Autism & Anxiety: Connections, Support Options, & Tips for Coping

What Is Anxiety?

Anxiety disorders are characterized by symptoms of immense worry, distress, and overwhelming nervousness that can greatly interfere with a person’s ability to function. Situational anxiety and specific phobias are typically linked to a certain set of triggers, whereas experiencing constant anxiety for any number of reasons may be diagnosed as generalized anxiety disorder (GAD).

The symptoms of anxiety differ based on the person, but are generally similar across the board. However, increased stress can exacerbate symptoms, making it more challenging for a person to cope with these disorders.

Common symptoms of anxiety include:

• Sleep disturbances
• Changes in appetite
• Restlessness
• Extreme worry
• Intense, ongoing negative thoughts
• Fatigue
• Headaches
• Stomachaches
• Unexplainable pains

How Does Anxiety Show Up In Autistic Individuals?

While the symptoms of anxiety are the same for autistic people as for neurotypical individuals, how these are exhibited differs. For example, an autistic person may experience anxiety if they notice others responding judgmentally to their autistic scripting or stimming behaviors. They are also often overwhelmed by certain stressors, which can lead to sensory overload.

Unfortunately, some people do not know how to react to an autistic individual’s difficulties relating to anxiety. Because of this, receiving adequate support as an autistic person can be challenging. This can further feed into the cycle of distress as an autistic person passes through different life stages.²

Anxiety in autistic individuals may be exhibited as:

Social Difficulties

Autism impacts how a person reacts to and behaviors in social situations. This in and of itself does not always cause problems for an individual, but may increase some autistic people’s anxiety nonetheless. For example, they may become concerned about how their social differences are being perceived by those around them. In turn, an autistic person may feel a need to mask their autistic symptoms through “social camouflaging,” which can be uncomfortable and draining.³

The anxiety that often accompanies social camouflaging can cause even more anxiety for an autistic person. When this distress builds up and becomes overwhelming, it can result in autistic burnout.

Distress Over Routine Changes

Autistic individuals have a preference for routine and sameness. Because of this, when a person’s schedule is disrupted or changed, they can struggle to find ways to adapt. Predictability and certainty is important for autistic people, so not knowing what to expect from a situation leads to increased anxiety.

Communication Challenges

Some autistic individuals find it difficult to express their emotions to others when facing challenging or problematic situations. Additionally, they may fear that how they communicate these feelings to others may be seen as odd or strange, which can lead to increased anxiety.

Sensory Overload

Sensory sensitivities are strongly associated with autism, and may include being easily bothered by noises, disliking the texture of certain foods, or reacting strongly to types of clothing. Unfortunately, these sensitivities can result in increased levels of anxiety for autistic individuals.⁶ Becoming overwhelmed by external stimuli, especially loud noises, can snowball and result in sensory overload.

Social Withdrawal

When an autistic person faces difficulties in social situations, they may respond by withdrawing entirely.⁷ This is often linked to how the individual feels about being perceived or judged by others because of their differences.

While there certainly is a tendency for autistic individuals to prefer time alone and less social interaction than neurotypical individuals, this preference does not produce anxiety or lead to social withdrawal.

Separation Anxiety

When an autistic person experiences separation anxiety, it may be due to the sense that they will not be able to successfully navigate a situation without a trusted companion. Being separated from this person can increase one’s fear of failing or not having support available when needed.

What Causes Autism & Anxiety?

Anxiety in autism is often related to problems associated with handling social situations and emotional distress. There also is evidence brain differences in autistic people can make them more susceptible to anxiety.⁸

Possible explanations for anxiety in autistic individuals include:

• Lack of support: Anxiety in autism may be associated with a person feeling that they lack the support they need to handle a certain situation.
• Genetic factors: Genetic factors often play a major role in any comorbidity of autism with other conditions.
• Social pressures: An expectation for autistic people to act like everyone else around them can increase anxiety.(FN9)
• Sensory sensitivities: Experiencing strong emotional distress related to sensory sensitivity can be a very strong cause of increased anxiety in autism.
• Poor self-esteem: Feeling negative about oneself is often a contributing factor to anxiety. Low self-esteem may increase the likelihood of developing anxiety as an autistic person.

Signs of Anxiety in Autistic Individuals

A major sign of anxiety in autistic individuals is often an increase in repetitive and disruptive behaviors. A person will also experience other common symptoms of anxiety such as restlessness, withdrawal, or tension. Being able to identify when anxiety occurs is important, as this can help determine the best approach to mitigating symptoms.

Signs of increased anxiety in autistic individuals may include:

• Increase in repetitive or stimming behaviors
• Insomnia
• Verbal statements of worry
• Loud and angry refusals
• Restlessness
• Social withdrawal
• Verbal or physical aggression
• Physical tenseness
• Negative statements
• Statements reflecting feel loss of control
• Arguing

How Is Anxiety Diagnosed in Autistic Individuals?

