Table of ContentsView AllTable of ContentsDefining AnxietyWhy Anxiety Is CommonCommon ChallengesAnxiety and Autism TraitsToolsTherapies and Medications
Table of ContentsView All
View All
Table of Contents
Defining Anxiety
Why Anxiety Is Common
Common Challenges
Anxiety and Autism Traits
Tools
Therapies and Medications
About 40% ofautisticpeople also experience significant anxiety.This is the case even though anxiety is not a part of thecriteria for diagnosing autism—nor is it one of the descriptive options available for clinicians to use when describing an autistic person.
Anxiety can play a huge role in the lives of autistic people, affecting the way they interact with the world and limiting the ways in which other people interact with them. Once identified, however, it is often possible to develop a set of tools that can reduce anxiety to a manageable level.
This article explains anxiety in autistic people, and how to deal with it so that treatment opens up a world of possibilities, including relationships, employment options, and community experiences.
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Many people with anxiety disorders have unreasonable fears or perceptions that are far from reality. Whether or not the source of the anxiety is realistic, however, the anxiety is very real and can result in symptoms such as panic attacks, emotional meltdowns, and self-injury.
There are many forms of anxiety including the following:
All of these can become challenges for autistic people, although social anxiety disorder appears to be the most common.However, it is important to recognize the difference between an autistic person with social anxiety and one who simply enjoys solitude, as many autistic people do.
Similarly, it can be hard to know whetherstimming behaviors(self-stimulatory behaviors) such as flapping or pacing are really a sign of anxiety or just a symptom of the underlying autism.
It takes time and patience to get to know an autistic person well enough to separate and identifyautism traits, personality quirks, and signs of anxiety. Often, parents and siblings are better than anyone else at noticing anxiety in an autistic person.
It’s unclear why anxiety is so common in autistic people. There are two prevalent theories, both of which are grounded in research and logical conclusions drawn from anxiety in autism:
Autistic people often struggle with the following shared challenges:
Sensory Assaults:For many autistic people, bright lights, loud noises, and large crowds can be physically painful. These stimuli can be found in virtually every public school, school bus, city street, movie theater, football game, and party. In other words, the probability is extremely high that an autistic person will experiencepainful sensory assaultsall day, every day. This is certainly a sufficient cause for anxiety.
Communication Challenges:Spoken languagecan be difficult for autistic people. Tone of voice and non-verbal body language are hard to distinguish, while idioms and slang can be incomprehensible. This means that many autistic people wonder whether they are understanding what is being said, and hoping that others understand them. Certainly, this can cause much anxiety.
Social Challenges:Few autistic people can accurately gauge a complex social situationand respond appropriately. It is relatively easy to follow scripts in a formal setting (saying hello, shaking hands), but it is much tougher to know whether you are or are not welcome to join a conversation, or whether a friendly greeting is a sign of romantic interest.
How to Help Someone Cope Through Their Anxiety
One of the most difficult aspects of diagnosing anxiety in autistic people is the reality that common autism traits closely resemble symptoms of anxiety. Rocking, flicking, pacing, saying or doing the same thing over and over again, insisting on routines, and avoiding social interaction are all actions that would look like intense anxiety in a neurotypical person.
In some cases, these behaviors are self-calming techniques that do reflect a response to anxiety.In other cases, however, the autism traits do not seem to relate to anxiety; they’re autism.
Another issue is that many autistic people have a difficult time communicating their emotional state to others. A significant number of autistic people arenon-verbal, while others have limited use of language. Even those who are verbal and have low support needs (often called high functioning) may have trouble recognizing and describing their emotional state as “anxious.”
While it is not always easy to distinguish anxiety from autism traits, you know what behaviors to expect from an autistic child or adult if you are the caregiver. Pay close attention to behaviors and signs that they may be experiencing anxiety.
If your autistic loved one is experiencing anxiety, this person may:
There are multiple techniques for avoiding, reducing, and managing anxiety for autistic people. The first step in the process is to determine the causes of anxiety; an autistic person may experience frustration, physical discomfort, social discomfort, fear of change, or worries about the future.
