AUTISM AND ANXIETY: WHEN CLINICAL ANXIETY APPEARS
There is an established connection between clinical anxiety and autism. Around four in every ten young autistics have a professional diagnosis of either elevated levels of anxiety or an anxiety disorder, in a clinical setting, according to the Anxiety and Depression Association of America.
Compared to neurotypicals (people that have not been diagnosed or identify as ASC), autistics are more likely to be diagnosed with additional psychiatric conditions. These diagnoses can include anxiety, depression, and ADHD as well as disruptive behavior disorders.
To be clear, not everyone that is on the ASC spectrum will have one or more of these other conditions, and not everyone with anxiety or depression is an autistic person. For instance, many neurotypicals experience stage fright, otherwise known as performance anxiety, which likely has nothing to do with ASC. Research doesn’t show that anxiety is caused by being autistic. Research suggests that autistics are more likely to have either an anxiety disorder or clinically elevated levels of anxiety.
(Having “clinically elevated anxiety” means that an individual scored relatively high on an anxiety assessment such as the GAD-7. People who score below the “clinically elevated” cutoff—often a score of 10 out of a possible 21 on the GAD-7—still experience anxiety, but it is typically less frequent and/or severe.)
Anxiety can make it difficult for someone to regulate their emotions and reduce their motivation to be social. What’s more, stress makes learning hard. Anxious people have more difficulty acquiring, retaining, and applying new information. For many autistics seeking therapy, anxiety is a formidable roadblock to their personal success.
In this final article of our three-part series on autism and anxiety, we’d like to show you how autism and clinically diagnosed anxiety are connected because anxiety among autistics is a serious concern for parents and families.
Explaining the Vicious Cycle of Anxiety (CBT Clinical Demonstration). In this video, an Australian clinical psychology service, the Centre for Clinical Interventions, illustrates how the vicious cycle of anxiety can have a serious effect on a person’s long-term well-being.
How Many Autistics Have Clinical Anxiety?
Determining how many autistic adults have some form of anxiety is a difficult task. Many adults who may meet the current criteria for ASC weren’t diagnosed when they were children and likely never will be. For this reason, it’s hard to a say precisely how likely it is for an autistic person to have some type of anxiety disorder.
But if the question is ‘how many young people on the ASC spectrum have anxiety,’ existing research indicates that around one in three experience anxiety. According to the Anxiety and Depression Association of America (ADAA), 40% of young people on the autism spectrum have either clinically elevated levels of anxiety or an anxiety disorder, including obsessive compulsive disorder.
Young autistics and autistic children are also more likely to be diagnosed with anxiety disorders than their neurotypical peers. A meta-analysis of 83 studies found that autistics experience “significantly higher levels of anxiety” when compared to the general population. Roughly 27% of neurotypical children have some form of anxiety disorder. This figure is considerably lower than the 40% anxiety disorder rate among young autistics.
What Does Clinical Anxiety Look Like in Autism?
The Anxiety and Depression Association of America (ADAA) lists the following manifestations of anxiety in ASC:
- Specific phobias
- Social anxiety
- Obsessive compulsive disorder (OCD)
- Separation anxiety
- Other symptoms of anxiety that don’t fit neatly into any of the above
In many cases, the anxieties that autistics confront aren’t unique to ASC. These include social anxiety and common phobias like a fear of heights or lightning strikes.
Some anxieties, however, are mostly unique to autistics. These take the form of anxieties related to sensory overload (too much noise or bright lights can be a source of anxiety for many), specific phobias that may not be widely recognized, and concerns about unfamiliar settings and interactions.
A study conducted by researchers from nine separate universities (including the National University of Singapore and Stanford University) looked at the anxieties of 287 autistic children and teenagers—as reported by their caregivers.
The study found that about half of anxieties experienced by autistic youth relate to ASC (sensory anxieties, uncommon specific fears, concerns about change/unpredictability) while the other half of anxiety were “common anxieties.” These common anxieties included concerns about social interactions, the weather, and dangerous animals like snakes and spiders.
Numerous anxiety triggers affect both autistics and neurotypicals. The three shown above are some of the most common.
Other anxiety triggers are largely unique to autistics. This may be because they relate to features of ASC—like sensory challenges and concerns about sudden change in routine.
Reactions to anxiety can vary, but some common behaviors include canceling plans frequently, wearing multiple layers of clothing despite warm weather, and experiencing seemingly random bouts of irritability.
Young Autistics Face an Anxiety Loop
Anxiety and the social challenges associated with autism can play off of each other, placing young autistics in a difficult cycle. According to a 2020 study published in the journal Autism, social anxiety can interfere with a person’s ability to regulate their emotions. Emotional regulation is how someone controls their reactions and feelings in order to navigate social settings.
