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Treating Anxiety in Adults with Autism: A Comprehensive Guide

This article provides a useful guide on treating anxiety in adults with autism, helping you understand the signs of anxiety in autism, and offering strategies for addressing anxiety in autistic adults.

Some adults with Autism Spectrum Disorder (ASD) exerience noticeable, and at times, distressing feelings of anxiety. Understanding and treating anxiety in adults with autism requires an approach that acknowledges the unique challenges of those with autism. This article provides a useful guide on treating anxiety in autistic adults, helping you understand the signs of anxiety in autism, and offering strategies for addressing anxiety in autistic adults. By the end of this article, I hope you’ll feel more informed and confident about managing anxiety and seeking the appropriate help.

Understanding Anxiety in Adults with Autism

Anxiety is not uncommon in the general population, but it manifests differently with autism. Adults with autism often experience heightened anxiety levels due to sensory sensitivities, difficulties in social interactions, and the struggle to navigate a world that feels overwhelming and unpredictable. Recognizing these sources is the first step toward addressing anxiety effectively.

Sources and Causes of Anxiety in Autism

To effectively treat anxiety in adults with autism, it’s crucial to understand its sources and causes. Anxiety in autistic adults can stem from various factors, often intertwined, making it essential to recognize each contributing element. Here’s a list of the common sources and causes:

Sensory Overload

Many autistic adults have heightened sensory sensitivities, making them more susceptible to sensory overload. Everyday environments that seem normal to neurotypical people can be overwhelming for someone with autism. For instance, bright lights, loud noises, crowded places, and strong smells can all trigger significant anxiety. The inability to filter out extraneous sensory input can lead to a constant state of heightened alertness, contributing to chronic anxiety.

Social Interactions

Social interactions can be a significant source of anxiety for autistic adults. Many people with autism find it challenging to read social cues, understand body language, and engage in typical social norms. The fear of saying or doing something inappropriate, coupled with past negative social experiences, can lead to social anxiety. This anxiety is not just about socializing but also about the anticipation of social events, making even routine interactions stressful.

Routine Disruptions

A strong preference for routine and predictability is common among autistic adults. This preference stems from the need to create a sense of order and control in a world that often feels chaotic. Unexpected changes or disruptions to established routines can be a significant source of anxiety. Even minor changes, such as a different route to work or an unexpected visitor, can trigger anxiety responses.

Comorbid Conditions

Autistic adults often experience comorbid conditions that can complicate anxiety. Conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and depression are common among individuals with autism. These conditions can amplify anxiety symptoms, creating a complex web of mental health challenges that need to be addressed concurrently.

Internal Factors

Personal traits and internal factors also play a significant role in the anxiety experienced by autistic adults. For example, perfectionism, a heightened sense of justice, and an intense focus on specific interests can contribute to anxiety. The drive for perfection and the frustration of not meeting self-imposed high standards can lead to chronic stress and anxiety. Additionally, a strong sense of justice can cause distress when witnessing perceived injustices or inconsistencies in the world.

Past Trauma

Past traumatic experiences can significantly impact the anxiety levels of autistic adults. Trauma, whether related to bullying, abuse, or significant life events, can leave a lasting impact. The way trauma is processed and internalized can vary, but it often results in heightened anxiety and fear responses. Understanding the role of past trauma is crucial in addressing and treating anxiety effectively.

Biological and Genetic Factors

Research suggests that biological and genetic factors may also contribute to anxiety in autistic individuals. Differences in brain chemistry, structure, and function can predispose individuals to anxiety disorders. Genetic predispositions can play a role, with anxiety and autism often running in families. Understanding these biological underpinnings can help in creating more targeted treatment approaches.

Environmental Stressors

Environmental stressors, such as a high-pressure job, relationship difficulties, or financial concerns, can increase anxiety in autistic adults. The added layer of stress from the external environment can overwhelm an already sensitive system. It’s important to recognize and mitigate these stressors to reduce overall anxiety levels.

Communication Challenges

Communication difficulties can be a significant source of frustration and anxiety for autistic adults. Struggling to express needs, thoughts, and emotions clearly can lead to misunderstandings and increased anxiety. The effort to continuously find the right words or gestures to convey feelings can be exhausting and anxiety-inducing.

Sensory Processing Differences

Sensory processing differences mean that autistic individuals often perceive and process sensory information differently. This can lead to anxiety in various environments, such as work, school, or social settings, where sensory stimuli are unpredictable and intense. Understanding these sensory differences is key to creating supportive environments that reduce anxiety.

Hyperawareness and Hyperfocus

Autistic adults often exhibit hyperawareness and hyperfocus, where they become intensely aware of their surroundings or fixated on specific interests. While this can be a strength, it can also contribute to anxiety. Hyperawareness can make a person more sensitive to potential threats or changes, while hyperfocus can lead to anxiety and difficulty engaging with areas of interest.

