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Autistic youth frequently experience interfering anxiety, and schools may be an ideal setting to deliver mental health care. A type 1 hybrid-effectiveness, cluster randomized trial was used to examine the effectiveness of school-based Facing Your Fears compared to usual care. Change in provider cognitive behavior therapy knowledge and treatment fidelity (adherence and provider competence) were also examined. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained via a train-the-trainer approach. Eighty-one students, ages 8–14 years, with autism or suspected autism and anxiety participated. Students who received school-based Facing Your Fears displayed significantly greater reductions in anxiety compared to students in usual care according to caregiver and child report (Screen for Anxiety and Related Emotional Disorders). Significant reductions in total anxiety ( p = 0.012), separation ( p = 0.002), and social anxiety ( p = 0.003) subscales occurred, according to parent report. Student self-report indicated significant reductions on the social anxiety subscales ( p = 0.001). Interdisciplinary school providers demonstrated significantly increased cognitive behavior therapy knowledge following training ( p Lay Abstract Autistic youth frequently experience anxiety that can negatively affect them at home, with friends, and at school. Autistic youth have difficulty accessing mental health care, and this is particularly true for youth from traditionally underserved backgrounds. Providing mental health programs in schools may increase access to care for autistic youth with anxiety. The purpose of the study was to train interdisciplinary school providers to deliver school-based Facing Your Fears, a cognitive behavior therapy program for anxiety in autistic youth. Seventy-seven interdisciplinary school providers across 25 elementary/middle schools were trained by their colleagues and members of the research (train-the-trainer approach). Eighty-one students with autism or suspected autism, ages 8–14 years, were randomly assigned to either school-based Facing Your Fears or usual care. Students in school-based Facing Your Fears showed significant reductions in anxiety compared to students in usual care according to caregiver and student report. Other measures involved examining change in provider cognitive behavior therapy knowledge after training and determining how well interdisciplinary school providers were able to deliver school-based Facing Your Fears. Results indicated that interdisciplinary school providers showed significant improvements in cognitive behavior therapy knowledge after training. Interdisciplinary school providers were able to deliver most of school-based Facing Your Fears activities and with good quality. The positive outcomes in this study are encouraging. Training interdisciplinary school providers to deliver school-based Facing Your Fears may increase access to care for anxious autistic students. Future directions and limitations are discussed.

Co-occurring psychiatric diagnoses are very common in individuals with ASD. Little is known about the effect that co-occurring psychiatric conditions may have on treatment response to CBT for children with ASD and anxiety. The present study examined the relationship between co-occurring psychiatric diagnoses and response to CBT for anxiety in ninety youth with ASD. Psychiatric complexity did not appear to differentially impact treatment response. A notable portion of youth with anxiety and externalizing disorders such as ADHD, no longer met criteria for those externalizing diagnoses following intervention. Results indicate that youth with ASD and anxiety present with complex psychiatric profiles and CBT for anxiety may positively affect co-occurring diagnoses. In addition, thorough and nuanced assessment of psychiatric symptoms in youth with ASD is needed to ensure the differentiation between diagnoses of anxiety and other co-occurring psychiatric symptoms.

Longitudinal growth modeling was utilized to examine adaptive behavior over eight years across the three time points (i.e., ages 2−10). Seventy-six parents completed the Vineland Adaptive Behavior Scales interviews of adaptive behavior. Child participants completed standardized developmental testing and an executive function task in toddlerhood and the Autism Diagnostic Observation Schedule across all time points. Growth models were specified for communication, daily living skills, and socialization domains of adaptive behavior. Mental age in toddlerhood was a significant predictor of trajectories of communication, daily living skills, and socialization. Executive function and autism severity were significant predictors of socialization. Findings suggest executive function as a potential target for promoting the growth of adaptive behavior skills in addition to autism symptomology.

