Untangling Anxiety and Autism


All children experience fears and worries at some point. Maybe it’s jitters brought on by the first few days of school or riding their bike again after a fall. However, if the child has autism spectrum disorder, they may be especially fearful of particular sights, sounds or places. Small changes in their routines can leave some children with ASD extremely distraught and can sometimes trigger challenging behaviors. Interacting with people can be so anxiety-provoking, they’re unable to make eye contact or communicate at all. Many parents might start to wonder: is there something going on with my child in addition to autism? CAR’s Dr. John Herrington has long been interested in the intersection between autism and anxiety. He and his colleagues recently published a set of studies that sheds some light how people with autism experience symptoms of anxiety.

What does the research say regarding co-occuring anxiety and autism?

Approximately 40% of children with autism spectrum disorder (ASD) receive a dual diagnosis of anxiety, but researchers have long puzzled over a central question: is anxiety is a condition that occurs in addition to autism, or is anxiety one symptom among the constellation of symptoms that contribute to ASD? On the surface, it may seem like splitting hairs. However, the answer has important implications for how we treat anxiety in people with autism.

"When a child with autism also has anxiety, we tend to see they are more likely to have specific and uncommon phobias...."

To answer this question, scientists have looked to differences in the brain. Findings from neuroscience show that the amygdala, the region of the brain responsible for processing emotions, plays a role in both anxiety and autism. However, the amygdala’s role in both diagnoses has remained unclear until new research from a team at CHOP's Center for Autism Research uncovered variations in its shape and structure in children with and without anxiety, and with and without ASD.

In separate studies published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging and in the Journal of Autism and Developmental Disorders, Dr. Herrington and colleagues found the amygdala to be smaller and more active in children who have ASD as well as an anxiety disorder. These findings suggest that symptoms of anxiety are not merely a facet of the core ASD symptoms, but suggest that anxiety can co-occur as a separate diagnosis in children with ASD.

The differences seen in the amygdala also help to explain the tendency of children diagnosed with both anxiety and ASD to express different anxiety symptoms than children diagnosed with anxiety alone. “Anxiety disorders in children generally fall into four basic categories: generalized anxiety, phobias, separation anxiety, and social anxiety”, explained Dr. Herrington. “When a child with autism also has anxiety, we tend to see they are more likely to have specific and uncommon phobias, unusual general anxiety especially around changes in daily routines, and social anxiety when compared with their typically developing peers.”

From a clinical perspective, this research increases the probability that traditional anxiety treatments, such as cognitive behavioral therapy (CBT) or medications, will prove effective for children with ASD and anxiety. However, these treatments will need modification to address the differences in symptomology seen in children with ASD.