Anxiety vs Autism: What Are The Similarities and Differences?

Anxiety vs autism: how do you tell them apart, and what happens when a person experiences both? This guide explains the social differences and sensory sensitivities they share, how they differ, how each is diagnosed and what support helps.

How Anxiety and Autism Are Linked

Anxiety and autism are two different things that very often occur together. The signs of anxiety are sometimes put down to autism and vice versa, which can lead to missed diagnoses and delayed support. This article looks at how autism and anxiety interact, and what it means for a person who experiences both.

Autism Spectrum Disorder (ASD) and Anxiety

ASD is a neurodevelopmental difference that affects around 2% of people. Autism is characterized by differences in social communication, along with repetitive behaviors and focused interests. To be diagnosed as autistic, these traits must have been present since early childhood.

There are many types of anxiety disorders. In general, anxiety is when a person feels fear or worry that is hard to control or out of proportion to the situation. Anxiety can affect not only thoughts and daily life, but also the body, which can make it even harder to cope.

When autism and anxiety occur together, they can make social situations and daily life much harder. An autistic person with anxiety may find everyday tasks, relationships and learning more difficult, and may need more support in those areas.

Understanding the Similarities and Differences Between Anxiety and Autism

Anxiety is one of the most common co-occurring conditions in autism, but it is important to remember that anxiety and autism are distinct from one another. Studies show that between 40 and 50% of people with autism also experience anxiety. Here are some of the similarities and differences between anxiety and autism.

Similarities

• Both can affect how a person interacts and socializes with others.
• Both can bring a general sense of feeling misunderstood by others.
• Both can drive a person’s need to escape or avoid certain situations.
• Unexpected change is hard for people with anxiety and/or autism.
• People with autism and anxiety can feel uncomfortable being the center of attention.

Differences

• Anxiety is an intense fear or discomfort in response to certain situations, whereas autism is a lifelong neurodevelopmental difference in communication, social interaction and behavior.
• Autism can have a big effect on how a person communicates.
• Autistic people often have repetitive behaviors, routines and stimming.
• Anxiety often causes physical responses (fast breathing, racing heart and so on).
• Autistic people often have sensory differences.
• Autistic people often develop deep, intense interests.

These are just some of the similarities and differences. When anxiety and autism occur together, they can affect a person in many more ways than we can understand unless we experience it ourselves.

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Early Risk Factors for Anxiety in Children with Autism

Research has looked at possible risk factors for anxiety in children with autism. Some of the findings are:

• Children with a higher IQ may be at greater risk of anxiety.
• Girls appear to be at higher risk of anxiety than boys.
• Sensory processing differences, particularly sensory over-responsiveness, are linked with later anxiety.
• Lower maternal education.
• Family stress levels and circumstances.
• Some research shows that more repetitive behaviors in early childhood can be an early predictor of anxiety in autistic children.

Must Read: Managing Difficult Behaviors of Autistic Children

Similarities Between Anxiety and Autism

While anxiety and autism share some effects, it’s important to remember they are separate conditions that can work together to affect a person’s daily life. Below we look more closely at how they overlap in social situations, sensory processing and behavior.

Social Differences

A core part of autism is a different way of communicating and interacting socially. Autistic people may find eye contact uncomfortable, communicate in a different style, read body language differently and find unwritten social rules confusing. Misunderstandings often run both ways between autistic and non-autistic people. For an autistic person who also has anxiety, social situations can feel very daunting, and they may need to withdraw or avoid them.

Avoiding social situations can lead to loneliness and isolation, and sometimes to depression, especially when the person wants friendships but finds them hard to build. Feeling connected and accepted is strongly linked to wellbeing and quality of life, so it helps to find social settings that suit the person, such as small groups based on shared interests.

Must Read: Social Difficulties With Autism

Sensory Sensitivities

Sensory sensitivity can be hyper (over) or hypo (under) sensitivity to lights, noises, touch, taste and smells. Sensory sensitivities vary widely from person to person.

Research shows that more than 40% of children with sensory hypersensitivity also meet the criteria for anxiety. The same research shows that 60% of children with both autism and anxiety have a significant level of sensory hypersensitivity. Studies have also found that almost 90% of children with autism and sensory hypersensitivity meet the criteria for anxiety.