Anxiety disorders occur at higher rates in youth with ASD than in neurotypical youth. Although the efficacy of CBT for anxiety in children with ASD is widely supported, factors that influence treatment outcomes are not well understood. This study examined the role of maternal anxiety in treatment outcomes for youth with ASD. Youth with ASD and anxiety (ages 8 to 14), along with their mothers (n = 87), participated in a group CBT intervention. Results indicated that maternal anxiety did not improve over the course of treatment. However, findings suggest that high levels of maternal anxiety at pre-treatment predicted higher levels of youth anxiety post-treatment. Importantly, the relationship between parent anxiety and youth outcomes was moderated by child age. The findings of the present study may provide initial insight into the role that maternal anxiety plays in treatment outcomes for children with ASD and co-occurring anxiety, particularly when considering child age.

Although cognitions are central to the conceptualization and treatment of anxiety in typically developing (TD) youth, there is scant research investigating automatic thoughts and their relationship with anxiety in youth with autism spectrum disorder (ASD). We sought to examine the types of automatic thoughts experienced by youth with ASD and co-occurring anxiety as well as the predictive relationship of anxiety to different types of automatic thoughts in 97 children, ages 8-14 years. We also explored the relationship of automatic thoughts and intolerance of uncertainty. Consistent with prior data, there was a strong relationship between anxiety and automatic thoughts pertaining to social and physical threat. Anxiety and IU were independently associated with thoughts pertaining to personal failure which raises the hypothesis that personal failure may serve as a common pathway between anxiety, IU, and depression in ASD youth. These findings highlight the importance of assessing and treating negative cognitions in youth with ASD and anxiety.

OBJECTIVE Few guidelines are available regarding optimal training models for practitioners delivering cognitive-behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety. METHOD Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P). RESULTS Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial. CONCLUSIONS Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings. (PsycINFO Database Record

Anxiety is one of the most common co-occurring diagnoses in youth with autism spectrum disorder (ASD). Cognitive behavior therapy (CBT) is an evidence-based treatment that has been tailored for youth with ASD and anxiety and has shown good efficacy in reducing youth anxiety immediately after treatment. One area that has not been widely studied is acceptability of CBT for anxiety in this population. Acceptability includes beliefs about the potential helpfulness and satisfaction with a given treatment and may be important in understanding treatment outcomes. This study focuses on parent, youth, and clinician acceptability of a well-researched CBT program, Facing Your Fears, for youth with ASD and anxiety. Data was collected as part of a larger multi-site study that compared three different instructional conditions for clinicians learning the intervention. Results indicated that parents rated acceptability as higher for the overall treatment compared to youth. Further, youth and parents rated exposure related sessions as more acceptable than psychoeducation, and higher exposure acceptability ratings were predictive of lower youth anxiety levels post-treatment. Clinicians who received ongoing consultation rated treatment acceptability lower than clinicians in the other training conditions. While some clinicians may be hesitant to implement exposure techniques with this population, findings suggest that it is the technique that parents and youth rated as the most acceptable. Results are discussed in terms of treatment and research implications for youth with ASD and their families.

Modified cognitive-behavioral therapy (MCBT) has been demonstrated to reduce anxiety in youth with autism spectrum disorder (ASD). However, non-response rates are fairly high. Few studies have investigated factors associated with response. Intolerance of uncertainty (IU) is a treatment target for anxiety and worry in neurotypical populations and has been linked to anxiety and ASD. We sought to examine whether IU affects outcomes following MCBT in 43 children, ages 8-14 years, with ASD without intellectual disability. Consistent with prior data, there was a significant reduction in parent reported anxiety following MCBT. Higher levels of pre-intervention IU predicted higher anxiety and worry pre- and post-intervention. These findings suggest that targeting IU may improve outcomes following MCBT in youth with ASD and anxiety.

