Anxiety is one of the most common mental health disorders affecting those on the autism spectrum. Anxiety can cause extreme fear, dread, sweating, restlessness, and even chest pain. “A lot of us do experience anxiety, and we struggle with it in our own ways,” says Jairo E. Arana, an autistic member of the Community Advisory Council for SPARK, the largest study of autism.

About 40 percent of youth with autism - and up to half of autistic adults - meet the clinical criteria of an anxiety disorder, such as social anxiety, phobia, panic disorder, or generalized anxiety, according to research studies. Among SPARK participants who have autism, anxiety disorders affect 18 percent of children, 34 percent of adults who have a guardian, and 52 percent of independent adults. By comparison, 7 percent of children and 19 percent of adults in the general U.S. population have anxiety disorders, according to federal health statistics. Children with autism may express anxiety by avoiding new tasks, running away, hitting, and having tantrums, explained child psychiatrist Antonio Y. Hardan, M.D., in a SPARK webinar. These are some of the same behaviors that are considered common to children with autism. So how do you separate autism from anxiety? And what can be done to help?

When Lindsay Gilroy was a child, she desperately wanted things to remain the same. “Insistence on sameness” is a symptom of autism, which Gilroy has, but it also may be related to anxiety. She would get very upset if her mother closed the kitchen cabinets or left her sight. Gilroy’s anxiety worsened with age. “In her late teens, things really started falling apart,” her mother says. Lindsay began taking anti-anxiety medications and learned coping strategies, such as breathing and counting exercises, and clenching her hands when anxious.

“We’ve seen a marked improvement, and in my mind, it’s about a better quality of life for her,” her mother says. Symptoms of anxiety and autism may overlap. Does a child have a tantrum when separated from a parent because he has separation anxiety - or because he does not like change, an autism symptom? Does a teenager stay in her room because she’s not interested in socializing - a sign of autism-  or because she has social anxiety?

Dr. Hardan described three ways of thinking about anxiety and autism:

• Anxiety is separate from autism. It presents the same in people with autism as it does in others.
• Autism increases the risk of anxiety. Difficulties in understanding the social world, or bullying, can trigger anxiety. Being overly sensitive to loud noises, bright lights, or other sensory input – also common to autism – can make someone feel anxious.
• Anxiety is simply part of autism, contributing to the need for sameness and predictability, and the avoidance of social situations.

That last theory is the subject of debate, Hardan says.

As he and others explained, anxiety and autism are treated differently. If you believe anxiety is part of autism, “there might be a tendency to overlook the anxiety and not treat it,” says Roma A. Vasa, M.D., a child psychiatrist who specializes in both anxiety and autism at Kennedy Krieger Institute in Maryland. “The standard treatments for autism - speech therapy, occupational therapy, and special education - are not going to target fears and anxiety.” It is important to recognize and treat anxiety, she says. “Anxiety can make autism symptoms worse.”, Vasa says.

Anxiety can affect schooling. One study of children with autism found that those who had symptoms of social anxiety made less progress in elementary school than those who did not. Youth also may have had bad experiences that cause anxiety about social situations. For example, children on the spectrum are more likely to be bullied than other children.

Navigating a social world can trigger anxiety, say some adults on the spectrum.

Breaking an unwritten social rule can have harsh consequences, says James Williams, an autistic member of SPARK’s Community Advisory Council. “When you are losing friends and being rejected - which to you seems out of the blue and you don’t understand why it’s happening -  that can cause anxiety in anyone. You wake up every morning and wonder if someone will still be your friend,” he says.

Having an anxiety disorder can be difficult. Do children and adults with autism face additional challenges with getting an anxiety diagnosis or treatment?

This blog post is extracted from original material written by Marina Sarris, SPARK Staff writer.

• Read Diagnosing and Treating Anxiety in People with Autism.
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About SPARK

SPARK is an online, research study for all individuals with a professional diagnosis of autism and their family members as is designed to provide much needed answers. The SPARK study collects a wealth of data including information on the presence of co-occurring mental health conditions including anxiety. April is world autism awareness month, and so there is no better time to bring to light not only the challenges associated with autism, but also the most common conditions that impact this community.