Once you know what the causes of anxiety look like, you can take productive action such as:
The same therapies and medications that help reduce anxiety in neurotypical people can be helpful for autistic people.Learning to recognize anxiety is important, but it is equally important they learn the skills to function successfully in complex social environments.
Treatments for Autism
Summary
Anxiety is a common co-occurring diagnosis for autistic people, though it’s unclear why. Social anxiety disorder is the most common type, but it can be hard to know if an autistic person is experiencing symptoms of anxiety or if behaviors are related to autism traits.
Tools and techniques, like removing a person from an anxiety-producing environment or situation, can help. So can cognitive behavioral therapies and medication as part of a treatment plan.
Autistic people have few defenses and can be vulnerable to bullying, intolerance, or negative behavior from others. In addition, many of the things that upset autistic people may be invisible to their neurotypical peers. It may be up to you, the caregiver, to notice and address anxiety in your loved one’s life.
Challenges and Treatments for Autism With High Support Needs
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Anxiety and Depression Association of America.Anxiety in Autism Spectrum Disorder.Sürmeli T.Treating thought disorders. In:Clinical Neurotherapy. Elsevier; 2014:213-251. doi:10.1016/B978-0-12-396988-0.00009-XSinghal A, Ross J, Seminog O, Hawton K, Goldacre MJ.Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.J R Soc Med. 2014;107(5):194-204. doi:10.1177/0141076814522033Spain D, Zıvralı Yarar E, Happé F.Social anxiety in adults with autism: a qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1803669. doi:10.1080/17482631.2020.1803669Kapp SK, Steward R, Crane L, et al.‘People should be allowed to do what they like’: Autistic adults' views and experiences of stimming.Autism. 2019;23(7):1782-1792. doi:10.1177/1362361319829628Vasa RA, Mazurek MO.An update on anxiety in youth with autism spectrum disorders.Curr Opin Psychiatry. 2015;28(2):83-90. doi:10.1097/YCO.0000000000000133South M, Rodgers J.Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders.Front Hum Neurosci. 2017;11:20. doi:10.3389/fnhum.2017.00020Tarver J, Pearson E, Edwards G, et al.Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management.Autism. 2021;25(2):429-439. doi:10.1177/1362361320962366American Psychiatry Association.Understanding Stimming: Repetitive Behaviors with a Purpose.Kennedy Krieger Institute.What Anxiety Treatments Work for People with Autism.Sukhodolsky DG, Bloch MH, Panza KE, Reichow B.Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis.Pediatrics. 2013;132(5):e1341-e1350. doi:10.1542/peds.2013-1193American Academy of Child and Adolescent Psychiatry with the American Psychiatric Association.Autism Spectrum Disorder Parents Medication Guide.Additional ReadingKerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., Storch, E. A. The treatment of anxiety in autism spectrum disorder (TAASD) study: Rationale, design, and methods.Journal of Child and Family Studies, 25(6), 1889-1902. doi:10.1007/s10826-016-0372-2Sarris, M.What anxiety treatments work for people with autism? Interactive Autism Network at Kennedy Krieger Institute. 2013.Vasa, R. A., Mazurek, M. O., Mahajan, R., Bennett, A. E., Bernal, M. P., Nozzolillo, A. A., Coury, D. L. Assessment and treatment of anxiety in youth with autism spectrum disorders.Pediatrics, 137, S115. doi:10.1542/peds.2015-2851JWilliams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD).The Cochrane Database of Systematic Reviews, (8),2013. doi:10.1002/14651858.CD004677.pub3Zaboski BA, Storch EA. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31-37. doi:10.2217/fnl-2017-0030
