Individuals with Autism Spectrum Disorders (ASD), such as Asperger Syndrome, often experience significantly higher levels of anxiety in their daily lives compared to the general population. Anxiety becomes a prominent source of stress for people with ASD, with worry becoming a constant companion and intermittent episodes of intense fear or panic.
Although the exact reasons for increased anxiety in people with ASD are not fully understood, several explanations have been proposed:
- Neurological factors: ASD is a neurodevelopmental disorder that affects specific components of the brain, leading to structural and functional changes. For example, changes in the amygdala, which plays a role in processing emotions, including anxiety, have been observed in individuals with ASD.
- Sensory sensitivities: Hypersensitivity to certain sensory experiences is a diagnostic criterion for ASD. Individuals may have phobic reactions to various auditory, tactile, visual and olfactory sensations they encounter throughout the day, contributing to an increased risk of aversive experiences and subsequent anxiety.
- High levels of anxiety: People with ASD often experience heightened anxiety due to a variety of factors, such as being frequent targets of bullying or victimisation, fear of failure and ridicule, uncertainty in unfamiliar or unexpected social situations, or heightened sensitivity to negative emotions expressed by others.
People with ASD use coping strategies to manage anxiety
Constant feelings of nervousness and fear can be emotionally and physically draining, leading to hyper-alertness, racing thoughts, difficulty sleeping and stress-related health conditions. So how can people with ASD effectively manage their anxiety? There are many strategies that are known to reduce anxiety, while some strategies should be avoided.
10 effective approaches to managing ASD and anxiety
Individuals often use a variety of coping strategies to deal with the challenges of autism spectrum disorder (ASD) and anxiety. Here we present a comprehensive overview of ten strategies commonly used in this context, categorised as either constructive or destructive. Understanding the potential impact of these strategies is critical to promoting healthy relationships and well-being.
Constructive coping strategies:
- Engage in physical activity: Regular exercise has been shown to be beneficial in managing anxiety symptoms and promoting overall well-being. Physical activity such as exercise, yoga or even a simple walk can help reduce stress levels.
- Practice relaxation techniques: Techniques such as deep breathing exercises, meditation, and progressive muscle relaxation can help calm the mind and body, providing relief from anxiety.
- Cultivate special interests: Encouraging and maintaining personal interests and hobbies can serve as a positive outlet for stress and anxiety and promote a sense of fulfilment and accomplishment.
- Seeking support from animals or loved ones: Spending time with animals or loved ones can be a source of comfort and emotional support, helping people with ASD to reduce anxiety symptoms.
- Maintain a healthy diet and nutrition: Proper nutrition plays a critical role in supporting mental well-being. Eating a balanced diet rich in essential nutrients can help manage anxiety effectively.
- Prioritise adequate sleep: Adequate and restful sleep is essential for overall mental health. Establishing a consistent sleep routine and creating a conducive sleep environment can help reduce anxiety levels.
Destructive coping strategies:
- Excessive control: Exercising excessive control over oneself or others may temporarily relieve anxiety, but in the long run it can strain friendships and relationships and hinder personal growth and well-being.
- Over-reliance on routines and rituals: While routines can provide structure and a sense of security, excessive reliance on them can limit flexibility and hinder adaptability, potentially exacerbating anxiety symptoms.
- Emotional outbursts: Outbursts of intense emotions, such as anger or frustration, may provide temporary relief from anxiety, but they can have a negative impact on interpersonal dynamics and contribute to further emotional distress.
- Alcohol and drug abuse: Resorting to substance use as a means of coping with anxiety can have harmful consequences, including addiction, impaired judgement, and compromised mental and physical health.
Four destructive coping strategies to avoid when managing anxiety:
To ensure the maintenance of healthy friendships and relationships, it is important to recognise and avoid the following four strategies commonly used by people with ASD to cope with anxiety. The negative effects of these strategies highlight the need for alternative and constructive approaches to effectively manage anxiety.
People with autism spectrum disorder (ASD) often use strategies to exert excessive control over their environment as a means of managing anxiety. These strategies may include refusing to participate in anxiety-provoking activities or using emotional manipulation, such as threats, to avoid situations that cause intense anxiety. Psychologists may refer to these strategies as oppositional defiant disorder (ODD) or pathological demand avoidance (PDA).
