Anxiety in Autism: Needs a different approach.

I have lost count of how many times I have heard the phrase, “They need to overcome their anxiety.”

It is often said as if anxiety is a temporary obstacle. Something to push through. Something irrational or dramatic. A fear of spiders. A fear of the dark. A social fear to be tackled through exposure and praise.

But when it comes to autism, I feel that lens does not fit. Anxiety for autistic people is not a fear to “get over.” It is often a fundamental part of how they interact with the world because the world was not built for them.

And I believe this thinking changes everything.

What anxiety looks like in autism

I see that anxiety in autism is not just about “worries.” It is about overwhelm. It can come from:

• Sensory overload
• Social pressure
• Sudden change
• The feeling of being misunderstood
• Feeling trapped in expectations you never asked for

These are not avoidable parts of life. They are constant.

And the more I support autistic students, the clearer it becomes: anxiety is not something wrong with them. It is often a logical, even healthy, response to a world that constantly demands they mask, adapt, and tolerate distress.

A brief history of anxiety, did they get it wrong?

Historically, anxiety has been understood through a neurotypical lens.

In the early 20th century, psychoanalytic theory saw anxiety as an inner conflict between desires and societal expectations (Freud, 1926). Behaviourists like Watson and Skinner then reframed it as a learned response—something triggered by negative stimuli and reinforced by avoidance.

Cognitive behavioural therapy (CBT), which still dominates clinical treatment today, built on these foundations by arguing that anxiety stems from unhelpful thought patterns (Beck, 1976). If we change the thought, we change the feeling.

I know that these therapies have a place and help thousands of people successfully; however, for autistic people, the issue is not just internal thinking. It is often about external realities.

You cannot reframe away bright lights, strong smells, a noisy classroom, or the pain of being socially excluded for just being yourself. Autistic anxiety is often embedded in sensory and relational experience, not simply a cognitive distortion.

Research is catching up.

Studies consistently show that autistic children and young people experience higher levels of anxiety than non-autistic peers (van Steensel et al., 2011; Vasa & Mazurek, 2015). In fact, research estimates up to 40% of autistic children meet clinical criteria for an anxiety disorder (Simonoff et al., 2008).

But labelling it solely as a “disorder” misses the point.

Many of the triggers for this anxiety come from the demands of a neurotypical world. Social norms. School environments. Communication expectations. Noise. Touch. Transitions. Even eye contact.

More recently, researchers have recognised that standard treatments for anxiety may not be suitable for autistic individuals. For example, traditional CBT has mixed outcomes (Lang et al., 2010), while acceptance-based therapies—like ACT (Acceptance and Commitment Therapy)—have shown greater promise because they focus on living with anxiety rather than trying to eliminate it (Pahnke et al., 2019).

That is exactly what I see in practice. When we stop trying to “fix” anxiety, and instead validate and accept it, everything changes.

Acceptance is the starting point

When an autistic student learns it is completely fine for them to eat alone rather than at the family table, or to say “no” without being punished or judged, that is when anxiety diminishes. Not because we solved it. But because we stopped fighting it.

This is why I believe acceptance is the starting point. Not exposure. Not strategies. Acceptance. When we give autistic people full permission to accept their needs and stop framing anxiety as a flaw, we build trust.

And in that trust, anxiety reduces.

Saying no is not avoidance. It is autonomy.

There is still a belief that we should “build resilience” in autistic students to do things they don’t like to do, such as group work, assemblies, in school or attending birthday parties, and sitting with family members at Christmas.

I believe we need to flip that thinking.

Saying no to a distressing situation is not a lack of resilience. It is wisdom. It is agency. It is self-protection.

If a child says I cannot handle loud crowds, and we accept that, they will feel safer.

If a student leaves the classroom because the light is too bright, and we believe me, they feel respected.

And if they say I cannot go to school because it makes me feel sick with panic, and we believe them, and look at ways of how we can support them in the home, before asking them to stand in the reception area for 10 minutes a day, or to touch the school gate, they will begin to trust again.

That is where anxiety can start to ease, not from exposure, but from understanding and acceptance.

Final thought

Anxiety in autism is not a side effect to manage. It is part of how a person copes with a world that often makes no sense.

We cannot remove it entirely. But we can stop adding to it.

And that begins with first accepting it for what it is.

---

References

Beck, A.T. (1976) Cognitive therapy and the emotional disorders. New York: International Universities Press.

Freud, S. (1926) Inhibitions, symptoms and anxiety. London: Hogarth Press.

Lang, R., Regester, A., Lauderdale, S., Ashbaugh, K. and Haring, A. (2010) ‘Treatment of anxiety in autism spectrum disorders using cognitive behaviour therapy: A systematic review’, Developmental Neurorehabilitation, 13(1), pp. 53–63.

Pahnke, J., Lundgren, T., Hursti, T. and Hirvikoski, T. (2019) ‘Outcomes of an acceptance and commitment therapy-based skills training group for autistic adults’, Autism, 23(3), pp. 712–723.

Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T. and Baird, G. (2008) ‘Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample’, Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), pp. 921–929.

Van Steensel, F.J., Bögels, S.M. and Perrin, S. (2011) ‘Anxiety disorders in children and adolescents with autistic spectrum disorders: A meta-analysis’, Clinical Child and Family Psychology Review, 14(3), pp. 302–317.

Vasa, R.A. and Mazurek, M.O. (2015) ‘An update on anxiety in youth with autism spectrum disorders’, Current Opinion in Psychiatry, 28(2), pp. 83–90.