There’s a saying that if you’ve met one autistic person, you’ve met one autistic person.
The truth is that no one person on the autism spectrum is the same as another.
Still, research suggests that autistic people as a whole may be more prone to anxiety.
To the layperson, autism spectrum disorder (ASD) and anxiety may look similar, and it may be difficult to distinguish between them.
Experts say that a better understanding of the relationship between autism and anxiety can help improve quality of life for autistic people.
Here’s what we know — and don’t know — about autism and anxiety.
Research suggests that anxiety is more common in autistic people.
A 2019 study of sibling pairs indicated that about 20 percent of autistic people had anxiety compared with about 9 percent of the population controls.
“Many [autistic] people are fully aware they’re struggling in ways their peers may not be, and that they have some sensitivities and issues that their peers may not,” says Dr. Jephtha Tausig, a New York City-based clinical psychologist.
Just as no two people on the spectrum are alike, no two people with anxiety are the same.
Knowing some of the common and unique characteristics in autistic people can aid in diagnosis and support.
According to board certified pediatric neurologist Dr. Dilip Karnik, there may be similarities in people with anxiety, whether they’re on the spectrum or not, including:
- separation anxiety, or distress when separated from a loved one or caregiver
- difficulty transitioning to new environments
- nervousness or fear over meeting new people
Tausig believes anxiety in autistic people may feel even more distressing.
She says it may be particularly upsetting if the distress is caused by a change to a routine, a common experience for autistic people.
“When they feel a surge in anxiety, it can feel disorienting and discombobulating… in addition to the feeling of the anxiety itself,” she says.
Anxiety can present through behavioral symptoms in autistic people, some of which may overlap with autism itself.
The Anxiety and Depression Association of America says common behaviors in both autistic people and people with anxiety include:
- a severe, specific, and irrational phobia
- obsessive-compulsive disorder (OCD)
- intense fear of being judged in social situations, or social anxiety
- separation anxiety
- severe distress about changes to a routine or environment
Tausig notes that anxiety becomes a problem when it affects day-to-day living.
“If it’s interfering with work, school, and life, it may meet diagnostic criteria,” Tausig says.
If you’re concerned about an adult loved one, Tausig suggests speaking with them about their feelings. She advises asking whether they feel anxious or another emotion, such as anger.
Tausig stresses that self-diagnosis of developmental and mental health conditions is not the best route. She recommends seeing a neurologist or psychologist for an official diagnosis.
Still, taking note of symptoms can be the first step in getting evaluated. Learn more in the Resources section of this article.
When it comes to communicating, people on the spectrum may speak to varying degrees, including not at all.
“For individuals without much language, observation and discussion with those who know them very well can be helpful,” Tausig says.
Caregivers can take a similar approach with children.
“Have conversations and observe,” Tausig says. “What are they avoiding? What is making them upset? What are the triggers? Why? In older children who are speaking and can label their feelings, you want to encourage them to let them know what’s going on.”
Autism is neurodevelopmental, whereas anxiety is a mental-emotional.
Still, the area of the brain involved in the expression of fear, called the amygdala, may play a role in comorbid anxiety and ASD, according to a
Karnik says development may play a role as well.
“In [neurotypical] children, the amygdala continues to grow into adulthood,” Karnik says. “But in children [on the spectrum], it grows faster in the early period — until around 12 years old — and then slows down. Sometimes, it may even shrink. These areas play a significant part in the behaviors of children [on the spectrum], especially anxiety.”
Social and emotional factors may also contribute to anxiety.
Autistic people may need support to learn how to read body language and other social cues. Sometimes these situations can make them feel overwhelmed and anxious.
Knowing symptoms may empower you to reach out for an evaluation for yourself or a loved one. Though symptoms will vary, here are some common ones to look out for.
General symptoms of anxiety
- feeling on edge
- trouble with concentration and memory
- muscle tension
- uncontrollable worries
- reduced amount or quality of sleep
Tausig adds that anxiety can also present in other ways, including:
- avoiding certain situations, such as crossing the street
- excessive sweating
- increased heart rate
Social anxiety vs. generalized anxiety
Tausig clarifies that people with social anxiety are more focused on situations involving people, such as giving a presentation at work or meeting friends for dinner.
“It has to do with someone feeling that others’ evaluations of them are going to be negative,” she says.
Researchers also suggested that the core traits of autistic people may contribute to their social anxiety, though more research on the topic is needed.
Separation anxiety is common in young autistic people, but can also show up in adults.
Tausig says an autistic child with separation anxiety will not necessarily develop anxiety later in life.
“It’s not an absolute indicator,” she says.
Anxiety is common in autistic people, and a trained healthcare professional can distinguish between the two conditions.
“Children with ASD need a very comprehensive evaluation and medical history, which should include discussing social anxiety, generalized anxiety, or any specific phobias,” Karnik says. “Anxiety and ASD symptoms [often] overlap, therefore careful screening is needed in these cases.”
Karnik suggests seeing a behavioral psychologist for a screening. They can ask questions about symptoms and triggers, which can help make a correct diagnosis. Adults can also benefit from these screenings.
The following treatments and supports can be effective for both autistic and nonautistic people who have anxiety.
Treatment for anxiety can include:
- cognitive behavioral therapy (CBT)
- exposure therapy
- management techniques
- lifestyle changes
Additional supports for anxiety can include:
- breathing exercises
- natural remedies
- complementary treatments, like acupuncture or hypnosis
The most important part of getting an anxiety diagnosis is that it allows people to get the right treatment and support.
Many strategies can help autistic people with anxiety manage their symptoms based on their individual goals. Different methods fall into different categories, like:
- environmental strategies
- behavioral interventions and skill-building
- cognitive behavioral therapy and psychotherapy
- personal strategies
Autistic people with anxiety can often go to school, work, and live fulfilling lives. Some basic strategies can help people cope in public or at home.