While these control mechanisms may provide temporary relief for individuals with ASD, they are often rejected by neurotypical individuals who perceive them as controlling or disruptive. Such behaviour can have a detrimental effect on friendships and relationships, leading to conflict and resentment.
It is important for people with ASD to communicate openly about the underlying anxiety and to work with others to explore alternative strategies for managing anxiety, rather than relying solely on avoidance. Encouraging courage and providing support in anxiety-provoking situations can be invaluable.
Routines and rituals
Over-reliance on routines and rituals is another common strategy for coping with heightened anxiety. These repetitive behaviours provide a sense of comfort and relaxation, effectively reducing anxiety. Notably, the DSM-5 diagnostic criteria for ASD include the presence of insistence on sameness, inflexible adherence to routines, and ritualised patterns of behaviour.
From a clinical perspective, these behaviours can be seen as mechanisms to alleviate chronic anxiety rather than as unique characteristics specific to ASD. While routines and rituals can be effective in reducing anxiety, they can become overly time-consuming and interfere with engagement in other activities. Disrupting or preventing these routines and rituals can cause extreme distress.
Another strategy that is not recommended is the rapid and destructive release of anxious energy as a means of ‘cleansing the system’. Anxiety serves a vital function in alerting the body to potential danger and mobilising energy for fight or flight responses.
However, determining how to effectively channel the surge of emotional energy is challenging. Engaging in physical or verbal confrontation as a response to anxiety is unwise because of the increased energy and strength associated with intense anxiety. The cognitive control necessary for thoughtful decision making tends to diminish in such circumstances. If an individual experiences an overwhelming urge for emotional release, a more controlled approach may involve ‘creative destruction’. For example, shredding recyclable items such as cans or cardboard can serve as a cathartic outlet for emotional energy.
A tempting but ill-advised strategy for coping with anxiety is the abuse of alcohol and drugs. While alcohol, when consumed in moderation, may initially provide a sense of relaxation, it is important to recognise that underage consumption is illegal for good reason.
Alcohol not only temporarily impairs brain function, but also disrupts and impedes brain development during adolescence and early adulthood. It impairs thinking, reasoning and judgement, which explains the legal restrictions on drinking and driving. Intoxication undermines cognitive abilities, and people with ASD particularly rely on their intellectual abilities to navigate social situations and cope with various aspects of life.
In addition, prolonged and excessive alcohol use can lead to clinical depression and affect friendships, relationships and employment prospects.
Marijuana, although it may temporarily reduce anxiety and create a sense of detachment from the social world, has its own set of problems. It is illegal in most countries, potentially addictive, and reduces motivation and cognitive performance. It is therefore not recommended as an anxiety management strategy.
If medication is considered necessary for anxiety management, there are prescription options that can be effective when used as prescribed. It is worth noting that people with ASD are not alone in experiencing high levels of anxiety and there are a number of medications that have been shown to be effective in managing anxiety when used as prescribed.
Six effective coping strategies for anxiety
When it comes to coping with anxiety, there are several constructive strategies that can be used. These strategies can be categorised into six main groups, each offering a range of solutions to reduce anxiety levels.
Regular physical activity and exercise provides an effective outlet for emotional energy and promotes clearer thinking. Despite challenges with coordination, people with ASD can benefit greatly from physical activities tailored to their body type and personality. Seeking the advice of a personal trainer can help to identify suitable activities such as cycling, swimming, horse riding or gymnastics.
Regular exercise not only contributes to mental and physical health, but also matches the perfectionism and determination often found in people with Asperger’s syndrome. In particular, many well-known athletes with Asperger’s syndrome serve as inspirational role models.
Relaxation techniques are valuable in relieving anxiety-related tension. Activities such as meditation and yoga, which are increasingly recognised in Western cultures for their wellbeing benefits, offer effective relaxation strategies. Listening to soothing music can induce a sense of relaxation at a lower level, while various meditation practices can promote deeper relaxation. Meditation is now part of the range of psychological treatments for anxiety offered by clinical psychologists.
