy L.Nonnemacher, PhD

Clinical Director

ODP/BAS

June 6, 2019

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• 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?

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Physical

Emotional Cognitive

Behavioral

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• 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

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~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?

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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.

• What is the real world application of this?

• What does this look like?

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

emotionally, or cognitively?

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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.

• What is the real world application of this?

• What does this look like?

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

emotionally, or cognitively?

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

Insistence on sameness and ability to self-regulate are

related to anxiety.

• What is the real world application of this?

• What does this look like?

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

emotionally, or cognitively?

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COGNITIVE BEHAVIORAL THERAPY

Graduated Exposure

Cognitive Restructuring

Psycho-Education

Relaxation

Techniques

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How do you adapt for autism?

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What does this look like for George?

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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

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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

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Focus on social skills

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Functional Communication

Training

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Increased involvement in

all team members

Increases generalization

Reinforces

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