Seeking a professional who is experienced in both autism and anxiety can help you receive an accurate diagnosis. This will often include tools used specifically for identifying anxiety symptoms, such as psychological tests developed for autistic individuals with anxiety.¹⁰

Treatment for Anxiety in Autistic Individuals

Learning better communication or social skills, as well as ways to handle difficult situations and emotions, is important when addressing anxiety symptoms. Psychotherapy is typically recommended first, with medication sometimes being used in combination with therapy.

However, it’s important to remember that it is not your responsibility to hide or mask your differences from others–and therapy isn’t designed to teach you how to, either. In contrast, it can help you learn how to address the negative thoughts you may have about yourself.

Therapy Options

Therapy for treating anxiety symptoms in autistic individuals focuses on helping clients develop better skills for navigating challenging or emotional situations. It is often most helpful to find a neurodiversity-affirming therapist who has experience with both autistic clients and anxiety.

Family therapy can be beneficial in some cases, but not always. If family members become too involved in an autistic person’s treatment,  this can take away the person’s sense of autonomy.

Therapy options for anxiety in autistic individuals may include:

• Cognitive behavioral therapy (CBT): CBT for anxiety and autism helps a person recognize how their negative thoughts impact their behaviors. This allows them to make necessary changes, build better coping skills, and handle challenging situations more effectively.
• Exposure therapy: Exposure therapy is used to help build a client’s resilience to anxiety triggers by having them face distressing situations directly.
• Functional analytic therapy: With this approach, sessions focus on clients practicing how to react to social interactions. This can help them become more comfortable when interacting with others, thus decreasing their anxiety when communicating.¹¹
• Family therapy: Family therapy can help family members learn and adopt effective communication skills with one another.
• Online therapy: Online therapy options are particularly helpful as it can lessen the anxiety often associated with starting therapy. It is also helpful for those who prefer receiving treatment in the comfort of their own home, rather than at a therapy office.
• Music Therapy: Music therapy for autism helps to increase emotional regulation, as well as verbal and non-verbal communication. It also help autistic individuals to develop their motor skills.

Medications

When it comes to treating anxiety disorders, considering medication is often best only when other approaches have not been effective. However, anxiety medications can be beneficial for some, so speak with a medical or mental health professional if you are interested in learning more.

7 Tips for Coping With Anxiety in Autism

Anxiety can be very challenging to deal with, but there are healthy ways to cope and reduce symptoms. Finding and using more effective ways to approach challenging situations is a good first step. You may be able to do some of these things on your own, but having the guidance of a mental health professional along the way can be beneficial and insightful.

Below are seven tips for coping with anxiety as an autistic person:

1. Maintain Emotional Self-Care

Practicing emotional self-care may involve utilizing relaxation skills, practicing gratitude, or finding a sense of purpose. Doing so can help you feel more in control over important aspects of your life, which can be particularly helpful when coping with anxiety.

2. Address Your Triggers

Addressing your anxiety triggers is important, and involves identifying the specific situations contributing to your symptoms and finding effective ways to navigate them. Common triggers may include life transitions, negative self-talk, or bullying. Notice whether these are external (related to your environment) or internal (related to your thoughts) in order to address them in realistic ways.

3. Seek Professional Support

Finding a professional familiar with both autism and anxiety can be one of the best ways to address anxiety symptoms. Occupational therapists can also help you learn better ways to handle sensory sensitivities, and speech therapists can teach you useful communications skills.  Developing these skills can decrease the emotional distress you may feel when interacting with others.

4. Spend Time Alone

Autistic people can feel overwhelmed by messages about the importance of staying social and making new friends. However, it’s important for you–and everyone in general–to set aside time for yourself. Becoming more comfortable with yourself, and having space to destress and unwind, can decrease negative thoughts associated with anxiety.

5. Practice Breathwork

When practicing relaxation techniques, learning how to use breathwork to your advantage is helpful. There are many forms of this method, and there are numerous books and online resources that can help you develop and hone this skill.

6. Find Meaning & Purpose

Whether it’s your job, volunteer opportunity, or quality time with others, engaging in meaningful and purposeful activities can be especially helpful for reducing anxiety. Finding ways to become involved in things you enjoy increases your positivity and sense of belonging, thus decreasing the negativity associated with anxiety.

7. Exercise Regularly

Staying physically active is important when working to reduce anxiety. Exercise increases endorphins in the body, and provides physiological responses that help lessen the fight-or-flight response associated with anxiety.

Final Thoughts

Autistic individuals often experience anxiety at various points throughout their lives, whether it be due to communication challenges, sensory experiences, or changes in routine. However,  while this can be challenging to cope with, there are effective ways to cope with and treat symptoms of anxiety. You don’t have to do this alone–seeking support is helpful.