Anxiety

Written By Brittyn Coleman, MS, RDN/LD

What is Anxiety?

  • Anxiety is a mood disorder often characterized by feelings of worry, dread, or nervousness about potential events that might happen. [1]

  • It is normal to have some level of anxiety, however, when it begins to interfere with the ability to function and live a normal life, it can be diagnosed as a formal mood disorder. [1]

  • Anxiety can be broken down into several categories:

    • Chronic anxiety

      • This is the general form of anxiety disorder. It is diagnosed when symptoms of unrealistic or excessive worry about a number of events or activities persist for at least 6 months. [2]

      • Depression can also be misinterpreted as anxiety.

    • Panic disorders/attacks

      • Panic attacks are a sudden episode of intense, terrifying fear that triggers severe physical reactions when there is no real danger or apparent cause. [2]

    • Phobias (social or specific)

      • Phobias are fear of an object or situation (i.e. animals, water, enclosed planes). [2]

      • Social phobia involves fear of social situations and may result in withdrawal from public environments or friends. [2]

 
 

Anxiety & Autism

  • There is considerable evidence that individuals with ASD are at heightened risk for anxiety and anxiety disorders, which can cause persistent distress, exacerbate ASD symptoms, and increase behavioral problems [13]

  • Nearly 75% of individuals with ASD have comorbid psychiatric conditions, which may include anxiety, attention-deficit hyperactivity disorder (ADHD), bipolar disorder, depression, Tourette syndrome, and others. [14]

  • Children with autism feel many of the same worries any child experiences, however, they might also worry or feel stressed about things that are less worrying for typically developing children. [1] These include things like:

    • Small disruptions in their routines

    • New sensations 

    • Unfamiliar social situations

    • Social situations where it is hard to interpret others thoughts or feelings

    • Their own thoughts and feelings, especially unfamiliar or unpleasant

    • Physical symptoms of panic attacks or gastrointestinal issues

  • One study shows that 39.6% of children with autism have also been diagnosed with an anxiety disorder. [4]

  • Since many children with autism have difficulty identifying, expressing, or verbalizing their anxious thoughts or feelings, it is very likely that many children with anxiety have not been diagnosed.

    • Therefore, the number of autistic children with anxiety is likely greater than reported.

Signs/Symptoms of Anxiety

Physical symptoms of anxiety can include:

  • Fatigue

  • Racing Heart

  • Shortness of Breath

  • Insomnia

  • Irritability

  • Sweating

  • Shaking or Trembling

  • Nausea

  • Suicidal thoughts

  • Headaches

Anxiety in children with autism can be difficult to identify as it can look very similar to some common characteristic of autism such as [1]:

  • Stimming

  • Obsessive or ritualistic behaviors (see the Obsessive-Compulsive Disorder note for more)

  • Resistance to changes in routines

  • Meltdowns or emotional outbursts

  • Withdrawal from social situations

  • Avoiding new tasks

  • Running away

  • Hitting

  • Self-harm behaviors such as:

    • Head-banging, scratching the skin, or hand/nail-biting.

Additionally, many children with autism have a hard time understanding their anxious feelings, or they may not be able to express how they are feeling, because of this you may notice an increase in challenging behaviors during times of anxiety. [1]

 
 

Contributing Factors

Research has found that there are both genetic and environmental risk factors that contribute to the development of anxiety


Next Steps

Diet

Supplements

 
 

Lifestyle

  • Seeking assistance from a licensed Psychologist. Psychologists have professional training in the treatment of mental conditions and can work with you and your child to come up with solutions to their anxiety. They incorporate things such as:

    • Cognitive Behavioral Therapy (CBT)

    • Stepladder approach to facing fears

    • Relaxation techniques to learn to relax

    • Social stories for preparation of anxious events.

  • Help your child learn and recognize what anxiety looks like in their body, so you both can identify it when it happens:

    • Draw an outline of your child’s body and have them color or describe what they feel when they are scared or worried.

    • Examples: sweaty palms, butterflies in their stomach, racing heart, their hands flap, etc. 

  • Try relaxation and calming techniques:

    • Taking 5 deep breaths

    • “Square Breathing” (see image below)

    • Counting to 10

    • Reading their favorite book

    • Running a few laps around the yard

    • Going to a quiet place

    • Looking at their favorite things

      • Help your child perform these calming techniques when they start to identify they are anxious.

  • Use visual tools to prepare your child for anxious situations

    • Example: If your child is anxious about being dropped off at school. 

    • Take photos of what your child will be doing such as: walking in the school doors, sitting in the classroom, eating lunch, etc. 

    • Share pictures of what you will be doing while you are not with your child such as: grocery shopping, cleaning, running errands.

    • Finally, share a picture of you returning to the school to pick your child up. 

  • Roleplay stressful social scenarios

  • If your child is non-verbal, identify a form of communication such as drawing pictures and having your child point to what they are trying to express.

  • Make sure your child is getting adequate sleep

 
 

DISCLAIMER: Before starting any supplement or medication, always consult with your healthcare provider to ensure it is a good fit for your child. Dosage can vary based on age, weight, gender, and current diet.

Anxiety & Autism in the Research

Anxiety Prevalence in Autism

  • A recent scientific review identified that 39.6% of children with autism have been diagnosed with at least 1 anxiety disorder. [4]

  • Since many children with autism have difficulty identifying, expressing, or verbalizing their anxious thoughts or feelings, it is very likely that many children with anxiety have not been diagnosed.

    • Therefore, the number of autistic children with anxiety is likely greater than reported.

