By Emma Hinze, Professor Tony Attwood and Dr. Michelle Garnett
In the world of autism, anxiety often accompanies individuals on their journey. Research indicates that up to 84% of young autistic people experience clinically elevated anxiety (White et al., 2009). What is noteworthy is that anxiety symptoms often make an early appearance in the lives of autistic children and tend to intensify over time (Vasa et al., 2020).
This experience of anxiety, ranging from mild to intense, permeates their daily lives and continues into adulthood. It is triggered by specific situations, such as changes in routines or expectations, uncertainty about actions or outcomes, fear of making mistakes, and overwhelming sensory stimuli. Even seemingly ordinary places like crowded shopping malls on Saturdays can evoke anxiety in autistic individuals. Research underscores that anxiety disorders are among the most common mental health challenges faced by autistic adults (Adams & Emerson, 2020). In some cases, the impact of anxiety can surpass the diagnostic characteristics of autism, significantly affecting daily functioning.
Anxiety, characterised by excessive worry, fear, and unease, is a common mental health condition. It can manifest in various forms, from generalised anxiety to specific phobias, and often triggers physiological responses like increased heart rate and sweating. For autistic individuals, anxiety can be especially challenging due to their unique experiences and sensory sensitivities.
The Prevalence of Anxiety in Autism
Research has shown that anxiety is an everyday companion to autism. Studies have found that between 42% and 79% of autistic children and adolescents meet diagnostic criteria for anxiety disorders (de Bruin et al., 2007; Kent & Simonoff, 2017; Simonoff et al., 2008). For autistic adults, the lifetime prevalence rate for anxiety was 42%, with social phobia and obsessive-compulsive disorder occurring most frequently (Hollocks et al., 2019). Moreover, emerging research suggests that autistic individuals may experience anxiety symptoms, even if they do not meet the diagnostic criteria for an anxiety disorder (White et al., 2009; Kerns & Kendall, 2012), with rates reported between 11% and 84% for autistic children experiencing some level of ‘impairing anxiety’. This means that anxiety, in various forms, is a pervasive concern for many autistic individuals.
The Impact of Untreated Anxiety
Anxiety is not a minor concern in autism; it has far-reaching implications for the individual’s life. For instance, untreated anxiety can hinder the development of supportive relationships, disrupt academic progress, and impact employment outcomes (Mazurek, 2018; Bellini, 2006; Maddox & White, 2015). Moreover, anxiety in autistic adults is associated with reduced quality of life, an increased risk of depression, loneliness, and even thoughts of self-harm (Maddox & White, 2015; White et al., 2018). The negative consequences of anxiety on autistic adults make it imperative that effective anxiety treatment options are accessible to this population.
Relationships:
Anxiety can strain relationships, both with family members and peers. Social situations that are already challenging for autistic individuals become even more daunting in the presence of anxiety. They may withdraw from social interactions, struggle to communicate their feelings, or react with frustration, further isolating themselves from potential sources of support. As a result, untreated anxiety can impede the development of meaningful and supportive relationships, exacerbating feelings of loneliness and social isolation.
Academic and Occupational Functioning:
The impact of anxiety often extends to academic and occupational settings. Anxiety can interfere with learning in school, making it difficult for autistic students to concentrate, non-attendance, engage with peers, or complete assignments. This can hinder their academic progress and limit their opportunities for skill development. In the workplace, untreated anxiety can lead to reduced productivity, difficulty coping with workplace demands, and increased absenteeism. Consequently, autistic individuals may face challenges in pursuing and maintaining meaningful employment.
Mental Well-being:
Perhaps the most concerning aspect of untreated anxiety is its toll on mental well-being. Anxiety can escalate to the point where it coexists with depression, creating a dual burden on an individual’s emotional health. Feelings of sadness, hopelessness, and despair may emerge, potentially leading to thoughts of self-harm or suicide. The persistent state of vigilance and emotional distress takes a toll on emotional resilience and self-confidence, compounding the overall impact on mental health.
