Autism and anxiety are often connected. It’s estimated that 40% of children with autism also have a diagnosed anxiety disorder, including phobias, OCD, and social anxiety. Some papers though report up to 80%. This is significantly higher than the general population, where anxiety is at around 8%. The trend of increased anxiety continues into adulthood, with autistic adults experiencing anxiety more than twice the rate of neurotypical adults.
But this is just reports on anxiety disorders – the normal feelings of anxiety and worry are high for autistic children too, but they may not have strategies to cope socially with these feelings.
Why is anxiety higher in autistic children?
Some research has theorised why anxiety may be higher in children with autism. The signs of anxiety can be confused with autistic traits, but may also contribute to anxiety. For example, children with restricted and repetitive behaviours (an autistic trait) where correlated to having OCD with ritualistic/sameness behaviours. Children with social and communication delays were associated with social anxiety. So anxiety could be related to the constant confusion around understanding the social world, the lack of control over routines and repetitive behaviours, as well as sensory over-sensitivity and difficulty regulating.
Autistic children that are “high functioning” or high IQ are more likely to experience anxiety. The meta-analysis found that “children with ASD had more negative expectations about the future, more negative beliefs about their abilities, and greater self-blame” than typically developing children. This led to a risk of anxiety three times higher than the general population. You could argue that neudivergent brains are always in a survival mode.
Anxiety may also peak at times of big transitions such as moving schools, graduating from school into work/further study.
This has ongoing impacts for life – those with anxiety disorders have worse life outcomes, lower quality of life and lower functioning.
What does anxiety look like?
Anxiety is a feeling. It can feel different for different people, but as an emotion it may exhibit as:
- looks jittery
- physical symptoms – tummy ache, headache, not sleeping
- avoiding situations – flight
- irritable or angry
- withdrawn
Anxiety is only a problem when it occurs int the wrong situations or in the wrong amounts. Anxiety as a feeling is uncomfortable but doesn’t actually harm you. It goes away with time even if you do thing. But you can be in control of your feeling of anxiety – just think about the benefits of stress for performances – “I’m a little nervous so I’ll do well”.
Anxiety disorders are different to anxiety as an emotion. The emotion is normal. Disorders occur when the anxiety doesn’t go away and even gets worse over time, and interferes with daily life.
What treatments are effective for anxiety disorders?
Treatment for anxiety in the general population commonly relies on serotonin re-uptake inhibitor medications (SSRIs). However there is little research on the effectiveness of these anxiety medications for autistic individuals.
So, Cognitive Behaviour Therapy (CBT) is likely to be more effective for treating anxiety in children with autism. This includes “use of visual supports to reinforce learning, modules to address emotional dysregulation, and strategies to help children reduce perseveration on special interests.” (source). However, some research suggests that first starting with skill building therapy may be more effective. This would include teaching social skills, enhancing emotional literacy, and developing regulation strategies.
One study looking at treating anxiety suggested skills and knowledge based intervention around:
Understanding and Describing Emotions
- be able to identify emotions
- be able to identify their own emotional states (e.g. with full body scans and interoception)
- use emotional regulation strategies for calming
- describe how different situations and thoughts can change emotional states
Mindfulness
- use mindfulness strategies such as non-judgemental awareness, breath work and grounding to practice tolerating emotional distress. Being able to acknowledge feelings, but have physical strategies to decrease the intensity of emotions, enables better problem solving and thinking.
Coping with Uncertainty in the Everyday
- become aware of their ‘window of intolerance of uncertainty’
- be more confident in managing uncertainty through CBT strategies
- use Virtual Reality to practice navigating through a scenario, using strategies they have learnt.
Strategies for coping with anxious feelings
A qualified professional like a clinical psychologist, occupational therapist focused on social thinking, or a speech pathologist are best placed to support anxiety disorder treatment. However, we have some evidence-based resources available that might support you at home with feelings of anxiety that get big. Check out the:
RESILIENCE JOURNAL – a journal that encourages reflection on personal strengths, gratitude, kindness and other strategies for building up positive psychology.
DOWNLOAD 63 CALMING STRATEGIES – a toolkit of calming strategies for developing emotional regulation.
DOWNLOAD 50 POSITIVE SELF-TALKS – poster that helps with building positive self-talk and combating negative self image that can be common in autistic children.
GRAB THE 7 WAYS TO BREATHE POSTER – a poster with 7 breathing strategies to encourage breath work that can bring children back into a window or zone of tolerance so they can think and problem solve.
Dr Kaylene Henderson, an Australian child psychologist, suggests 4 steps for dealing with anxiety in children.
- Talk about it. You can find picture books on anxiety and other tricky topics at Little Parachutes.
- Control the physical symptoms. Anxiety has a physical effect on the body. Manage the body symptoms through relaxing muscles, deep and slow breathing.
- Break unhelpful thinking. Kids often get stuck on their thoughts. Change the TV channel on your thoughts and think about something else. This is important because thoughts impact on feelings – change your thoughts and you can change your feelings. Ask “are your thoughts helpful or accurate?”
- Face your fears. Go out and do stuff as family to how that we can do hard things. We can show up and not avoid – this builds resilience because we need to experience ups and downs. Remind kids “I know this feels tough, but I also know that yo’ure an incredibly capable kid”
The University of Queensland also has a self-help online program that is free to access called Brave 4 You, all about anxiety and resilience.