Anxiety Among Autistic People

Autism 

Autism is a neurodevelopmental difference characterized by social communication challenges along with a number of other features, often including sensory sensitivities, a strong desire for predictability, and repetitive behaviors. As a field, we now view autism as a constellation of naturally occurring brain-based differences. Some of these differences can be strengths, like a fine-grained attention-to-detail, focus on passions, and strong adherence to rules. Other differences can be disabling, especially because autistic people live in a world that was mostly made up by non-autistic people who might have expectations that do not match their strengths. For example, many autistic people thrive when thing are predictable, but because life often changes (sometimes unpredictably), this can cause a great deal of anxiety. Unfortunately, anxiety and depression are among the most common disabling factors among autistic people.

Anxiety, OCD, and autism

Anxiety is common among autistic individuals for two major reasons - 1) there is a lot of overlap between some autistic features and anxiety, and 2) autistic people often face more difficult experiences in life.

1. A few of the overlapping features between autism and anxiety:

   • Insistence on sameness. Autistic people thrive on predictability, but of course, change is constant in life. People with anxiety disorders often have a hard time dealing with uncertainty or unpredictability. When things do change, people who prefer predictability often feel very anxious

   • A tendency to get "stuck" on topics. This can be a strength of autistic people when this is directed towards a passion, but when someone gets stuck on a potential scary situation, it can lead to more anxiety. 

   • Difficulty labeling and expressing emotions. Autistic people often have a difficult time understanding or speaking about their emotions. This is the first step to coping with difficult emotions like anxiety. 

   • Sensory sensitivities: Autistic people are often very sensitive to certain noises, lights, or textures. This can overlap with sensitivity anxious people feel about similar situations.

2. Difficult life experiences among autistic people

   • Trauma - autistic people are more likely to experience trauma,  which is a primary factor that can drive anxiety

   • Bullying - similarly, autistic people are almost always bullied, especially in childhood

   • Poor fit between autistic experience and the non-autistic world. The world was set up primarily by non-autistic people, and we tend to expect people to act in a non-autistic way (for example, when we expect autistic students to transition easily in a noisy, loud, crowded hallway between class). 

Therapy for autistic people with anxiety and depression

Fortunately, many studies have shown that cognitive behavioral therapy works very well for many autistic people. This is especially the case when therapists adapt what they are doing to meet the strengths of autistic people they work with. My colleagues and I have worked with autistic self-advocates, parents, youth, and providers to study how therapy might be adapted for autistic people. Some of the examples of changes experts and people with lived experience recommend include providing information multiple different ways, taking time to ensure concepts are understood, and tying therapy to their interests and goals. That said, it is very important for a therapist to work with the individual in front of them to understand how therapy might be match their specific needs, strengths, and difficulties.