Tausig recommends caregivers work with the school to find “outs” for a child when they feel triggered.
“If the student is feeling upset, can they raise their hand or show the teacher a special signal that allows them to leave the classroom to get a drink of water?” Tausig suggests. “Just knowing some sort of agreed-upon strategy [is there] can do a lot to help mitigate somebody’s distress.”
In the workplace
As a person enters adulthood and the workforce, building on the coping strategies they learned as a child can help them self-soothe in professional settings.
“This is where being aware of how you’re feeling is important,” Tausig says. “Really see what will be helpful for you in that moment.”
Focusing on breathing, going for a short walk, and getting a drink of water are all strategies Tausig recommends.
In social settings
Similar to the workplace, coping in social situations often means managing symptoms with others around.
“You can do [deep belly breathing] in public, and no one needs to know what you’re doing because it isn’t visible,” Tausig says.
When it’s too difficult to hide anxious feelings, Tausig adds that asking to be excused and finding a quiet space like the bathroom may help.
At home, taking time to recharge and do self-care can help reduce anxiety.
Getting enough sleep is important, too, Tausig says.
“If you’re stressed and overtired, that’s a form of stress on your system and can make anxiety worse,” she says.
Tausig also recommends exercising and eating well.
Eating a balanced diet is key. Foods that are high in sugar or overly processed can cause spikes and crashes in glucose levels that can mimic feeling anxious, she says.
Behavioral interventions and skill-building
Beyond coping mechanisms, specific behavioral strategies often help autistic people with anxiety. These may improve social interactions and academic or professional performance.
Social skills training
Tausig says social skills training can help autistic people interact with others, such as knowing to say hello when they enter a building or asking someone about their day.
A small 2013 study involving 58 adolescents ages 11 to 16 suggests that people who participate in social skills training have better knowledge of friendship skills and less social anxiety than their peers.
Applied behavioral analysis
Applied behavioral analysis (ABA) centers around decreasing unhelpful behaviors that may draw unwanted social attention.
For example, a student can ask to leave class if they’re anxious rather than disrupting the other students.
This method involves rewarding desirable behavior and setting consequences for undesirable behavior.
But not everyone wants to replace behaviors related to autism, such as flapping.
At the same time, Tausig advises against forcing ABA on anyone.
“Everybody is different,” she says. “If there’s a struggle to get them to the ABA facility or welcome the ABA person to school or home and it’s not getting anywhere, I don’t know it makes sense to push things further.”
Occupational therapy can help people learn skills needed to live self-sufficient lives, including brushing teeth and hair.
Karnik recommends it particularly for younger people, and says he’s seen the benefits.
“Many children with sensory integration disorder will benefit from early intervention and modification by utilizing [occupational therapy] or speech therapy to improve their problems with touch, loud sounds, taste or light sensitivity,” he says.
Cognitive behavioral therapy and psychotherapy
Cognitive behavioral therapy (CBT) shows a lot of promise for reducing anxiety in both people who are autistic and those who aren’t.
One 2013 study of autistic children ages 7 to 11 with anxiety indicated a significant improvement in anxiety symptoms in the participants after 16 weeks and 32 CBT sessions.
The sessions focused on emotional regulation and social coaching to improve peer interactions.
Medication won’t cure anxiety, but it may help manage symptoms, according to Karnik.
“SSRI medications have been seen to be effective in anxiety,” he says.
- sertraline (Zoloft)
- fluoxetine (Prozac)
- escitalopram (Lexapro)
Other medications that may be prescribed to treat anxiety include:
Karnik suggests that people, particularly children, undergo a full evaluation by a neuroscience expert, such as a neurologist or psychiatrist, before taking medications.
Personal strategies that can help you or a loved one manage anxiety include:
- taking time for hobbies and passions
- setting aside time to vent your worries
Tausig recommends practicing mindfulness regularly to manage anxiety. This may help by providing strategies to use when in public.
Having passions outside of work and friends is also a form of self-care.
“Help volunteer in your community if it makes you feel good,” she says. “It’s not always about work. Balance is important.”
People can also have “stress time” each night, where they set a timer for 15 minutes, write down or say their worries, and then put them to rest when the timer goes off, she says.
Testing and support are best done in conjunction with professionals. If you or a loved one are on the autism spectrum, have anxiety, or both, help is available.
Tausig says autistic people who may also have anxiety should get a psychological or neuropsychological evaluation.
You can find a psychologist or neurologist through:
- your insurance company
- a referral from your primary care doctor or pediatrician
- your child’s school
- Healthline’s FindCare directory
Once there’s a formal diagnosis, there are plenty of resources to find a therapist. In addition to the options listed above, you can find a therapist through:
- employee assistance programs
- friend and family referrals
- the National Alliance on Mental Illness (NAMI)
Not all autistic children or adults will benefit from support groups, though some may.
Parents of autistic children who may have anxiety can also find support groups.
In addition to the options listed above, you can find support groups through:
- local nonprofits
- local hospitals
- Mental Health America
Autism and anxiety can have similar symptoms, such as difficulties in social situations and with routine changes.
Still, they are separate, though often co-occurring, conditions.
Autism is neurodevelopmental, while anxiety is a mental health condition. Research indicates that autistic people are more prone to having anxiety than the general population.
Autistic people who may have anxiety should receive a formal evaluation by a mental health professional.
Utilizing coping mechanisms and services, like mindfulness, CBT, ABA, and social skills training, can help make anxiety more manageable.
Beth Ann Mayer is a New York-based writer. In her spare time, you can find her training for marathons and wrangling her son, Peter, and three furbabies.