How anxiety affects children with autism

Anxiety is a state of heightened alertness. When anxiety increases, it may reach the state called “fight or flight.” In fight or flight, heart rate increases, pupils dilate and palms get sweaty. Many things can trigger anxiety, such as giving a speech, going to a job interview, an upcoming math exam, the first day at a new school, or walking down an unfamiliar street at night.

When a specific type of anxiety interferes with everyday life, it may be an anxiety disorder. For example, many children starting kindergarten may be anxious about being separated from a parent. These separation worries often subside after a few to several days. But a child who shows marked distress that lasts for several weeks and refuses to go to school may be diagnosed with separation anxiety disorder.

The most common anxiety disorders in children and teens include:

  • Separation anxiety disorder
  • Generalized anxiety disorder
  • Social anxiety disorder
  • Simple phobia

Anxiety is not a defining feature of autism spectrum disorder (ASD). However, many parents of children with autism report that anxiety affects their child’s behavior.

A parent's perspective

At Marcus Autism Center, we conducted a series of focus groups with parents to learn more about the signs of anxiety in children with autism. Many parents reported that their child’s overreaction to change in routines, difficulty with transitions, reluctance in new situations, avoidance in social situations, and need for reassurance about upcoming events could be driven by anxiety.

Parents agreed that language and cognitive delays could limit a child’s ability to express worries about upcoming events or report physical signals of anxiety, such as increased heart rate. Parents also acknowledged that behaviors such as overreaction to changes in routine could be part of autism and not due to anxiety.

There are still several unanswered questions about the connection between autism and anxiety:
  • It may be that anxiety disorders are separate from autism and no different than anxiety disorders in the general population of children.
  • The need to follow daily routines may cause children with autism to be on the lookout for changes and foster a sense of uncertainty. This feeling of uncertainty may make anxiety worse.
  • There may be a more complicated blending of autism and anxiety, making it difficult to separate one from the other. For example, children with autism often have trouble reading social cues. Difficulty reading social cues may get in the way of social interaction and promote social anxiety.


We recognize that every child is unique and that the content of this article may not work for everyone. This content is general information and is not specific medical advice. We hope these tips will serve as a jumping-off point for finding the best approach to helping a child with autism. Always consult with a doctor or healthcare provider if you have any questions or concerns about the health of a child. In case of an urgent concern or emergency, call 911 or go to the nearest emergency department right away. Some physicians and affiliated healthcare professionals on the Children’s Healthcare of Atlanta team are independent providers and are not our employees.