We all experience anxiety from time to time, but for autistic individuals, anxiety can be a frequent and overwhelming companion.
Autismand anxiety often intertwine, creating a complex landscape for those navigating both experiences.
There are many possible reasons why an autistic person may experience anxiety, as well as different ways in which anxiety may present in autism.
The relationship between autism and anxiety is multifaceted, with each condition potentially exacerbating the other.
Understanding this intricate connection is crucial for autistic individuals, their families, and healthcare professionals alike.
This article explores the unique ways anxiety manifests in autism, the factors that contribute to heightened anxiety in autistic individuals, and effective strategies for managing these challenges.
Signs of anxiety in autistic individuals
Autistic individuals may display anxiety in many ways. Below are some common signs that may indicate someone is experiencing anxiety.
It’s important to note that anxiety may manifest differently in each autistic individual. Some may show more obvious signs, while others might internalize their anxiety.
Many of the signs of anxiety in autism may overlap with those associated with signs of sensory overload orautistic burnout.
There is probably not a clear distinction between anxiety and these other autistic experiences, it is likely they all impact each other or anxiety is the starting point before sensory overload and then eventually burnout occurs.
If an autistic person also has a co-existing anxiety disorder, they might also show the typical signs associated with these.
What can cause an autistic person to be anxious?
There are several ways in which anxiety can be triggered in autistic individuals. Below are some of these ways, but note that this is not an exhaustive list:
Sensory differences
Autistic individuals often experience sensory sensitivities, andresearch has shown a correlationbetween sensory processing difficulties and anxiety in autistic individuals.
“The idea of going to shopping malls makes me extremely anxious. The bright, florescent lights, loud chatter of other shoppers, crowds, and feeling stuck indoors can make me feel panicked and overstimulated. If I want to shop, I would prefer to shop on a high street and at quieter times, so I have access to fresh air and less noise.”
Communication differences
Communication difficulties can hinder an autistic individual’s ability to express their anxiety and internal experiences, making it difficult for others to recognize and provide appropriate support.
The inability to effectively communicate their needs and anxieties can lead to feelings of being misunderstood, which can further exacerbate anxiety.
“When I’m given the time to process and be creative, I can articulate words well. It’s just when speaking I feel pressured and rushed to respond.”
Social situations
Navigating social situations can be particularly challenging for autistic individuals due to inherent difficulties withsocial communication and interaction.
These difficulties can lead to heightened social anxiety, as autistic individuals may experience anxiety related to potential negative evaluation or judgment from others.
“Often, I would just stay quiet in social situations because they felt too stressful. Then, I would be labeled as shy. I developed an aversion to that word because it always felt like it was used as a criticism against me as a kid.”
Changes in routine and uncertainty
The need for predictability and adherence to routines is common among autistic individuals, and deviations from established routines or exposure to unexpected events can be particularly anxiety-inducing.
Research indicates thatdifficulties withuncertaintyare prevalent among autistic individuals and are strongly associated with anxiety.
“I have this need to always know exactly what is going on. If something doesn’t make sense and no one is able to tell mewhysomething is the way that it is, then I feel anxious because I do not have the full picture.”
Masking or camouflaging
Camouflaging, which involvesmasking or compensating for autistic traits, can lead to increased anxiety in autistic adults. This is because the effort to maintain a ‘neurotypical’ facadeis often experienced as draining and stressful.
Autistic individuals may feel anxious before or during times of masking because of this.
Moreover, camouflaging can create a sense of inauthenticity and disconnect from one’s true self, potentially leading to lower self-esteem, feelings of isolation, and a diminished sense of belonging.
“Once I realized I was autistic, it made me rethink my whole personality and the way I acted, and I realized that I was pretty disconnected from who I actually was deep down and that I’d been repressing a lot of my interests. Realizing this really helped me reconnect with myself, but it also started feeling more and more exhausting to mask because I was repressing so much of myself and acting in a way unnatural to me.”
Executive function demands
Executive functioning demands can trigger anxiety in autistic individuals due to challenges with information processing.
The need to quickly filter, prioritize, and respond to multiple inputs can be overwhelming, especially paired with multiple stimuli at once.
This can cause confusion and fear of misunderstanding, especially in fast-paced environments requiring quick processing and decision-making, resulting in heightened anxiety.
“During this group project discussion at school, I had to process multiple people speaking at the same time, formulate my own responses, recognize when it was the appropriate time for me to speak, and try to problem-solve for the actual task at hand. All of this made me feel overloaded and that I could not participate effectively.”
Anxiety disorders in autism
Many autistic individuals may have co-existing anxiety disorders that can present with further difficulties or can exacerbate signs of anxiety associated with autism:
Social Anxiety Disorder
Social anxiety disorder (SAD) is consistently highlighted as a frequently diagnosed condition in autistic individuals. There also are a lot of overlaps in signs ofautism and social anxiety.
Challenges in social communication and interaction in autism can lead to social anxiety due to difficulties understanding social cues and fear of negative evaluation in social situations.
Research indicatesa strong association between SAD and difficulties with social skills, social functioning, and reduced social motivation in autistic individuals.
