Identifying and Treating Anxiety Disorders in People with Intellectual Disabilities

Categories: ASD and DD, Adult-focused

By Margaret Walsh, M.A., BCBA
Anxiety disorders are very common, affecting 15 to 20% of the general population. For individuals with intellectual disabilities (ID), the percentage is even higher. Left untreated, generalized anxiety and other anxiety disorders – such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) – can be very detrimental to the ID population. These conditions can impact their ability to live safely in the community as well as their relationships, employment, and overall adaptive functioning.
Identifying and treating anxiety disorders in adults with ID can be complicated by communication deficits that make it difficult for them to effectively describe their feelings and fears. With this population, it is often a person’s behavior that indicates the presence of an anxiety disorder. He or she may become irritable and aggressive, refuse to engage in certain activities, and experience insomnia.
If you observe a dramatic change in the behavior of someone with ID, it is important to take it seriously and get help for that person.
The first thing to do is to explore possible causes for the behavioral changes. A primary care physician can rule out medical causes by conducting a formal physical examination. It is usually in the best interest of the adult with ID to have someone who knows them well go to the appointment with them. This friend or family member can help explain their symptoms and help them follow up on recommendations a physician might make.
If the physician determines that anxiety is the primary issue, he or she can make referrals to other professionals who can help the person with ID better manage the anxiety disorder.
The good news is that there are many treatment options that have proven effective for adults with ID. Cognitive behavior therapy (CBT), for example, is a very helpful treatment for all people with anxiety disorders. This kind of therapy helps people by teaching them to recognize maladaptive thought patterns and how these patterns impact behavior. Once a person understands these patterns, he or she can start to work on developing new ways of thinking and learn new behaviors to cope with situations that have caused anxiety in the past. 
Counseling can also help people with ID identify the challenges they face and help them deal with the day-to-day conflicts that could be contributing to their difficulties coping with anxiety. Counseling can be individualized to meet each person’s unique needs; a skilled counselor will use a variety of methods to help each person communicate his or her feelings effectively. Counselors can also educate the people caring for individuals with ID about anxiety disorders and how to effectively help them if they are fearful or worried.
Medication can also be very helpful in treating anxiety by reducing or alleviating symptoms. For maximum benefit, however, it should be combined with other treatment approaches. If the individual with ID is taking medication, it is best to consult with a psychiatrist on a regular basis and be prepared to provide detailed information on the person’s progress.
One of the most effective things to do for an adult with ID who has an anxiety disorder is to help him or her recognize and reduce daily stress. If they like an activity and it makes them happy, for example, find a way to make this activity a part of their day-to-day routine.
Helping an individual with ID obtain a diagnosis of and treatment for anxiety can make a tremendous difference in quality of life. Remember that the best and most effective intervention might be spending quiet time with that person and making a sincere effort to understand how he or she feels.
Margaret Walsh, M.A., BCBA, is the Clinical Director for the western Massachusetts division of the May Center for Adult Services. She can be contacted in West Springfield at 413-734-0300 (ext. 262) or at
May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis, serving individuals with autism spectrum disorder and other developmental disabilities, brain injury and neurobehavioral disorders, and other special needs. Founded more than 65 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. The May Center for Adult Services in West Springfield provides day and residential services to adults with developmental disabilities living in western Massachusetts. For more information, call 800.778.7601 or visit