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Anxiety and Depression Association of America.Anxiety in Autism Spectrum Disorder.Sürmeli T.Treating thought disorders. In:Clinical Neurotherapy. Elsevier; 2014:213-251. doi:10.1016/B978-0-12-396988-0.00009-XSinghal A, Ross J, Seminog O, Hawton K, Goldacre MJ.Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.J R Soc Med. 2014;107(5):194-204. doi:10.1177/0141076814522033Spain D, Zıvralı Yarar E, Happé F.Social anxiety in adults with autism: a qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1803669. doi:10.1080/17482631.2020.1803669Kapp SK, Steward R, Crane L, et al.‘People should be allowed to do what they like’: Autistic adults' views and experiences of stimming.Autism. 2019;23(7):1782-1792. doi:10.1177/1362361319829628Vasa RA, Mazurek MO.An update on anxiety in youth with autism spectrum disorders.Curr Opin Psychiatry. 2015;28(2):83-90. doi:10.1097/YCO.0000000000000133South M, Rodgers J.Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders.Front Hum Neurosci. 2017;11:20. doi:10.3389/fnhum.2017.00020Tarver J, Pearson E, Edwards G, et al.Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management.Autism. 2021;25(2):429-439. doi:10.1177/1362361320962366American Psychiatry Association.Understanding Stimming: Repetitive Behaviors with a Purpose.Kennedy Krieger Institute.What Anxiety Treatments Work for People with Autism.Sukhodolsky DG, Bloch MH, Panza KE, Reichow B.Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis.Pediatrics. 2013;132(5):e1341-e1350. doi:10.1542/peds.2013-1193American Academy of Child and Adolescent Psychiatry with the American Psychiatric Association.Autism Spectrum Disorder Parents Medication Guide.Additional ReadingKerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., Storch, E. A. The treatment of anxiety in autism spectrum disorder (TAASD) study: Rationale, design, and methods.Journal of Child and Family Studies, 25(6), 1889-1902. doi:10.1007/s10826-016-0372-2Sarris, M.What anxiety treatments work for people with autism? Interactive Autism Network at Kennedy Krieger Institute. 2013.Vasa, R. A., Mazurek, M. O., Mahajan, R., Bennett, A. E., Bernal, M. P., Nozzolillo, A. A., Coury, D. L. Assessment and treatment of anxiety in youth with autism spectrum disorders.Pediatrics, 137, S115. doi:10.1542/peds.2015-2851JWilliams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD).The Cochrane Database of Systematic Reviews, (8),2013. doi:10.1002/14651858.CD004677.pub3Zaboski BA, Storch EA. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31-37. doi:10.2217/fnl-2017-0030
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Anxiety and Depression Association of America.Anxiety in Autism Spectrum Disorder.Sürmeli T.Treating thought disorders. In:Clinical Neurotherapy. Elsevier; 2014:213-251. doi:10.1016/B978-0-12-396988-0.00009-XSinghal A, Ross J, Seminog O, Hawton K, Goldacre MJ.Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.J R Soc Med. 2014;107(5):194-204. doi:10.1177/0141076814522033Spain D, Zıvralı Yarar E, Happé F.Social anxiety in adults with autism: a qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1803669. doi:10.1080/17482631.2020.1803669Kapp SK, Steward R, Crane L, et al.‘People should be allowed to do what they like’: Autistic adults' views and experiences of stimming.Autism. 2019;23(7):1782-1792. doi:10.1177/1362361319829628Vasa RA, Mazurek MO.An update on anxiety in youth with autism spectrum disorders.Curr Opin Psychiatry. 2015;28(2):83-90. doi:10.1097/YCO.0000000000000133South M, Rodgers J.Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders.Front Hum Neurosci. 2017;11:20. doi:10.3389/fnhum.2017.00020Tarver J, Pearson E, Edwards G, et al.Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management.Autism. 2021;25(2):429-439. doi:10.1177/1362361320962366American Psychiatry Association.Understanding Stimming: Repetitive Behaviors with a Purpose.Kennedy Krieger Institute.What Anxiety Treatments Work for People with Autism.Sukhodolsky DG, Bloch MH, Panza KE, Reichow B.Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis.Pediatrics. 2013;132(5):e1341-e1350. doi:10.1542/peds.2013-1193American Academy of Child and Adolescent Psychiatry with the American Psychiatric Association.Autism Spectrum Disorder Parents Medication Guide.
Anxiety and Depression Association of America.Anxiety in Autism Spectrum Disorder.