Youth with autism spectrum disorders frequently experience significant symptoms of anxiety. Empirically supported psychosocial interventions exist, yet access is limited, especially for families in rural areas. Telehealth (i.e. videoconferencing) has potential to reduce barriers to access to care; however, little is known about the feasibility or efficacy of directly intervening with youth with autism spectrum disorders through this modality. This study details the pilot testing of a telehealth version of an empirically supported intervention targeting anxiety in youth with autism spectrum disorders. The primary focus of this study is on feasibility, with evaluation of outcomes as a starting point for future randomized trials. In all, 33 families of youth with autism spectrum disorders and significant anxiety symptoms participated in this study (Telehealth Facing Your Fears (FYF) Intervention: n = 17; Wait-list control: n = 16). Youth of all functioning levels were included. Acceptability was strong; however, the usability of the technology was problematic for some families and impeded some sessions significantly. Fidelity of the telehealth version to the critical elements of the original, in vivo version was excellent. More work is needed to improve delivery of exposure practices and parent coaching. Preliminary efficacy analyses are promising, with improvements observed in youth anxiety over time (relative to a comparison group waiting for live intervention) and parent sense of competence (within group). Clearly, stronger designs are necessary to evaluate efficacy sufficiently; however, this study does provide support for further investigation of clinic-to-home videoconferencing as a direct intervention tool for youth with autism spectrum disorders and their parents.

In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence.

Anxiety disorders and other co-occurring psychiatric disorders significantly impact adaptive functioning for many children with autism spectrum disorder (ASD). This descriptive study examines the complexity of psychiatric comorbidity in treatment-seeking youth with ASD and anxiety symptoms. Forty-two parents of 8- to 14-year-old children with ASD and anxiety symptoms completed a structured psychiatric interview (K-SADS) and provided information about the child's past and current psychological functioning as part of a screening process to enter an anxiety intervention program. Overall, comorbidity was very complex, with children obtaining an average of 4 psychiatric diagnoses (including anxiety disorders) on a structured clinical interview (range = 0-9). Onset and course differed by psychiatric disorder. Complexity of comorbidity did not differ significantly by age, sex, or autism severity. Despite clinical significance of the symptoms reported, few children were currently (or ever) engaged in mental health treatment or group psychosocial intervention. Although the specificity of the current sample limits the generalizability of these results, findings suggest that treatment-seeking children with ASD and anxiety often present with additional psychiatric symptoms, which supports a transdiagnostic approach to research and intervention in this area. Accurate assessment of comorbidity may provide valuable information for families and clinicians regarding individualized treatment approaches.

Anxiety disorders frequently co-occur in youth with autism spectrum disorders. In addition to developing efficacious treatments for anxiety in children with autism spectrum disorders, it is important to examine the transportability of these treatments to real-world settings. Study aims were to (a) train clinicians to deliver Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders to fidelity and (b) examine feasibility of the program for novel settings. A secondary aim was to examine preliminary youth treatment outcome. Results indicated that clinicians obtained excellent fidelity following a workshop and ongoing consultation. Acceptability ratings indicated that Facing Your Fears Therapy was viewed favorably, and critiques were incorporated into program revisions. Meaningful reductions in anxiety were reported posttreatment for 53% of children. Results support the initial effectiveness and transportability of Facing Your Fears Therapy in new clinical settings.

Abnormalities in CHRNA7, the alpha7-nicotinic receptor gene, have been reported in autism spectrum disorder. These genetic abnormalities potentially decrease the receptor's expression and diminish its functional role. This double-blind, placebo-controlled crossover study in two adult patients investigated whether an investigational receptor-specific partial agonist drug would increase the inhibitory functions of the gene and thereby increase patients' attention. An electrophysiological biomarker, P50 inhibition, verified the intended neurobiological effect of the agonist, and neuropsychological testing verified a primary cognitive effect. Both patients perceived increased attention in their self-ratings. Alpha7-nicotinic receptor agonists, currently the target of drug development in schizophrenia and Alzheimer Disease, may also have positive clinical effects in autism spectrum disorder.