Social anxiety disorder in autism:
Specific Phobias
Specific phobias are very common in autistic individuals, particularly in children.
Specific phobias in this population can manifest as fears of common childhood stimuli (e.g., needles, insects, animals)as well as more uncommon or idiosyncratic fears.
The latter often relate to sensory sensitivities (e.g., loud noises, bright lights, specific textures), changes in routine, or unfamiliar situations.
Notably, these phobias frequently stem from sensory hypersensitivity, a core characteristic of autism.
Specific phobias in autism:
Generalized Anxiety Disorder
Autistic individuals with GAD may often experience worries about a wide array of topics, including school, finances, the future, and potential negative events.
Generalized anxiety disorder in autism:
Obsessive-Compulsive Disorder
While no longer classified as an anxiety disorder in the DSM-5,Obsessive-Compulsive Disorder (OCD) is often discussedin the context of anxiety in autistic individuals.
While present in both autistic and non-autistic individuals, OCD can stem from distinct underlying mechanisms. For instance, in autism, these may be rooted in a need for sameness and predictability rather than solely from anxiety.
Obsessive-compulsive disorder in autism:
Managing anxiety as an autistic person
Address your sensory sensitivities
Create a list of specific triggers that lead to anxiety or sensory overload in a journal. You could group these triggers into categories based on type:
Next, try to adjust your environment as much as you can to limit sensory input and have a sensory-friendly environment. This can depend on the situation you are in and what is causing you to feel anxious, for instance:
By proactively addressing sensory needs, autistic individuals can reduce anxiety triggers and create a more comfortable daily experience.
Communicate your needs
Ideally, communicating with people you live with, friends, and family is helpful for them to understand what makes you anxious and how they can help you.
Below are some ways in which you can communicate your needs:
It’s important not to rely on another person to help you entirely as you still need to put in the work yourself, but there may be things that they can feasibly do to help.
Plan ahead
Planning ahead is important because it can allow you to anticipate and prepare for challenging environments or situations.
By thinking through potential triggers and having strategies ready, you can reduce your anxiety and be better equipped to navigate potentially anxiety-inducing experiences.
Some examples of planning ahead include:
Sleep hygiene
Research indicatesa strong link between chronic sleep problems and anxiety in autistic adolescents and young adults. Addressing sleep issues can be a crucial aspect of anxiety management for autistic individuals.
Implement relaxation techniques before bed, such as gentle stretching, deep breathing exercises, or listening to calming music. Keep a sleep diary to track patterns and identify triggers that may be affecting your sleep quality.
Gradually unmask
Unmasking, or allowing yourself to be your authentic autistic self, can be a powerful tool for reducing anxiety. However, it’s important to approach this process gradually and thoughtfully.
Steps to start unmasking:
Gradually increase your unmasking as you become more comfortable. Remember to practice self-compassion throughout this process, as it can be emotionally challenging. Celebrate your progress and recognize that setbacks are normal.
Consider disclosing your autism to trusted individuals if you feel safe doing so. This can often lead to more understanding and allow for more authentic interactions. Seek support from friends, family, therapists, or support groups as needed.
Remember, unmasking is a personal journey that looks different for everyone. Find a balance that feels safe and authentic to you, and go at your own pace.
Have your own coping strategies
It can be crucial to equip yourself with a toolbox of coping mechanisms tailored to your individual needs and preferences when anxiety strikes.
Some ideas of these include:
Cognitive-behavioral therapy
Cognitive-behavioral therapy (CBT), a form of therapy that addresses negative thought patterns and behaviors, can be beneficial in managing anxiety in autistic individuals. This may be particularly helpful for those with co-occurring anxiety disorders.
However, it may be necessary to modify standard CBT approaches to better suit the cognitive and social-communication styles of autistic individuals.
Research suggeststhe following modifications may increase the effectiveness of CBT for autism:
References
Chen, Y., Hantman, R. M., & Tager-Flusberg, H. (2023). Parent-rated anxiety in autistic adolescents and young adults: Concurrent links to autism traits and chronic sleep problems.Research in Autism Spectrum Disorders,101, 102104.https://doi.org/10.1016/j.rasd.2023.102104
Hull, L., Levy, L., Lai, M. C., Petrides, K. V., Baron-Cohen, S., Allison, C., … & Mandy, W. (2021). Is social camouflaging associated with anxiety and depression in autistic adults?.Molecular autism,12, 1-13.https://doi.org/10.1186/s13229-021-00421-1
Jenkinson, R., Milne, E., & Thompson, A. (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis.Autism,24(8), 1933-1944.https://doi.org/10.1177/1362361320932437
Lau, B. Y., Leong, R., Uljarevic, M., Lerh, J. W., Rodgers, J., Hollocks, M. J., … & Magiati, I. (2020). Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics.Autism,24(5), 1111-1126.https://doi.org/10.1177/1362361319886246
Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018). Social anxiety in autism spectrum disorder: A systematic review.Research in autism spectrum disorders,52, 51-68.https://doi.org/10.1016/j.rasd.2018.04.007
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