Sürmeli T.Treating thought disorders. In:Clinical Neurotherapy. Elsevier; 2014:213-251. doi:10.1016/B978-0-12-396988-0.00009-X
Singhal A, Ross J, Seminog O, Hawton K, Goldacre MJ.Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage.J R Soc Med. 2014;107(5):194-204. doi:10.1177/0141076814522033
Spain D, Zıvralı Yarar E, Happé F.Social anxiety in adults with autism: a qualitative study.Int J Qual Stud Health Well-being. 2020;15(1):1803669. doi:10.1080/17482631.2020.1803669
Kapp SK, Steward R, Crane L, et al.‘People should be allowed to do what they like’: Autistic adults' views and experiences of stimming.Autism. 2019;23(7):1782-1792. doi:10.1177/1362361319829628
Vasa RA, Mazurek MO.An update on anxiety in youth with autism spectrum disorders.Curr Opin Psychiatry. 2015;28(2):83-90. doi:10.1097/YCO.0000000000000133
South M, Rodgers J.Sensory, Emotional and Cognitive Contributions to Anxiety in Autism Spectrum Disorders.Front Hum Neurosci. 2017;11:20. doi:10.3389/fnhum.2017.00020
Tarver J, Pearson E, Edwards G, et al.Anxiety in autistic individuals who speak few or no words: A qualitative study of parental experience and anxiety management.Autism. 2021;25(2):429-439. doi:10.1177/1362361320962366
American Psychiatry Association.Understanding Stimming: Repetitive Behaviors with a Purpose.
Kennedy Krieger Institute.What Anxiety Treatments Work for People with Autism.
Sukhodolsky DG, Bloch MH, Panza KE, Reichow B.Cognitive-behavioral therapy for anxiety in children with high-functioning autism: a meta-analysis.Pediatrics. 2013;132(5):e1341-e1350. doi:10.1542/peds.2013-1193
American Academy of Child and Adolescent Psychiatry with the American Psychiatric Association.Autism Spectrum Disorder Parents Medication Guide.
Kerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., Storch, E. A. The treatment of anxiety in autism spectrum disorder (TAASD) study: Rationale, design, and methods.Journal of Child and Family Studies, 25(6), 1889-1902. doi:10.1007/s10826-016-0372-2Sarris, M.What anxiety treatments work for people with autism? Interactive Autism Network at Kennedy Krieger Institute. 2013.Vasa, R. A., Mazurek, M. O., Mahajan, R., Bennett, A. E., Bernal, M. P., Nozzolillo, A. A., Coury, D. L. Assessment and treatment of anxiety in youth with autism spectrum disorders.Pediatrics, 137, S115. doi:10.1542/peds.2015-2851JWilliams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD).The Cochrane Database of Systematic Reviews, (8),2013. doi:10.1002/14651858.CD004677.pub3Zaboski BA, Storch EA. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31-37. doi:10.2217/fnl-2017-0030
Kerns, C. M., Wood, J. J., Kendall, P. C., Renno, P., Crawford, E. A., Mercado, R. J., Storch, E. A. The treatment of anxiety in autism spectrum disorder (TAASD) study: Rationale, design, and methods.Journal of Child and Family Studies, 25(6), 1889-1902. doi:10.1007/s10826-016-0372-2
Sarris, M.What anxiety treatments work for people with autism? Interactive Autism Network at Kennedy Krieger Institute. 2013.
Vasa, R. A., Mazurek, M. O., Mahajan, R., Bennett, A. E., Bernal, M. P., Nozzolillo, A. A., Coury, D. L. Assessment and treatment of anxiety in youth with autism spectrum disorders.Pediatrics, 137, S115. doi:10.1542/peds.2015-2851J
Williams, K., Brignell, A., Randall, M., Silove, N., & Hazell, P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD).The Cochrane Database of Systematic Reviews, (8),2013. doi:10.1002/14651858.CD004677.pub3
Zaboski BA, Storch EA. Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurol. 2018;13(1):31-37. doi:10.2217/fnl-2017-0030
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