Best practice for assessment of anxiety symptoms in children suggests that child self-report is an important element to consider. Yet, it is not known if it is a reliable assessment method for children with high-functioning autism spectrum disorders (ASDs). The present study examines the extent to which verbally fluent children with ASD and their parents agree on the child's symptoms of anxiety. Sixty-three children with ASD and their parents independently completed the Screen for Child Anxiety Related Emotional Disorders (SCARED). Intraclass correlations indicated moderate-to-strong agreement on several domains. Associations among child factors (e.g., verbal IQ, metacognitive ability) and parent–child agreement were explored. More advanced verbal ability was associated with better agreement on Separation, School Avoidance, and Total Anxiety; higher metacognitive skills were associated with better agreement on Social Anxiety. Implications for the use of child self-report are discussed.

Background: Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavioral therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions for anxiety in children with ASD have also yielded promising results. Methods: Fifty children with high-functioning ASD and anxiety were randomized to group CBT or treatment-as-usual (TAU) for 12 weeks. Independent clinical evaluators, blind to condition, completed structured interviews (Anxiety Disorders Interview Schedule – Parent Version; ADIS-P) pre- and post-intervention condition. Results: Forty-seven children completed either the CBT or TAU condition. Results indicated markedly better outcomes for the CBT group. Significant differences by group were noted in Clinician Severity Ratings, diagnostic status, and clinician ratings of global improvement. In the intent-to-treat sample, 10 of 20 children (50%) in the CBT group had a clinically meaningful positive treatment response, compared to 2 of 23 children (8.7%) in the TAU group. Conclusions: Initial results from this randomized, designed treatment study suggest that a group CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety. Limitations of this study include small sample size, lack of an attention control group, and use of outcome measures normed with typically developing children.

The purpose of this study was to assess the cognitive skills of children with autism spectrum disorders (ASD) thought to be necessary for Cognitive Behavioral Therapy (CBT). Forty children with ASD and forty age-matched typically developing children between the ages of 7–12 years participated. Groups were comparable with regard to nonverbal IQ, but children with ASD had significantly lower verbal IQ. Children completed three CBT-related tasks requiring emotion recognition, discrimination among thoughts, feelings and behaviors, and cognitive mediation. With the exception of the emotion recognition task, children with ASD performed comparably to typically developing children and with a high rate of accuracy.

Navigating adolescence can be extremely difficult, especially for teens who are also dealing with the core symptoms of autism spectrum disorders (ASDs). Adolescence can also be a difficult time period for parents who struggle to know how best to support their teen. The present study aimed to (a) acquire information via focus groups about the concerns and service needs of parents regarding the sexuality development of their youth with ASDs and (b) evaluate the effectiveness of an 8-week parent sexuality-education curriculum. Themes that emerged from the parent focus groups are discussed along with outcomes from the parent education curriculum.

The present study used a context-based model of assessment and intervention to explore whether interventions that modify context result in reduction of problem behavior in ecologically valid settings (i.e., typical routines implemented by typical education personnel in neighborhood schools). The Contextual Assessment Inventory (CAI) and a postassessment interview were administered to parents and teachers of eight children with Autism Spectrum Disorder to identify problem contexts. Then, environmental modification techniques were implemented in three priority contexts: namely, transitions, termination of preferred activities, and presence of a feared stimulus. Our results demonstrated an almost complete elimination of problem behavior in the priority contexts as well as successful completion of activities and routines related to those contexts. We discuss the value of conceptualizing problem behavior as a function of context with respect to facilitating both assessment and intervention, and the need for enhancing breadth of effects to determine the larger impact of a context-based approach on promoting meaningful behavior change in the community.