By understanding these various sources and causes of anxiety, caregivers, therapists, and individuals themselves can better address and manage anxiety in autistic adults. Recognizing the multifaceted nature of anxiety is the first step towards creating effective and comprehensive treatment plans.

Signs of Anxiety in Autism

Identifying anxiety in autistic adults is often challenging due to the overlap of symptoms between anxiety and autism. However, being aware of specific signs can help in early detection and intervention. Here is an overview of the signs of anxiety in autistic adults:

Behavioral Changes

  1. Increased Stimming: Autistic adults often engage in self-stimulatory behaviors (stimming) such as rocking, hand-flapping, or repeating phrases. An increase in the frequency or intensity of these behaviors can be a sign of heightened anxiety. Stimming is often a self-soothing mechanism to cope with overwhelming emotions or sensory input.
  2. Avoidance Behavior: Avoidance of certain situations, places, or people that trigger anxiety is common. This can manifest as reluctance to leave the house, avoiding social gatherings, or withdrawing from activities that were previously enjoyed. Avoidance behavior can significantly impact daily functioning and quality of life.
  3. Compulsive Behaviors: Engaging in repetitive, ritualistic behaviors or routines more rigidly can indicate anxiety. These behaviors might include arranging objects in a specific order, following strict routines, or performing tasks in a particular sequence. Compulsive behaviors are often an attempt to create a sense of control and predictability.

Physical Symptoms

  1. Somatic Complaints: Anxiety can manifest physically through symptoms like headaches, stomachaches, muscle tension, and increased heart rate. These symptoms may not have an apparent medical cause and can fluctuate based on the person’s anxiety levels.
  2. Sleep Disturbances: Difficulty falling asleep, staying asleep, or experiencing restless and disturbed sleep can be indicative of anxiety. Insomnia and frequent nightmares are common, and poor sleep quality can exacerbate anxiety symptoms.
  3. Appetite Changes: Anxiety can lead to changes in eating habits, either increasing or decreasing food intake. Some individuals may experience a lack of appetite and significant weight loss, while others may turn to food for comfort, leading to weight gain.

Emotional and Cognitive Signs

  1. Emotional Outbursts: Unexplained anger, irritability, or emotional meltdowns can be indicative of underlying anxiety. These outbursts may seem disproportionate to the situation and can be triggered by minor frustrations or changes in routine.
  2. Heightened Fear or Phobias: Development, or worsening, of specific fears or phobias, such as fear of certain animals, places, or situations, can signal anxiety. These fears can lead to avoidance behavior and impact daily functioning.
  3. Overwhelm and Panic Attacks: Experiencing feelings of overwhelm, panic attacks, or intense fear that seem to come out of nowhere can be signs of anxiety. Panic attacks might include symptoms like chest pain, shortness of breath, dizziness, and a sense of impending doom.
  4. Difficulty Concentrating: Anxiety can impair cognitive functions, leading to difficulty concentrating, focusing on tasks, and making decisions. The person may seem distracted, forgetful, or unable to complete tasks efficiently.

Social Signs

  1. Withdrawal from Social Interactions: A noticeable withdrawal from social interactions and a preference for solitude can be a sign of anxiety. This might include avoiding eye contact, not engaging in conversations, or physically distancing oneself from others.
  2. Reluctance to Engage in Social Activities: Anxiety can cause reluctance or refusal to participate in social activities, even those that were previously enjoyable. This reluctance is often due to the fear of judgment, misunderstanding, or social mistakes.

Communication Changes

  1. Changes in Speech Patterns: Anxiety can affect communication, leading to changes in speech patterns. This might include increased speech rate, mumbling, difficulty finding words, or sudden silence during conversations.
  2. Expressive and Receptive Language Difficulties: Anxiety can impact both expressive and receptive language abilities, making it harder to articulate thoughts or understand what others are saying. This can lead to misunderstandings and increased frustration.

Additional Signs

  1. Frequent Reassurance Seeking: Seeking constant reassurance from others about decisions, safety, or social interactions can be a sign of anxiety. This behavior stems from a lack of confidence and increased worry about making mistakes.
  2. Hypervigilance: A heightened state of alertness to potential threats or changes in the environment, often leading to increased startle responses and difficulty relaxing.
  3. Catastrophic Thinking: Tendency to assume the worst-case scenario in various situations, leading to excessive worry and stress about future events or outcomes.

Recognizing these signs can help in seeking timely and appropriate intervention. By being attentive to behavioral, physical, emotional, social, and communication changes, caregivers, therapists, and individuals themselves can better identify and manage anxiety in autistic adults. Early detection and intervention are crucial in improving outcomes and enhancing the quality of life.

Addressing Anxiety in Autistic Adults

Once anxiety is identified, the next step is addressing it through effective treatments and interventions. Addressing anxiety in autistic adults involves a multi-faceted approach tailored to individual needs. This includes a combination of psychotherapy, medication, lifestyle modifications, support networks, and self-care practices.

