Autism and Anxiety: Understanding the Connection and Finding Support
A comprehensive guide to anxiety in autistic individuals – why it's so common, how it presents, and effective strategies for support.
Our Perspective
"Anxiety is not just 'behavior'. It is a nervous system feeling unsafe. We build confidence at Buzz ABA. We help children feel safe to explore."
Anxiety often comes with autism. Understanding this helps us support them. When we treat anxiety, other things improve too.
How Common Is Anxiety in Autism?
Research says 40-80% of autistic people have anxiety. This is much higher than the 15% in others. The Journal of Autism and Developmental Disorders confirms this.
According to the National Institute of Mental Health, anxiety is a common co-occurring condition.
Types of Anxiety Common in Autism
- Generalized Anxiety Disorder: Persistent worry about many things
- Social Anxiety: Fear of social judgment or situations
- Specific Phobias: Intense fears of particular things
- Separation Anxiety: Distress when away from caregivers
- OCD traits: Obsessive thoughts, compulsive behaviors
- Situational Anxiety: Anxiety about specific situations or changes
Why Is Anxiety So Common in Autism?
Many things cause high anxiety in autism:
Neurological Factors
- Heightened amygdala (fear center) activity
- Difficulty with uncertainty and prediction
- Differences in interoception (body awareness)
- Sensory processing differences
- Overlapping genetic factors
Experiential Factors
- History of negative social experiences
- Bullying or social rejection
- Feeling "different" without understanding why
- Past sensory trauma
- Failed attempts at fitting in
Environmental Factors
- Unpredictable social world
- Sensory-unfriendly environments
- Pressure to mask or conform
- Lack of accommodations
- Not being understood
Processing Differences
- Difficulty reading social cues creates uncertainty
- Literal thinking may amplify worries
- Strong memory for negative experiences
- Difficulty with cognitive flexibility
- Intense focus on worries
How Anxiety Presents Differently in Autism
Anxiety can look different in autism. It is often missed or misunderstood.
Behavioral Presentations
- Increased stimming
- Meltdowns or shutdowns
- Aggression or irritability
- Avoidance and refusal
- Increased rigidity or controlling behavior
- Regression in skills
- Changes in eating or sleeping
- Withdrawal or isolation
Physical Presentations
- Stomach aches, headaches
- Bathroom urgency
- Appetite changes
- Fatigue or exhaustion
- Sleep difficulties
- Muscle tension
- Rapid heartbeat
- Restlessness
Why It's Often Missed
They might not say they are anxious. Behaviors like meltdowns can be a sign. Some struggle to know their own feelings.
Common Anxiety Triggers in Autism
Understanding triggers helps with prevention and support:
Uncertainty & Change
- Changes in routine or schedule
- Not knowing what to expect
- Transitions between activities
- New environments or situations
- Broken promises or changed plans
Social Situations
- Unpredictable social interactions
- Group settings
- Fear of saying the "wrong" thing
- Not understanding social expectations
- Fear of rejection or judgment
- Performance situations (presentations, tests)
Sensory Environment
- Overwhelming sensory input (see our sensory guide)
- Anticipating sensory discomfort
- Lack of control over environment
- Unpleasant past sensory experiences
Demands & Expectations
- Pressure to mask or act neurotypical
- Too many demands at once
- Fear of making mistakes
- Perfectionism
- Unclear expectations
Strategies to Support Anxious Autistic Individuals
1. Increase Predictability
- Use visual schedules and timers
- Prepare for changes as far in advance as possible
- Provide clear, concrete information about what will happen
- Use "First-Then" boards
- Create consistent routines
- Give warnings before transitions
2. Address Sensory Needs
- Create sensory-safe environments
- Provide sensory tools (headphones, sunglasses, fidgets)
- Allow sensory breaks
- Reduce sensory demands when possible
- Work with an occupational therapist
3. Reduce Unnecessary Demands
- Prioritize essential demands during high-anxiety times
- Allow escape routes from overwhelming situations
- Reduce pressure to mask or perform socially
- Provide downtime and recovery periods
- Recognize when anxiety is behind "behavior"
4. Teach Coping Skills When Calm
- Practice strategies during low-anxiety times
- Use visual supports for coping steps
- Identify early warning signs together
- Create a "calm down kit" or plan
- Consider adapted breathing exercises or grounding techniques
5. Validate and Accept
- Take their anxiety seriously – don't dismiss it
- Validate that their experience is real
- Avoid minimizing ("there's nothing to be scared of")
- Model calm responses
- Praise brave attempts, not just outcomes
6. Support Social Situations
- Practice social scenarios in advance
- Use social stories
- Provide scripts for common situations
- Identify safe people to go to
- Allow breaks from social demands
Clinical Director's Insight
"Anxiety drives many behaviors. I have seen this for 20 years. Fixing triggers helps a lot. It improves life for the whole family."
– Jennifer Harbour, M.S., BCBA
Anxiety Therapy for Autistic Individuals
Traditional anxiety treatments can be effective when adapted for autism:
Modified Cognitive Behavioral Therapy (CBT)
CBT can be effective when adapted to include:
- Visual supports and concrete examples
- Special interests incorporated into treatment
- Longer treatment duration
- Parent/caregiver involvement
- Sensory factors addressed
- Social skills components
- Less reliance on abstract thinking
Other Therapeutic Approaches
- Acceptance-based therapies: ACT, mindfulness
- Occupational therapy: For sensory-related anxiety
- Play therapy: For younger children
- Art or music therapy: Alternative expression
Finding the Right Therapist
- Experience with autism specifically
- Understanding of sensory needs
- Willingness to adapt approaches
- Neurodiversity-affirming perspective
- Good fit with your child's communication style
Medication Considerations
For some autistic individuals, medication may be helpful alongside behavioral strategies:
- SSRIs (selective serotonin reuptake inhibitors) are commonly prescribed
- Often start at lower doses than typical due to sensitivity
- Side effects may present differently
- Close monitoring is important
- Medication works best alongside behavioral support
Always consult with a physician experienced in autism when considering medication. Discuss both potential benefits and risks.
Start Your Child's Journey Today
Buzz ABA provides comprehensive, evidence-based ABA therapy in Concord, Manchester, Nashua, and surrounding NH communities. Our neurodiversity-affirming approach helps children thrive.
Start Your JourneyFrequently Asked Questions
Why is anxiety so common in autism?
It affects 40-80% of autistic people. Only 15% of others have it. Causes include sensory overload and fear of change. Masking and past trauma also play a role.
How does anxiety present differently in autism?
It can look like more stimming or meltdowns. Some kids shut down or act out. Others become rigid or avoid things. They might not say they are worried.
What triggers anxiety in autistic children?
Triggers include sensory overload and routine changes. Social situations can be hard too. New places and uncertainty are common causes. Fear of mistakes matters also.
How can I help my autistic child with anxiety?
Use routines and visual schedules. Prepare for changes early. Create safe spaces. Teach coping skills when they are calm. Validate their feelings.
Can autistic children benefit from anxiety therapy?
Yes, therapy helps. CBT works well when adapted. It uses visuals and clear examples. Look for a therapist who knows autism.
Related Resources
Understanding Masking
How masking contributes to anxiety and burnout.
Routine & Transitions
Managing anxiety around changes and transitions.
Understanding Meltdowns
Anxiety often contributes to meltdowns – learn more.
Holiday & Event Survival
Managing anxiety during holidays and social events.
Sensory Issues in Autism
Sensory overload is a major anxiety trigger.
Understanding PDA
Anxiety-driven demand avoidance in autism.