Autism and Anxiety: An Underrecognized Combination
Approximately 40–60% of autistic people have a co-occurring anxiety disorder. Anxiety in autism often looks different from anxiety in neurotypical children — it may present as:
- Increased stimming (stimming escalates under anxiety)
- Meltdowns that seem "out of proportion" to triggers (anxiety + sensory load = overload)
- Rigid insistence on sameness (control as anxiety management)
- Sleep difficulties
- Somatic complaints (stomach aches, headaches before school)
- Avoidance of previously enjoyed activities
- Excessive questioning and reassurance-seeking
What Causes Anxiety in Autistic Children
Sensory sensitivity: Being in sensory-painful environments constantly is stressful.
Social confusion: Not understanding social rules and expectations is anxiety-provoking.
Predictability need: The world is inherently unpredictable, which conflicts with autistic need for routine.
Communication difficulties: Not being able to express needs or understand others generates ongoing stress.
Masking: Suppressing autistic behavior to fit in is exhausting and generates chronic anxiety.
Evidence-Based Anxiety Strategies for Autistic Children
Predictability and preparation: Detailed advance notice, visual schedules, previewing new situations through Social Stories™ or video.
Identifying and reducing sensory triggers: Environmental modifications (headphones, adjusted lighting, scheduled breaks).
AAC and communication support: Reducing communication uncertainty reduces anxiety.
Adapted CBT: Cognitive behavioral therapy adapted for autism uses visual supports and focuses on concrete strategies.
Medication: SSRIs may be indicated for significant anxiety — discuss with psychiatrist.