Anxiety in Autistic People: Common at Every Age, Too Often Overlooked

Anxiety is one of the most common health needs autistic people live with, from childhood into adulthood. Estimates run from under one in ten autistic children in population studies to more than four in ten autistic adults over a lifetime, and where autistic and non-autistic people are compared directly, anxiety is diagnosed two and a half to more than four times as often. Yet it is still too often missed, or put down to “just the autism”.

It is the child who cannot walk into a roaring dinner hall, and whose distress is written up as “behaviour”. It is the teenager who rehearses every sentence before a phone call, then cannot make it. It is the adult who has carried a constant hum of dread through offices and waiting rooms built for other nervous systems — and who, on finally asking for help, is told it is simply part of being autistic. Anxiety is a health need. It is common, it can be disabling, and it deserves proper care rather than explanation away.

Anxiety is common at every age — how common depends on who is counted

The World Health Organization lists anxiety among the conditions autistic people often live with, alongside epilepsy, depression and ADHD^[3]. A 2019 meta-analysis pooling 96 studies put anxiety disorders at 20% of autistic people — second only to ADHD (28%) among the diagnoses it examined — and found higher estimates in clinical samples than in population-based and registry studies^[4].

Who is counted matters. A 2011 meta-analysis of 31 studies, covering 2,121 autistic young people under 18, found that 39.6% had at least one anxiety disorder^[5]. A 2022 meta-analysis restricted to population-based studies found lower but still considerable rates: 11.1% overall, 7.8% of autistic children and 21.5% of autistic adolescents^[6]. A 2024 review of 15 community studies (4,459 young people) found anxiety symptoms or disorders in 33% by self-report questionnaire (12 studies) and 19% by clinician-administered interview (3 studies)^[7]. In a King’s College London study of 112 children aged 10 to 14 from a population-derived cohort, social anxiety disorder was the most common single diagnosis, at 29.2%^[8]. And a 2017 meta-analysis of 83 studies found autistic children had higher anxiety levels than non-autistic children, urging careful monitoring as they move into adolescence^[9].

Nor is anxiety confined to childhood. A 2019 systematic review of 35 studies estimated that 27% of autistic adults currently have an anxiety disorder (pooling 13 studies) and 42% have had one at some point (pooling 8), with wide variation between studies depending partly on how anxiety was measured^[1].

Anxiety is diagnosed several times as often as in non-autistic peers

Two large population studies compare autistic and non-autistic people directly. In Canada’s 2019 national survey of children and youth, parents reported an anxiety disorder diagnosis for 22.5% of autistic 5- to 17-year-olds, against 4.8% of their non-autistic peers — more than four times the rate^[10]. In Stockholm, Sweden, health registers covering 4,049 autistic and 217,645 non-autistic adults aged 18 to 27 showed an anxiety disorder diagnosis on record for 20.1% against 8.7%: an adjusted relative risk of 2.62. Risk was greatest for autistic adults without an intellectual disability (23.1%), and almost every individual anxiety disorder was more common^[2].

Anxiety rarely arrives alone. The adult meta-analysis put current depression at 23%^[1], which we cover in our piece on autism and depression. Research on preventing suicide among autistic people, in which access to good mental health care is one of many factors studied, is covered with care in our article on suicide and autism research.

Social anxiety, phobias and OCD lead the list

Among autistic under-18s, the 2011 meta-analysis found specific phobia to be the most frequent anxiety disorder (29.8%), followed by obsessive-compulsive disorder (OCD, 17.4%) and social anxiety disorder (16.6%)^[5]. In adults the picture tilts towards social anxiety (29% currently) and OCD (24%)^[1]. In the Swedish registers, OCD was diagnosed in 3.4% of autistic young adults against 0.5% of their peers, an adjusted relative risk of 8.07^[2].

Register figures count only diagnoses ever recorded in health services by ages 18–27, so they run far lower than interview or questionnaire estimates. Compare within a column, not across columns. “–” = not reported in the source abstract.

Anxiety can also look different. In one study of 59 autistic young people aged 7 to 17, 17% showed anxiety matching standard diagnostic definitions, 15% showed anxiety that did not, and 31% showed both^[11]. Examples include fear of change or novelty and unusual phobias^[7].