Once anxiety is identified, the next step is addressing it through effective treatments and interventions. Managing anxiety in autistic adults involves a multi-faceted approach tailored to individual needs. This includes a combination of psychotherapy, medication, lifestyle modifications, support networks, and self-care practices.


Psychotherapy plays a vital role in treating anxiety in autistic adults. It provides a structured environment where individuals can explore their feelings, understand their anxiety triggers, and develop effective coping mechanisms. While Cognitive Behavioral Therapy (CBT) is a popular approach, there are other valuable therapeutic options that focus on understanding the emotional sources of anxiety.

  • Talk Therapy: This form of therapy, also known as traditional psychotherapy, emphasizes open-ended conversations where individuals can discuss their thoughts and feelings in a non-judgmental setting. This can help in identifying the emotional sources of anxiety, such as unresolved trauma, relationship issues, or chronic stressors. Talk therapy encourages self-reflection and insight, which can lead to a deeper understanding of one’s emotional landscape and more effective anxiety management.
  • Mindfulness-Based Therapy: This approach incorporates mindfulness practices to help individuals become more aware of their thoughts and feelings without becoming overwhelmed by them. Techniques such as mindful breathing and meditation can promote relaxation and reduce anxiety.
  • Acceptance and Commitment Therapy (ACT): ACT encourages individuals to accept their thoughts and feelings rather than struggling against them. It also focuses on committing to actions that align with one’s personal values, which can provide a sense of purpose and reduce anxiety.
  • Dialectical Behavior Therapy (DBT): Initially developed for borderline personality disorder, DBT has been adapted to help individuals regulate emotions and cope with stress. It combines acceptance strategies with change strategies, teaching skills such as distress tolerance and emotional regulation, which are particularly useful for autistic adults experiencing anxiety.


In some cases, medication may be necessary to manage anxiety symptoms. Selective serotonin reuptake inhibitors (SSRIs) and other anti-anxiety medications can be effective. However, it’s essential to work closely with a healthcare provider to monitor the effects of medication and adjust dosages as needed. Medication should be considered as part of a broader treatment plan that includes psychotherapy and lifestyle changes.

Lifestyle Modifications

Adjusting daily routines and environments can significantly reduce anxiety. Here are some strategies that can help:

  • Sensory-Friendly Environment: Creating a sensory-friendly space at home or work can help reduce anxiety. This might include using soft lighting, reducing noise levels, and incorporating sensory tools like weighted blankets or noise-canceling headphones.
  • Structured Routine: Establishing a consistent daily routine can provide a sense of predictability and control, which can help reduce anxiety. This includes regular sleep schedules, meal times, and activities.
  • Physical Activity: Regular physical activity is known to reduce anxiety. Encouraging activities that the individual enjoys, such as walking, swimming, or yoga, can be beneficial.
  • Healthy Diet: A balanced diet impacts overall well-being. Ensuring a diet rich in nutrients and avoiding excessive caffeine and sugar can help manage anxiety symptoms.

Support Networks

Having a strong support network is crucial for managing anxiety. This can include family, friends, support groups, and professional caregivers. Social support provides a sense of belonging and understanding, which can alleviate feelings of isolation and anxiety. Support networks can also offer practical assistance and encouragement, making it easier to implement and maintain coping strategies.

Self-Care Practices

Encouraging self-care practices can empower autistic adults to manage their anxiety. These practices might include:

  • Mindfulness and Meditation: Regular mindfulness exercises and meditation can help in grounding and calming the mind. Apps and online resources can provide guided sessions for beginners.
  • Hobbies and Interests: Engaging in hobbies and interests can provide a constructive outlet for stress and anxiety. Whether it’s art, music, gardening, or reading, having a passion can be a significant source of comfort and joy.
  • Relaxation Techniques: Techniques such as deep breathing, progressive muscle relaxation, and guided imagery can be effective in reducing anxiety. These can be practiced daily to maintain a calm state of mind.


Anxiety is a significant challenge for many adults with autism, but with the right understanding and strategies, it can be managed effectively. By recognizing the signs of anxiety, understanding its sources, and implementing therapeutic and lifestyle interventions, you can help alleviate anxiety and improve the overall quality of life for autistic adults.

If you or a loved one is struggling with anxiety, don’t hesitate to seek professional help. Contact me for a virtual consultation to explore tailored strategies and support for managing anxiety. Together, we can work towards a calmer and more confident future.

By understanding and addressing anxiety in autistic adults, you are taking a crucial step towards enhancing well-being and fostering a supportive environment. Remember, you are not alone in this journey, and help is always available.


Dr. Kenneth Roberson

Dr. Kenneth Roberson is an Adult Autism Psychologist in San Francisco with over 30 years of experience. Click below to ask a question or schedule an appointment.

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