Anxiety is one of the most common mental health challenges among youth. Anxiety is often categorized into one of several different ‘disorders’ grouped around a core set of symptoms. Everyone experiences anxiety in their own way, so it’s important to understand your child’s specific anxiety symptoms and triggers. You might find that some of your child’s anxieties fall into these disorder categories very clearly, while others may not. Some fears and anxieties are more common than others, and some anxieties may be difficult to understand. It’s important to recognize that no matter what your child is afraid of, those fears are most likely intense and very real to your child, even if they seem trivial or confusing to you.
The table below will tell you more about the different types of anxiety disorders and their associated symptoms. Or, you can view this as a PDF.
| Anxiety Disorders | Core Symptoms |
|---|---|
| Social Anxiety Disorder | Anxiety about other people thinking badly of you, fear of being judged, fear of embarrassment, fear of rejection in social situations, and in autism, fear of not understanding how to act in social situations. |
| Specific Phobias | Extreme fear and distress because of a specific object or situation. Common fears: animals, natural environments (like storms), blood, injection, or injuries, situations like being somewhere high, or something else. |
| Separation Anxiety Disorder | Anxiety about separation from a loved one (usually the caregiver) and/or being away from the home. |
| Generalized Anxiety | Uncontrollable negative thinking across a range of everyday topics happening over and over. Youth with generalized anxiety are commonly afraid of making mistakes. They may also worry about bad things that could happen in the future. They may experience perfectionism, or worry about how competent they are at something (like sports, hobbies, school, etc.). |
| Selective Mutism | Someone cannot speak or respond to others in certain settings in which they are expected to speak e.g., school (although they are able to speak in other settings). |
| Panic Fears | Experiences unexpected panic attacks over and over, which is when someone feels extremely scared very quickly and experiences uncomfortable physical sensations. Some people may also become anxious about any future panic attacks they might have. |
| Agoraphobia | Fear about situations in which you cannot easily escape or get help if needed (like in enclosed places or big crowds). |
| Obsessive Compulsive Disorder (OCD) | Experiences unwanted thoughts (obsessions) and performs repetitive behaviors (compulsions) to relieve distress from the thoughts. Common themes include contamination (fears of contamination and washing or cleaning behavior), harm (fears of harm and checking/reassurance-seeking), taboo thoughts (having “bad” thoughts and checking or reassurance-seeking behaviors), and/or symmetry (needing things to be “just-right” or even). |
Although OCD is no longer considered an anxiety disorder by many people, we have found in our work that it is still very useful to think about it this way. Most kids with OCD are afraid of their intrusive thoughts, and the CBT models for OCD and anxiety disorders overlap a lot. This is something you will be learning more about in module 3!
It can be hard to understand why your child may have a particular fear. It is important to try and empathize with your child’s fears and validate their feelings, even if you don’t understand where they are coming from. Ultimately, what is important is understanding how to support your child in managing their anxiety.
Anxiety and Autism
Anxiety disorders are very common in autistic youth, affecting about half of all children at some point in time. Autistic teens and children may also experience anxiety in distinct or different ways. They are more likely to be afraid of something very unusual, like people with beards. Their fears could also stem from sensory challenges, such as loud sounds or overwhelming places. Additionally, autistic youth are more likely to experience anxiety around changes in routine, new situations, social rejection, social confusion, sensory overload, and passionate interests.
The table below will tell you more about how anxiety may present in autism. Or, view this as a PDF.