“It’s just the autism”: why anxiety is so often missed

When anxiety and autism share surface features, one can hide behind the other. Researchers call this diagnostic overshadowing: avoiding social situations can look like social anxiety, and repetitive behaviours can resemble the compulsions of OCD. It can cut both ways: studies using questionnaires produced higher estimates of OCD and social anxiety than those using clinical interviews, which the authors suggest may partly reflect autistic traits being read as anxiety^[1].

In practice, autistic people most often describe anxiety being waved away. A 2019 inquiry by the All Party Parliamentary Group on Autism (APPGA), informed by the views of over 11,000 autistic people and their families in England, heard from people who felt “overlooked by healthcare professionals who often failed to identify or even ignored their mental health needs because they were autistic”. Some were told their mental health problems were “due to their autism” and so could not get help from mental health teams^[12].

People who communicate distress in less conventional ways may be missed most. In the Swedish registers, autistic adults with an intellectual disability had a recorded anxiety rate of 12.5%, against 23.1% for those without. The authors caution that carers or clinicians may attribute signs of anxiety to the intellectual disability itself, and that many anxiety symptoms are tied to verbal ability^[2]. Even the GAD-7 questionnaire used to track anxiety in England’s NHS talking therapies has not been fully validated for autistic adults^[13]. Reviewers recommend routine screening, using more than one informant^[7].

A world not built for autistic people adds to the load

Much of the research on why anxiety is so common is correlational, but its recurring threads concern the fit between autistic people and environments not designed with them in mind. The National Autistic Society’s Too Much Information campaign listed experiencing anxiety in social situations, experiencing anxiety with unexpected changes, and finding noise, smells and bright lights painful and distressing among the things autistic people wanted the public to understand^[12].

Uncertainty. Intolerance of uncertainty — finding the unexpected or unknown especially hard to cope with — was consistently elevated in autistic participants across 12 studies, and a meta-analysis of 10 of them found a large correlation with anxiety (r = 0.62). The authors, noting the small evidence base, suggest it may be a useful target for support^[14].

Sensory experience. A 2024 meta-analysis of 63 studies (11,659 participants) linked sensory processing differences — particularly hypersensitivity and visual, auditory and tactile sensitivities — with more internalising and externalising problems, the former including anxiety^[15].

The social world. Among autistic adults without an intellectual disability, camouflaging — masking autistic characteristics in social situations — was associated with more generalised and social anxiety, though only modestly beyond autistic traits and age^[16]. The Swedish researchers point to peer rejection and repeated social misunderstandings, alongside possible biological and genetic contributions^[2]. Bullying is covered in our piece on bullying and victimisation.

NICE’s adult guideline already asks professionals to take into account an “increased propensity for elevated anxiety about decision-making in autistic people”, and whether environments are suitably adapted for people with sensory sensitivities^[17]. None of these associations proves cause on its own — but uncertainty, sensory overload and social strain are things services, schools and workplaces can change.

Adapted support can help — if people can reach it

NICE’s guideline for autistic children and young people says services should consider group CBT adjusted for autistic young people with anxiety who have the verbal and cognitive ability to engage in it, or individual CBT for those who find groups difficult, with adaptations such as more written and visual information, a more concrete and structured approach, regular breaks and the young person’s own interests^[18]. The adult guideline sets out similar adaptations, including plain English and avoiding excessive use of metaphor and ambiguity^[17].

The trial evidence is encouraging but thin. A 2021 meta-analysis of 19 randomised trials (833 autistic young people) found CBT reduced anxiety by the end of treatment — a large effect on clinician ratings (g = 0.88), smaller effects on parent (0.40) and child (0.25) reports — but the benefits were not maintained at follow-up in the few trials that checked, and most trials raised concerns about reporting bias^[19]. A 2023 network meta-analysis of 71 trials (3,630 participants) found some forms of CBT and mindfulness therapy may help autistic people without an intellectual disability; the trials did not report what works for people with one^[20].