Anxiety and sensory sensitivity can lead to challenges with sleep, eating, behavior and health. When a sensory experience is unpleasant, a person may try to avoid it in future, which can show up as a strong need for sameness and finding change very hard. These patterns are already common in autistic people, with or without anxiety.

Eating is a good example of how sensory sensitivities affect daily life. Every food has its own range of textures and tastes. Not knowing exactly how a food will feel or taste often leads to a list of “safe” foods that are predictable and the same every time.

For example, a person might really like the flavor of strawberries but not enjoy eating them. That’s because the taste and texture of a strawberry changes depending on its ripeness, size and shape, so you never quite know what you’ll get.

Many autistic people with sensory-related anxiety prefer foods that are always the same, such as crackers or packaged foods made consistently.

Intolerance of Uncertainty

Intolerance of uncertainty (finding it very hard to cope with not knowing what will happen) is common in people with anxiety, and it is very common in people with both anxiety and autism. Research suggests that people can gradually become more comfortable with uncertainty when they face challenging situations with support, which builds a sense of safety over time.

Needing certainty is closely linked to the need for sameness and routine, which is a core characteristic of autism. Researchers have also found links between intolerance of uncertainty and sensory processing differences. When sensory input is unpredictable or overwhelming, everyday life can feel stressful and harder to manage.

When overwhelmed, autistic and anxious people often find it hard to use calming strategies in the moment. Over time, sticking closely to routines and predictable patterns can become an important source of comfort.

Intolerance of uncertainty may look like:

• Seeking a lot of reassurance from others
• Extremely detailed to-do lists
• Needing to follow the same route each day
• Following step-by-step instructions exactly as presented, every time
• Significant worry and fear about the environment and the world
• Feeling overwhelmed by unexpected events and change

Some research suggests that anxiety about uncertainty may also be linked to the rejection and misunderstanding many autistic people experience in childhood, including before and during the diagnosis process.

Differences Between Anxiety and Autism

Anxiety and autism often share overlapping signs, so telling them apart can be challenging.

Developmental Origins

Both anxiety and autism are influenced by a mix of genetic and environmental factors. Anxiety is a state of fear or worry that happens when a person senses a threat. Autism is a lifelong neurodevelopmental difference in how a person communicates, interacts and experiences the world.

Important points about the origins of anxiety:

• It results from a complex mix of genetic, environmental and psychological factors.
• Research shows that anxiety is associated with differences in brain structure and function.
• Some people are more prone to anxiety because of family history and genetics.
• How intensely a person experiences anxiety is affected by many environmental factors, including life events, trauma, parenting styles, bullying and rejection.

Important points about the origins of autism:

• Autism is strongly linked to genetics, with many genes involved.
• Like anxiety, autism is associated with differences in brain structure and function.
• People with autism are born autistic. Autism does not develop as a result of environmental factors alone.
• There is evidence that some prenatal exposures, such as certain infections or chemicals, may slightly increase the likelihood of ASD.
• How autism symptoms show up, and how much support a person needs, is also influenced by their learning experiences and environment.

When supporting an autistic person who also has anxiety, it is important to understand their behavior (sometimes through a functional behavior assessment) and to talk with them at length to understand whether behaviors of concern come from anxiety, from autism, or from both together. This understanding is essential for an individual, targeted support plan.

Response to Treatment

For autism, early support is one of the most effective ways to help children develop skills and wellbeing. Research consistently shows that early intervention leads to better outcomes.

Anxiety on its own often responds well to psychological therapy and counseling. There are many supports available for both.
Below are common supports for anxiety and autism.

Anxiety

Exposure therapy: an approach that gradually and safely introduces the person to the situation that causes anxiety. It helps the person face fears that once controlled their thoughts and worsened their anxiety, at a pace they can manage.

Counseling: setting goals and building long-term problem-solving strategies that can be used in different situations. Counseling also helps after major life events that have triggered anxiety, supporting the person to develop coping strategies and move forward.

Psychotherapy: helping people make links between the past and present and explore how their anxiety has developed. Psychotherapy is usually a longer-term approach.

