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How to Treat Anxiety in Autistic Children & Adults

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