Often Undiagnosed but Treatable: Case Vignettes and Clinical Considerations for Assessing Anxiety Disorders in Youth with Autism Spectrum Disorder and Intellectual Disability.
Often Undiagnosed but Treatable: Case Vignettes and Clinical Considerations for Assessing Anxiety Disorders in Youth with Autism Spectrum Disorder and Intellectual Disability.
复制标题
DOI：
10.1080/23794925.2021.1923090
复制
发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Solomon M
中科院分区：
文献类型：
--
作者：
Winder-Patel B;Tudor ME;Kerns CM;Davis K;Nordahl CW;Amaral DG;Solomon M
据报道，患有自闭症谱系障碍 (ASD) 和智力障碍 (ID) 的儿童的焦虑程度各不相同。最近的报告采用了经过调整的半结构化访谈方法，表明这些儿童的焦虑风险与患有自闭症谱系障碍且智商处于平均或高于平均水平的儿童相同。这种广泛的比率源于评估语言能力有限/严重发育迟缓的人的焦虑相关的挑战。本文通过三个案例来说明进行发育敏感家长访谈的方法，以检测自闭症谱系障碍和智力障碍患者的焦虑情况。由于准确评估焦虑对于指导适当的心理健康治疗的重要目标至关重要，因此我们的研究和文献提供了实际的评估考虑因素，包括：1）考虑患有自闭症谱系障碍和智力障碍的儿童是否可能患有未确诊的焦虑症，2）使用针对自闭症谱系障碍儿童进行验证的半结构化访谈，重点关注行为示例，3）考虑防御级联或6F，4）考虑焦虑的身体症状，5）区分预期性焦虑/恐惧避免其他潜在情绪，6）考虑特殊的应对方法，7）考虑是否存在“不同”的焦虑领域，8）考虑临床医生培训。其中包括对这三种情况适合发育的治疗方案的讨论。探讨了临床医生培训的局限性和未来方向。
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.