Anxiety: autistic children and teenagers

About anxiety in autistic children and teenagers

Autistic children feel many of the same worries and fears as other children.

But autistic children might also worry or feel stressed about things that are less worrying for typically developing children. These include things like:

small disruptions to their routines or new sensations they feel in their bodies
unfamiliar or unpredictable social situations
situations where it’s hard to know what other people are thinking or feeling
their own thoughts and feelings, especially unfamiliar or unpleasant physical symptoms that are related to worried thoughts and feelings.

Reducing a child’s anxiety might reduce the behaviour associated with the core characteristics of autism, but it won’t get rid of the characteristics or behaviour.

Signs of anxiety in autistic children and teenagers

When autistic children get worried or anxious, the way they show their anxiety can look a lot like common characteristics of autism – stimming, obsessive and ritualistic behaviour and resistance to changes in routine.

Also, because autistic children have trouble recognising their own anxious thoughts and feelings, they can’t always tell you that they’re feeling anxious. Instead, you might notice an increase in challenging behaviour.

For example, your anxious child might:

insist even more on routine and sameness
have more trouble sleeping
have meltdowns or emotional outbursts
avoid or withdraw from social situations
rely more on obsessions and rituals, like lining up or spinning objects
stim by rocking, spinning or flapping hands
do things to hurt themselves, like head-banging, scratching skin or hand-biting.

Anxiety is a natural part of life and something that everyone experiences at some stage. But there are some things you can do to help ease your child’s worries, and encourage your child to manage their own anxiety levels.

Anxiety triggers: how to identify them in autistic children and teenagers

Finding out what makes your autistic child anxious is a first step in reducing your child’s anxiety and helping them to manage it.

Because autistic children and teenagers can have trouble with understanding and managing emotions, you might need to read your child’s signals and work out what makes your child feel anxious or stressed.

Some of the common triggers for anxiety in autistic children include:

changes in routine – for example, not going to a weekly piano lesson because the teacher is sick
changes in environment – for example, a new house, new play equipment at the local park, or furniture in different places at home
unfamiliar social situations – for example, a birthday party at an unfamiliar house
sensory sensitivities – for example, sensitivities to particular noises, bright lights, specific flavours or food textures
fear of a particular situation, activity or object – for example, sleeping in their own bed, going to the toilet, balloons or vacuum cleaners.
times of transition – for example, moving into a new school year, starting secondary school, or the start of puberty.

Once you’ve worked out some of the things that make your child feel anxious, it can help to make a list of them, so that you can find ways to help your child manage these situations.

Give your child lots of opportunities to practise dealing with these things and situations in safe environments.

It helps if other people who look after your child – for example, child care workers, teachers and family members – also know what makes your child feel anxious and what they can do to help your child with managing anxiety in these situations.

Ways to help autistic children recognise anxiety

Your autistic child might need to learn what anxiety feels like in their body. For example, when your child feels anxious:

their palms get sweaty
they get a strange feeling in their stomach
their heart beats faster
their hands flap.

You could try drawing an outline of a person’s body. Inside the outline, help your child draw or write what happens in each part of their body when they feel scared or worried.

Relaxation and calming strategies for when autistic children feel anxious

You can help your child learn ways to calm down when they start feeling anxious or stressed. These might include:

counting slowly to 10
taking 5 deep breaths
running around the yard 5 times
doing 50 jumps on the trampoline
looking at a collection of favourite or special things
reading a favourite book
closing eyes for a few moments
going to a quiet part of the house.

Get your child to practise these strategies when they’re calm. Once your child knows the strategies well, you can gently guide your child to try them when they feel anxious.

Visual tools to help autistic children prepare for anxious situations

If visual supports and social stories work well for your child, you could use these tools to help your child prepare for situations that make them anxious.

For example, if your child gets anxious when you drop them off at school, you could take some photos of what your child will be doing – walking in the school gate, sitting in the classroom, playing sport, eating lunch and so on. You could also take photos of what you’ll be doing while you’re not together, like driving home, grocery shopping, gardening and so on. A clear picture of you coming back to pick your child up would be important too.

If your child gets anxious when there’s a change in routine, daily or weekly visual schedules can help prepare your child. When you know a change is coming up – for example, no swimming lessons in the school holidays – you can show this on your schedule. Leading up to the change, look at the schedule regularly with your child so that your child knows the weekly routine will be different.

Some children like to be warned about a change or an event a day in advance. Some like to know a week in advance. But for some, too much warning can mean they worry until the event happens.

Opportunities to practise stressful or anxious situations

If you give your child opportunities to practise for situations that they find stressful, it can help your child understand these situations and feel more prepared for them.

For example, if going to the hairdresser makes your child feel anxious, you could try taking your child for a practice run. You could ask the hairdresser if you could come at a time of day when it’s quiet and calm, then go through the steps with your child. Or perhaps your child could watch someone else get their hair cut.

If your child gets anxious in social situations you could practise these together. You could practise different situations and take turns playing different roles. Try to keep the scenarios short and simple, and encourage and praise your child

Getting help with managing anxiety in autistic children and teenagers

A psychologist might be able to help if your child is very anxious. Psychologists have specialised training in mental health conditions, and can work directly with your child and family to develop strategies for reducing anxiety.

Psychologists use a range of approaches, including:

cognitive behaviour therapy – this helps children develop skills to change their thinking in situations that make them anxious
therapies and supports that use gradual exposure to help children face their fears – for example, the stepladder approach
social stories – these can help prepare children for unfamiliar or stressful situations that generally make them anxious
relaxation training to help your child learn to relax.

Mental health occupational therapists are another option to help your child with managing anxiety.

You can ask your GP or paediatrician to recommend a psychologist or therapist.

Medication can also help reduce anxiety symptoms in autistic children. It’s usually recommended only when anxiety is affecting a child’s everyday life and behaviour strategies haven’t reduced the anxiety enough. You can speak to your GP or paediatrician about this option.