High Functioning Autism and Anxiety: Insights into Treatment Choices

High Functioning Autism and Anxiety: Insights into Treatment Choices
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How Anxiety Manifests in People with Autism

Children and adults with high functioning autism and anxiety present with similar anxiety symptoms as neurotypical individuals, although they may be more pronounced. In most patients, anxiety manifests as irritability and avoidance of social situations. They may experience nightmares, phobias, and feelings of near panic. Symptoms are often at their worst during social activities, when transitions are necessary, or in unique or novel environments. But excessive worry can also manifest itself over a variety of other situations that are not connected to social activities.

Anxiety Treatments for People with High Functioning Autism and Anxiety

Treating a high functioning autistic individual with anxiety requires approaches from three different angels; environmental modifications, medication, and cognitive therapy. Mild anxiety is treatable with just medication and cognitive therapy, but most individuals also require some modifications to their daily routine. Severe anxiety often requires intense involvement in all three areas. No matter the severity of the anxiety, most patients see the best results when using a combination of at least two approaches.

Environmental Modifications

Especially concerning children with high functioning autism and anxiety, environmental modifications are necessary. These modifications may be temporary until the child learns coping techniques, or in some instances, they may be permanent changes. Environmental modifications can be as simple as increasing the person’s physical activity level to provide increased stimulation. Or they can be more drastic, such as placing them in smaller classrooms or in private one-to-one tuition.

People with high functioning autism naturally crave more sensory input. This can be accomplished with physical activities, such as aerobic exercise, heavy muscle or deep pressure activities and swinging. Some examples might be a child wearing a weighted vest, falling or jumping into piles of pillows, or being allowed short recess breaks to swing, slide, or otherwise move around. Such sensory-heavy activities help sooth anxiety. This is one reason why karate classes for children on the spectrum hold much benefit.


Both children and adults on the spectrum suffering with anxiety find relief from symptoms through medication. Common SSRI (selective serotonin reuptake inhibitor) medications like Celexa, Zoloft, and Prozac are used to alleviate troublesome anxiety symptoms. More severe anxiety may require antipsychotic medications such as Risperdal or Abilify for those with severe irritability, debilitating phobias, or self-injurious behaviors.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is based on how a person thinks, feels, and acts in a variety of situations. It is a blend of two therapeutic approaches, behavior modification and cognitive therapy. Both children and adult patients benefit from individual and group settings that utilize a CBT approach. Individual therapy allows for focused efforts, where group settings allow for practice and rehearsal, especially for social anxieties.

With CBT, negative thoughts are replaced over time with positive ones, thus changing how a person feels about a particular activity, environment, or situation. The idea is that by changing thoughts, the patients will subsequently change their behavior. Patients learn to apply new approaches to anxious situations through repetitive rehearsal until the response is reflexive and more positive. The CBT approach is used in a variety of mental health treatments, although slightly different methods are used in cases of people with high functioning autism and anxiety.

References and Resources

Autism Help.org, Generalized Anxiety Disorder https://www.autism-help.org/comorbid-general-anxiety-disorder.htm

Indiana University, Living in Fear: Anxiety in Adolescents with Autism https://www.iidc.indiana.edu/?pageId=481

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