Autism and Anxiety: Understanding the Overlap
- Amanda Moses Psychology
- Jul 2
- 4 min read
Autism and anxiety often show up together—and sometimes, they look almost identical on the surface. A client might present with social withdrawal, shutdowns, overwhelm, or high levels of distress. But what’s underneath those behaviours can be very different. In many cases, autistic clients—particularly those who mask—are misdiagnosed with anxiety alone. The greater clinical risk isn’t over-diagnosing autism, but missing it entirely. When that happens, clients are left without the support, understanding, or accommodations they actually need.
Understanding how these presentations interact, and where they differ, helps reduce misdiagnosis and ensures clients get support that actually fits. Autism isn’t just a diagnostic label—it’s a neurotype. Missing it means missing the opportunity for someone to understand themselves, advocate for their needs, and access the right accommodations.
When It’s Not Just Anxiety: It's Autism
Autistic people are facing a mental health crisis. Rates of anxiety, depression, and suicide are significantly higher—suicide rates alone are up to 8 times higher than in the general population. And we now know that prolonged masking can take a serious toll on mental health. When autism goes unrecognised, interventions often miss the mark and may even worsen anxiety rather than relieve it.
Autism and anxiety often coexist, but they’re not interchangeable. Getting it wrong has consequences.
Understanding the Difference Between Autism and Anxiety
Many clinical frameworks approach anxiety as a “distorted” way of thinking—but for autistic people, anxiety often reflects real, lived challenges. It’s not irrational to feel overwhelmed in a sensory-hostile workplace. It’s not a cognitive distortion to fear being misunderstood if you have social communication differences.
Here are some key distinctions to look for:
✔️ Social Communication vs. Social Anxiety:
Autistic people may communicate in a different style—not because they’re anxious, but because that’s how their brain works. However, fear of being judged or excluded can compound these differences and lead to true social anxiety. These experiences are layered, not mutually exclusive.
✔️ Need for Predictability vs. GAD
A strong preference for routine and difficulty with change are common among Autistic people. Given that intolerance of uncertainty is a key feature of Generalised Anxiety Disorder (GAD), it is unsurprising that Autistic people may be particularly vulnerable to experiencing it. While life is inherently unpredictable, for an autistic person, this unpredictability can generate significant and understandable anxiety
✔️ Sensory Sensitivities vs. Specific Phobias
Many Autistic people experience sensory processing differences, which can make certain environments feel overwhelming or even distressing. For example, sensitivities to loud noises, particular textures, or crowded spaces may lead to behaviours that resemble specific phobias. But these responses often arise from genuine sensory overwhelm—not irrational fear.
When Autism Is Misunderstood as Anxiety
When we don’t understand the difference between anxiety-driven behaviours and those rooted in a person’s neurotype, we risk missing or delaying an autism diagnosis. Without recognising the underlying neurotype, interventions may target the wrong issue—often worsening anxiety rather than easing it. This is why thorough assessments that consider both autism and anxiety are essential. They help ensure individuals receive support that actually addresses the root of their distress, not just the surface-level symptoms.
Practical Tips for Clinicians
Observe context: Anxiety fluctuates. Autistic traits persist.
Ask about triggers: Sensory and social stressors may point to autism.
Use collaborative assessment: Ask how the world feels to them—not just what behaviours you see.
Remember autism is lifelong: Anxiety can ebb and flow. Autism is a neurotype, not a phase.
What Helps?
When It’s Anxiety:
CBT or ACT are both evidence-based interventions for anxiety
Exposure work is always an essential component of anxiety treatment
Building in coping strategies and skill-building
When It’s Autism:
Reduce demands, increase regulation
Ensure you are accomodating their sensory-processing differences, not engaging in exposure work (this will make it worse)
Encourage stimming and engagement with special interests
Don’t try to “fix” traits—support the person
When It’s Both:
Combine therapeutic support with neurodivergent-affirming practice
Use adapted CBT with a focus on predictability, regulation, and agency
Help the client build self-advocacy and a positive identity
Focus on what feels supportive—not just what’s evidence-based on paper
Final Thoughts
When we don’t understand the difference between anxiety-driven behaviours and those rooted in a person’s neurotype, we risk missing or delaying an autism diagnosis. Without recognising the underlying neurotype, interventions may target the wrong issue—often worsening anxiety rather than easing it. This is why thorough assessments that consider both autism and anxiety are essential. They help ensure individuals receive support that actually addresses the root of their distress, not just the surface-level symptoms.
If you're wanting to build your skills in telling these presentations apart, my Differential Diagnosis: A Spotlight on Neurodivergence training is a great next step. It’s designed to help you feel more confident navigating complex cases where ADHD, trauma, autism and anxiety intersect.
💡 Looking for more support tools?
You might find my Generalised Anxiety Treatment Manual helpful—it’s filled with practical strategies, client handouts, and evidence-based tools you can start using in sessions right away.
✨ Want to Deepen Your Understanding of Autism?
If this topic resonates, I’ll be unpacking it further in my upcoming live webinar What is Autism?—with a particular focus on masked and internalised presentations. I’ll walk through the DSM criteria and show how traits can show up differently in real life, especially for those who’ve spent years compensating.
