How are autism and anxiety related?

Generally, research estimates that around half of people with autism also have anxiety. The explanation for this connection is multifaceted, but it often has to do with the way that living with autism in a neurotypical world can be stressful and exhausting. In addition, brain differences in people with autism may play a role.

It’s important to understand how anxiety and autism overlap and are different. The way anxiety is treated in neurotypical people can be ineffective for people with co-occurring autism and anxiety and, in many cases, can even make them more anxious.

Where anxiety and autism overlap

Research shows that anxiety disorders are one of the most common types of mental health conditions that co-occur with autism. One study found that more than 20% of people with autism had a co-occurring anxiety disorder. (It’s important to note that this study included obsessive-compulsive disorder, which is not an anxiety disorder).

Researchers don’t believe autism directly causes anxiety. Instead, many autistic people experience challenges that can make anxiety more likely over time. These may include:

• Social situations that feel unpredictable or overwhelming

• Sensory sensitivities, like loud noises or bright lights

• Difficulty coping with unexpected changes in routines

• Stress related to masking autistic traits or trying to fit in

• Traumatic or stressful life experiences

Biology also appears to play a role. Genetics, family history, and differences in brain structure and function may all increase the likelihood that someone will experience both autism and anxiety. For example, one study found that autistic adults with co-occurring anxiety had differences in how the amygdala and anterior cingulate cortex — two brain regions involved in fear and emotional regulation — communicated with one another.

Not everyone with autism develops an anxiety disorder. In fact, studies have found that autistic people with an intellectual disability may have a lower risk of co-occurring anxiety than autistic people without an intellectual disability.

Can autism cause anxiety?

Yes. While autism doesn’t directly cause an anxiety disorder, autistic people are more likely to experience anxiety than the general population.

Everyday challenges like sensory sensitivities, changes in routine, social situations, and bullying can increase stress over time. Genetics and differences in brain function may also make some autistic people more vulnerable to developing anxiety.

Can anxiety cause autism?

No. Anxiety does not cause autism.

Autism is a neurodevelopmental condition that begins early in life and is thought to be influenced largely by genetics and differences in brain development. While anxiety and autism often occur together, one condition does not cause the other.

Symptoms of autism and anxiety together

As is the case with any co-occurring conditions, living with both autism and anxiety can pose additional challenges.

In addition to the unique symptoms of each condition, some additional or worsened symptoms you could experience if you live with both include:

• Social anxiety and isolation: Even if you don’t have social anxiety disorder, you might experience heightened anxiety in social situations if you live with both autism and anxiety. You might have a harder time developing close relationships and worry excessively about making “mistakes” in social situations.

• Fear of leaving your home: Studies have found that agoraphobia is one of the most common anxiety disorders that people with autism face. You might worry about being in places where you can’t easily return to the comfort of your home. You may feel safest when you’re in familiar, predictable places.

• Sensory sensitivity: Both autism and anxiety can cause sensory sensitivities, which means you could become more easily overwhelmed by sensory input. For example, you might have a harder time in noisy places or places with bright lights.

• A need for strict routines: Some people with autism might need more predictability in their routines when they’re feeling anxious. Autism can make you more sensitive to routine changes, and predictability in your routine can sometimes be a way you try to cope with anxiety.

• Repetitive behaviors: You might engage in repetitive calming or self-stimulating behaviors (also called “stimming”) when you’re feeling more anxious.

• Separation anxiety: Separation anxiety is also a factor. Although this mostly affects children with autism, adults can experience separation anxiety too. For example, you might feel safe and comfortable when your partner is around but find it more difficult to cope when they’re away.

What triggers anxiety in autistic people?

Anxiety triggers can look different for everyone. However, some experiences are especially common among autistic people, including:

• Changes in routine: Unexpected schedule changes or disruptions can feel overwhelming

• Sensory overload: Loud noises, bright lights, crowded spaces, or certain textures can trigger anxiety

• Social situations: Meeting new people, making small talk, or worrying about social expectations can be stressful

• Uncertainty: Not knowing what to expect or facing unfamiliar situations may increase anxiety

• School or work demands: Deadlines, transitions, or balancing multiple responsibilities can become overwhelming

• Masking autistic traits: Constantly trying to fit in or hide autistic behaviors can be emotionally exhausting and increase anxiety over time

• Past negative experiences: Bullying, rejection, or other stressful life events can make future situations feel more threatening

How is anxiety diagnosed in people with autism?

