Autism and anxiety: types, tips and support

While anyone can experience anxiety, research shows that it’s even more common in people on the autism spectrum, sometimes complicating the challenges that autistic people already face. A recent National Autistic Society study found that, out of the autistic people surveyed:

• 94% reported feeling anxiety
• 6 in 10 said it affected their ability to function on a daily basis
• Almost half fall into the ‘severe’ category on the generalised anxiety disorder (GAD-7) questionnaire
• 2 in 5 are currently diagnosed with anxiety

Here, we explore the relationship between autism and anxiety. We also provide practical advice on identifying and managing anxiety in autistic people, as well as the tailored support that can be offered. 

Common types of anxiety amongst autistic people

Autistic people may experience a number of different types of anxiety. Each type of anxiety comes with its own characteristics and can significantly impact the person’s daily life and wellbeing. Some of the types of anxiety that are common in the autistic population include: 

Generalised anxiety disorder (GAD) 

GAD is commonly seen in autistic people and involves excessive and persistent worrying about everyday things, such as health, finances or day-to-day activities. 

This type of anxiety can be more intense in people on the autism spectrum, due to the differences in the ways these people may cope with uncertainty and change. 

Physically, GAD might cause fatigue, muscle tension and restlessness, which can be worsened by the heightened sensory sensitivities that many autistic people experience. 

Social anxiety 

Social anxiety in autistic people often goes beyond typical nervousness in social settings. It can include intense fears of social interactions where there’s potential for the person to be judged or make mistakes. 

This type of anxiety can be especially challenging for autistic people. They may have challenges when it comes to interpreting verbal and non-verbal cues, understanding social norms, or responding appropriately in conversations. For example, an autistic person might worry excessively about maintaining eye contact, misinterpreting sarcasm or understanding emotions. This can intensify their anxiety and make social environments feel overwhelming. 

Phobias 

Phobias are also common in autistic people. These may include specific phobias related to sensory experiences, such as an overwhelming fear of loud noises or over-crowded environments, which can be felt even more intensely by someone with sensory processing differences.

Separation anxiety 

Separation anxiety is common in younger autistic people. Autistic children might show extreme distress when they’re apart from their parents, beyond what would be expected at their age. This can be linked to a heightened need for routine and familiarity, which provides a sense of security.

Recognising anxiety in autistic people

Autistic people show some common signs of anxiety, but they can display different symptoms as well. Identifying anxiety in autistic people involves looking out for symptoms that manifest differently compared to the general population.

Some of the most common symptoms of anxiety to look out for in autistic people include:

• Physical symptoms - sweating, trembling, increased heart rate, dizziness and sleep disturbances 
• Psychological symptoms - excessive worry or fear, difficulty concentrating, restlessness and irritability
• Behavioural symptoms - avoiding anxiety-triggering situations and social withdrawal

Autistic people may also experience a range of other anxiety symptoms that are more common in autism. These may include:

• Increased repetitive behaviours - autistic people may show an increase in repetitive actions (also known as ‘stimming’), such as hand-flapping or rocking, as a coping mechanism to manage stress
• Anxious about disruptions in routine - for autistic people, unexpected changes to their routine can make anxiety worse, leading to intense distress
• Non-verbal signs - for people who are non-verbal or less verbal, anxiety might show up as increased physical restlessness, changes in eating or sleeping patterns, or aggression and irritability

It’s important to monitor and document these symptoms in order to understand and manage anxiety in autistic people. Some of the ways to do this include:

• Daily logs - it can be useful for autistic people, and those close to them, to keep a record of any anxiety symptoms, what triggers them, and any coping strategies the person finds helpful
• Track mood and behaviour - tracking changes in the person’s mood and behaviour can help to identify patterns and triggers for their anxiety. There are a number of apps that have been designed to track mood and behaviour. These apps can provide reminders to enter information, record data over time and even analyse trends in behaviour that might not be easily noticeable. An example is Molehill Mountain, which has been designed specifically to help autistic people understand and self-manage their anxiety
• Use multiple sources - it’s important to obtain information from teachers, therapists and other people who regularly interact with the autistic person. Having input from different sources can provide a more rounded view of how their anxiety manifests in different settings

Monitoring an autistic person’s anxiety symptoms can help provide deeper insights into their anxiety levels and the effectiveness of the support they’re getting.