Specific Phobias in Autism-Spectrum Disorder (ASD) Patients

Close your eyes and imagine your worst fear. Maybe it's looking over a cliff, snakes, or spiders. Perhaps even talking in front of a crowd. Focus on that bubbling anxiety within you, feeling it all the way down to your stomach, the overwhelming urge to run away from it, to scream. Your heart rate accelerates, your palms begin to sweat, and your whole body is on high alert in anticipation of this feared object or situation. In that very moment when you're facing that fear, it may feel like the end of the world. For me, my whole body goes into the fight or flight response, and it’s fascinating to see how something so small or insignificant to others may create such an overwhelming response in others.

I’d say most people are not immune to fear. I myself am very scared of bugs, but I am only afraid of certain ones, and I don’t go out of my way to avoid them, even though they do put me on high alert most of the time. Being afraid is normal and happens to the best of us. It is a natural human reaction, and important to have when reacting to a potentially dangerous event– but there is a difference between fear and having a phobia.

Phobias are defined as an irrational and uncontrollable fear of certain objects, stimuli, or situations to the extent that a person will do anything in their power to avoid the feared stimuli. While there are various types, I will be covering specific phobias (SP), which are an extreme fear or anxiety about a specific object or situation that isn’t typically harmful (Johns Hopkins Medicine, n.d.). So, if my fear of bugs were to turn irrational, for instance never leaving the house in order to avoid them, it would be classified as a ‘specific phobia’. Furthermore, it is important to note that phobias can be expressed differently in every one of us, it is very multifaceted. Biological, environmental, or cultural factors can influence how, and when a phobia is developed or expressed, and even the type of phobia. Seeing the various factors, I wanted to look into SP with different diverse groups. Specifically, after conducting personal research about the hyperfixations and sensitivity difficulties in ASD children and adults, I wanted to look into whether there is a connection between these characteristics and their contribution to potentially developing SP.

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder – approximately 2.21% of adults in the US are diagnosed with it (CDC, n.d.), and they have characteristics of sensory sensitivity, such as hypersensitivity, hyposensitivity, and sensory-seeking. Given that this topic in ASD research is still evolving, there is evidence suggesting that ASD patients with SP have hypersensitivity or sensory sensitivity, creating a question of whether there’s a connection between sensitivity difficulties and the manifestation of phobias (Mazurek et al., 2013). Due to the sensory sensitivity, negative responses such as avoidance and distress can occur, these symptoms overlap with the criteria for SP in the DSM-5. Knowing this, researchers are suggesting a model for SP in ASD, which is based on classical fear conditioning theory, where the sensory sensitivity to certain stimuli causes a negative response such as anxiety. This then conditions the individual to associate the negative sensation with the feared stimuli and ends up eliciting fear and anxiety, such as seen in SP (Muskett et al., 2019).

In regard to treatments, research shows that trials with virtual reality (VR) treatment, such as flat screen computer–delivered VR, psychoeducation sessions, and cognitive behavior therapy (CBT) sessions with a psychologist, were effective treatments for ASD patients with SP (Maskey et al., 2019). The VR treatments are a form of exposure therapy, which is great for managing phobias.

During the therapies, the patients are virtually presented with anxiety-inducing stimuli, and throughout the whole experience the patient’s anxiety level is measured. Afterwards, with gradual and repeated exposure to the feared stimuli, the patients with ASD start to learn techniques on how to manage their anxieties when facing the feared stimuli. Given the effectiveness of this type of treatment it indicates that these treatments can be used to treat diverse groups of people, highlighting its efficacy. While I myself do not fit the criteria of having SP, repeated exposures to bugs have helped me control my reaction to it.

In conclusion, I believe it is important to develop an awareness of the differences in population seen with SP and to get a better sense of how to help minimize anxiety or triggers when in company with or treating someone who has ASD and potentially SP. Additionally, I believe awareness should be raised to increase ASD research in order to develop accommodating techniques and treatment methods for phobias and other related disorders.

References:

American Psychological Association. (n.d.). Apa Dictionary of Psychology. https://dictionary.apa.org/fear

American Psychological Association. (n.d.). Apa Dictionary of Psychology. https://dictionary.apa.org/phobia

Centers for Disease Control and Prevention. (n.d.). Key findings: Estimated number of adults living with autism spectrum disorder in the United States, 2017. Centers for Disease Control and Prevention https://www.cdc.gov/autism/publications/adults-living-with-autism-spectrum- disorder.html#:~:text=Approximately%202.21%25%20of%20adults%20in,U.S.%20children%20diagnosed%20with%20ASD

Mazurek, M. O., Vasa, R. A., Kalb, L. G., Kanne, S. M., Rosenberg, D., Keefer, A., et al. (2013). Anxiety, sensory over-responsivity, and gastrointestinal problems in children with autism spectrum disorders. Journal of Abnormal Child Psychology, 41(1), 165–176. 

Maskey, M., McConachie, H., Rodgers, J., Grahame, V., Maxwell, J., Tavernor, L., & Parr, J. R. (2019). An intervention for fears and phobias in young people with autism spectrum disorders using flat screen computer-delivered virtual reality and cognitive behaviour therapy. Research in Autism Spectrum Disorders, 59, 58–67. https://doi.org/10.1016/j.rasd.2018.11.005

Muskett, A., Radtke, S., White, S., & Ollendick, T. (2019). Autism Spectrum Disorder and Specific Phobia: the Role of Sensory Sensitivity: Brief Review. Review Journal of Autism and Developmental Disorders, 6(3), 289–293. https://doi.org/10.1007/s40489-019-00159-wLinks to an external site.

Phobias. Johns Hopkins Medicine. (n.d.). https://www.hopkinsmedicine.org/health/conditions-and-diseases/phobias