| Anxiety Disorders | Ways Anxiety Might Show Up in Autism |
|---|---|
| Social Anxiety Disorder | Autistic people are often nervous in situations where they are expected to accurately interpret social cues and understand social subtleties. For autistic people who do not understand social expectations, interacting with others can cause significant anxiety. Autistic teens and kids might worry about being rejected by others due to their differences. Alternatively, some autistic individuals may not take part in social situations because they do not have an interest in them and would prefer to be alone, not because they are afraid of social situations. This is important to distinguish as we are trying to help autistic kids with their anxiety, not change who they are. |
| Specific Phobias | Autistic people are more likely to have uncommon fears such as beards, toilets, or certain textures. They are also more likely to be afraid of loud noises or specific sounds. However, fear is different from sensory sensitivities. An autistic person may avoid certain noises due to sensory issues, rather than fear. |
| Separation Anxiety Disorder | Autistic individuals are sometimes very attached to their routines. If an autistic child has separation anxiety, they may become anxious and upset when a routine with a family member changes (for example, if one parent goes out of town for the week and cannot drive them to school or eat dinner with them like usual, this may cause anxiety). |
| Generalized Anxiety | Autistic people are more likely to have daily worries involving sticking to their schedules and routines. They may experience a lot of distress when they face new situations or when they are forced to change their routine. Their daily worries may also be tied to their special interests (for example, they may worry about not having enough time to practice a hobby or blog about their favorite TV show). |
| Panic Fears | Panic fears may show up differently in autistic people due to sensory sensitivities or body-related self-soothing behaviors. |
| Selective Mutism | Sometimes, selective mutism is caused by severe social anxiety- kids and teens might not speak in certain situations because they are worried about what others will think or about saying the wrong thing. In other cases, kids may have trouble using their words to communicate. Other times, selective mutism can be caused by a combination of both issues. Many autistic people have trouble using words to communicate, so it can be hard to figure out why an autistic individual is having communication challenges. |
| Agoraphobia | If an autistic person finds it difficult to explain why they are afraid in these situations (situations they cannot easily leave or escape from), they may experience an autistic meltdown or shutdown. |
| Autism-Specific Fears | Some autistic people may worry excessively only about their special interest. For example, they may worry about having enough time to engage in a special interest, or fear losing something related to that special interest. Other autistic people may only fear changes in routine, even if they are very minor. For example, they may struggle if they must drive on a different route to school than usual, or if they have to skip a step in their morning routine. |
| Obsessive Compulsive Disorder (OCD) | Many autistic people have “repetitive behaviors”, such as playing a favorite game over and over, or discussing a topic they enjoy over and over, but this might not mean they have OCD. OCD involves reoccurring thoughts and behaviors that cause distress to the person experiencing them. The need for something to be “just-right” in OCD can look a lot like repetitive autistic behaviors that lead to feelings of satisfaction (like organizing). Similarly, sensory issues seen in autism can sometimes look like the disgust felt in OCD obsessions related to contamination. |
Another detail about LUNA is that it’s specifically designed to help autistic kids and teens. In the video below, you will learn more about how autistic individuals experience anxiety differently.
Autistic people’s brains work differently than people who are not on the autism spectrum. For example, autistic people often say they can focus really well on the things they are passionate about. You can be really successful and skilled at your passions because of this. Other differences are harder to deal with. For example, you might have trouble knowing what you are expected to say in situations with new people or understanding how you or other people feel. Similarly, you might feel overwhelmed in crowded or noisy places because of sensory issues. Autistic people can also experience emotions differently. You might feel emotions a lot more intensely than others, or you might not feel intense emotions at times when others do. You might not always know how you feel or be able to talk about it with someone else, even when you are feeling an intense emotion. Sometimes when things unexpectedly change, it can make you feel upset or scared. If you keep thinking about it over and over, that can also be really upsetting. It makes sense, then, that lots of autistic people struggle with anxiety.
Remember, anxiety is the emotion you feel when you expect something bad to happen. For example, if it is hard to know how to act with others, what new situations will be like, and what upsetting sounds, sights, or textures you might have to deal with, it would make sense that you would feel anxious sometimes.
This is what makes LUNA special. LUNA is meant to specifically help autistic teens deal with anxiety because we know the anxiety you experience is unique. Let's join George and Sophia as we work together to overcome our challenges and reach our goals!
A brief note about language
You may notice that LUNA uses identity-first language (e.g., “autistic person”) rather than person-first language (e.g., “person with autism”). Many autism advocates prefer identify-first language because it acknowledges the autism spectrum as a positive and inherent part of the individual’s identity (for example, see Kenny et al., 2016; Bury et al., 2020). We have chosen to describe autism this way here but understand that might not be the preference of all families.
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20(4), 442-462. https://doi.org/10.1177/1362361315588200
Bury, S. M., Jellett, R., Spoor, J. R., & Hedley, D. (2020). “It defines who I am” or “It’s something I have”: What language do [autistic] Australian adults [on the autism spectrum] prefer?. Journal of autism and developmental disorders, 1-11. https://doi.org/10.1007/s10803-020-04425-3