Experts say that a better understanding of the relationship between autism and anxiety can help improve quality of life for autistic people.

Research suggests that autistic people may be more prone to anxiety.

To the layperson, autism spectrum disorder (ASD) and anxiety may look similar, and it may be difficult to distinguish between them.

Here’s what we know — and don’t know — about autism and anxiety.

Research suggests that anxiety is more common in autistic people.

A 2019 study of sibling pairs indicated that about 20 percent of autistic people had anxiety compared with about 9 percent of the population controls.

“Many [autistic] people are fully aware they’re struggling in ways their peers may not be, and that they have some sensitivities and issues that their peers may not,” says Dr. Jephtha Tausig, a New York City-based clinical psychologist.

Unique characteristics

Just as no two people on the spectrum are alike, no two people with anxiety are the same.

Knowing some of the common and unique characteristics in autistic people can aid in diagnosis and support.

According to board certified pediatric neurologist Dr. Dilip Karnik, there may be similarities in people with anxiety, whether they’re on the spectrum or not, including:

  • separation anxiety, or distress when separated from a loved one or caregiver
  • difficulty transitioning to new environments
  • nervousness or fear over meeting new people

She says it may be particularly upsetting if the distress is caused by a change to a routine, a common experience for autistic people.

“When they feel a surge in anxiety, it can feel disorienting and discombobulating… in addition to the feeling of the anxiety itself,” she says.

Behavioral symptoms

Anxiety can present through behavioral symptoms in autistic people, some of which may overlap with autism itself.

The Anxiety and Depression Association of America says common behaviors in both autistic people and people with anxiety include:

Still, the area of the brain involved in the expression of fear, called the amygdala, may play a role in comorbid anxiety and ASD, according to a 2020 study.

Karnik says development may play a role as well.

“In [neurotypical] children, the amygdala continues to grow into adulthood,” Karnik says. “But in children [on the spectrum], it grows faster in the early period — until around 12 years old — and then slows down. Sometimes, it may even shrink. These areas play a significant part in the behaviors of children [on the spectrum], especially anxiety.”

Social and emotional factors may also contribute to anxiety.

Autistic people may need support to learn how to read body language and other social cues. Sometimes these situations can make them feel overwhelmed and anxious.

Anxiety is common in autistic people, and a trained healthcare professional can distinguish between the two conditions.

“Children with ASD need a very comprehensive evaluation and medical history, which should include discussing social anxiety, generalized anxiety, or any specific phobias,” Karnik says. “Anxiety and ASD symptoms [often] overlap, therefore careful screening is needed in these cases.”

Karnik suggests seeing a behavioral psychologist for a screening. They can ask questions about symptoms and triggers, which can help make a correct diagnosis. Adults can also benefit from these screenings.

Testing and support are best done in conjunction with professionals. If you or a loved one is on the autism spectrum, has anxiety, or both, help is available.

Testing

Tausig says autistic people who may also have anxiety should get a psychological or neuropsychological evaluation.

You can find a psychologist or neurologist through:

  • your insurance company
  • a referral from your primary care doctor or pediatrician
  • your child’s school
  • early intervention programs

Therapy

Once there’s a formal diagnosis, there are plenty of resources to find a therapist. In addition to the options listed above, you can find a therapist through:

Support groups

Not all autistic children or adults will benefit from support groups, though some may.

Parents of autistic children who may have anxiety can also find support groups.

In addition to the options listed above, you can find support groups through:

Autism and anxiety may have similar symptoms, such as difficulties in social situations and with routine changes.

Still, they are separate, though often co-occurring, conditions.

Autism is neurodevelopmental, while anxiety is a mental health condition. Research indicates that autistic people are more prone to having anxiety than the general population.

Autistic people who may have anxiety should receive a formal evaluation by a mental health professional.

Utilizing coping mechanisms and services, like mindfulness, CBT, ABA, and social skills training, may help make anxiety more manageable.