Anxiety in Autistic

Children and Teenagers

Key Points

Anxiety is a normal response to perceived threats and varies with age.
Autistic young people may feel stressed about things their typically developing peers might not find worrying.
Autistic children often experience anxiety due to changes in routine, sensory sensitivities, unfamiliar social situations, and difficulties in understanding emotions.
Signs of anxiety include intense emotions, distressing thoughts, physical symptoms (e.g., headaches, stomach aches), and behavioural changes (e.g., avoidance, meltdowns).
Anxiety can severely affect daily life and is more common in autistic children (40%) than in the general population (10 – 15%).
Anxiety disorders are separate conditions from autism and can be treated.

About Anxiety in Autistic Children and Teenagers

All children and teenagers experience anxiety as a natural response to things they see as threats.

It helps them stay cautious and protect themselves from possible harm, whether it’s physical or emotional. As they grow up and face new challenges, their anxiety can vary in intensity and the things that concern them.

Autistic young people may also feel stressed about things that their typically developing peers might not find as worrying.

These include things like:

Disruptions to routines or unfamiliar sensations in their bodies.
Unpredictable or unfamiliar social situations.
Challenges in understanding others’ thoughts and feelings.
Difficulty managing their own thoughts and emotions, especially when they lead to physical discomfort.
Frustration over not being able to engage in their special interests freely.
Stress related to masking behaviours to blend in, which involves learning and practising certain behaviours while hiding aspects of their autism.

When Anxiety Becomes a Problem

For some children and teenagers, anxiety happens so often and intensely that it affects their daily lives and well-being. This can show up as:

Worrying about failing tests or being teased, leading to avoiding school or social events
Strong fears of dogs, causing them to avoid parks or friends who have dogs
Constantly on edge, worrying about bad things happening

When anxiety disrupts life for long periods, it is recognised as an anxiety disorder.

Research shows that anxiety disorders are much more common in autistic children and teenagers compared to their peers. While about 10 – 15 percent of the general population experiences an anxiety disorder at some point, around 40 percent of autistic children and teenagers have at least one anxiety disorder, often more (van Steensel et al., 2011). Specific phobias and social anxiety are particularly common.

40%	of autistic children, adolescents and adults are thought to have at least one and often more than one anxiety disorder

40%

of autistic children, adolescents and adults are thought to have at least one and often more than one anxiety disorder

It is important to understand that anxiety disorders are not simply a part of autism but are separate conditions that can be treated.

Identifying and treating anxiety in a timely manner can greatly improve a child or teenager’s quality of life and daily functioning.

Signs of Anxiety in Autistic Children and Teenagers

Anxiety in all children and teenagers can manifest as emotional and/or physical symptoms, distressing thoughts and challenging behaviours. For example:

Intense emotions
Feeling overwhelmed, anxious, angry, lonely, or having low self-esteem. They may also experience mood swings, irritability, or agitation.
Thought patterns
Common thought patterns include expecting the worst, believing bad things are likely to happen, focusing on negatives, seeing things in black-and-white, overgeneralising, and trying to guess others’ thoughts. Additionally, there may be an intense need to give the right answer, achieve perfect marks, perform well, and please others.

These thoughts are often not rational and fuelled by anxiety but feel real and logical to the young person with anxiety.

Physical Sensations
Anxiety can cause tense muscles, chest pain, headaches, and a racing heart. They may also complain of stomach aches, feeling tired or lethargic, nausea, or changes in body temperature.
Behavioural Changes
These can include avoiding situations that trigger anxiety, seeking reassurance frequently, becoming withdrawn, or reacting strongly to minor issues. They may exhibit restlessness, revert to less mature behaviours, or show increased challenging behaviours like biting, kicking or arguing. They may also display clinging behaviour, have difficulty eating, relaxing, or sleeping, struggle with concentration and memory, daydream often, feel confused, and find decision-making challenging.

Autistic people often have different sensory experiences and may struggle to understand their own emotions. This makes the world feel unpredictable and hard to handle. Repetitive behaviours might be a coping mechanism to create a sense of order. Additionally, autistic children can’t always tell you that they’re feeling anxious.

Their anxiety might not look like typical signs, such as excessive worry or talking about their feelings. Instead, it might appear as intensified common autism traits, such as stimming, fixation on special interests, and resistance to changes in routine.