Theoretical considerations suggest that problem behavior should increase when a child’s competency does not match the curricular demands of the environment (i.e., when there is poor environmental fit). In the present study, environmental fit was examined for six children with autism spectrum disorders. Results indicated that the children exhibited high rates of problem behavior associated with poor motor or academic competency. Curricular modifications resulted in (a) a decrease in the level of problem behavior, (b) an increase in the percentage of task steps completed correctly, and (c) improved affect. Adults who worked with the children reported ease of intervention techniques. The concept of environmental fit and its usefulness in guiding both assessment of and intervention for problem behavior are discussed.

Individuals with autism spectrum disorders (ASD) are at increased risk for developing anxiety disorders relative to children without ASD and those with other developmental disabilities. Thirty-three children with high-functioning ASD and their parents participated in an original, manualized cognitive behavioral group treatment aimed at reducing severity of anxiety symptoms. Parent-child dyads entered into either an Active Treatment Condition or Wait List Control Condition. Results indicated significant reductions in parent report of anxiety symptoms after the delivery of the group treatment, compared with the Wait List Control Condition. The findings of this study are promising, particularly in light of the high rates of comorbidity between ASD and anxiety. Limitations and recommendations for future research directions are discussed.

This study evaluated the impact of a peer training intervention on social interactions among three students with autism spectrum disorders (ASD) and their typical peers. Two second graders and one fourth grader with ASD participated. For each student with ASD, two to four typical peers participated in training sessions that targeted increased social interactions. Data collected during lunchtime and recess showed that the peer training intervention generally resulted in increased initiations by trained peers as well as increased initiations and responses by students with ASD. Unexpectedly, untrained peers also showed increased initiations. Future research directions are discussed, including characteristics of the peers selected for training (e.g., gender, popularity) and measurement of qualitative changes in social relationships and opportunities.

Children with autism spectrum disorder (ASD) are at increased risk of developing co-occurring anxiety symptoms. However, the assessment of anxiety symptoms in this population is often challenging for researchers and clinicians. This study evaluated the psychometric properties of a questionnaire measure of child anxiety symptoms, the Screen for Child Anxiety Related Emotional Disorders (SCARED), in school-aged children and adolescents with high-functioning ASD. Children and parents recruited for an anxiety treatment study completed the SCARED—parent and child versions prior to the start of treatment. Both versions demonstrated factor structures, internal reliability, and score distributions largely consistent with those from typically developing samples ( Birmaher et al., 1999 ). The SCARED showed moderate convergent validity with a structured clinical interview and had good sensitivity and specificity. Differences were explored by child age, gender, and ethnicity. Together, these findings support the use of the SCARED as a valid assessment tool in an ASD population.

Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing psychiatric symptoms, particularly anxiety symptoms. Cognitive behavioral treatments (CBTs) are frequently used in the general pediatric population with good success to reduce anxiety symptoms. Recently published studies, including eight randomized clinical trials, have demonstrated significant reductions in anxiety symptoms for youth with ASD following the delivery of modified CBT interventions. Because these treatment studies have occurred exclusively in tightly controlled university settings, generalizability to other clinical settings may be limited. To enhance the portability and generalizability of novel interventions, it may be important to introduce new interventions into real-world clinical settings to inform protocol development, increase adoptability of the intervention, and subsequently maximize success for clinical practice, thus narrowing the research to practice gap. This chapter reviews barriers to the dissemination of evidence-based treatments and suggests approaches for fostering the dissemination and eventual adoption of empirically supported programs for the youth with ASD in real-world settings. Best practice guidelines for conducting clinical trainings also are discussed. Given the limited research conducted to date on dissemination and implementation of autism treatment research, particularly for focused interventions targeting comorbid psychiatric symptoms, examples of the successful dissemination of mental health interventions are presented to inform practice for autism research. Preliminary efforts in the dissemination of a group CBT program for managing anxiety in youth with ASD in clinic and school settings, as well as via telehealth delivery, also are examined.