Solitude, the state of being alone rather than lonely, can also serve as a relaxant for people with ASD. Finding opportunities for solitude during breaks or retreating to a safe and secluded space can provide emotional refreshment and true relaxation. In addition, connecting with nature, walking or camping, and engaging in activities that appreciate patterns and symmetry (e.g. mathematics, architecture) or repetitive, calming and creative pursuits (e.g. knitting, carpentry, watch repair) can provide other sources of relaxation.
The presence of special interests, a diagnostic criterion for ASD, can play an important role in managing anxiety. Immersion in a special interest can act as a ‘thought blocker’, creating a barrier to anxious thoughts and providing a period of anxiety-free time. This involvement can be deeply enjoyable and fulfilling. However, it is important to recognise that intense involvement in a special interest can become almost addictive, and others may not fully appreciate its value in maintaining mental health.
Special interests may arise from a desire to overcome fears or as an escape from everyday worries. Acquiring knowledge about a particular area can help to reduce fears and anxieties, such as developing a special interest in weather systems to overcome a fear of thunder. Engaging in fictional worlds or internet games can create a safe imaginary space where one feels valued, socially successful and free from anxiety. While this can be a useful strategy, it is important to balance it with other activities to prevent it from becoming overwhelming and compulsive. It’s worth noting that relying heavily on a special interest for anxiety relief can lead to severe anxiety if access to it is restricted.
Special interests also have an emotional aspect, providing a rejuvenating experience for those with high levels of anxiety. As anxiety can be mentally and physically draining, time spent on a special interest can replenish energy levels.
It is important to understand the many benefits of special interests. While others may not fully appreciate their value, developing tolerance and understanding of the time spent on special interests can lead to a better compromise. Finding a balance will ensure that the interest does not take up too much time or interfere with family activities.
Spending time with animals or a trusted person
Engaging in social strategies can be effective in reducing anxiety. Spending time with beloved pets that provide a sense of security and comfort, or being in the company of someone who acts as a supportive listener, can be extremely helpful. Keeping pictures of pets or important people who bring calm and acceptance on a mobile phone or nearby can provide comfort. In addition, an audio recording of a supportive friend offering positive and reassuring comments can be beneficial in moments of anxiety.
For people who find it difficult to express their anxiety face-to-face, using electronic communication methods such as email or text messaging allows them to express their inner thoughts and feelings more clearly by writing rather than speaking.
It is important to recognise the importance of a balanced diet in reducing anxiety. Junk food may provide immediate satisfaction and comfort, but the disadvantages outweigh the benefits. Excessive consumption of fats and refined sugars not only contributes to weight gain, but can also increase anxiety levels. Conversely, studies have shown that a diet rich in whole grains, fruits, vegetables, nuts, complex carbohydrates and lean proteins has a positive effect on both sleep quality and mood. A healthy diet promotes a healthy mind.
Sleep has many functions, including rejuvenating the mind and body. People with ASD often struggle with sleep patterns and insufficient sleep. Sleep cycles in ASD may be atypical, with difficulty falling asleep (especially when plagued by worries about past or future events) and disturbances in the depth and quality of sleep.
Attention to dietary choices and consideration of medications such as melatonin may help to establish a more regular sleep pattern. If sleep problems persist, referral to a sleep clinic at a local hospital may provide further insight and strategies for improvement. Restful and deep sleep contributes significantly to better emotional management, including anxiety.
Taking control of anxiety
While individuals with Autism Spectrum Disorder (ASD) often face heightened levels of anxiety, there are constructive strategies that can effectively reduce its intensity and frequency. In my experience counselling individuals with ASD who are seeking guidance and therapeutic support in managing anxiety, I often emphasise a valuable truth: “Rather than allowing anxiety to control you, it is possible to gain control over your anxiety”.
Tony Attwood, Ph.D., is a clinical psychologist specializing in autism spectrum disorders since 1975. He's an adjunct professor at Griffith University, Queensland, and a senior consultant at Minds and Hearts clinic in Brisbane. His book, "Asperger’s Syndrome – A Guide for Parents and Professionals," sold over 350,000 copies and is translated into 25 languages. A prolific author, he speaks at international conferences, conducts workshops, and works with individuals of all ages with Asperger’s syndrome or Autism Spectrum Disorder.