Piloting an Integrated Anxiety Intervention for Preschool Children with Autism Spectrum Disorder

Principal Investigator(s):
Amy Keefer, Ph.D.
Grant Type:
Applied Research
Hugo W. Moser Research Institute at Kennedy Krieger, Inc.
Baltimore, Maryland
Year Awarded:
Behavior, Emotions, Mental Health; Early Intervention


Anxiety disorders are prevalent in children with autism spectrum disorder (ASD) and often begin in the preschool years. In ASD, anxiety negatively impacts functioning and increases risk for psychiatric disorder. Although an empirically-based treatment for anxiety has been developed for older children with ASD (i.e., modified cognitive behavioral therapy; mCBT), preschool children have largely been neglected and currently have no available treatment options.

The present project seeks to address this gap by piloting an integrated treatment model for anxiety in preschool children with ASD. This parent-mediated group therapy model combines three treatment elements to target the child’s specific fears as well as intrinsic and environmental factors known to contribute to anxiety. 1) mCBT strategies are utilized, including parent education about anxiety in the context of ASD and how to expose a young child to specific fears. 2) Intolerance of uncertainty, an underlying mechanism of anxiety in ASD, is addressed through parent education and in session child exposures to naturalistic situations involving uncertainty. 3) Parental accommodation, an established maintaining factor of child anxiety, is addressed by teaching parents how to reduce behaviors that reinforce their child’s avoidance and anxiety. This study is the first to pilot an anxiety treatment designed for preschoolers with ASD and offers a first step toward an early intervention model for anxiety in this population.


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