Effective emotional regulation is what allows someone to respond to a situation instead of simply reacting. If, for example, someone cuts in front of you when you’re in line at a store, emotional regulation is what allows you to weigh your options (calmly confronting the cutter, letting it go, etc.) as opposed to going with your first instinct—which may look like shouting, storming out of the store, or some other kind of outburst in this case.
The 2020 study describes the relationship between anxiety, emotional regulation, and a third factor: Social motivation. This term basically refers to how likely someone is to step out of their comfort zone. For some, this can take the form of performing at a talent show or singing karaoke in front of a crowd; for others, being socially motivated may just mean they’re able to go to the grocery store or walk to a nearby park.
Autistics with low social motivation are more likely to avoid interacting with others, face an increased sense of social anxiety, and appear socially awkward. Consequently, those who frequently find themselves having difficulty in social settings may develop anxiety about the possibility of making what they perceive as errors. And when someone’s sense of anxiety increases, it becomes more difficult for them to regulate their emotions.
Difficulties with the three factors at play above—emotional regulation, social motivation, and social anxiety—can place young autistics in an anxiety loop. Here’s a step-by-step explanation of what this can look like:
- First, let’s establish that anxiety—i.e., feeling overwhelmed, worried, inadequate, or any other combinations of “anxious” emotions—can make it difficult for someone to remain calm and regulated.
- Second, impaired emotional regulation—which young autistics are already at a higher risk for when compared to neurotypical youth—can make everyday interactions more difficult and, thereby, decrease an autistic person’s social motivation, the feeling that they’ll find social interaction rewarding.
- Third, because they’re less socially motivated, an autistic person may be less likely to seek out social interactions, meaning their sense of anxiety will persist—or perhaps even grow.
- Finally, this sense of anxiety, without intervention, will most likely continue to impair emotional regulation, perpetuating the cycle.
How Interactive Avatars Reduce Anxiety
The process described above may make the outlook for anxious autistics seem dire, but the anxiety loop many young autistics find themselves in isn’t as inescapable as it may appear. Invirtua’s Avatar Adventures provides clients with experiences and lessons that help them learn how to better regulate their emotions, reduce their anxiety levels, and build their self-confidence.
Let’s put this another way: Fearful persons look out into the world through dirty windows, clouded by anxieties. Invirtua’s learning framework helps them clean these windows by removing the obstacles that prevent young autistics from seeing who they are in reality and, perhaps more so, the potential within themselves.
How Reducing Anxiety Kick-starts a Positive Feedback Loop
What makes the Invirtua Effect especially impactful is how it simultaneously helps autistics let go of anxiety and gain self-confidence.
Here’s how the Invirtua Effect enables autistics to overcome feelings of distress and anxiety:
- First, the presence of an interactive avatar reduces anxiety.
- Second, a less anxious client has more productive sessions.
- Lastly, having more productive sessions makes clients more confident and less anxious.
- Less anxiety leads to more productivity and vice versa.
In other words, once a young autistic’s anxiety starts to decrease, sessions get easier and easier. Invirtua’s clients have made incredible progress by learning in this relaxed setting. And being able to see their efforts pay off helps their self-confidence grow.
How Parents Can Use the Invirtua Effect
The Invirtua Effect isn’t restricted to Avatar Adventures. Parents can get involved too!
Here are some steps parents can take to help their child manage clinical anxiety and autism outside of sessions and apply the lessons learned within them:
- Seek opportunities for conversation with your child about their Avatar Adventures, the interactive avatar, and their sources of anxiety
- Encourage your child to practice skills learned in sessions by telling them you’re proud of the effort they’re making
- Join the Autism Animated community to interact with other parents of autistic children and learn more about the condition
- Work with the Invirtua team to help develop learning goals that are ideal for your child
- Ask the Invirtua team about our “Family Circle,” where family members of your choice can join video calls and share in the experience
By working with therapists, parents, and our autistic clients, Invirtua’s Avatar Adventures makes learning less stressful and more rewarding. With your help, we can give your child the tools they need to build their self-confidence and manage their anxiety.
Do like what you’ve learned from this article? If you haven’t yet, take a look at parts one and two of this three-part series on autism and anxiety:
- In “How Interactive Avatars Reduce Anxiety,” we dive into how Invirtua’s Autism Adventures encourage young autistics to better understand and, thereby, lower their anxiety.
- In “The Impact of Sensory Processing Differences,” Invirtua Senior Partner Leslie Baldwin walks readers through the relationship between sensory processing challenges and anxiety among autistics.
Andrew Ciampi is a content writer based in the state of Washington. His areas of interest include the autism spectrum, emerging technologies (practical or recreational), and the transportation sector.
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