Autism and Anxiety

Anxiety is a natural human response to danger or stress. Most of us experience it from time to time, and it can actually help motivate us to do things or keep us safe from harm.

Think about when a deadline is looming for a test or work project and you need to focus. Or when you stay ‘switched on’ while exploring an unfamiliar part of town. This healthy anxiety keeps us alert and ready to act.

But when anxiety lasts a long time  and is out of proportion to the actual threat, it can start to impact your quality of life. You may experience panic attacks or go from feeling alert to being frozen in fear.

And for people with autism, these symptoms are an uncomfortable reality.

Research shows they’re more likely to experience anxiety. But how can you tell when anxious feelings are – or aren’t – a sign of autism?

In this guide, Dr Lisa Williams looks at the relationship between autism and anxiety, and what you can do to support loved ones displaying symptoms of these disorders.

The relationship between ASD and anxiety

Before we look at the link between ASD and anxiety, it’s important to understand what we mean by these terms…

What is ASD?

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that impacts how people experience and interact with the world.

Like all of us, every autistic person is different. But to be diagnosed as autistic, you must show the ‘core characteristics’ of autism. These include differences in social communication, interaction and patterns of behaviour.

The current diagnostic criteria also defines different types of autism, based on the severity of symptoms.

What is anxiety?

Anxiety is an emotional state characterised by feelings of worry, fear or panic – typically related to things that are about to happen or might happen in the future.

Anxiety can impact our thoughts, feelings, physical sensations and behaviours.

What does it look like?

Anxiety presents differently in individuals. It often starts as negative thoughts and feelings that eventually cause physical sensations in the body and can lead to the person adapting their behaviour as a result.

Below we explore some of the common thoughts, sensations and behaviours presented by those experiencing heightened anxiety:

While these are some of the common feelings and symptoms displayed by those experiencing anxiety, it isn’t an exhaustive list. Everyone faces stress and anxiety differently.

Can autism cause anxiety?

While ASD doesn’t always cause anxiety, there is a correlation between the two.

It’s believed that around 10%-15% of the general population have experienced an anxiety disorder during their lives. But for autistic people, this figure is much higher.

It’s estimated that between 42%-79% of people with autism will experience anxiety disorders.

Why is anxiety more common in those with ASD?

So, what explains this increased presence of anxiety among people with autism?

Autistic people experience the world in a different way from non-autistic people. And some of these unique traits and experiences can make everyday tasks more stressful and uncomfortable.

These differences often include:

• Sensory experiences – these can often be more intense for those with autism, making busy, loud or visually-dazzling environments an overwhelming experience.
• Differences understanding their own emotions – this is known as ‘alexithymia’, and can make it more difficult to find appropriate coping mechanisms.
• Differences in understanding the feelings and intentions of others – this can make social interactions and relationships more frustrating and less enjoyable for people with autism, and may lead to them avoiding them altogether.

These differences can make the world feel like an unpredictable, uncertain and scary place. And it’s believed that the increased rates of anxiety in autistic people are a result of this ‘intolerance of uncertainty’.

Anxiety or ASD?

Anxiety can look similar across autistic and non-autistic people – which can often lead to confusion over the cause of someone’s behaviour. But they’re not always linked.

It’s not uncommon for neurotypical people to believe they might be autistic – or to be labelled as such by others – because of their response to anxiety.

Overlapping traits

When someone feels anxious, they might also experience social difficulties. Stress and anxiety can make people go within themselves and become shy or less talkative – all of which could be seen to replicate the difficulties autistic people often experience in social relationships.

Overwhelming feelings of anxiety might also lead neurotypical people to have emotional outbursts or breakdowns that can be similar to autistic meltdowns.

There can also be similarities in how autistic and non-autistic people manage feelings of anxiety. For example, some neurotypical people may create routines or lean on comforting, repetitive behaviours as a way of feeling in control amid uncertainty. This can often be confused with the repetitive behaviours often displayed and favoured by those with autism.

What if someone has both ASD and an anxiety disorder?

Some unique challenges can also arise when someone has both ASD and heightened anxiety.

Anxiety can often be overlooked and attributed to ‘just being part of’ a person’s autism. This is called ‘diagnostic overshadowing’ and can lead to people failing to learn about their anxiety or develop appropriate coping mechanisms.

Luckily, awareness in this area is growing and screening measures are being developed to help identify anxiety disorders in autism – including revised scales for measuring development in children with ASD.

How to reduce anxiety in adults and children?

The first step in helping an autistic person experiencing anxiety is understanding what is causing these feelings. Everyone is different.

A person’s anxiety may be underpinned by one thing (such as their sensory sensitivities) or it may be underpinned by multiple factors. And any interventions should be targeted to their unique experiences.

Some common and helpful approaches for dealing with anxiety in autistic populations include:

• Psychological therapies: such as cognitive behavioural therapy (CBT) or mindfulness-based therapy (MBT). When dealing with autistic children, this might also include parent-led interventions such as CUES (Coping with Uncertainty in Everyday Situations).
• Sensory strategies: these will be developed by an occupational therapist, and may include tinted glasses, dimmable lights, wobble cushions, noise-cancelling headphones, weighted blankets and fidget toys.
• Support with understanding social situations: this may be more common among children and might include tools such as Social Stories and Comic Strip Conversations.

Ultimately, further assessment with an experienced professional will help to unpick what is happening and what treatments or approaches will be most beneficial to each individual.

Are you or someone you love experiencing heightened anxiety that’s impacting your quality of life?

It may or may not be a sign of autism. But getting a clinical diagnosis can help you access more targeted support.

Adult and Child Autism Assessments with The Autism Service are designed to identify signs of autism and can be the first step to getting the support that’s right for you or those around you.

Find a clinic.

Frequently Asked Questions

• How common is anxiety with autism?

The latest research suggests that between 42%-79% of people with autism also experience anxiety disorders.

This is much higher than in neurotypical populations – around 10%-15% of whom have experienced an anxiety disorder during their lives.

• Can autism be mistaken for anxiety?

People can often confuse autism with anxiety because of the many overlapping traits that are common among people with the disorders. This can include emotional meltdowns, social difficulties and reliance on routines.

This is why it’s important to seek further assessment with an experienced professional who can determine whether a person’s behaviours are a sign of autism, anxiety or both. They can then suggest targeted interventions to help people manage their unique symptoms.

• How do you treat anxiety in autism?

There are various methods for treating anxiety in people with autism – based on their unique experiences and triggers.

Some common interventions include CBT or adapting sensory-friendly environments, for example, with dimmable lights and noise-cancelling accessories.