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UBC Theses and Dissertations

Integrating positive behavior support and cognitive behavior therapy in the treatment of anxiety in a child with autism and an intellectual disability : a single case experimental analysis Millar, Monica


A fair proportion of children with Autism Spectrum Disorder (ASD) and a mild intellectual disability (ID) may experience anxiety-related problem behavior. This study evaluated the effects of a Family Centered Positive Behavior Support (FCPBS) approach enhanced with Cognitive Behavior Therapy (CBT) on child behavior during the steps of an anxiety hierarchy in a valued family routine in the community. The study included an 11-year-old girl with ASD, ID and anxiety-related problem behavior and her mother. The setting selected and defined in collaboration with the child’s mother was a park routine in which the child manifested a fear of playing near or with other children in a playground at the park. Dependent variables included: (a) child problem behavior, (b) child positive engagement, (c) parent and child ratings of child’s level of anxiety; and (d) parent rating of social validity. The study employed an experimental, single case changing criterion design and a clinical case study design across two phases, baseline and intervention. Results documented a functional relation between the implementation of FCPBS enhanced with CBT and steps achieved by the child within the anxiety hierarchy. There was also showed a precipitous decrease in problem behavior and increase in positive engagement associated with implementation of the intervention phase. Social validity results indicated that the child’s mother viewed the FCPBS approach enhanced with CBT to be important and acceptable in regard to family goals, plan procedures, and child outcomes. Results are discussed in terms of their relation to the literature, unique contributions, implications, limitations and future research.

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