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.

Reviewed by Jennifer Harbour, M.S., BCBA

•Published: January 15, 2025

Our Perspective

"We've seen firsthand how anxiety can be a silent barrier for so many children. It's not just about 'behavior'—it's about a nervous system that feels unsafe. At Buzz ABA, our goal isn't just to teach skills, but to build the confidence and emotional safety that allows a child to step out into the world without fear."

Anxiety and autism frequently occur together, and understanding this connection is crucial for providing effective support. When anxiety is addressed, many other aspects of functioning often improve as well.

How Common Is Anxiety in Autism?

Research published in the Journal of Autism and Developmental Disorders indicates that anxiety disorders affect 40-80% of autistic individuals, compared to about 15% of the general population.

According to the National Institute of Mental Health, anxiety is one of the most common co-occurring conditions with autism.

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?

Multiple factors contribute to the high rates of anxiety in autistic individuals:

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 may not look like "typical" anxiety in autistic individuals, which can lead to it being missed or misinterpreted:

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

Autistic individuals may not verbalize anxiety in typical ways, especially those with communication differences. Behaviors like avoidance or meltdowns may be attributed to "autism" rather than recognized as anxiety symptoms. Additionally, alexithymia (difficulty identifying emotions) can make it hard for the person themselves to recognize they're anxious.

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

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Clinical Director's Insight

"In my 20+ years of working with autistic children and families, I've seen how anxiety often underlies many of the behaviors that concern parents most. When we identify and address anxiety triggers – whether sensory, social, or related to uncertainty – we often see dramatic improvements in overall functioning and quality of life."

– 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.

Schedule Free Consultation

Frequently Asked Questions

Why is anxiety so common in autism?

Anxiety affects 40-80% of autistic individuals, compared to about 15% of the general population. Contributing factors include sensory overwhelm, difficulty predicting social situations, fear of change, past negative experiences, masking exhaustion, and neurological differences in how the brain processes uncertainty and threat.

How does anxiety present differently in autism?

Anxiety in autism may look different: it can present as increased stimming, meltdowns, shutdowns, aggression, avoidance, rigid/controlling behavior, physical symptoms, sleep problems, or increased repetitive behaviors. Traditional anxiety signs like verbalizing worry may be less common, especially in those with communication differences.

What triggers anxiety in autistic children?

Common triggers include sensory overload, changes in routine, social situations, transitions, unexpected events, new environments, uncertainty about what will happen, feeling misunderstood, pressure to mask or act neurotypical, and past traumatic experiences. Many autistic individuals are also anxious about making mistakes or being judged.

How can I help my autistic child with anxiety?

Strategies include: providing predictability through routines and visual schedules, preparing for changes in advance, creating sensory-safe spaces, teaching coping skills when calm, validating feelings, reducing unnecessary demands, addressing underlying sensory needs, and working with therapists experienced in autism and anxiety. Avoid forcing exposure without support.

Can autistic children benefit from anxiety therapy?

Yes, with appropriate modifications. Traditional CBT (Cognitive Behavioral Therapy) can be effective when adapted for autism – using visual supports, concrete language, and addressing sensory and social factors. Look for therapists experienced with neurodivergent clients. Some autistic individuals benefit from different approaches like acceptance-based therapies or occupational therapy for sensory-related anxiety.