Anxiety is the most common comorbid condition for children with autism. Between 25% and 75% of all youth who are diagnosed with autism spectrum disorder (ASD) also struggle with anxiety. Adults with autism often report anxiety symptoms as well.
Anxiety often looks different in someone with autism than it does in someone who does not have the disorder. As a result, it can be easily missed or go unrecognized.
Anxiety can increase behavior problems in people with autism. It can lead to greater health issues and potential safety concerns.
For someone with autism, treatments for anxiety will be somewhat different than they are for neurotypical individuals. Treatment usually includes behavior therapies and specialized interventions that include assistance from parents and caregivers.
The Connection Between Autism & Anxiety
Autism is a neurodevelopmental disorder characterized by communication and socialization issues as well as repetitive and ritualistic behaviors. Anxiety is the body’s stress reaction that activates the fight, flight, or freeze response.
Anxiety and autism are often closely intertwined, and this can be related to a neurological response. Specific overlapping areas of the brain are likely involved in both the manifestation of autism and anxiety. For example, neural responses in the brain related to how a person processes rewards can be a risk factor for anxiety and a risk factor for autism.
In someone with autism, anxiety symptoms can be both typical and atypical. This means that regular symptoms like nervousness and worry are common, but in someone with autism, anxiety symptoms can also include nonfunctional repetitive behaviors and physical symptoms, such as sweating, a racing heart, muscle tension, and gastrointestinal problems.
Anxiety symptoms can also be closely related to autism symptoms, and this can make it harder to spot and differentiate anxiety from ASD. Repetitive behaviors are a typical symptom of autism, for instance. These repetitive behaviors can also be a sign of anxiety in someone with autism when they are doing something that doesn’t serve a specific purpose, such as banging their head against a wall or shredding paper.
Understanding the connection between autism and anxiety, and being able to identify each condition, can help with lowering stress and health risks related to these comorbid disorders.
Comorbid Anxiety & Autism
Studies show that around 40% of people with an autism spectrum disorder also have at least one anxiety disorder. When two disorders occur in the same person at the same time, this is called comorbid disorders.
The actual prevalence of anxiety with autism is difficult to quantify since anxiety is often overlooked in someone with autism. Recent studies are showing the overlap more and more, however.
Autism and anxiety involve similar regions of the brain. Both conditions have genetic and environmental risk factors, but they likely do not just happen to co-occur. Someone with autism is more likely to struggle with anxiety than someone without autism.
Symptoms of autism that exacerbate stress levels can lead to anxiety. This can then increase rates of anxiety in this population over the general public.
The most common anxiety disorders in someone with autism are:
- Generalized anxiety disorder.
- Specific phobia.
- Obsessive-compulsive disorder (OCD).
- Social anxiety disorder.
- Separation anxiety.
Some symptoms of anxiety with autism include:
- Intolerance and fear of change and uncertainty.
- Worry about not being able to engage in an area of fixated interest.
- Fear of social situations (not only related to fears of being bullied).
- Phobias that are unusual.
- Difficulties leaving a parent or caregiver.
- Hypersensitivity to specific stimuli.
Managing Anxiety in Children With Autism
Autism can interfere with a child’s ability to communicate and socialize effectively. This can then increase stress levels and therefore the risk for anxiety. There are several helpful things that parents and caregivers can do to minimize the likelihood of anxiety in children with autism.
It is important to know your child’s triggers and what can be done to minimize stressors in their life. If your child is hypersensitive to bright lights, for example, keeping the lights low can help. Likewise, investing in noise-cancelling headphones for outings can help to limit sensory overload and exposure to loud sounds. Both of these practices can help to decrease stress and related anxiety.
Here are other tips for minimizing anxiety with autism:
- Modify the environment when possible to create a calm and productive space.
- Create a calendar with a specific plan that can help your child know what to expect. This can help them to transition between activities more smoothly.
- Use problem-solving techniques and a step-by-step process to move through issues. This can help children who think in an inflexible manner to see things from a new perspective and discover ways to do things differently.
- Help children find an effective method to communicate feelings, so they can recognize stress and tell you when their stress levels are escalating.
- Introduce yoga, exercise, and/or mindfulness practices to lower stress levels, decrease pent-up and excessive nervous energy, and help children become more in tune with their bodies and feelings.
- Encourage socializing within comfortable parameters. Set up structured environments with clear social boundaries as well as concise expectations, rules, and consequences for actions.
- Help your child to recognize and work with their strengths, and connect over shared interests.
Undiagnosed autism can lead to anxiety, as a child struggles to cope with symptoms of a disorder they don’t yet know they have. To prevent anxiety from escalating, early diagnosis of autism and enrollment in an early intervention program is important.
Parents are the number one advocates for their children. If you are concerned about autism symptoms, anxiety symptoms, or both, talk to your child’s doctor as soon as possible. Take note of behavior changes, mood swings, shifts in eating and sleeping habits, and difficulties at school or with learning. Be sure to share these observations with your pediatrician.
How to Help Adults With Anxiety
Adults with autism are more likely to also battle depression and/or anxiety than their peers without autism. Adults face different issues than children do, and anxiety can manifest differently in adults with autism.
Some typical symptoms of anxiety for adults with autism can include:
- Incessant worry about personal health.