Mindfulness: a form of self-awareness training that helps the person notice their anxiety triggers and choose ways to relax in response.

Autism

Applied Behavior Analysis (ABA): uses reinforcement to build skills and changes to the environment, and teaches communication and functional skills that meet the same need as a behavior of concern. Many autistic adults have raised concerns about ABA that focuses on compliance, so look for respectful, play-based providers.

Discrete Trial Training (DTT): a structured approach that uses step-by-step instructions and positive reinforcement to teach specific skills.

Pivotal Response Training (PRT): a play-based approach that focuses on “pivotal skills”, like motivation and starting interactions, which open the door to learning more complex skills. It usually happens in everyday settings.

Anxiety and Autism

Cognitive Behavioral Therapy (CBT): a psychological approach that helps people make links between thoughts, feelings and behaviors. CBT adapted for autistic people (for example with more visual supports and concrete language) can be effective for anxiety.

Medication options vary. Anxiety medication may help regulate serotonin levels to ease symptoms. There is no medication for autism itself, but medication may be used for co-occurring conditions like ADHD, anxiety and depression.

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Tailored Support Plans: both anxiety and autism benefit from individual approaches. Professionals should consider each person’s strengths, challenges, preferences and specific needs.

Some families also try alternative approaches, such as big changes to diet, chiropractic care, art therapy, relaxation therapy or herbal supplements. The evidence for some of these is limited, so talk with your doctor before trying them.

Autism is lifelong, and anxiety can also be long-lasting, so many people benefit from ongoing support. It is important that support is accessible whenever it’s needed. Because anxiety and autism overlap, support in one area can often help in the other.

Involving autistic and anxious people in every step of their support plan is essential for their autonomy, voice and understanding of what matters most to them.

Impact on Daily Life

Both anxiety and autism can make daily life harder in different ways, especially when the environment doesn’t fit the person. Here are some of the ways each can cause stress and overwhelm.

Anxiety

• Social interactions can be hard for anxious people. Anxiety can make people very self-conscious and fearful of social situations.
• Anxiety affects concentration, decision making and the ability to finish tasks, which can affect school and work.
• Anxiety can cause physical symptoms, including headaches, tense muscles, sleep problems and fatigue.
• Anxiety affects mental health and emotional wellbeing. It can leave people feeling irritable and restless, with a sense of dread. Anxiety often occurs alongside depression, as ongoing fear can lead to sadness, hopelessness and low self-esteem.
• Anxious people may avoid places that trigger their anxiety, which can limit where they can go and what they can do.
• Anxiety affects memory and attention.
• Anxiety can have a big impact on quality of life. People with anxiety often report feeling frustrated, helpless and isolated.

Autism

• Like anxiety, autism affects social interaction. Autistic people may find social cues, emotions and body language hard to read, and non-autistic people may misread them too. This can make friendships harder to build without understanding on both sides.
• Autism can affect communication, both verbal and non-verbal. Autistic people may have delayed speech, find conversations hard to keep going or use repeated phrases. Not being understood can lead to distress and overwhelm.
• Sensory sensitivities can make some environments extremely overwhelming, and the person may avoid them altogether.
• Repetitive behaviors and stimming help with self-regulation, though some can make daily tasks or social situations harder.
• The need for sameness and predictability can make uncertain times very hard.
• Autistic people may find big emotions hard to manage, leading to meltdowns and overwhelm.

If autism and/or anxiety are having a big impact on daily life, it is important to seek support from health professionals.

Is It Anxiety or Autism?

Many parents and adults ask “is it anxiety or autism?” or “is it autism or anxiety?”. The honest answer is that it can be both, and only a professional assessment can tell you for sure. Some helpful questions to think about:

• When did it start? Autism traits are present from early childhood, even if they were not noticed. Anxiety can start at any age, often after stressful events.
• Is it there in calm, safe situations too? Autistic differences in communication, sensory processing and interests are there even when the person feels safe. Anxiety usually eases when the trigger is removed.
• What drives the need for routine? In autism, routines often bring comfort and enjoyment. In anxiety, routines are mainly about preventing something feared from happening.
• Are there deep interests and stimming? These are common in autism but are not part of anxiety.

