Although feelings of anxiety are not part of the official autism diagnostic criteria, generalized anxiety disorder is autism’s most common comorbid condition. This means that many autistic people experience high levels of anxiety. Research suggests that up to half of all people with an ASD diagnosis also have a clinical diagnosis of anxiety.
It is important to recognise the signs of anxiety in young people with autism as it can it greatly impact certain aspects of ASD, including social interaction and repetitive behaviors.
Autism Spectrum Disorder (ASD)
Autism is medically referred to as autism spectrum disorder (ASD). ASD is a developmental disorder that is caused by differences in the brain. Although individuals, particularly women, are often diagnosed in adolescence or even later in life, ASD is a disorder that you are born with.
There is no treatment or cure for the disorder but there are multiple therapies and treatment modalities to help people with the disorder create coping mechanisms and alleviate certain symptoms.
Speech and language therapy, occupational therapy and animal therapy are just some of the approaches to supporting people with autism to live fulfilling and successful lives. Autism is a spectrum, meaning that each person with autism can experience different symptoms.
Recognising Autism Spectrum Disorder
Recognising autism spectrum disorder in young people compared to adults can be different.
Children With Autism Spectrum Disorders Often:
- Prefer a strict daily routine and getting very upset if this routine changes
- Avoid eye contact
- Don’t smile back when people smile at them
- Get very upset in response to certain tastes, smells or sounds
- Are not as talkative as other children
- Like to repeat the same phrases
- Make repetitive movements or behaviours such as flapping their hands, clicking their fingers or tapping or rocking their body
- Don’t always understand what other people are thinking or feeling
- Find it difficult to express how they feel
- Develop a very strong interest in particular subjects or activities
- Get upset when asked to do something
- Find it making friends difficult or prefer being alone
- Take phrases very literally such as “an arm and a leg” or “a piece of cake”
An autistic child may need additional support at school or with social tasks. As a parent, try to ensure your child feels accepted and understood, without shielding them from challenges of the outside world.
Autism is often not recognised until adulthood, especially in women who tend to have quieter adapted behaviours and appear to cope in social situations.
Autistic Adults Will Often:
- Find it difficult to understand what others people may be thinking or feeling and also find it difficult to express how they feel
- Get very stressed and anxious about socialising or being in social settings
- Come across as blunt, rude or not interested in others
- Follow a particular routine each day and get upset or anxious if it changes
- Don’t understand certain socially accepted “rules”
- Avoid direct eye contact
- Get upset or stressed if a person touches or gets too close to them
- Notices and points out details, patterns, or sounds or other sensations that others do not notice
- Prefers to plan things out meticulously before they happen
Most people will experience anxiety in their life whether generalised or related to something in specific.
Anxiety can take many forms, with some people experiencing physical symptoms such as restlessness, dizziness, wobbly legs and shortness of breath. Others experience symptoms of anxiety in their mind, manifesting as feelings of dread, feeling on edge, panicked or irritable, experiencing difficulty concentrating, and even feeling detached from themselves or the world.
Some people experience physical and/or mental symptoms of anxiety occasionally, whereas others have to deal with these feelings constantly, day in and day out. The latter is the sign of an anxiety disorder.
There are many forms of anxiety disorders including:
- Social anxiety disorder
- Generalized anxiety disorder (GAD)
- Panic disorder
- Separation anxiety disorder
Every one of these disorders can be challenges for individuals with autism, although social anxiety disorder seems to be the most common. Certain social situations, especially those that are loud or cause a lot of sensory stimulation can increase stress and anxious feelings for people with autism.
A recent survey by the National Autistic Society revealed that around 59% of people with autism spectrum disorder said anxiety had a high impact on their ability to get on with life.
Parents are in a particularly unique position, often knowing the person with anxiety more than anyone else. This allows them to recognise which traits and behaviours are linked to ASD and which might be a sign of both autism and anxiety disorders being present.
Autism and Anxiety
Anxiety and autism spectrum disorder can both result in difficulty navigating social situations and communication difficulties. Anxiety is a significant challenge for many autistic adults; the National Autistic Society states that severe anxiety is particularly common in social situations or when facing change. Recognising when you begin to feel anxious whether in social integrations or other situations can be a greater challenge for people with autism spectrum disorders.
The National Autistic Society express the importance of learning to recognise triggers for anxiety or panic attacks and find coping mechanisms to help reduce anxiety for autistic people. However, it is common for autistic people to experience difficulty recognising and regulating their emotions when they recognise anxiety symptoms.
Accurately diagnosing and treating anxiety is crucial, so that autistic people can create healthy coping mechanisms to ease the stress of social interactions, sensory overload, unwanted and intrusive thoughts and make daily life easier.
Diagnosing Anxiety in Autistic Children
Standard methods of assessments used to diagnose anxiety do not always work as effectively in autistic children. There are overlapping symptoms between both disorders and so it can often go unnoticed, leading to suspected high rates of untreated comorbid anxiety in autism.
As a parent, recognising patterns of anxiety in certain situations or places, and physical signs, such as tremors, restlessness, sweating, body aches, and sleep problems can help medical professionals find an accurate diagnosis.
Approaches to Treatment for Anxiety with Autism
People with autism and anxiety are more likely to have meltdowns and outbursts as well as withdraw completely because they struggle to explain that they are feeling anxious, so it is important to address anxiety, practice social skills, address disruptive behaviors, irrational fear and social communication impairment.
There are a range of approaches treat anxiety disorders, including medication or therapy and often a combination of both. While research into the effectiveness of anxiety treatments for autistic children or adults is increasing, results remain mixed and further study is required.
There is growing evidence in support of the use of cognitive–behavioural therapy to manage symptoms of anxiety in autistic children with adequate verbal skills; however, there is mixed evidence of its success in treating repetitive behaviors.
Cognitive behavioral therapy (CBT) works by helping a person change behavioural patterns or unhelpful, distorted thoughts they have about themselves. It widely regarded as an effective treatment for depression, anxiety, post traumatic stress disorder, obsessive compulsive disorder and a range of other mental disorders.
Researchers have been testing some modifications to traditional cognitive behavioural therapy that aim to address the communication and social challenges of anxiety in autism, and make the treatment more accessible for those with developmental disabilities. These modifications include the use of pictures, lists, videos, concrete language, and social stories, in addition to recognising and utilising the special interests common in autistic people.
In terms of medication for autistic people with anxiety, research is lacking clarity reliability. A number of studies have shown that children taking either the antidepressant citalopram or the anti-anxiety drug buspirone showed some improvement in anxiety symptoms. Whereas the more commonly prescribed selective serotonin-reuptake inhibitors (SSRI) produced behavioral activation side effects, commonly appearing as hyperactivity, impulsiveness, or trouble sleeping.
Other treatment approaches for managing anxiety include mindfulness training, exposure therapy and strategies that focus on reducing stress through sensory integration training and helping with managing sensory differences.
Conventional treatment approaches to relieve anxiety such as behavioral interventions are often not appropriate or accessible for young people with ASD. Compared to the general population, it is important to allow increased time for developing a therapeutic relationship with autistic patients. In addition, understanding and adapting practice to address the sensory issues and lack of awareness of one’s own emotions ASD can cause is fundamental when drawing up treatment plans.
At The Wave, we believe in recovery through action, combining clinical approaches to anxiety treatment with practices such as yoga and hands-on experiences such as cookery classes.
Our gardening group also serves as an effective addition to anxiety treatment, with nature based interventions shown to increase mental health outcomes and reduce anxiety.
If you are worried that your teenager may have overlapping behaviours that suggest a co-occurrence of anxiety and autism reach out to The Wave today.