The Connection Between the Anxiety and Autism Spectrum Disorder
Anxiety is one of the most prevalent mental health disorders in the United States. The National Institute of Mental Health estimates that roughly 32% of adolescents have or have had an anxiety disorder, and approximately 19% of adults have had an anxiety disorder in the past year, with rates higher in females than males. What is more, an estimated 31.1% of adults will experience an anxiety disorder at some time in their lives. Rates of Autism Spectrum Disorder (ASD) have also spiked in the last 20 years as reported by the Center for Disease Control. In 2002, rates of Autism were thought to be 1 in 150 children. By 2018, 1 in 44 children were suspected to fit the criteria for an ASD diagnosis. So how and when do these disorders intersect, and in cases of comorbidity, what can parents look for or expect? In order to better understand, we need to look at what each condition is.
What is Anxiety?
The Diagnostic and Statistical Manual (DSM-5) defines anxiety as “excessive worry and apprehensive expectations, occurring more days than not for at least 6 months, about a number of events or activities, such as work or school performance”. We all experience anxiety occasionally, but to meet the criteria of having an anxiety disorder, these anxious thoughts interfere with daily activities like schoolwork and relationships. There are different types of anxiety disorders ranging from Generalized Anxiety Disorder, to Post Traumatic Stress Disorder, Social Anxiety Disorder, Panic Disorder and more. It is common for anxiety disorders to co-occur with other disorders such as ADHD, depression, and eating disorders. The Autism Research Agency reports that Anxiety is also reported at much higher rates for people with ASD, with half of autistic adults also meeting criteria for an anxiety disorder. Steensel et. Al. (2011) found that 40% of autistic children experience a comorbid anxiety disorder.
What is Autism Spectrum Disorder?
According to the DSM-5, ASD is an extremely broad diagnosis that encompasses a wide array of children who have persistent deficits in social communication, social interaction, and restricted, repetitive patterns of behavior, interests, or activities. ASD may or may not be accompanied with intellectual impairment, medical, genetic, or environmental factors. Severity ranges from “Requiring support” (Level 1) to “Requiring very substantial support” (level 3).
Why would individuals who meet criteria for an ASD diagnosis be more likely to fit criteria for an anxiety disorder? Our world is not designed with the function and comfort of neurodivergent individuals in mind. It is not surprising that trying to function in an environment that is not designed with one in mind would lead to stress or anxiety. This question is still being researched but from my own professional experience I have observed several phenomena:
- Individuals with ASD are more likely to be inflexible or have rigidities. When they may not be able to have their need for rigidity met, and know this to be the case, anxiety is a natural response.
- Individuals with ASD are likely to have a different sensory experience than a “neurotypical” person. Things like sounds can be physically painful to them. Anticipation of possible pain is a reasonable cause for anxiety.
- Social situations are not intuitive for many individuals with ASD. It is common for people with ASD to know that they are not meeting social expectations without knowing what they should be doing differently. This is another cause for anxiety.
- It is not unusual for individuals on the Autism Spectrum to struggle with communicating their needs effectively. Being unsure that one’s needs will be met or understood is a reasonable cause for anxiety.
- Some individuals with ASD have been taught to “mask”. Another way of describing this phenomenon is these individuals have been persistently and consistently taught that behaving in a way that is counter to what they naturally enjoy or experience is the only way to access preferred stimuli or social acceptance. Constantly suppressing the behaviors that feel right to these individuals creates stress and anxiety.
How do you recognize if a neurodivergent child is experiencing anxiety?
Just like anxiety that is not accompanied by a comorbid diagnosis, presentation can look a little different for everyone. Sometimes the anxiety is obvious—your child’s breathing and heart rate may elevate, they may hide, say “I’m scared”, verbalize what their anxiety feels like and is happening around, or do something else to make it easy for parents to identify. Other times, it’s not so obvious. Anxiety can often look like avoidance or a lack of interest in the activity that is generating anxiety for someone who falls on the Autism Spectrum. In my practice, I have frequently seen anxiety in children on the spectrum look like anger, or a temper tantrum. When children are asked to participate in an activity that makes them anxious, they may not have the language or self-awareness to describe that emotion as anxiety. This can lead to children genuinely feeling angry that someone is trying to make them participate in an activity that makes them anxious, and mask the anxiety, which can be confusing and frustrating for parents. Seeking to control things is another common way anxiety can be expressed. Children may act out and behave in ways they know to be inappropriate to escape a situation that is creating anxiety.
Anxiety for children with Autism Spectrum Disorder is normal. If you think your child could benefit from some help recognizing and addressing their feelings of anxiety, please feel free to contact us. We would love to help you!