Helping People With Autism Manage Anxiety

About 40% of people with autism spectrum disorder also suffer from significant anxiety. This is the case even though anxiety is not a part of the criteria for diagnosing autism—nor is it one of the descriptive options available for clinicians to use when describing a person's autism. Anxiety can play a huge role in the lives of people on the spectrum, controlling the way they interact with the world, and limiting the ways in which other people interact with them.

Unfortunately, it can be difficult to find the cause (or in some cases the existence) of anxiety in a person with autism. Once it is identified, however, it is often possible to develop a set of tools that can reduce anxiety to a manageable level. This opens up a world of possibilities, including forming new interpersonal relationships, employment options, and community experiences.

Defining Anxiety

Anxiety is an emotional state characterized by fear, apprehension, and worry. Some anxiety is perfectly normal, but anxiety disorders can become a major roadblock to daily life. Often, anxiety disorders are the result of disordered thinking.

Many people with anxiety disorders have unreasonable fears or perceptions that are far from reality. Whether or not the source of the anxiety is realistic, however, the anxiety is very real and can result in symptoms such as panic attacks, emotional meltdowns, and self-injury.

There are many forms of anxiety including the following:

• Social anxiety disorder
• Generalized anxiety disorder
• Panic disorder
• Phobias
• Separation anxiety disorder

All of these may be challenges for individuals with autism, although social anxiety disorder appears to be the most common. However, it is important to recognize the difference between a person on the spectrum with social anxiety and a person on the spectrum who simply enjoys solitude, as many people with autism do. Similarly, it can be hard to know whether stimming behaviors (self-stimulatory behaviors) such as flapping or pacing are really a sign of anxiety or just a symptom of the underlying autism.

It takes time and patience to get to know an autistic individual well enough to separate autistic behaviors, personality quirks, and signs of anxiety. Often, parents and siblings are better than anyone else at noticing anxiety in a person with autism.

Why Anxiety Is Common

No one knows for sure why anxiety is so common in autism. There are two prevalent theories, both of which are grounded in research and logical conclusions drawn from anxiety in autism:

1. Anxiety is a common symptom of autism which may be caused by the same combination of genes and environmental factors as autism itself. There is no doubt that anxiety is common among people with autism. There is also some evidence of a correlation between higher IQ and greater age with an increase in anxiety among people on the spectrum. People with autism often behave as if they were anxious even when they are in familiar settings. In many cases, this could suggest that anxiety is simply a part of autism spectrum disorder.
2. People with autism may experience anxiety due to the common challenges they face. This theory makes sense considering the various stresses autistic people face, especially if they are navigating school, work, and various social interactions.

Common Challenges

Those with autism often struggle with the following challenges:

Sensory Assaults: For many people with autism, bright lights, loud noises, and large crowds can be physically painful. These stimuli can be found in virtually every public school, school bus, city street, movie theater, football game, and party. In other words, the probability is extremely high that a person with autism will experience painful sensory assaults all day, every day. This is certainly a sufficient cause for anxiety.

Bullying and Intolerance: Autistic people are different from many of their peers, and differences almost inevitably lead to some level of bullying and intolerance. In addition, many people with autism have a hard time distinguishing good-natured teasing from bullying, which results in people with autism often feeling targeted by this type of harassment more often than their peers do.

Communication Challenges: Spoken language can be difficult for people with autism. Tone of voice and non-verbal body language are hard to distinguish, while idioms and slang can be incomprehensible. This means that many people on the spectrum spend much of their day wondering whether they are understanding what is being said, and hoping that others understand them. Certainly, this can cause much anxiety.

Social Challenges: Few people on the autism spectrum can accurately gauge a complex social situation and respond appropriately. It is relatively easy to follow scripts in a formal setting (saying hello, shaking hands), but it is much tougher to know whether you are or are not welcome to join a conversation, or whether a friendly greeting is a sign of romantic interest.

It is very anxiety-inducing to know that you cannot interpret these social situations; you may make the wrong guess and wind up insulting someone unintentionally or be made of fun of by your peers.

Symptoms

One of the most difficult aspects of diagnosing anxiety in autistic people is the reality that common autism symptoms closely resemble symptoms of anxiety. Rocking, flicking, pacing, saying or doing the same thing over and over again, insisting on routines, and avoiding social interaction are all actions that would look like severe anxiety in a typically developing person.

In some cases, these behaviors are self-calming techniques that do reflect a response to anxiety. In other cases, however, the behaviors do not seem to relate to anxiety and they are simply a part of being autistic.

Another issue is that many people with autism have a difficult time communicating their emotional state to others. A significant number of people on the spectrum are non-verbal, while others have minimal use of language. Even those who are verbal and high functioning may have trouble recognizing and describing their emotional state as "anxious."

While it is not always easy to recognize anxiety in autism, you know what behaviors to expect from an autistic child or adult if you are the caregiver. Pay close attention to behaviors and signs that they may be experiencing anxiety.

If your loved one with autism is experiencing anxiety, this person may:

• Appear frightened or apprehensive
• Be unwilling to leave the house
• Sweat or shake
• Have more emotional meltdowns than usual or be unusually upset
• Begin to behave in aggressive or self-abusive ways
• Refuse to go into certain places or rooms
• Place hands over eyes or ears
• Appear unusually jumpy (paces, flicks, rocks, or mumbles more than usual)

Tools

There are multiple techniques for avoiding, reducing, and managing anxiety for people with autism. The first step in the process is to determine the causes of anxiety; a person on the spectrum may be experiencing frustration, physical discomfort, social discomfort, fear of change, or worries about the future.

Once you know what the causes of anxiety look like, you can take productive action such as:

• Removing whatever is causing anxiety (or remove the person from the anxiety-causing situation). If bright lights or loud noises are causing discomfort and related anxiety, find a way to reduce the lights or sounds. If being in a crowded theater is causing anxiety, leave the theater as soon as possible.
• Making accommodations or providing supports. For example, many people with autism wear sound-canceling headphones or sunglasses to reduce sensory challenges. "Lunch Bunch" groups, Best Buddies, and other peer-to-peer social programs can help reduce social anxiety.
• Teach techniques for managing anxiety. When anxiety-producing situations are unavoidable, it is helpful to teach someone with autism techniques for managing anxiety. Squeezing stress balls, counting to ten, meditating, and exercise are all useful methods for managing stress and anxiety.

Therapies and Medications

The same therapies and medications that help reduce anxiety in typically developing people can be helpful for people with autism.

For people with autism, learning to recognize anxiety is important, but it is equally important they learn the skills to function successfully in complex social environments.

1. Cognitive Behavioral Therapy (CBT) can be very useful for people with high functioning forms of autism. By talking through fears and problems with self-image, some people with autism can overcome their anxieties. This approach, coupled with social skills training, can have a significant positive impact.
2. Medications can be very helpful for anxiety in autism, however, it is important to work with a knowledgeable practitioner. People with autism can be unusually susceptible to side effects, so small doses are usually preferable. Some of the medications used most successfully include SSRI antidepressants, sertraline (Zoloft), Prozac, Celexa, or escitalopram (Lexapro).

A Word From Verywell

It can be hard to know if a person with autism is experiencing anxiety. As a result, anxiety is undertreated among people on the spectrum. It is important to stay alert to signs that your loved one with autism is not behaving in a way that is normal for him or her.

People with autism have few defenses and can be very vulnerable to bullying, intolerance, or negative behavior from others. In addition, many of the things that upset people on the spectrum may be invisible to their typical peers. It may be up to you, the caregiver, to notice and address anxiety in your loved one's life.