Fact Sheet - Autism & anxiety

Young boy curled in a ball in the corner

Autism and anxiety - extended version

What is anxiety?

Anxiety is a normal response to things that threaten us. Sometimes these are real threats and sometimes they will be things that we think are threats but might not really be a problem. It includes feelings of worry and tension. Some anxiety is normal for most people. It helps us think about and avoid danger. However, some children have more severe problems with anxiety that can interfere with everyday activities.

Children who are anxious may show:

  • muscle tension,

  • difficulty concentrating, restlessness and being easily startled,

  • sweating, flushing or feeling very hot or cold,

  • recurring headaches, stomach aches, backaches, and

  • fatigue and sleeping difficulties.

Some changes in behaviour that may show anxiety could be:

  • refusing to go to school,

  • withdrawing from friends and family,

  • avoiding an object or situation,

  • seeking reassurance.

Children on the autism spectrum and with anxiety may show some or all of these signs as well as agitation or aggression, increased obsessiveness and increased rigidity. 

Sometimes when anxiety is severe, a psychologist might say that a child has an anxiety disorder. Types of anxiety disorders include:

  • social anxiety,

  • selective mutism,

  • separation anxiety, panic disorder, specific phobias, and

  • generalised anxiety disorder (GAD).

Autism and ASD

Children on the spectrum often have feelings of anxiety because of the difficulty understanding their surroundings. Unexpected changes or new social situations can also cause anxiety for some children. Rates of anxiety in children on the spectrum are more than children in the general population. It is important to remember that children with an intellectual disability may feel anxiety but it might be harder to tell. The characteristics of autism can make anxiety a bigger problem.

Some of these characteristics include difficulties with:

  • understanding other people’s views,

  • coping in social situations,

  • talking about feelings, needs and wants,

  • understanding language such as instructions,

  • coping with sensory information, and

  • high need for predictability, difficulties coping with change or new situations.

It is often difficult to know the difference between characteristics of autism and anxiety.

How is anxiety diagnosed?

It is normal for everyone to feel anxious at times. A diagnosis of an anxiety disorder is made because the anxiety is causing difficulties in everyday life, including at school and in social situations. Psychologists, paediatricians or psychiatrists are normally the people who diagnose anxiety. Psychologists are in private practice, community health centre and some schools and hospitals. Assessment for anxiety normally involves talking to parents and their child and completing checklists. Families should find a psychologist with who works with the same age group as their child. The psychologist needs to understand both autism and anxiety.

Treatment

Feelings of anxiety can be managed using tools such as:

  • visuals and social stories to prepare children for the change or event,

  • relaxation and calming techniques,

  • spending time engaging in their special interests, and

  • modified cognitive behaviour therapy (CBT) (see information below).

Cognitive Behaviour Therapy (CBT) is a treatment for children with anxiety. Research over the last 10 years has shown that it can also be a good treatment for children on the spectrum and anxiety. It seems to work better with some modifications such as repetition, hands on tasks and visual supports. There is less information about treating anxiety in children with intellectual disability and autism.

One of the main parts of CBT for anxiety is ‘graded exposure’. Graded exposure involves helping children gradually try tasks or activities that increase their stress or anxiety (for example, if someone is scared of spiders, a psychologist might help them go from looking at a picture of a spider to looking at a real spider and finally holding a spider while making sure the person knows they are safe and keeping calm). This is important as anxiety often leads to avoidance and children will miss the opportunity to learn that they can cope with their fear or stress, and it will decrease over time.

Medication may also play a role in treatment for some children and should be discussed with a paediatrician or psychiatrist.

Summary

Anxiety is a common for many people on the autism spectrum. It can cause difficulties in everyday activities, such as going to school or work. Feeling anxious can also make it harder for some children to learn. Useful strategies can involve identifying what makes a child feel anxious, followed by visual supports and other techniques to prepare them for stressful situations, along with relaxation techniques. There is evidence that modified cognitive behaviour therapy can be effective, and medication may also play a role in helping some people.

 

 

(Reviewed in November 2016)