Children with high-functioning autism spectrum disorders (ASD) are at high risk for developing significant anxiety. Anxiety can adversely impact functioning across school, home and community environments. Cognitive behavioral therapies (CBT) are frequently used with success for children with anxiety symptoms. Modified CBT interventions for anxiety in children with ASD have also yielded promising results.Fifty children with high-functioning ASD and anxiety were randomizedto group CBT or treatment-as-usual (TAU) for 12 weeks. Independent clinical evaluators, blind to condition, completed structured interviews (Anxiety Disorders Interview Schedule – Parent Version;ADIS-P) pre- and post-intervention condition.Forty-seven children completed either the CBT or TAU condition. Results indicated markedly better outcomes for the CBT group. Significant differences by group were noted in Clinician Severity Ratings, diagnostic status, and clinician ratings of global improvement. In the intent-to-treat sample, 10 of 20 children (50%) in the CBT group had a clinically meaningful positive treatment response, compared to 2 of 23 children (8.7%) in the TAU group.Initial results from this randomized, designed treatment study suggest that agroup CBT intervention specifically developed for children with ASD may be effective in decreasing anxiety. Limitations of this study include small sample size, lack of an attention control group, and use of outcome measures normed with typically developing children

Adolescents with high-functioning autism spectrum disorders (ASDs) are at high risk for developing psychiatric symptoms, with anxiety disorders among the most commonly cooccurring. Cognitive behavior therapies (CBTs) are considered the best practice for treating anxiety in the general population. Modified CBT approaches for youth with high-functioning ASD and anxiety have resulted in significant reductions in anxiety following intervention. The purpose of the present study was to develop an intervention for treating anxiety in adolescents with ASD based on a CBT program designed for school-aged children. The Facing Your Fears-Adolescent Version (FYF-A) program was developed; feasibility and acceptability data were obtained, along with initial efficacy of the intervention. Twenty-four adolescents, aged 13–18, completed the FYF-A intervention. Results indicated significant reductions in anxiety severity and interference posttreatment, with low rates of anxiety maintained at 3-month follow-up. In addition, nearly 46% of teen participants met criteria for a positive treatment response on primary diagnosis following the intervention. Initial findings from the current study are encouraging and suggest that modified group CBT for adolescents with high-functioning ASD may be effective in reducing anxiety symptoms. Limitations include small sample size and lack of control group. Future directions are discussed.

The current study describes everyday executive function (EF) profiles in young children with Down syndrome. Caregivers of children with Down syndrome (n = 26; chronological ages = 4–10 years; mental ages = 2–4 years) completed the Behavior Rating Inventory of Executive Function—Preschool (BRIEF-P; G. A. Gioia, K. A. Espy, & P. K. Isquith, 2003), a caregiver report measure of everyday/functional EF skills in multiple domains. On the BRIEF-P, elevations were noted on a global EF composite as well as the Working Memory and Plan/Organize scales in particular (relative to norms developed for typically developing children of a similar mental age). These results suggest a specific pattern of EF weaknesses in young children with Down syndrome, consistent with the extant literature that has focused primarily on older individuals who have been tested using laboratory EF tasks.

There is growing evidence of an association between physical illness and problem behavior in children with developmental disabilities. Such behavior can compromise school performance. Therefore, the purpose of the present study was to evaluate, using a group design, the effectiveness of medical intervention alone ( N = 11) versus behavioral plus medical intervention ( N = 10) for illness-related problem behavior in a school setting. Following intervention, the behavioral plus medical intervention group showed lower levels of problem behavior and completed more academic tasks than did the medical intervention alone group. The results are discussed with respect to the concept of illness and pain as a setting event for problem behavior. The need for research to develop algorithms that allow one to select the best combination of medical and behavioral interventions for specific illnesses and contexts is noted.

The effects of wrist weights on the self-injurious and adaptive behaviors of a young boy with profound mental retardation were evaluated. Application of wrist weights reduced SIB by 92% and was associated with either increases or stable levels of multiple novel and preexisting adaptive behaviors.