Autism and Anxiety in Children: Signs and What Helps

Autism and anxiety often go together. Research suggests that about 4 in 10 autistic children and teens have at least one anxiety disorder [1]. Anxiety can look different in autistic kids, so it is easy to miss. The good news is that it can be treated. CBT adapted for autism has the strongest evidence [8][10].

How common is anxiety in autistic children?

Anxiety is very common in autistic children. A 2011 meta-analysis combined 31 studies with 2,121 autistic young people under 18. It found that 39.6% had at least one anxiety disorder [1]. The most common types were specific phobias (29.8%), obsessive-compulsive disorder (17.4%), and social anxiety disorder (16.6%) [1].

A larger 2019 review in Lancet Psychiatry looked at autistic people of all ages. It estimated that 20% had an anxiety disorder. Rates were higher in clinic samples than in population studies [2]. A 2023 review of 340 studies also listed anxiety disorders among the most frequent co-occurring conditions in autism [3]. Anxiety often continues into adulthood. One review found that 27% of autistic adults had a current anxiety disorder [16].

Numbers vary between studies. They depend on age, IQ, and how anxiety was measured [1]. But the message is clear: autism and anxiety are linked, and anxiety deserves attention. To learn more about autism itself, see our guide to understanding autism.

Autism and anxiety: how it can look different

Some autistic children show anxiety in the usual ways. They worry, cling to a parent, or avoid scary things. Others show it in ways that are less typical. In one study of 59 autistic youth aged 7 to 17, 17% had typical anxiety, 15% had “atypical” anxiety, and 31% had both [4]. “Atypical” means anxiety that does not fit the usual checklist definitions. Autism traits helped predict it [4].

Signs to watch for

• Meltdowns. A meltdown may follow a build-up of worry, noise, or change. Our guide to meltdowns vs. tantrums explains the difference.
• Avoidance. Refusing places, people, foods, or school. The NHS lists avoiding everyday activities, including school, as a sign of anxiety in older children [15].
• Insistence on sameness. A routine can be comforting. But panic when it changes can be a sign of anxiety.
• Need for certainty. Asking “what’s next?” again and again. Many autistic people find uncertainty very hard. A 2020 review found that 9 of 10 studies linked intolerance of uncertainty with anxiety in autistic people [5].
• Sensory distress. In the study above, being very sensitive to sensations predicted typical anxiety [4].
• Body signs. Sleep problems, stomachaches, headaches, irritability, and anger can all be signs of anxiety in children [14][15].

Anxiety or autism traits?

This can be hard to sort out. Routines, special interests, and repeated questions are often part of being autistic. They can bring comfort and joy. A helpful question is: is this behavior driven by fear? If a change leads to panic, or your child starts avoiding things they once enjoyed, anxiety may be involved. Write down what happens before and after hard moments. These notes help professionals.

How autism and anxiety are assessed together

NICE, the UK health guidance body, says professionals working with autistic children should recognize common co-occurring conditions, including anxiety and depression [6]. When a child has behavior that challenges, NICE advises checking for possible causes. These include anxiety, pain, noise or lighting, changes to routine, and a lack of predictability and structure [6].

Standard anxiety questionnaires were built for non-autistic children. They may miss autism-related worries. The Anxiety Scale for Children-ASD (ASC-ASD) was adapted for autistic children aged 8 to 16. It added items on sensory anxiety, uncertainty, and phobias. It has parent and child versions with 24 items each [7]. A psychologist may use tools like this along with interviews. In the US, the CDC says the first step is an evaluation by a health care provider [14].

Treatment for autism and anxiety: what the evidence says

CBT adapted for autism

Cognitive behavioral therapy (CBT) teaches children to understand their feelings and face fears in small steps. NICE suggests considering CBT for autistic children with anxiety who have the language and thinking skills to take part [6]. It recommends adaptations such as emotion recognition training, more visual and written information, concrete activities, regular breaks, using the child’s special interests, and involving a parent [6].

