What is the link between autism and anxiety?
- Dr Harry Woodward
- Jan 13
- 3 min read
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If you’re parenting an autistic child and find that anxiety seems to be an almost permanent house guest (often arriving unannounced and refusing to leave), you’re very much not alone.
Anxiety is extremely common in autistic children and young people. In fact, it’s one of the most frequent co-occurring difficulties we see in clinic — and often one of the most exhausting for families to manage. Understanding why autism and anxiety so often travel together can be a huge step towards helping your child feel safer, calmer, and more confident in their world.
Let’s gently unpack the link.
Autism and anxiety: how common is it?
Research suggests that around 40–50% of autistic children experience clinically significant anxiety at some point — much higher than in non-autistic children.
This isn’t because autistic children are “over-sensitive” or “coping badly”. It’s because many everyday experiences are genuinely more demanding, unpredictable, or overwhelming for an autistic nervous system.
The NHS also recognises anxiety as a common mental health difficulty alongside autism, particularly as children get older and become more aware of social expectations and differences
Why do autism and anxiety often go hand in hand?
1. An unpredictable world feels unsafe
Autistic brains tend to like predictability, clarity, and routine. Unfortunately, the real world is often noisy, rushed, and full of surprises.
When a child doesn’t know what’s coming next — a change of teacher, a substitute lesson, a cancelled plan — their brain may interpret this as a threat. Anxiety is, at its core, the brain’s alarm system working overtime.
2. Sensory overload increases stress
Many autistic children experience heightened sensitivity to sound, light, touch, or movement. A classroom that seems “fine” to others may feel painfully loud or chaotic.
Living in a body that is constantly bombarded by sensory input can keep stress levels permanently elevated — making anxiety far more likely.
The National Autistic Society has an excellent overview of sensory processing differences
3. Social situations are cognitively demanding
Social interaction doesn’t come automatically for many autistic children. Reading facial expressions, tone of voice, and unspoken rules requires significant mental effort.
Over time, repeated social confusion or past negative experiences (misunderstandings, teasing, exclusion) can lead to anticipatory anxiety — worrying about things that haven’t happened yet but might.
4. Difficulties expressing emotions
Many autistic children struggle to identify, label, or explain their internal feelings (sometimes called alexithymia (prounounced: “a-lexy-thigh-me-ah”)).
When emotions can’t be easily understood or communicated, anxiety may show itself in other ways — meltdowns, shutdowns, tummy aches, headaches, sleep problems, or avoidance.
How does anxiety look in autistic children?
Anxiety in autistic children doesn’t always look like “worrying” in the traditional sense. Instead, you might notice:
Increased rigidity or need for control
Avoidance of certain places or activities
Physical complaints (especially before school)
Sleep difficulties
Emotional outbursts or anger that seems sudden or intense
These behaviours are often signals of distress, not defiance.
Does anxiety worsen autistic traits?
In short: yes — anxiety and autism can create a feedback loop.
When anxiety rises, children may:
Mask more (which is exhausting)
Withdraw socially
Become more rigid
Struggle with attention and executive function
This can then increase anxiety further. Breaking that cycle often starts with reducing demands and increasing predictability, rather than trying to “push through”.
Supporting an autistic child with anxiety
While every child is different, supportive strategies often include:
Clear routines and visual supports
Advance warnings for changes
Emotion coaching and naming feelings
Reducing sensory overload where possible
Building in recovery time after stressful events
NICE guidance emphasises the importance of adapting environments and expectations to the child — not the other way around
If anxiety is significantly impacting daily life, seeking support from professionals who understand both autism and mental health can be very helpful.
A reassuring final thought
Anxiety in autistic children is understandable, common, and — importantly — manageable with the right support.
Your child isn’t broken, fragile, or failing. Their nervous system is doing its best in a world that isn’t always designed with them in mind. With understanding, patience, and the right scaffolding, many autistic children learn to feel safer and more confident over time.
And you, as ever, are doing far better than you think.
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