Anxiety and Autism

Future Research

Summary of Current Research

• Anxiety and specific anxiety disorders are very common in people on the autism spectrum
• It is unclear if anxiety is simply a condition that commonly occurs alongside autism, if it is a core feature of autism, or if it is a separate but not independent condition
• It is difficult to measure anxiety in people on the autism spectrum because of overlap between symptoms in the two conditions, the limited ability of some people on the autism to assess and report on their own anxiety,  and a lack of specific tools designed to measure anxiety in autistic people
• There are a number of underlying risk factors associated with autism and anxiety although the relationship between them is unclear and sometime contradictory.  Potential risk factors include age, gender, diagnosis, cognitive function, cognitive processing difficulties, emotional regulation difficulties, physiological difficulties etc.
• There is very strong research evidence to suggest that cognitive behavioural therapy may be effective in reducing anxiety in some children and young people on the autism spectrum without learning disabilities, provided it has been adapted to meet their particular needs
• Determining the benefits of other interventions to treat anxiety in for individuals on the autism spectrum is not currently possible.  We must wait for further research of sufficiently high quality to be completed.  The fact that there is little or no research evidence to show that some interventions are effective doesn’t mean that they do not work. It may simply mean that more research is required to find out if they do
• There is some evidence to suggest that some interventions used to treat anxiety, such as some antidepressants, may cause significant side effects.  Because of this they should only be used with extreme care
• There is a lack of robust and rigorous clinical studies which examine the efficacy of interventions over the long term in real world settings
• There is a lack of research which identifies which groups of people on the autism spectrum with anxiety might benefit most from which interventions or which identify the specific components of interventions which appear to be most successful in reducing anxiety
• There is a lack of studies which involve racially, ethnically, and socioeconomically diverse participants
• There are no studies which involve people on the autism spectrum to review the efficacy and ethical basis of interventions in this area.

Recommendations for Future Research

There is a need for further research into the anxieties faced by people on the autism spectrum and the most effective interventions to overcome those anxieties. Specifically there is a need for studies which 

• Identify the most appropriate, comprehensive assessment and outcome measures for anxiety in people on the autism spectrum.
• Determine if anxiety is simply a condition that commonly occurs alongside autism, if it is a core feature of autism, or if it is a separate but not independent condition
• Identify the potential risk factors that may cause anxiety and specific anxiety disorders in specific groups on the autism spectrum
• Identify which groups of people on the autism spectrum with anxiety might benefit most from which interventions
• Identify the specific components of interventions which appear to be most successful in reducing anxiety
• Examine if any reductions in anxiety can occur in typical settings (home or school) with typical agents (parents and teachers)
• Examine the effects of interventions over a much longer period (longitudinal studies)
• Assess collateral gains (increased rate of learning, social relationships, improved activity patterns) following interventions
• Examine the interplay between different types of intervention (such as medications and behavioural interventions)
• Use more rigorous and robust methods (such as large scale, randomised controlled trials)
• Involve participants who are more racially, ethnically, and socioeconomically diverse
• Involve people on the autism spectrum to review the efficacy and ethical basis of interventions in this area.

Updated

02 Nov 2017