Several trials on autism and anxiety support this approach:

• A large US trial. In 2020, a trial in JAMA Psychiatry included 167 autistic children aged 7 to 13. Positive response rates were 92.4% with CBT adapted for autism, 81.0% with standard CBT, and 11.1% with usual care [8]. The adapted CBT did better than standard CBT on the main anxiety measure [8].
• Facing Your Fears. This group CBT program was designed for autistic children. In a trial of 50 children, 50% in the CBT group had a meaningful response, compared with 8.7% of those receiving usual care [9]. The authors noted the sample was small. They also receive royalties from the program [9].
• A meta-analysis. A 2021 review of 19 randomized trials found CBT reduced anxiety in autistic young people [10]. Effects were large when clinicians rated anxiety but smaller when parents or children did. Few trials showed lasting gains at follow-up, and many had a risk of reporting bias [10].

Parent-focused approaches

Parents often change routines to calm a child’s anxiety. This is called family accommodation. It comes from love. But in the large US trial, children whose families accommodated more before treatment had higher anxiety after treatment [11]. The authors said accommodation should be a target of treatment [11].

SPACE (Supportive Parenting for Anxious Childhood Emotions) is a program where parents meet with a therapist. The child does not need to attend. A small pilot study with 15 autistic children aged 6 to 10 found that anxiety and family accommodation dropped after 13 weekly sessions [12]. This is early evidence only. There was no control group, and one author receives royalties from SPACE books [12].

What about medication?

NICE says not to use antidepressants, antipsychotics, or anticonvulsants to manage the core features of autism in children [6]. A Cochrane review of SSRIs (a common type of antidepressant) found no evidence of benefit for autism in children, and emerging evidence of harm [13]. The same review said decisions about SSRIs for co-occurring anxiety should be made case by case [13]. This review searched studies up to 2013, so newer research is not included.

For other co-occurring conditions, NICE says to follow the usual guidelines for that condition [6]. Talk with your child’s doctor about the risks and benefits. Our guide to autism medication options explains more.

How to help an anxious autistic child at home

Living with autism and anxiety can be hard for the whole family. These steps are drawn from NICE, NHS advice, and the research above. They are not a replacement for therapy.

• Make the day predictable. NICE lists a lack of predictability and structure as a possible trigger for distress [6]. The NHS also suggests keeping routines predictable [15]. A visual schedule can show what is coming next.
• Prepare for change. The NHS advises preparing children for changes in advance [15]. Use pictures, stories, or a countdown. Our guide to autism transitions has more ideas.
• Adjust the environment. NICE names noise and lighting as factors to look at [6]. Ear defenders, a quiet corner, or dimmer lights may help.
• Listen and name feelings. Take worries seriously and do not dismiss them [15]. Visual feeling charts can help children who find words hard.
• Face fears in small steps. Do not force your child into a scary situation without talking first [15]. Instead, plan tiny steps together and praise effort.
• Have a calm-down plan. Practice simple breathing when your child is calm [15]. Agree on a safe space and a signal for “I need a break.”
• Do not accommodate everything. Fair adjustments are good. But always removing feared situations can keep anxiety going [11].
• Look after yourself. The NHS suggests trying not to become overprotective or anxious yourself [15]. Your calm helps your child feel safe.

When to talk to a professional

Seek help if anxiety is severe, lasts, or gets in the way of daily life [15]. The CDC advises getting an evaluation if fears do not fade with age or if they affect school, home, or play [14]. Watch for:

• Refusing or struggling to attend school [15]
• Changes in eating or sleep [14]
• Frequent meltdowns or new avoidance
• Persistent sadness or hopelessness [14]
• Self-injury or talk of wanting to die, which can be signs of serious depression [14]

Start with your child’s doctor or pediatrician. Ask for a referral to a psychologist who knows both autism and anxiety. If your child is in danger or talks about suicide, get help right away. In the US, call or text 988 [14]. In an emergency, call your local emergency number.

Frequently asked questions

Is anxiety part of autism?

No. Anxiety is a separate condition, but it is very common alongside autism. A 2011 meta-analysis found about 40% of autistic children and teens had at least one anxiety disorder. Anxiety is a separate condition that can be treated. Treating it can make daily life much easier for your child and your family.

How can I tell if it is anxiety or just autism?

It can be hard, even for experts. A useful question is whether a behavior is driven by fear or worry. Routines and special interests often bring comfort. If a routine change causes panic, or your child avoids things they used to enjoy, anxiety may be involved. Keep notes on what happens before and after, and share them with your child’s doctor or psychologist.

Does CBT work for autistic children with anxiety?