Anxiety, Mindfulness, and Behavior Therapy

  • In one study, mindfulness based stress reduction (MBSR) and cognitive behavioral therapy (CBT) were both studied as a potential therapy for anxiety, depression, autism symptoms, rumination, and mood. [5]

  • Study results indicated that both MBSR and CBT were effective in reducing anxiety, depression, autistic symptoms, rumination and improvement of mood in adults with autism. [5]

  • MBSR was the preferred method for treatment of anxiety when individuals had a positive mood prior to beginning therapy. [5]

Anxiety & Sleep Issues

  • This study on the relationship between sleep and emotional regulation discovered that the two often go hand in hand. [8]

  • Persistent sleep problems were associated with a 10x increase in dysregulation of  emotions, cognition, and aggression. [8]

  • See the Sleep Issues note for more information

Anxiety and Neurotransmitters

  • GABA, gamma-aminobutyric acid, a chemical messenger in our brain helps to regulate excessive excitation in the cortex of the brain. [6]

  • Glutamate is an excitatory neurotransmitter in the brain. [6]

  • This study found that a balanced ratio of glutamate and GABA was necessary to maintain balance of excitatory and inhibitory brain chemicals. [6]

  • When the ratio of glutamate/GABA is elevated, there appears to be an over excitation in individuals with more social and interpersonal difficulties such as: social anxiety, social skills, and communication. [6]

Anxiety and Gastrointestinal Health

  • Individuals with irritable bowel syndrome, regardless of diarrhea or constipation sub-type, had a 67.7% higher incidence of anxiety than control groups who did not experience gastrointestinal complaints. [11]

  • Young adults who reported symptoms of depression and anxiety were significantly more likely to also report gastrointestinal symptoms. [12]

  • Both of these studies suggest that there is a close relationship between gastrointestinal dysfunction and anxiety. 

Autism and Suicidal Thoughts

  • One study found that children with autism are 14% more likely to experience suicidal thoughts, this is 28x more likely than non-autistic children. [7]

*If you or your child is experiencing suicidal thoughts or self-harm, please seek support from a licensed professional or call 1-800-273-TALK to find out what resources are available. 

  • [1] Anxiety: autistic children and teenagers. Raising Children Network. Accessed April 24, 2021. https://raisingchildren.net.au/autism/health-daily-care/mental-health/anxiety-asd

    [2] NIMH  » Anxiety Disorders. Accessed April 24, 2021. https://www.nimh.nih.gov/health/topics/anxiety-disorders/

    [3] Vasa RA, Mazurek MO, Mahajan R, et al. Assessment and Treatment of Anxiety in Youth With Autism Spectrum Disorders. Pediatrics. 2016;137 Suppl 2:S115-S123. doi:10.1542/peds.2015-2851J 

    [4] Van Steensel FJ, Bögels SM, Perrin S Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302–317pmid:21735077https://raisingchildren.net.au/autism/health-daily-care/mental-health/anxiety-asd

    [5] Sizoo BB, Kuiper E. Cognitive behavioural therapy and mindfulness based stress reduction may be equally effective in reducing anxiety and depression in adults with autism spectrum disorders. Res Dev Disabil. 2017;64:47-55. doi:10.1016/j.ridd.2017.03.004

    [6] Ford TC, Nibbs R, Crewther DP. Glutamate/GABA+ ratio is associated with the psychosocial domain of autistic and schizotypal traits. PLoS One. 2017;12(7):e0181961. Published 2017 Jul 31. doi:10.1371/journal.pone.0181961

    [7] Susan Dickerson Mayes, Angela A. Gorman, Jolene Hillwig-Garcia, Ehsan Syed. Suicide ideation and attempts in children with autism. Research in Autism Spectrum Disorders. Volume 7, Issue 1. 2013. Pages 109-119. https://doi.org/10.1016/j.rasd.2012.07.009.

    [8] McMakin DL, Alfano CA. Sleep and anxiety in late childhood and early adolescence. Curr Opin Psychiatry. 2015;28(6):483-489. doi:10.1097/YCO.0000000000000204

    [9] Richards G, Smith A. Caffeine consumption and self-assessed stress, anxiety, and depression in secondary school children. J Psychopharmacol. 2015;29(12):1236-1247. doi:10.1177/0269881115612404

    [10] Teresa Badillo. Balancing GABA and Glutamate. The Autism Exchange. http://www.theautismexchange.com/organized-information/aex-blog/artmid/1541/articleid/1020/balancing-gaba-and-glutamate. Accessed May 7, 2021.

    [11] Hartono JL, Mahadeva S, Goh KL. Anxiety and depression in various functional gastrointestinal disorders: Do differences exist?J Dig Dis. 2012;13(5):252-7. doi:10.1111/j.1751-2980.2012.00581.x

    [12] Söderquist, F., Syk, M., Just, D. A cross-sectional study of gastrointestinal symptoms, depressive symptoms and trait anxiety in young adults. BMC Psychiatry 20, 535 (2020). https://doi.org/10.1186/s12888-020-02940-2

    [13] Postorino V, Kerns CM, Vivanti G, Bradshaw J, Siracusano M, Mazzone L. Anxiety Disorders and Obsessive-Compulsive Disorder in Individuals with Autism Spectrum Disorder. Curr Psychiatry Rep. 2017 Oct 30;19(12):92. doi: 10.1007/s11920-017-0846-y. PMID: 29082426; PMCID: PMC5846200.

    [14] Sharma SR, Gonda X, Tarazi FI. Autism Spectrum Disorder: Classification, diagnosis and therapy. Pharmacol Ther. 2018 Oct;190:91-104. doi: 10.1016/j.pharmthera.2018.05.007. Epub 2018 May 12. PMID: 29763648.

Authors

Brittyn Coleman, MS, RDN/LD, CLT

Sinead Adedipe, MS

Brittyn Coleman, MS, RDN/LD https://www.autismdietitian.com
Previous

Autism Spectrum Disorder
Next

ARFID