Image of a young boy with his hands over his ears.

Around 40% of Autistic children and adolescents experience clinical levels of anxiety. When we compare this to the incidence of anxiety in the neurotypical population, which is about 15%, it is obvious that this is a big issue for Autistic youth and is something we need to get better at identifying and addressing.

When I talk about clinical levels of anxiety, I am not talking about feeling a little nervous about going to a new place or performing in front of a class; it is anxiety that impacts on a child’s ability to do everyday things without distress, and negatively affects their quality of life.

You may have heard anxiety mentioned with regard to Autism as just something that all Autistic individuals experience because of differences in communication and social interaction that make the world uncertain at times. Or perhaps that the way our brains work makes us more sensitive to stress and experiencing anxiety. Yes, for many Autistic individuals the uncertainty of the neurotypical world makes situations anxiety provoking, and yes, Autistic brains appear to be more susceptible to stress. But it is not as simple as that. Anxiety shouldn’t be considered an inevitable part of the Autistic experience that children and adolescents have to just get used to because of their neurotype. If it is causing distress and limiting their ability to function, we should prioritise support. 

We now know that the Autistic experience of anxiety can differ significantly from the non-autistic population and consequently often requires different approaches to supports. For example, even when an Autistic child or adolescent is demonstrating what appears to be separation anxiety, which is also experienced by neurotypical individuals, the driving cause of the anxiety may be different and they may therefore need different supports. The child may indeed be anxious that something will happen to a parent in their absence or that the parent will not come back to collect them at the end of school or kinder. Or the child could be experiencing difficulties with what Dr Wenn Lawson calls Object Permanence, resulting in the child cognitively being aware that the parent will return, but experiencing an intense emotional sense of loss and disconnection when the parent is out of sight. These different underlying causes for the anxiety need to be addressed in different ways.

Research suggests that some Autistic children and adolescents experience anxiety triggers that are similar to non-autistic individuals such as fear of spiders, dogs, separating from a parent, or taking a test. However, it has also been found that Autistic individuals can demonstrate fears and anxiety around more novel triggers such as, for example, men with beards, mannequins, and sensory stimuli (e.g. smells and sounds). 

It also appears that while anxiety typically involves thoughts or cognitions as well as uncomfortable or distressing physiological changes, in Autistic individuals anxiety can occur without associated thoughts, particularly when a sensory stimuli is the trigger, making therapy approaches such as Cognitive Behaviour Therapy often ineffective. Unfortunately, it is common for therapists without an understanding of anxiety in Autistic individuals to assume that cognitions are present and insist that an Autistic child or adolescent identify these (possibly non-existent) thoughts to progress in therapy. This can result in the Autistic young person thinking that they are doing something wrong when they can’t identify any thoughts that are causing them to feel anxious, but it is actually the therapist that is on the wrong track.

Further, for Autistic individuals with anxiety associated with sensory input, distress can result from being exposed to the sensory stimuli, and also in anticipation of being exposed. So a child who experiences loud noise as painful to their ears may have a physiological anxiety response when exposed to loud noise, but also be anxious about attending anywhere that may be noisy such as school assembly or a sporting event, resulting in them becoming distressed at the thought of being in these situations. For children with sensory based anxiety, accommodations to support their sensory needs are the most effective approach. More ‘standard’ interventions such as graded exposure actually cause the Autistic individual further distress and potential trauma because their sensory systems do not become desensitised with repeated exposure, however they are still regularly being used with Autistic children and adolescents in therapy due to a lack of understanding of the unique Autistic experience.

It is essential that parents, educators, and allied health professionals listen to Autistic children and adolescents to understand their experiences and seek out reliable information about how to provide the best possible supports for Autistic young people in their care. With better understanding of how anxiety can present in Autistic children and adolescents, and knowledge of approaches that can more effectively meet their needs, I am confident that we can make a difference to the wellbeing of Autistic youth and in turn the Autistic community as a whole.

If you found this article helpful and you would like to learn more, please join me on April 15th 2024 for my webinar “Anxiety in Autistic Children: Causes, Consequences and Considerations.” If you miss it, you’ll be able to access the recording on my video site at https://videos.okeydokey.com.au.

Category:
Adolescents, anxiety, Autism, Behaviour, Children, disability, Parenting, School
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