Utilizing physiological measures to facilitate phobia treatment with individuals with autism and intellectual disability: A case study

Abstract

Despite the conceptualization of phobic fear as a multi-factorial response, the measurement and treatment of phobias is often not comprehensive. The extant literature on the treatment of phobias for individuals with intellectual disabilities has exclusively focused on indices of behavioral avoidance. The present study demonstrates the treatment of behavioral avoidance and physiological reactivity in a child diagnosed with autism, intellectual disability, and a dog phobia. The results indicate that the individual often experienced physiological reactivity in the presence of the feared stimulus despite engaging in behavioral approach. Treatment of both behavioral avoidance and physiological reactivity resulted in successful generalization of treatment effects across three additional dogs and maintenance of treatment effects during a six-month follow-up assessment. Implications for examining multiple aspects of the anxious response when treating children with intellectual disabilities and severe language delays are discussed.

A Review of Behavioral Interventions for Anxiety‐Related Behaviors in Lower‐Functioning Individuals with Autism

“…It is of interest to note that there were multiple studies that almost met full inclusion criteria for the review. For example, five studies in this process were identified as treating anxiety in individuals with LFA, but the within-subject design procedures did not meet full inclusion criteria because of a lack of experimental control (Chok, Demanche, Kennedy, & Studer, 2010;Ellis, Ala'i-Rosales, Glenn, Rosales-Ruiz, & Greenspoon, 2006;Grider, Luiselli, & Turcotte-Shamski, 2012;Ricciardi, Luiselli, & Camare, 2006;Slifer et al, 2011). Another within-subject study on increasing tolerance to injections omitted a baseline phase and did not attribute the symptoms to anxiety; otherwise, it would have met full inclusion criteria (Birkan, Krantz, & McClannahan, 2011).…”

A Systematic Review of the Treatment of Fears and Phobias Among Children with Autism Spectrum Disorders

“…Included studies were assessed to determine whether challenging behaviors were reported to occur in the presence of the targeted fear or phobia. Twelve of the 16 studies reviewed (Chok et al 2010;Davis et al 2007;Ellis et al 2006;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luiselli 1978;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006) reported the occurrence of challenging behavior in the presence of the feared stimulus prior to intervention. Most common were disruptive vocalizations and verbalizations, such as screaming or crying, which were elicited in the presence of the feared or phobic stimulus in 11 studies (Chok et al 2010;Ellis et al 2006;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luscre and Center 1996;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006).…”

“…Twelve of the 16 studies reviewed (Chok et al 2010;Davis et al 2007;Ellis et al 2006;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luiselli 1978;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006) reported the occurrence of challenging behavior in the presence of the feared stimulus prior to intervention. Most common were disruptive vocalizations and verbalizations, such as screaming or crying, which were elicited in the presence of the feared or phobic stimulus in 11 studies (Chok et al 2010;Ellis et al 2006;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luscre and Center 1996;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006). Elopement, or attempts to elope, was described by 10 studies (Chok et al 2010;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luiselli 1978;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006).…”

“…Most common were disruptive vocalizations and verbalizations, such as screaming or crying, which were elicited in the presence of the feared or phobic stimulus in 11 studies (Chok et al 2010;Ellis et al 2006;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luscre and Center 1996;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006). Elopement, or attempts to elope, was described by 10 studies (Chok et al 2010;Gillis et al 2009;Jackson and King 1982;Koegel et al 2004;Love et al 1990;Luiselli 1978;Rapp et al 2005;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006). Topographies of self-injury such as hitting the face or head, self-biting, and self-choking were reported by five of the studies reviewed (Chok et al 2010;Davis et al 2007;Rapp et al 2005;Schmidt et al 2013;Shabani and Fisher 2006), while topographies of aggressive behavior were reported by a further five studies (Davis et al 2007;Ellis et al 2006;Ricciardi et al 2006;Schmidt et al 2013;Shabani and Fisher 2006).…”

Intensive One-Session Treatment of Specific Phobias

“…Reinforcement is especially useful for those with low motivation, which is a common problem in those with ID/DD, as insight is particularly poor (Koegel et al 2010). RP has also been used in several uncontrolled case studies and open clinical trials by several researchers (e.g., Chok et al 2010;Luiselli 1977;Obler and Terwilliger 1970;Shabani and Fisher 2006) to treat a variety of fears including those of dogs, blood-injection-injury, toileting, and buses.…”