Autism and Co-occurring Anxiety

Autism and Co-occurring Anxiety focuses on assessment and care for autistic children, adolescents, and adults who experience generalized, social, or specific anxiety—often masked by sensory sensitivities, rigidity, or communication differences. This page translates evidence into practice: adapting CBT with visual supports and graduated exposure, aligning psychopharmacology with sleep and GI needs, and building school/work accommodations that target function, not just symptoms. If you’re comparing events like an autism anxiety conference, you’ll find concrete strategies for distinguishing uncertainty intolerance from classic worry cycles, using strengths-based goal setting, and embedding caregiver training. Because anxiety frequently overlaps with OCD traits and selective mutism, we cross-link to Anxiety Disorders so teams can tune protocols without losing neurodiversity-informed principles.

Implementation thrives on co-design. Plans begin with sensory mapping, predictable routines, and communication supports, then layer exposure hierarchies that respect processing time and predictability needs. Medication choices—SSRIs, alpha-2 agonists, or off-label options—are sequenced carefully, with slow titration and shared metrics for benefit and tolerability. Sleep and circadian tuning reduce daytime reactivity; school or workplace adjustments (quiet zones, flexible timing, clear task breakdown) sustain gains. Family coaching focuses on supportive responses that avoid accommodation traps, while peer and digital tools extend practice between sessions. Telehealth and home-based exposure expand access for individuals who find travel or new settings overwhelming.

Core Focus Areas

Neurodiversity-informed assessment

  • Clarify anxiety signals vs sensory overload and uncertainty intolerance.
  • Use visual scales and caregiver/teacher input to track change.

Adapted CBT and exposure

  • Translate concepts into concrete, visual steps with predictable pacing.
  • Build hierarchies around sensory triggers and social demands.

Medication strategy

  • Titrate slowly with clear goals and side-effect tracking.
  • Align choices with sleep, GI issues, and co-occurring ADHD.

Function-first accommodations

  • Define supports at school/work that reduce avoidance.
  • Review plans regularly to prevent over-accommodation.

Implementation and Support Pathways

Caregiver training
Coach supportive responses and gradual independence; avoid reinforcing avoidance.

School and workplace collaboration
Write practical supports—visual schedules, quiet spaces, structured transitions.

Sleep and circadian health
Stabilize routines to reduce reactivity; reassess anxiety after sleep improves.

OCD and rigidity interfaces
Differentiate compulsions from insistence on sameness; sequence ERP when indicated.

Communication supports
Use AAC/visual aids to express worry and negotiate exposure steps.

Sensory-informed environments
Modify lighting, noise, and seating; incorporate movement breaks.

Equity and access
Tailor materials for language and literacy; enable telehealth for sensory barriers.

Measurement and outcomes
Track function, participation, distress tolerance, and quality of life.

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