The core characteristics of autism spectrum disorder – also known as autism or ASD – include challenges with social skills, communication skills, and experiencing restricted or repetitive behaviors. These behaviors are different for everyone. Some examples of these types of behaviors that a person with autism might experience include flapping their hands, rocking back and forth, skin-picking, lining up toys, and more. In addition to these core traits of ASD, many people with autism have what are called co-occurring conditions. This means that, in addition to having autism, they also have another disorder. They could also have medical conditions in addition to their autism.
Co-Occurring Disorders with Autism Spectrum Disorder
Some disorders or conditions that often co-occur with autism include things like gastrointestinal disorders, autoimmune disorders, attention deficit hyperactivity disorder (ADHD), depression, obsessive compulsive disorder (OCD), and anxiety disorders. Having multiple conditions or disorders can make understanding a loved one’s behavior even more complex. However, in this article, we’ll share with you some more information specifically about the experience of people who have autism spectrum disorder as well as anxiety.
Anxiety Disorders and ASD
Anxiety disorders are the most common co-occurring conditions that are experienced by people with autism spectrum disorder. It is very important for parents, therapists, and educators to consider whether someone with ASD is experiencing anxiety. This can be difficult to do, though, as some behaviors that might seem to simply be a trait of autism could also be related to anxiety. For instance, having trouble with small talk or staying engaged in a conversation could be a symptom of autism as this relates to the characteristic of autism that has to do with communication and social difficulties. However, this same behavior can be related to anxiety since anxiety can make a person very uncomfortable when it comes to talking to other people.
Approximately 40% of young people with autism have clinical levels of anxiety or at least one anxiety disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety disorders are generally considered disorders which result in a person experiencing excessive fear, anxiousness, and related behavioral disturbances.
Types of Anxiety Disorders that can be Experienced by People with Autism
Anxiety disorders include the following:
- Separation anxiety disorder
- Selective mutism
- Specific phobias
- Social anxiety disorder
- Panic disorder
- Generalized anxiety disorder
Other disorders that are closely related to anxiety disorders but that are no longer identified as anxiety disorders in the most recent DSM (the DSM-5), but that were previously considered anxiety disorders include:
- Obsessive-compulsive disorder
- Acute stress disorder
- Posttraumatic stress disorder
Recognizing Anxiety as it is Experienced by a Loved One with Autism
As we look at the possible disorders that a person with autism might also experience, specifically anxiety-related disorders, it’s clear to see how complex it can be to differentiate between what behaviors might be related to their anxiety and what behaviors might be related to their autism. This is important to acknowledge; however, it is not something to get too caught up on when trying to help someone with autism as it is not always possible to completely separate autism and anxiety from the person’s experience. They can be very inter-connected. If we recognize that the person with autism also experiences anxiety, we can try to express care and compassion when encouraging them to learn new things and trying to encourage them to move outside their comfort zone.
For instance, with the example we provided earlier about someone struggling with conversations, parents and therapists can identify what is important for the individual and what is in the child’s best interest when it comes to being able to have conversations with others. They can also consider what the child would like to achieve if the child is able to communicate or express a preference about this. And then, knowing that the child experiences anxiety related to communicating with others AND knowing that autism makes communicating with others more difficult than it might be for people without autism, the parent or therapist can gently support the child in working toward their goals but also not push the child so far that they experience extreme distress or prolonged discomfort. This can make anxiety even worse.
Another way in which anxiety might affect ASD symptoms is that when a person experiences more anxiety, they might also experience greater rates of restricted or repetitive behaviors. This means that a person who picks at their skin or rocks back and forth or demonstrates any other stereotyped behaviors will likely display those behaviors even more when they experience more anxiety.
When anxiety isn’t addressed for people with autism, the untreated or unrecognized anxiety might lead to experiences of depression, more aggressive behaviors, or even self-injury.
How Anxiety Can Look in People with Autism
Although it can be difficult to recognize when someone with autism is experiencing anxiety (while sometimes it can be very noticeable), it’s important to take the time to identify if and how a person with autism experiences anxiety and, if they do experience it, parents and therapists should help them manage their anxiety.
Some examples of how anxiety disorders might look in people with autism include:
- Having a specific phobia – which is considered an intense and typically an irrational fear of something that poses little to no danger. A phobia can develop in people with autism for many reasons. For instance, being over responsive to sensory input (such as loud noises) can create phobias. This can be seen when a child develops a phobia of vacuums. If the loud noise scares them, they may develop an excessive fear of vacuums. They might even get scared or anxious every time they see a vacuum in their environment even if the vacuum isn’t running.
- Obsessive compulsive disorder – which involves excessive intrusive thoughts with related compulsory behaviors. People with autism might show repetitive behaviors which is also seen in people with OCD. However, the difference is that people with OCD are specifically doing this behavior to cope with anxiety; whereas people with autism might do this to comfort themselves or because they are excited or for many other reasons.
- Experiencing social anxiety – which is related to having extreme distress, specifically anxiety, worry, or fear, as it relates to one’s interactions with others. Social anxiety is often associated with a fear that other people might think negatively of a person. Repeated experiences of social anxiety often lead to avoiding social situations which then gives the person even less opportunities to practice social skills which is already a challenging area for individuals with ASD.
- Other anxiety symptoms can be experienced, such as experiencing excessive distress when a routine is interrupted or when expectations change or feeling overly worried about a new experience.
Helping People with Autism with Their Anxiety
Unrecognized and untreated anxiety can cause more challenges and distress for children and adults with autism. It is important that parents and therapist and even educational staff (like teachers and school support staff), take the time to address and support people with autism with their anxiety. Helping people with ASD to cope with and lessen their anxiety will greatly improve their quality of life in their current and future experiences.
Some ways to help people with autism who also experience anxiety include:
- Social skills interventions
- Interventions that are based on both cognitive and behavioral methods can be beneficial in helping people with autism cope with their anxiety. Social skills intervention should include a focus on psychoeducation about anxiety (such as learning what is helpful and unhelpful anxiety), cognitive strategies (such as improving psychological flexibility), behavioral strategies (such as gradual exposure or desensitization to feared stimuli) or repeated practice in a compassionate manner of anxiety-producing experiences, and parent-mediated interventions that involve parents changing their responses to their child’s anxiety-related behaviors.
- Emotional literacy
- Increasing awareness of one’s own emotions and recognizing triggers and positive coping strategies
- Mindfulness-based interventions
- Teaching the individual to use mindfulness and other relaxation strategies to stay calm and reduce stress as well as to help themself learn to tolerate unpleasant or feared situations more effectively
- For more severe anxiety, medications may be considered
Considering Anxiety in People with Autism
Recognizing that many children (and adults) with autism might experience anxiety co-occurring with their ASD – whether that is occasional symptoms of anxiety or clinical anxiety disorders – is important. When parents, therapists, and educators consider the person’s anxiety when they are caring for them and helping them learn new skills and manage challenging behaviors, the person with ASD will have a much better quality of life and will avoid many troubles that can arise when their anxiety isn’t recognized.
Autism and Impact on Mental Health
Bhatt, N. V. (2019). According to the DSM-5, which diagnoses are classified as anxiety disorders? Medscape. Retrieved May 8, 2022 from https://www.medscape.com/answers/286227-14511/according-to-the-dsm-5-which-diagnoses-are-classified-as-anxiety-disorders
Hollander, E., Burchi, E. (2018). Anxiety in Autism Spectrum Disorder. ADAA. Retrieved May 8, 2022 from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/anxiety-autism-spectrum-disorder