Daily Functioning:
Anxiety can disrupt even the most routine aspects of daily life. Simple tasks, such as grocery shopping or taking public transportation, may become overwhelming challenges. Individuals may avoid these situations altogether, leading to a reduction in their quality of life. Enjoyable activities that once provided a sense of pleasure can also fall victim to anxiety-induced avoidance, depriving individuals of sources of joy and relaxation.
Physical Health:
The consequences of untreated anxiety aren’t limited to mental health; they can also affect physical well-being. Chronic anxiety can lead to sleep disturbances, which, in turn, can result in fatigue and exacerbate emotional distress. Over time, this cycle of sleep disruption and anxiety can impact an individual’s overall physical health.
Dispelling Myths and Stereotypes
It is essential to debunk the myth that anxiety is not prevalent among autistic individuals. The evidence is clear: anxiety is a significant and common concern in this population. Recognising and addressing this reality is crucial for providing the support and understanding that autistic individuals need to thrive.
Conclusion
In conclusion, the connection between autism and anxiety is undeniable. Research has highlighted the high prevalence of anxiety disorders and symptoms among autistic individuals. Untreated anxiety can have profound negative effects on their lives, affecting relationships, academic performance, and mental well-being. Acknowledging and addressing this issue is a crucial step towards creating a more inclusive and supportive environment for autistic individuals to flourish.
Where to from here?
Michelle and Tony created a full-day online course, Anxiety and Autism, within which they draw on the latest research on the association of autism with anxiety, as well as their over 80 combined years of clinical experience in the area. They discuss the neurological underpinnings of anxiety and autism and how life experiences can alter neural circuitry to lead to both acute and chronic experiences of anxiety. This understanding leads to how to support and accommodate anxious autistic individuals and how to modify conventional treatments for anxiety for an autistic person. The course was designed for parents, carers, professionals and autistic adults and covers anxiety across the lifespan.
References
White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical psychology review, 29(3), 216–229. https://doi.org/10.1016/j.cpr.2009.01.003
Vasa, R.A., Keefer, A., McDonald, R.G., Hunsche, M.C. and Kerns, C.M. (2020), A Scoping Review of Anxiety in Young Children with Autism Spectrum Disorder. Autism Research, 13: 2038-2057. https://doi.org/10.1002/aur.2395
Adams, D., Emerson, LM. The Impact of Anxiety in Children on the Autism Spectrum. J Autism Dev Disord 51, 1909–1920 (2021). https://doi.org/10.1007/s10803-020-04673-3
de Bruin, E. I., Ferdinand, R. F., Meester, S., de Nijs, P. F., & Verheij, F. (2007). High rates of psychiatric co-morbidity in PDD-NOS. Journal of autism and developmental disorders, 37(5), 877–886. https://doi.org/10.1007/s10803-006-0215-x
Prevalence of Anxiety in Autism Spectrum Disorders. In Anxiety in Children and Adolescents with Autism Spectrum Disorder: Evidence-Based Assessment and Treatment (pp. 5-32). Elsevier Inc.. https://doi.org/10.1016/B978-0-12-805122-1.00002-8
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929. https://doi.org/10.1097/CHI.0b013e318179964f
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Kerns, C. M., & Kendall, P. C. (2012). The presentation and classification of anxiety in autism spectrum disorder. Clinical Psychology: Science and Practice, 19(4), 323–347. https://doi.org/10.1111/cpsp.12009
Mazurek, M.O. (2018). Anxiety in adolescents and adults with autism spectrum disorder.
Bellini, S. (2006). The Development of Social Anxiety in Adolescents With Autism Spectrum Disorders. Focus on Autism and Other Developmental Disabilities, 21(3), 138–145. https://doi.org/10.1177/10883576060210030201
Maddox, B.B., White, S.W. Comorbid Social Anxiety Disorder in Adults with Autism Spectrum Disorder. J Autism Dev Disord 45, 3949–3960 (2015). https://doi.org/10.1007/s10803-015-2531-5
White, S. W., Simmons, G. L., Gotham, K. O., Conner, C. M., Smith, I. C., Beck, K. B., & Mazefsky, C. A. (2018). Psychosocial treatments targeting anxiety and depression in adolescents and adults on the autism spectrum: Review of the latest research and recommended future directions. Current Psychiatry Reports, 20(10), 1–10.
