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How Does Anxiety Manifest in People with ASD?

Children with autism can struggle with identifying anxiety within themselves.

Anxiety is a complex and pervasive mental health issue that affects individuals across the entire spectrum of human diversity. Among the many populations impacted by anxiety, individuals with Autism Spectrum Disorder (ASD) often experience a unique interplay between their core characteristics and anxiety symptoms. ASD is a neurodevelopmental disorder characterised by difficulties in social communication and interaction, as well as restricted, repetitive patterns of behaviour, interests, or activities. The co-occurrence of anxiety in individuals with ASD presents a complex and challenging scenario, influencing various aspects of their lives. This article aims to explore how anxiety manifests in people with ASD, shedding light on the nuanced interactions between these two conditions, with references to relevant studies.

1. Prevalence and Comorbidity: The coexistence of anxiety and ASD is a well-documented phenomenon. Research indicates that individuals with ASD are at a higher risk of developing anxiety disorders compared to the general population. A study by van Steensel et al. (2011) found that approximately 40% of children and adolescents with ASD have at least one comorbid anxiety disorder. This high prevalence highlights the need for a deeper understanding of how anxiety manifests within the context of ASD.

2. Communication and Social Challenges: Individuals with ASD often struggle with social interactions and communication, which can amplify feelings of anxiety. Difficulties in interpreting nonverbal cues, understanding social norms, and establishing meaningful connections can lead to social isolation and heightened anxiety. Research by Bellini (2006) suggests that social anxiety is particularly prevalent in individuals with ASD, and it may manifest as avoidance of social situations or extreme discomfort during interactions.

3. Sensory Sensitivities and Overwhelm: Many individuals with ASD experience sensory sensitivities, reacting strongly to stimuli such as noise, light, or touch. These sensitivities can contribute to a heightened state of arousal and anxiety. A study by Green et al. (2019) demonstrated a link between sensory sensitivities and anxiety symptoms in individuals with ASD. The study found that sensory symptoms were associated with increased anxiety severity, emphasising the intricate relationship between sensory experiences and anxiety manifestation.

4. Rigidity and Routine Disruptions: Individuals with ASD often exhibit a strong preference for routines and can become distressed when these routines are disrupted. Such disruptions can trigger anxiety due to the individual's difficulty in adapting to changes. A study by Kerns et al. (2014) highlighted that rigid thinking and resistance to change were significant predictors of anxiety in children with ASD, indicating how the need for predictability can contribute to anxiety symptoms.

5. Uncertainty and Generalised Anxiety: Uncertainty is a common trigger for anxiety, and individuals with ASD may experience heightened anxiety when faced with ambiguous situations. Their reliance on concrete thinking and difficulties in understanding abstract concepts can lead to increased worry and generalised anxiety. Research by Rodgers et al. (2012) suggests that individuals with ASD may struggle with intolerance of uncertainty, contributing to anxiety symptoms.

6. Obsessions and Compulsions: Restricted, repetitive behaviours, which are core features of ASD, can sometimes overlap with symptoms of anxiety disorders, such as obsessive-compulsive disorder (OCD). Individuals with ASD may develop rituals or obsessions that serve as coping mechanisms to alleviate anxiety. A study by Stewart et al. (2011) found that repetitive behaviours in individuals with ASD were associated with increased anxiety, suggesting a potential link between these behaviours and anxiety manifestation.

In conclusion, the manifestation of anxiety in individuals with Autism Spectrum Disorder is a multifaceted phenomenon influenced by various factors, including communication challenges, sensory sensitivities, routine disruptions, intolerance of uncertainty, and the presence of obsessions or compulsions. Understanding the interplay between ASD and anxiety is crucial for developing effective interventions that address the unique needs of this population. As research continues to uncover the complex relationship between these two conditions, mental health professionals can tailor their approaches to provide comprehensive support, enhancing the overall well-being and quality of life for individuals with ASD.

Written by: Sharon


Bellini, S. (2006). The development of social anxiety in adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 21(3), 138-145.

Green, S. A., Ben-Sasson, A., Soto, T. W., & Carter, A. S. (2012). Anxiety and sensory over-responsivity in toddlers with autism spectrum disorders: bidirectional effects across time. Journal of Autism and Developmental Disorders, 42(6), 1112-1119.

Kerns, C. M., Kendall, P. C., Berry, L., Souders, M. C., Franklin, M. E., Schultz, R. T., ... & Herrington, J. (2014). Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(11), 2851-2861.

Rodgers, J., Glod, M., Connolly, B., & McConachie, H. (2012). The relationship between anxiety and repetitive behaviours in autism spectrum disorder. Journal of Autism and Developmental Disorders, 42(11), 2404-2409.

Stewart, M. E., Barnard, L., Pearson, J., Hasan, R., & O'Brien, G. (2006). Presentation of depression in autism and Asperger syndrome: A review. Autism, 10(1), 103-116.

van Steensel, F. J., Bogels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302-317.

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