Anxiety is the most common mental health challenge facing autistic children, teens, and adults, yet for decades it was overlooked, misunderstood, or mistaken for something else entirely. On a recent episode of Autism Weekly, host Jeff Skibitsky sat down with Dr. Lauren Moskowitz, a clinical psychologist and researcher at St. John’s University, to talk about how anxiety shows up in autistic individuals and what families can do, starting today.
Anxiety and autism go hand in hand more than most people realize. Research shows that around 69% of autistic children experience clinically significant anxiety, and about 42% of autistic adults have had an anxiety disorder at some point in their lives. Dr. Moskowitz says even those numbers are likely an underestimate, since anxiety can be especially hard to recognize in people who communicate differently.
For years, anxiety in autistic individuals was dismissed as simply “escape behavior.” But Dr. Moskowitz pushed back on that idea early in her career, asking a simple question: what if some of these behaviors aren’t about avoiding a task, they’re about fear?
What anxiety can look like in autistic kids
One of the most important things Dr. Moskowitz shared is that anxiety doesn’t always look the way we expect. For some kids, it shows up the way it does in any child: worry, clinginess, crying, avoidance. But for many autistic children, anxiety shows up in much more individual ways, things like:
- A change in the frequency or intensity of a behavior the child already does. A kid who rocks sometimes might rock faster or harder when anxious.
- A specific throat sound, a frozen stare, or a particular facial expression that shows up only in certain situations.
Anxiety can also overlap heavily with traits associated with autism itself, like a need for routine, repetitive questions, or avoiding social situations. The key, Dr. Moskowitz explains, is context. The same behavior can mean different things depending on what’s happening around it and what tends to follow.
For families, this means becoming a bit of a detective. Watching closely, over time, often reveals a pattern only a parent or caregiver would know to look for.
A message for autistic readers: your anxiety is real, and it makes sense
If you’re autistic and reading this, here’s something Dr. Moskowitz wants you to know: anxiety is not a flaw, and it’s not something to be ashamed of. It’s your body’s alarm system, and, like any alarm system, sometimes it goes off when there isn’t really a fire. That doesn’t mean what you’re feeling isn’t real. It just means the alarm might be a little more sensitive than it needs to be in that moment.
You are not broken for feeling anxious. You are not “too much” for needing things to be predictable, or extra time, or your special interests as a source of comfort. Those things can actually become tools, not problems, when the people around you understand how to use them well.
And if you’ve ever been told to “just calm down” or that something isn’t scary when it feels very scary to you, Dr. Moskowitz wants you to know that’s not how this works, and it’s not your fault that it didn’t help.
What can help
The good news is that effective treatment exists, and it’s built on a foundation of respect, not out of force.
- Exposure should never mean forcing. Dr. Moskowitz was direct about this: exposure therapy, done right, is about motivation, not coercion. She described working with a child who was terrified of medical visits by slowly building positive associations using his favorite toy, never holding him down, never forcing anything. Step by step, on his terms, he became able to tolerate something that once felt unbearable.
- Visual supports make a huge difference. Social stories, comic strips, and visual schedules help turn abstract feelings into something concrete that makes sense. Many autistic kids do best when they can see what’s being asked of them, not just hear it.
- Special interests can be an asset, not a distraction. If a child loves Harry Potter, framing coping strategies around “casting a spell” against anxiety isn’t just fun; it builds real understanding and motivation.
- Reassurance can backfire. It feels natural to answer a worried child’s questions over and over (“Am I going to get sick? Are you sure?”), but constant reassurance can feed anxiety rather than ease it. Instead, the goal is to help kids build the confidence that they can handle uncertainty, even without a guaranteed answer.
For parents: you don’t have to fix everything at once
Dr. Moskowitz, who is also a parent of two, was candid about how overwhelming this can feel. Her advice: pick one thing.
You don’t need to address every accommodation or every anxious behavior at once. Choose the issue that’s having the biggest impact on your family’s quality of life, and start there. Everything else can wait.
She also offered a simple but powerful idea: be a coping model, not a perfect model. Kids don’t need to see parents who are never scared. They need to see parents who get scared and still try. Saying out loud, “I’m nervous about this too, but I’m going to do it anyway,” teaches more than pretending fear doesn’t exist.
You’re not alone in this
Whether you’re a parent trying to understand your child’s behavior for the first time, a teacher noticing something doesn’t add up, or an autistic person trying to make sense of your own anxiety, this conversation is a reminder of something simple: anxiety in autism is real, it’s common, and it’s treatable.
Progress is being made. Programs are training more providers to feel confident working with autistic individuals. Free resources, visual tools, and evidence-based treatments are more available than ever.
And most importantly, you don’t have to face it alone, and neither does your child.
