This guide outlines everyday anxieties that autistic people can experience; the symptoms of an anxiety disorder that indicate the need to seek support and approaches to reduce anxiety.
 

What is anxiety? 

“Anxiety is a feeling of unease, such as worry or fear that can be mild or severe.” The National Health Service (NHS) 

Everyone has feelings of anxiety at some point in their life. For example, you may feel worried about sitting an exam, or having a medical test. During times like these, feeling anxious can be perfectly normal. 

But some people find it hard to control their worries. Their feelings of anxiety are more constant and can often affect their daily lives.
 

Are autistic people more likely to be anxious? 

It is unclear exactly how many autistic people have significant levels of anxiety. 

Research suggests that some anxiety disorders are very common in autistic people.  Autistica outlines the types of anxiety disorder more likely to affect autistic people as: 

• generalised anxiety disorder 
• fear of social situations (social anxiety) 
• fear of open spaces and crowds (agoraphobia) 
• other specific fears (phobias).
   

What causes anxiety? 

Autistic people may experience anxiety for a range of reasons, including: 

• differences in sensory processing for example, being over or under-sensitive to noises, lights and smells 
• finding it hard to predict or adapt to certain sensory situations 
• difficulties with communication and social interactions 
• having alexithymia (difficulties identifying and describing your own and other people's emotions) - it is more difficult to regulate emotions if you cannot identify what you are feeling 
• worrying about uncertainty and change or transitions, which comes with a fear of the unknown. Many autistic people like predictability and routines, and experience high levels of anxiety if things change 
• people trying to ‘fit in’ or attempt to appear ‘normal’ by changing their behaviour and internalising any stress/anxiety they feel in certain situations 
• performance anxiety – at school or in work.
   

Identification and assessment of anxiety in autistic people

It can be difficult to identify and measure anxiety in autistic people. It is often difficult to identify when the general level of anxiety associated with autism progresses to become clinical anxiety as a mental health disorder. 

Autistic people are more likely to be experiencing higher levels of general anxiety daily as they must navigate a complicated and often confusing sensory and social world. Potentially this will make them more susceptible to a clinical diagnosis of anxiety disorder. 

Assessing anxiety should include the use of standardised assessments combined with detailed information from the autistic person and a number of people who know them well. 

Symptoms of anxiety in autistic and non-autistic people include: 

• sweating 
• sleep issues 
• panic attacks 
• hyperventilating 
• negative thoughts 
• catastrophising. 

Anxiety in autistic people can lead to: 

• meltdowns 
• depression 
• needing control over people or situations 
• self-harm 
• eating disorders (particularly in autistic females). 
   

Ways to help with anxiety 

Most of the approaches for dealing with anxiety are the same for autistic and non-autistic people. 

Counselling and therapy 

People can access counselling or therapy via their GP or privately. There are many types of talking therapy, including cognitive behavioural therapy (CBT) that has been shown to be effective for some autistic people. All talking therapies should be adapted to be effective for autistic people. 

Visit our mental health support page for more information on counselling and therapy.

Medication 

There is limited research into the use of medications to treat anxiety in autistic people. Researchers suggest all medications, such as anti-anxiety and anti-depressant medications, should be prescribed cautiously and be closely monitored. There is guidance about the use of medication for autistic people from NICE.

Behavioural approaches

• Mindfulness training for autistic young people and adults.
• Behavioural techniques such as exposure therapy (gradually exposing someone to the thing that makes them anxious).  
• Tools such as social stories and visual schedules. 
• Programmes such as social skills groups and vocational skills training which teach the individual how to deal with specific stressful situations. 

Approaches and strategies 

To help reduce anxiety, advise autistic people or their parents/carers to: 

• keep a diary to help identify symptoms and triggers 
• adapt the environment to take into consideration sensory differences 
• use sensory tools and/or behaviours such as stimming to reduce anxiety levels and self-soothe 
• try relaxation methods 
• help develop emotional awareness so that they can identify when they are anxious and use methods to reduce it. 

Two apps have been developed to support autistic young people/adults who are experiencing anxiety: 

• Brain in Hand – a diary, notes and reminders of daily tasks, individual coping strategies, system to monitor anxiety levels and access to support from the National Autistic Society. 
• Molehill Mountain – tracks mood, identifies triggers and gives evidence-based tips on how to self-manage anxiety levels. 
   

Advice for teachers 

In the school setting, even the smallest changes can trigger anxiety, for example, moving desk. School can be noisy, and break and lunchtimes are unstructured parts of the day that may be particularly stressful. Triggers of anxiety can be cumulative and can often result in the child being unable to learn, as they are constantly looking for danger. 

To help reduce anxiety at school: 

• use clear visual supports or timetables to minimise confusion 
• make sure you prepare pupils for any change to their routine 
• evaluate the school environment and identify potential sensory triggers 
• have quiet spaces at lunchtimes 
• allow children to leave/enter classrooms before corridors get busy at break and lunchtimes 
• use a stress scale to help pupils identify changes in emotions 
• offer a safe and quiet place where they can go to get away from social pressures.