Diagnosing anxiety in an autistic person usually starts with a comprehensive clinical evaluation. A mental health professional will ask about your symptoms, when they occur, how long they’ve lasted, and whether they’re affecting your daily life. They may also ask about your medical history, family history, and experiences at home, school, or work.

Because anxiety and autism can share some similar features, providers also look at what’s causing the distress. For example, feeling uncomfortable in a loud environment may be related to sensory sensitivities rather than an anxiety disorder. However, persistent worries, racing thoughts, sleep problems, or avoiding everyday situations because of fear may suggest a co-occurring anxiety disorder.

Providers may also use screening questionnaires or other diagnostic tools to better understand your symptoms and help distinguish anxiety from the characteristics of autism. This helps ensure you receive the most accurate diagnosis and appropriate treatment.

Helpful strategies for coping with autism and anxiety

Although getting treatment for co-occurring anxiety can be very helpful, there are also coping strategies you can use to try to manage anxiety on your own.

• Find ways to self-soothe. Whether it’s stimming, using fidget toys, practicing breathing techniques, or engaging in another pleasant activity, it can be helpful to understand how to calm yourself down when you’re feeling anxious. How do you self-soothe, and how can you incorporate these strategies into your everyday life

• Connect with your community. When you’re autistic, it can cause anxiety to try to force yourself to behave like neurotypical people. It can help to build a community of autistic and other neurodivergent people to understand that there’s nothing “wrong” with you — your brain simply works differently than others. These communities can also provide a safe place for you to be your full self without the anxiety of trying to fit in.

• Adapt your environment. Sometimes, it may be your physical environment that’s causing anxiety for you. Consider adapting your environment as much as you can. For example, you can get dimmer, warmer lighting or wear noise-canceling headphones. In addition, keep in mind that both anxiety and autism are eligible for reasonable workplace accommodations under the Americans with Disabilities Act.

• Practice basic self-care. When you neglect basic self-care — like getting enough restful sleep every night, exercising, and eating nourishing meals — you’re more vulnerable to the effects of anxiety. Even though it might not make you feel better immediately, it’s important to build healthy habits.

Specialized treatment for anxiety and autism

Treatment for co-occurring anxiety and autism can be complex because professionals typically approach these two conditions in different ways. Anxiety is a mental health condition that, by definition, causes emotional distress. Autism, on the other hand, is a neurodevelopmental condition. It typically causes distress because of the way other people respond to people with this condition and the way the world is set up for neurotypical people.

Anxiety is often treated using exposure therapy, a treatment that aims to reduce people’s fears by gradually exposing them to uncomfortable situations. But functional MRI studies have found that autistic brains don’t adapt to anxiety triggers, like sensory sensitivities, in the same way neurotypical brains do. In fact, trying to force someone with autism to get used to uncomfortable experiences typically only increases emotional distress and makes them even more anxious.

These findings have rightfully led autism advocacy groups to fight to keep exposure and aversive therapies out of treatment for autistic people with (or without) anxiety.

On the other hand, research shows that some therapy methods that may support people with co-occurring anxiety and autism include:

• Cognitive behavioral therapy (CBT): This type of therapy can help you examine thinking patterns that might be causing you to feel more anxious and reframe these thoughts to be more helpful and accurate.

• Mindfulness-based therapies: Mindfulness is an evidence-based approach to reducing stress and anxiety. It can help you stay in the present moment, approach strong emotions with self-compassion, and learn new strategies (like breathing techniques) to calm yourself down.

Some people with co-occurring anxiety and autism take medication. Medications should never be used to try to diminish symptoms of autism (rather than directly addressing the anxiety). Any treatments that are used for co-occurring autism and anxiety should recognize that, unlike anxiety, autism isn’t a “disorder” that requires treatment. Rather, it’s a normal variation of the human brain.

Clinician’s take

It can be very beneficial to find the ‘right’ self-soothing techniques to reduce your anxiety symptoms. These can vary from person to person, so taking your time to develop your very own toolbox is important.

Ashley Ayala, LMFT

Clinical reviewer