Assessment of anxiety and associated disorders

Many developmental disability syndromes predispose people to anxiety, either as a symptom or as a psychiatric disorder. In addition to assessing anxiety as for the neurotypical population (see Overview of anxiety and associated disorders), consider the observable signs that may indicate anxiety in a person with developmental disability; see Observable features that may indicate anxiety in a person with developmental disability.

Common anxiety disorders in people with developmental disability include:

Generalised anxiety disorder
Obsessive compulsive disorder—may be difficult to distinguish from ritualistic behaviours of autism spectrum disorder
Phobic disorders—simple phobias are common (eg specific phobias); manifestations can overlap with features of autism spectrum disorder
Posttraumatic mental health disorder
Panic disorder.

Table 1. Observable features that may indicate anxiety in a person with developmental disability
Core symptoms	Observable features
anxious mood	short tempered, irritable, constant worry, appears tense, withdrawn crying, meltdowns, tantrums in children panicking verbal or physical aggression
hyperarousal agitation	increasing repetitive behaviours, speech and stereotypies pacing increased preoccupation, compulsions or rituals self-injurious behaviour increased vocalisation constant reassurance-seeking, repetitive questioning fear—fight or flight response, sweating, flushed, trembling, fast breathing disturbed sleep or appetite
changes in function	social withdrawal loss of baseline function needing constant support, not wanting to separate from caregiver avoidance of situations or anxiety provoking stimuli, absconding, refusal of activity
Note: Source: Fletcher RJ, Barnhill J, Cooper SA, editors. DM-ID 2 A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD Press; 2017. [URL]