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An estimated one-third of autistic people are minimally verbal, yet little research examines mental health treatment for this group. In 2019, OAR awarded a $2,000 Graduate Research Grant to Ashley Muskett, a doctoral student in psychology at Virginia Tech, to investigate the feasibility of implementing an observational anxiety assessment and concurrent physiological data collection for minimally verbal autistic children.

The goal of her research study, Feasibility of Concurrent Observational and Physiological Data Collection for Children with Minimally Verbal ASD, was to determine if an observational assessment of anxiety was:

  • Acceptable
  • Used/in demand
  • Practical to carry out in a clinic setting



Muskett recruited 12 children under the age of six and one parent of each child to participate in the study. Of the 12 children, 92% were male and 83% were white/Caucasian. Each child and parent were required to visit the Virginia Tech Autism Clinic for a three-hour appointment. During that appointment, children completed a series of measures of expressive and receptive language, anxiety, and autism symptomatology, and parents completed several questionnaires to assess their children’s current functioning.

The parent questionnaires provided information about the parents’ assessment of their children’s behavioral and emotional functioning, their rating of their children’s anxiety level, and a sensory profile to determine their tactile sensitivity. The goal of the profile was to make sure the children could tolerate electrodes that would be used to measure their heart rate and heart rate variability.

A clinician administered assessments of the children, including one that confirmed an autism diagnosis, one that measured intellectual functioning, and another to observe behavior that indicated anxiety. Two additional assessments were performed: one that measured each child’s ability to understand and comprehend spoken words, and one that measured each child’s ability express themselves with words and retrieve words they want to use. They also participated in a measure designed to facilitate observation of anxiety.

Unfortunately, Muskett could not collect and analyze physiological data — which would have included measuring heart rate and heart rate variability — due to the small sample size. The majority of children (83%) scored too high on tactile sensitivity to make the attempt of physiological data collection practical.



Muskett’s exploratory analysis of the results of measures assessing the prevalence of anxiety in the participants revealed that the majority did not present with clinically significant anxiety. Because there were some issues with the measures used to determine that prevalence, she noted that her results should be interpreted with caution. She recommended that future studies continue to examine the level of anxiety in minimally verbal autistic children as well as the theoretical reasons why they may not have significant anxiety.

Her study results did indicate that the observational anxiety assessment is acceptable to parents and children and practical, as noted by parents. However, there may not be enough demand for such a measure based on the number of interested participants. Overall, the study reached about 58% of its proposed recruitment goal, and only 11% of potentially eligible families reached out to express interest in the measure. As Muskett noted in her final report, that may not definitively show that there is low demand for the anxiety assessment. Research has shown that parents of autistic children may prioritize anxiety treatment as less important than attention to other autism-related concerns. Additionally, parents of autistic children often have many demands on their time, including time needed for therapies.

The small sample size and the fact that the study recruited participants from only one community also may affect the lack of demand. In addition to suggesting that future studies target multiple communities and populations, Muskett also suggested that finding out if clinicians believe such a measure is needed would also be an important facet of future studies. To aid in collection of data, Muskett recommended that future studies consider physiological measures that can be collected without placing any electrodes on the child’s skin.

The study provides some initial support to suggest that this measure is feasible and acceptable and that it is correlated with some empirically validated extant measures of anxiety. However, future studies should continue to examine whether anxiety is a prevalent problem in minimally verbal autistic children and whether there is demand in the community for this type of measure.

Sherri Alms is the freelance editor of The OARacle, a role she took on in 2007. She has been a freelance writer and editor for more than 20 years.