Handbook of Assessment and Diagnosis of Autism Spectrum Disorder by Johnny L. Matson

Author:Johnny L. Matson
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Specific Phobia

Specific phobia is characterized by markedly intense and excessive fear or anxiety about a specific object or situation, leading to active avoidance or distress when the object or situation is endured (APA, 2013). The fear or anxiety is typically an immediate reaction to the specific object or situation and present for at least 6 months. There are five types of a specific phobia diagnosis: animal type (e.g., spiders, insects, dogs), natural environment type (e.g., heights, storms, water), blood-injection-injury type (e.g., needles, invasive medical procedures), situational type (e.g., airplanes, elevators, enclosed places), and other type (e.g., choking, vomiting, loud sounds, costumed characters).

For youth with ASD, specific phobia has been found in some studies to be the most common co-occurring disorder (e.g., Leyfer et al., 2006; Sukhodolsky et al., 2008; van Steensel et al., 2011), so it is likely that clinicians will encounter this comorbidity. We recommend the following considerations when assessing for possible comorbid specific phobia in individuals with ASD (Davis & Ollendick, 2014; Kerns et al., 2014; Kerns & Kendall, 2014; Matson & Nebel-Schwalm, 2007; Mayes et al., 2013):

Physiological reactions . Although physiological symptoms can be present in all anxiety disorders, they may be particularly prevalent in specific phobias, both in anticipation of or during exposure to the feared stimulus (APA, 2013). Individuals with animal, natural environment, and situational specific phobia types tend to show sympathetic nervous system arousal (e.g., increased heart rate), similar to the physiological manifestations of anxiety in other anxiety disorders. However, individuals with the blood-injection-injury type often have a vasovagal syncope (fainting) or near-fainting response because their initial increase in heart rate and blood pressure is followed by a drastic drop in both.

Unusual fears. Individuals with ASD may present with atypical fears that are not generally reported in the specific phobia literature, such as fear of vacuum cleaners or graffiti (Kerns et al., 2014; Mayes et al., 2013). Clinicians are encouraged to include open-ended questions when assessing for specific phobia in people with ASD, given that standardized measures of fears may not capture the variety of unusual fears experienced by many of these individuals. If the presenting fear is excessive, unreasonable, distressing, circumscribed to a specific stimulus, and impairing to daily functioning, then it may meet criteria for specific phobia. Of note, typically developing youth have also been documented to experience unusual fears (e.g., buttons, mushrooms), so this type of specific phobia is not exclusive to ASD (Davis & Ollendick, 2014).

General hypersensitivity. Hypersensitivity t o sensory input is part of the recently revised ASD diagnostic criteria (APA, 2013), and a specific phobia diagnosis may not be warranted if the fear is part of a generalized sensitivity. For example, an individual with hypersensitivity to most noises may show distress at the sound of a specific tone, but this distress is better accounted for by the ASD diagnosis. By comparison, an individual who does not exhibit a general sensitivity to noise but responds with excessive fear and avoidance to particular tones, noises, or other sensory stimuli (e.g., sight of men with beards) may meet criteria for specific phobia.

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