Real-world data show the gap. Of more than 2.5 million adults who completed at least two sessions of NHS primary care psychological therapy in England in 2012–19, 8,761 had an autism diagnosis. Symptoms fell for most autistic adults, but less often than for matched non-autistic adults: 56.1% reliably improved against 61.7% (adjusted odds ratio 0.75), and 9.2% deteriorated against 7.2%. The researchers estimated autistic adults were under-represented in the service by 2.4 to 5.3 times relative to national prevalence estimates, and that the share who received adaptations was unknown^[13].

Access is a barrier in itself. In the APPGA survey, 76% of autistic adults said they had sought mental health support in the previous five years, and 82% said getting support from mental health services took too long^[12].

The pattern is not confined to England. In US interviews with 22 autistic adults, 44 community mental health clinicians and 11 agency leaders, most reported barriers came down to clinicians’ limited knowledge, experience and confidence in working with autistic adults^[21], and the WHO names health-care providers’ inadequate understanding of autism as a common barrier to care^[3]. We look at these barriers in our piece on healthcare barriers for autistic adults.

What the evidence asks of us

Researchers have long said that “careful assessment of mental health is an essential component of care for all people on the autism spectrum”^[4]. Autistic people and families agree: when Autistica’s 2016 James Lind Alliance partnership asked over 1,000 people for their top research questions, first place went to which interventions improve mental health in autistic people and how they should be adapted, and “Which interventions reduce anxiety in autistic people?” also made the top ten^[22]. The evidence asks services, funders and policymakers to:

• Look for anxiety routinely, and never dismiss it as “just the autism” — using more than one informant^[7], with clinicians who understand how anxiety and autism overlap^[1], and including people with an intellectual disability^[2].
• Make adaptation the default, and measure it. NICE has recommended adapted therapy for over a decade^[17][18]; services should record which adaptations autistic people receive and whether outcomes close the gap^[13].
• Close the access gap. Autistic adults are under-represented in England’s main talking-therapy service^[13], and few say local services meet their needs^[12].
• Train clinicians with autistic people, not just about them. Autistic adults, clinicians and agency leaders alike suggested involving autistic adults in creating and delivering training^[21].
• Fund the research autistic people asked for: longer follow-up of therapies^[19], trials that report outcomes for people with an intellectual disability^[20], and studies of support that targets uncertainty and sensory load^[14][15].
• Change environments, not only people. NICE already asks services to minimise the negative impact of physical environments, including sensory sensitivities to lighting and noise^[18].

As the APPGA put it: “Poor mental health should not be an inevitable part of being autistic.”^[12]

Language: this piece uses identity-first language (“autistic people”), the preference of most autistic-led organisations, and uses clinical terms such as “autism spectrum disorder” only when naming a study or diagnostic category.

Why we're publishing this

Health Insurance UK is a commercial health-insurance resource, not a charity and not a campaign. We compiled this evidence because autistic people, their families and autistic-led organisations have said for years that anxiety is common, draining and too often dismissed — and they deserve the research behind that case clean, current and in one place, ready to put in front of a commissioner, a clinician or a journalist. The case belongs to the community living it. Our part is to stand alongside it and say plainly what the figures show: anxiety is common at every age, too often missed, and the adapted support that can help is still too hard to reach.

How to read this data

The figures come from different kinds of study and are not interchangeable. Meta-analyses pool smaller studies, some drawn from clinics, which tend to give higher estimates than population or register studies. Register data, such as Stockholm’s, count only recorded diagnoses. The Canadian figures are parent-reported diagnoses; the report gives the autistic figure as 22.5% in its chart and 22.1% in its text, with the same confidence interval. “More than four times” is our own calculation from those percentages, not an adjusted estimate. The APPGA figures come from a self-selected survey. Current and lifetime prevalence answer different questions, and estimates from different reviews are not a trend. Links with uncertainty, sensory differences and camouflaging come mostly from cross-sectional studies and do not on their own show cause. Most of this research comes from high-income countries — including the UK, Sweden, Canada, the US, Australia and the Netherlands — and covers children and working-age adults; we found no verified anxiety estimate for autistic people over 65. People with an intellectual disability are under-represented, especially in therapy trials. This is a summary of published research, not new research.

Use this data

Free to cite with attribution to Health Insurance UK. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch. For the wider picture, see the Autism & Health research library.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

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