- Fear of the unknown.
- Stress over events and things that are out of their control.
- Forgetting how to act in everyday situations.
- Difficulties identifying feelings.
Adults with autism often struggle with lingering anxiety — worrisome thoughts and stress that persist for at least 10 minutes. Anxiety in adults can increase the risk for depression and self-harming behaviors. It can also increase physical health issues and decrease a person’s ability to function in everyday life.
For adults with autism, increased structure and stress management techniques can help to manage anxiety. Exercise, proper nutrition, and sleep schedules can all help to lower the frequency and severity of anxiety. Holistic measures, such as mindfulness meditation and yoga, are also helpful.
Adults can benefit from social skills groups and peer support groups that are focused on both autism and anxiety. While these groups won’t replace traditional treatment, they can be a solid addition to other interventions and therapies.
Treating Anxiety & Autism With Modified Cognitive Behavioral Therapy (CBT)
The standard for treating anxiety and autism at the same time is a modified version of cognitive behavioral therapy (CBT). CBT can help to break cycles of anxiety, and the modified version for autism adds in a progressive exposure therapy technique.
CBT aims to identify the root of the stressor, helping people to recognize what is causing their anxiety. Once the particular trigger is found, practical methods are devised to address it.
Anxiety is typically a fear that is irrational or prolonged in light of the actual danger that exists. CBT can help to dismiss these fears by pointing them out logically. Sessions may also examine the way that feelings, thoughts, and bodily responses are connected to actions.
CBT can include both group and individual therapy sessions. During individual sessions, clients can work on specific triggers, reactions, and coping mechanisms. Group sessions often include life skills training and the development of tools to manage stress and anxiety. In group sessions, clients also learn from the shared experiences of others with autism who also struggle with anxiety.
The second part of CBT for comorbid autism and anxiety includes learning how to face fears head on through direct exposure. The buildup will be gradual, helping a person to tolerate the feared event, action, or sensation for a short period of time and then progressing to longer and longer time periods. Coping skills are taught, so clients can manage this exposure to stressful stimuli.
With CBT, homework is often given in between sessions, so clients can practice their newly acquired skills. Parents and caregivers should work with the therapy and intervention team to support their family member. This work can help ensure that the therapy methods will continue to be useful beyond the sessions and translate into everyday life.
Additional Treatments for Anxiety & Autism
Autism is a spectrum disorder. There are varying degrees of severity, which can mean that different people may need higher levels of support.
Autism is often treated with a combination of:
- Behavior therapies, like applied behavior analysis (ABA), to reinforce positive behaviors while decreasing behaviors that are undesired.
- Occupational therapy to teach life skills and aid in self-care and independence.
- Speech therapy to improve language, communication, and social skills.
- Educational interventions to help engagement in a classroom and improve academic performance.
Anxiety in the general public is often treated with medications, but there are no medications that are specifically approved for the treatment of anxiety in someone with autism. Medications can often have undesired side effects and risk factors for someone with autism. Any medications should be taken with caution and discussed in depth with the supervising physician.
Autism & Anxiety Resources
Many support groups, online resources, and local organizations offer education, information, and support for families and individuals impacted by autism and anxiety.
- National Alliance on Mental Illness (NAMI): This online resource offers a wealth of information. NAMI hosts local chapters for in-person support. They also offer a NAMI helpline and free crisis counseling.
- SAMHSA National Helpline: Serviced by the Substance Abuse and Mental Health Services Administration (SAMHSA), this 24-hour free and confidential helpline is available seven days a week. They provide information and referrals to families seeking help for mental health concerns.
- Autism Speaks Resource Guide: This guide provides a host of information on treatment resources, support groups, advocacy, information, and education on autism for families, parents, and individuals impacted by the disorder.
- Anxiety and Depression Association of America (ADAA): This nonprofit organization offers a comprehensive resource for families in need, providing free information, education, and support for anxiety and mood disorders as well as co-occurring disorders.
Doctors, therapists, and teachers can also offer information on local resources for you and your family. With the right support in place, you can learn to effectively manage both autism and anxiety.
An Update on Anxiety in Youth With Autism Spectrum Disorders. (January 2018). Current Opinions in Psychiatry.
Disentangling the Autism – Anxiety Overlap: fMRI of Reward Processing in a Community-Based Longitudinal Study. (June 2016). Translational Psychiatry.
Comorbid Autism Spectrum Disorder and Anxiety Disorders: A Brief Review. (February 2018). Future Neurology.
Unmasking Anxiety in Autism. (October 2017). Spectrum.
Anxiety in Autism Spectrum Disorder. Anxiety and Depression Association of America (ADAA).
Adults With Autism Feel Frequent, Lingering Anxiety. (June 2014). Spectrum.
Managing Anxiety in Children With Autism. (May 2014). Autism Speaks.
How Common Are Anxiety Disorders in People With Autism? (September 2018). Autism Speaks.
Support & Education. National Alliance on Mental Illness (NAMI).
National Helpline. (April 2020). Substance Abuse and Mental Health Services Administration (SAMHSA).
Resource Guide. (2020). Autism Speaks.
About ADAA. (2018). Anxiety and Depression Association of America (ADAA).