It seems that autism and anxiety often go hand-in-hand. But why is this the case? And what do we actually mean when we say someone has anxiety?
Research studies have consistently pointed to a higher prevalence of anxiety disorders among autistic people compared to the general population. According to a study published in The Journal of Autism and Developmental Disorders (Sukhodolsky et al., 2018), nearly 40% of autistic children meet the diagnostic criteria for at least one anxiety disorder. This rate is significantly higher than that observed in neurotypical children. As an autistic person myself and someone who works with neurodivergent adults, I can attest to this finding. It seems that autism and anxiety often go hand-in-hand. But why is this the case? And what do we actually mean when we say someone has anxiety?
Understanding Anxiety:
The term anxiety can be used both informally and clinically. Most people experience some form of anxiety in their lives; the clinical diagnosis of anxiety disorder depends on the degree to which anxiety affects individuals and the duration of their symptoms. Anxiety can range from mild discomfort, such as overthinking social interactions, to a debilitating and overwhelming feeling of terror. At its worst, anxiety can make daily life incredibly challenging. It is my personal belief that the higher suicide rates observed in the autistic population may be connected to the elevated rates of anxiety.
Different Forms of Anxiety:
Anxiety can take various forms and have a range of presentations; in my practice the types I see most frequently include: social anxiety (anxiety related to social situations), health anxiety (excessive worry about being seriously ill), death anxiety (fear of death or existential anxiety), and generalised anxiety (anxiety linked to a wide range of things and events). Generalised anxiety can be so intense that it meets the diagnostic criteria for generalised anxiety disorder (GAD).
Exploring the Causes of Anxiety in Autism:
When we examine the research, several ideas and theories emerge to explain why autistic individuals seem particularly prone to anxiety. One theory suggests that autistic characteristics themselves may be contributing factors:
A. Sensory Sensitivities: Many autistic people experience heightened sensitivities to sensory stimuli, such as loud noises, bright lights, or certain textures. These sensitivities can trigger anxiety responses, leading to increased levels of anxiety.
B. Social Challenges: Difficulties in social interactions, which are a core characteristic of autism, can contribute to heightened anxiety. The desire to fit in, interpret social cues, and navigate complex social situations can create significant stress and anxiety for individuals.
However, it is important to consider the secondary, psycho-social, issues connected to being autistic that also likely contribute to anxiety. Autistic people often experience social exclusion and passive or active bullying from their neurotypical peers, which can be traumatising. Trauma causes hyper-vigilance, leading individuals to constantly scan the environment for perceived threats and, in turn, experience chronic anxiety. I write about bullying in a previous post.
Research Supporting the Connection:
Research studies have shed light on the relationship between autism, anxiety, and trauma. Although clear prevalence rates are yet to be established, the rates of probable post-traumatic stress disorder (PTSD) in autistic people (32-45%) are much higher than those in the general population (4-4.5%) (Rumball et al., 2020; Rumball et al., 2021; Haruvi-Lamdan et al., 2020). Some studies emphasise neurological factors, such as difficulties with emotional regulation and a tendency toward rumination, as contributors to anxiety in autism (Kerns et al., 2015; Hoover, 2015; Haruvi-Lamdan et al., 2018). Others highlight the negative social effects of being a neuro-minority, such as unmet needs, challenges in following neurotypical social interactions and cues, and social exclusion and abandonment by loved ones (Rumbball et al., 2020; Kerns et al., 2022).
The Impact of Trauma and Social Exclusion:
Considering all aspects, it is not surprising that autistic individuals are significantly affected by anxiety. When working with an autistic person, it is crucial to be mindful of the potential effects of trauma. Even if we haven’t experienced what is traditionally seen as a “traumatic event,” we are often subjected to a chronic “background noise” that stems from daily life in a world that is not designed for us.
Finding Solutions and Coping Strategies:
While anxiety may never completely disappear for autistic people, it is essential to maintain hope. There are strategies that can help manage and alleviate anxiety. Here are a few techniques you may wish to try:
Distraction: When you catch yourself entering an anxiety loop, engaging in an activity that absorbs your attention can be helpful. It could be a pleasant hobby or interest, or even listening to podcasts that distract you from your inner anxious voice. Physical activities like walking or consciously engaging in stimming while listening to music can also provide a distraction (as well as a neurological prompt to de-escalate).
Soothing: For more intense anxiety episodes with physical symptoms like chest or stomach tightness, soothing activities can aid in regulation. Consider activities like using a weighted blanket in a quiet room, surfing on your iPad (while avoiding content that triggers more anxiety), or petting a comforting animal. If you feel the need to soothe, prioritise it and act on that thought, as self-regulation is crucial.
Cooling Down: Diverting your brain’s attention and grounding yourself in the present moment can help calm anxiety. Splash cold water on your face or hold a cold pack or Ziplock bag with ice water against your eyes and cheeks. These actions are also a neurological prompt to your body and can provide a calming effect and help you reconnect with your body to feel more grounded.
Grounding: This technique is particularly useful when anxiety reaches its peak. Grounding involves focusing on the present moment and your immediate surroundings. You can do this by naming five things you can see, four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This exercise helps shift your attention away from anxious thoughts and into the present reality. This only one way to ground yourself and you can google “grounding exercises” to find more.
Conclusion:
Understanding the link between autism and anxiety is crucial for providing support and developing coping strategies. While autistic individuals may be more prone to anxiety due to sensory sensitivities, social challenges, and the impact of trauma, it is important to remember that each person’s experience is unique. By acknowledging the intersection of neurology and sociology, we can develop interventions and support systems that cater to the specific needs of autistic people. In general, “behaviourist” approaches (e.g. CBT) are less helpful for autistic people as they focus on building tolerance through exposure to anxiety in ways which do not take into account the particular neurology of the autistic brain. What works better is gravitating towards things which are soothing and regulating and move us away from our fears. Although anxiety may persist, employing coping strategies can help make it more manageable.
References:
Sukhodolsky, D. G., Bloch, M. H., Panza, K. E., & Reichow, B. (2018). Cognitive-behavioral therapy for anxiety in children with high-functioning autism: A meta-analysis. Journal of Autism and Developmental Disorders, 48(8), 2613-2623.
Rumball, F., Boyce, P., Reardon, T., & Bourke, J. (2020). The prevalence and impact of post-traumatic stress disorder and burnout syndrome in adults with an Autism Spectrum Disorder: A systematic review. Journal of Autism and Developmental Disorders, 50(7), 2365-2383.
Kerns, C. M., Kendall, P. C., Zick
Dr Stephanie Aspin 