Your anxious child might also:

Have more trouble sleeping
Experience meltdowns or emotional outbursts
Avoid or withdraw from social situations

Identifying Anxiety Triggers

To reduce your child’s anxiety and help them manage it, first identify what makes them anxious. Autistic children and teenagers often struggle with understanding and managing emotions, so you may need to observe their signals to determine what causes their anxiety or stress.

Common triggers for anxiety in autistic children include:

Changes in routine – e.g., missing a weekly art lesson because the teacher is sick.
Changes in environment – e.g., moving to a new house, new play equipment at the park, or rearranged furniture at home.
Unfamiliar social situations – e.g., attending a birthday party at an unfamiliar house.
Sensory sensitivities – e.g., crowded places, particular noises, bright lights, specific flavours, or food textures.
Fear of specific situations, activities, or objects – e.g., sleeping in their own bed, using the toilet, balloons, or vacuum cleaners.
Times of transition – e.g., starting a new school year, moving to secondary school, or beginning puberty.

Triggers related to changes to routines

Over the past ten years, researchers have learned a lot about why anxiety is common in people with autism. A key idea is that “intolerance of uncertainty” is at the heart of anxiety in autism. This means that autistic children are often in a heightened state of arousal and find it hard to know what to pay attention to when things change.

Changes in routine – e.g., missing a weekly art lesson because the teacher is sick.
Changes in environment – e.g., moving to a new house, new play equipment at the park, or rearranged furniture at home.
Unfamiliar social situations – e.g., attending a birthday party at an unfamiliar house.
Sensory sensitivities – e.g., crowded places, particular noises, bright lights, specific flavours, or food textures.
Fear of specific situations, activities, or objects – e.g., sleeping in their own bed, using the toilet, balloons, or vacuum cleaners.
Times of transition – e.g., starting a new school year, moving to secondary school, or beginning puberty.

A parent’s hypothesis about why autistic children are averse to change

“There’s a visual [memory] bank already there…you don’t have to update it all the time [if things stay the same]. ‘I’ve seen this before, I’ve scanned it’, I’m not there thinking ‘oh my God, I have to log all of this, I can’t do this because it makes my head hurt. And also when I’m logging it, I’ve got to look out for lions and tigers because they might kill me’. I think a lot of it is the basic desire to survive”

(Ozsivadjian et al., 2012)

Triggers related to sensory stimulation

Research shows that anxiety and sensory stimulation can interact in a cycle, increasing anxiety in autistic individuals.

An autistic individual’s experience of anxiety and sensory overload

“If a baby’s crying really upsets me, I will go outside and start noticing that my clothes are annoying me…. it just all triggers everything”

(Acker et al., 2018)

Research shows that anxiety and sensory stimulation can interact in a vicious cycle, increasing anxiety in autistic individuals. Sensory difficulties can cause anxiety, and anxiety can worsen sensory difficulties.

Sensory-related anxiety varies greatly in autistic children. Their sensory needs and preferences can both cause and result from anxiety. They may struggle to filter out and ignore things they see, hear, touch, smell, and taste, leading to feelings of exhaustion, stress, and being overwhelmed.

Once you know what triggers your child’s anxiety, you can find the best ways to help them manage it. It’s important that others who care for your child, like childcare workers, teachers, and family members, also understand what makes your child anxious and how to support them.

Find out more strategies to help your autistic child manage anxiety at

Managing Anxiety in Autistic Children and Teenagers

References

Acker, L., Knight, M., & Knott, F. (2018). ‘Are they just gonna reject me?’Male adolescents with autism making sense of anxiety: an interpretative phenomenological analysis. Research in Autism Spectrum Disorders, 56, 9-20.
Neilson, C., & Bond, C. (2023). The experience of anxiety for autistic children and young people: A thematic synthesis review. Research in Autism Spectrum Disorders, 109, Article 102274. https://doi.org/10.1016/j.rasd.2023.102274
Ozsivadjian, A., Knott, F., & Magiati, I. (2012). Parent and child perspectives on the nature of anxiety in children and young people with autism spectrum disorders: a focus group study. Autism, 16(2), 107-121. https://doi.org/10.1177/1362361311431703
van Steensel, F. J. a, Bögels, S. M., & Perrin, S. (2011). Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis. Clinical Child and Family Psychology Review, 14(3), 302–317. https://doi.org/10.1007/S10567-011-0097-0