Yes, adapted CBT has the best research support so far. A 2021 meta-analysis of 19 randomized trials found that CBT reduced anxiety in autistic young people, with the largest effects on clinician ratings. Benefits were smaller when parents or children rated them. Few studies checked whether gains lasted. CBT adapted for autism, with visuals and parent involvement, appears to work best.

Should my autistic child take medicine for anxiety?

That is a decision to make with your child’s doctor. NICE advises against antidepressants for core features of autism. A 2013 Cochrane review found no evidence that SSRIs help core autism features in children, and some signs of harm. It said decisions about SSRIs for co-occurring anxiety should be made case by case. Therapy is usually tried first.

Is it wrong to avoid things that make my child anxious?

Some adjustments are helpful and fair, like turning down noise or giving warnings before changes. But always removing every feared situation can keep anxiety going. In a large autism trial, children whose families accommodated anxiety more had more anxiety after treatment. The goal is to support your child while helping them face small, manageable challenges step by step.

References

1. van Steensel FJA, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14:302-317. doi:10.1007/s10567-011-0097-0 Link
2. Lai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, Szatmari P, Ameis SH. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):819-829. doi:10.1016/S2215-0366(19)30289-5 Link
3. Micai M, Fatta LM, Gila L, et al. Prevalence of co-occurring conditions in children and adults with autism spectrum disorder: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2023;155:105436. doi:10.1016/j.neubiorev.2023.105436 Link
4. Kerns CM, Kendall PC, Berry L, Souders MC, Franklin ME, Schultz RT, Miller J, Herrington J. Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(11):2851-2861. doi:10.1007/s10803-014-2141-7 Link
5. Jenkinson R, Milne E, Thompson A. The relationship between intolerance of uncertainty and anxiety in autism: a systematic literature review and meta-analysis. Autism. 2020;24(8):1933-1944. doi:10.1177/1362361320932437 Link
6. National Institute for Health and Care Excellence (NICE). Autism spectrum disorder in under 19s: support and management. Clinical guideline CG170. Published 28 August 2013; last updated 14 June 2021. Link
7. Rodgers J, Wigham S, McConachie H, Freeston M, Honey E, Parr JR. Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res. 2016;9(11):1205-1215. doi:10.1002/aur.1603 Link
8. Wood JJ, Kendall PC, Wood KS, Kerns CM, Seltzer M, Small BJ, Lewin AB, Storch EA. Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: a randomized clinical trial. JAMA Psychiatry. 2020;77(5):474-483. doi:10.1001/jamapsychiatry.2019.4160 Link
9. Reaven J, Blakeley-Smith A, Culhane-Shelburne K, Hepburn S. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. J Child Psychol Psychiatry. 2012;53(4):410-419. doi:10.1111/j.1469-7610.2011.02486.x Link
10. Sharma S, Hucker A, Matthews T, Grohmann D, Laws KR. Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: a systematic review and meta-analysis. BMC Psychol. 2021;9(1):151. doi:10.1186/s40359-021-00658-8 Link
11. Frank HE, Kagan ER, Storch EA, Wood JJ, Kerns CM, Lewin AB, Small BJ, Kendall PC. Accommodation of anxiety in youth with autism spectrum disorder: results from the TAASD study. J Clin Child Adolesc Psychol. 2022;51(2):219-229. doi:10.1080/15374416.2020.1759075 Link
12. Rozenblat S, Shimshoni Y, Lebowitz ER, Perez M, Koller J. A pilot trial of SPACE (Supportive Parenting for Anxious Childhood Emotions) in autism. Child Psychiatry Hum Dev. 2025;56(1):249-263. doi:10.1007/s10578-023-01555-4 Link
13. Williams K, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane Database Syst Rev. 2013;(8):CD004677. doi:10.1002/14651858.CD004677.pub3 Link
14. Centers for Disease Control and Prevention (CDC). Anxiety and depression in children. Children’s Mental Health. Last updated June 11, 2025. Accessed October 2026. Link
15. NHS. Anxiety in children. Last reviewed 5 August 2026. Accessed October 2026. Link
16. Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis. Psychol Med. 2019;49(4):559-572. doi:10.1017/S0033291718002283 Link

Professional review: this guide is waiting for review by a qualified clinician. It was written and checked against the published sources listed above. How we check our guides.

This guide is general education, not medical advice. Always talk to your child’s doctor or care team. Last checked: October 2026.