Is Autism an Anxiety Disorder?

No. Autism is a neurodevelopmental difference, not an anxiety disorder, and anxiety is not autism. But autistic people are much more likely than others to experience anxiety. Researchers also describe “autism-distinct anxiety”, which includes worries that are especially common for autistic people, such as fear of change, sensory-related fears and social confusion, and which may not fit neatly into standard anxiety categories.

Is Anxiety on the Autism Spectrum?

No. Anxiety is not part of the autism spectrum and is not a type of autism. It is a separate mental health condition that many autistic people also experience. When comparing autism vs anxiety, the overlap (avoiding social situations, finding change hard, needing reassurance) is why the two are so often confused.

Anxiety vs Autism in Children

In children, anxiety vs autism can be especially hard to tell apart. Both can show up as clinginess, meltdowns, avoiding new places or difficulty with transitions. Look at the bigger picture: an autistic child will usually also show differences in early communication, play and sensory responses. If your child is anxious, it is worth asking whether autism might be part of the picture, and vice versa.

Do I Have Anxiety or Autism?

Many adults wonder “do I have anxiety or autism?”, especially if they were treated for anxiety for years without it fully helping. If social situations have always felt confusing (not only frightening), you have strong sensory sensitivities or deep interests, or you have spent years masking, it may be worth seeking an adult autism assessment.

Challenges in Diagnosis and Differentiation

As this article has discussed, telling anxiety and autism apart is challenging because of the overlap. When planning support, it is important to understand which needs come from autism and which come from anxiety, so that each can be supported in the right way.

Overlapping Signs

Some of the overlapping signs of anxiety and autism are:

• Effects on social communication
• Nervousness about new interactions and new environments
• Finding both expected and unexpected changes in routine hard
• Avoiding eye contact and withdrawing in social situations
• Finding transitions between activities and places hard
• Fear of meeting new people and entering unfamiliar places

Assessment

Health professionals diagnose anxiety and autism using separate criteria for each. Below is a summary of the DSM-5 criteria for each condition (the DSM uses clinical language).

Anxiety (Generalized Anxiety Disorder):

• Excessive anxiety and worry occurring more days than not for at least 6 months.
• The person finds the worry hard to control.
• The worry is associated with three or more of the following: restlessness, being easily fatigued, difficulty concentrating, irritability, muscle tension and sleep problems.
• The focus of the worry is not limited to particular events.
• The anxiety or worry causes clinically significant distress or impairment in social, work or other important areas of life.
• The symptoms are not caused by something else, such as medication or substance use, a medical condition or another mental health condition.

Autism:

• Persistent deficits in social communication and social interaction across multiple contexts, including nonverbal communication and developing, maintaining and understanding relationships.
• Restricted, repetitive patterns of behavior, shown by at least two of the following: repetitive motor movements or use of objects; insistence on sameness and inflexibility to change; restricted, fixated interests that are unusually intense or focused; hyper- or hypo-reactivity to sensory input.
• Symptoms must be present in the early developmental period.
• Symptoms must cause clinically significant impairment in social, work or other important areas of life.
• The symptoms are not better explained by intellectual disability.

Anxiety is usually diagnosed by GPs, psychologists or psychiatrists. Autism is diagnosed by pediatricians, psychiatrists or psychologists, often with input from allied health professionals.

Conclusion

Autism and anxiety share many similarities and differences that overlap and combine in unique ways for each person. Anxiety is the most common co-occurring condition in autism, and it can have a big impact on daily life. Understanding the similarities and differences is key to an accurate diagnosis and the most helpful support.

Anxiety is characterized by excessive fear and worry, while autism is a lifelong difference in social communication, sensory processing and behavior. Overlapping signs, such as social differences and sensory sensitivities, can make it hard to know which one is behind behaviors of concern.

Early support plays a crucial role for both, alongside therapy and, where appropriate, medication. Support plans should always be tailored to the person and put their own views and preferences first. Small changes to the environment (more predictability, fewer sensory triggers, clear communication) often make a big difference.

As research into anxiety and autism continues, and as awareness and understanding grow, we can better support people who experience anxiety, autism or both, and help them enjoy a better quality of life.