Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics.
Half of caregiver-reported anxieties in autistic youth are autism-specific, so add custom open-ended anxiety items to your intake.
01Research in Context
What this study did
Lau et al. (2020) asked caregivers to list every fear or worry they saw in their autistic child. The team sorted each worry into two piles: everyday fears like dogs or tests, and autism-linked fears like sensory noise or routine change.
They used simple counts, not rating scales. This let new, odd fears show up naturally.
What they found
Half of the worries were everyday. Half were autism-specific. Kids with stronger autism traits had more of the odd, autism-type fears.
Caregivers named fears you will not find on standard anxiety checklists, such as fear of ceiling fans or of a different grocery store route.
How this fits with other research
Richards et al. (2017) asked teens themselves, not caregivers, and still found the same link: more repetitive behavior went with more anxiety. The match across reporters boosts confidence.
Van Hees et al. (2018) and van Timmeren et al. (2016) zoom in on one special fear—hoarding. They show one in three to four anxious autistic kids hoard objects. Yen’s open list makes room for these niche fears instead of missing them.
Spackman et al. (2025) step beyond autism and find the same anxiety–sameness link in ADHD and OCD. This tells us the tie between anxiety and rigid behavior is not unique to autism, so watch for it in any client who insists on sameness.
Why it matters
Standard anxiety forms will miss half the story in autistic clients. Add one open question: "What does your child avoid that surprises you?" Write the answer verbatim. Those odd items often become the first targets for treatment and can explain sudden spikes in problem behavior when routines shift.
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02At a glance
03Original abstract
Anxiety is common in autism spectrum disorder. Many anxiety symptoms in autism spectrum disorder are consistent with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) anxiety disorders (termed "common" anxieties), but others may be qualitatively different, likely relating to autism spectrum disorder traits (herein termed "autism-related" anxieties). To date, few studies have examined both "common" and "autism-related" anxiety experiences in autism spectrum disorder. We explored caregiver-reported Spence Children's Anxiety Scale-Parent version data from a multi-site (United Kingdom, Singapore, and United States) pooled database of 870 6- to 18-year-old participants with autism spectrum disorder, of whom 287 provided at least one written response to the optional open-ended Spence Children's Anxiety Scale-Parent item 39 ("Is there anything else your child is afraid of?"). Responses were thematically coded to explore (a) common and autism-related anxiety presentations and (b) their relationship with young people's characteristics. Nearly half of the responses were autism-related anxieties (mostly sensory, uncommon, or idiosyncratic specific phobias and worries about change and unpredictability). The other half described additional common anxieties not covered in the original measure (mostly social, weather and environmental disasters, and animals). Caregivers of participants who were more severely affected by autism spectrum disorder symptoms reported more autism-related, as compared to common, additional anxieties. Implications for the assessment and understanding of anxiety in autism are discussed.
Autism : the international journal of research and practice, 2020 · doi:10.1177/1362361319886246