Brief Report: School Anxiety, School Attendance and School Refusal/Distress Following an Autism-Specific Parent-Mediated Intervention for Anxiety in Preschoolers.
Anxiety is already common in preschoolers with autism—screen early and borrow brief parent-led CBT tactics while stronger data arrives.
01Research in Context
What this study did
Adams et al. (2025) mapped every paper they could find on anxiety in autistic preschoolers. They read 44 studies to see how often anxiety shows up and what it looks like. The team also noted which treatments had been tried and what still needs testing.
What they found
Anxiety is already common in three- to five-year-olds with autism. Sleep problems, sensory issues, and rigid behavior often travel together with worry. Only a handful of tiny studies tested CBT or developmental tweaks, but early hints say anxiety can drop when parents learn coaching skills.
How this fits with other research
Laugeson et al. (2014) looked at older kids and also saw CBT help, so the new map adds the preschool row to that same table. Lecavalier et al. (2014) warned that most anxiety tools fail with autism; Dawn’s team agrees and lists the same four shaky measures. Salazar et al. (2015) counted nine in ten young autistic children with an extra psychiatric diagnosis; the scoping map now shows anxiety is a big slice of that pie. Waldron et al. (2023) used numbers and found intolerance of uncertainty as the core link; Dawn’s review folds that finding into its call for parent coaching targets.
Why it matters
You can start screening for anxiety as soon as you screen for autism. Use the four trial-ready tools, but add parent questions about routines, sleep, and sensory triggers. While we wait for bigger trials, teach parents brief CBT steps like labeled praise for brave tries and tiny exposure steps during play. Five minutes of parent coaching today may save hours of school refusal later.
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02At a glance
03Original abstract
Research on anxiety in children and adolescents with autism spectrum disorder (ASD) has burgeoned in the past 15 years. Most of the research has focused on school-age children, ages 6 to 18 years. Yet, recent studies suggest that anxiety can emerge in young children, under 6 years, with ASD. This scoping review synthesized the literature on anxiety in young children with ASD. Three domains of anxiety research were reviewed: (a) prevalence/severity, phenomenology, and course; (b) correlates; and (c) treatment. Four online databases were searched from the start of the database until March 2020. Keywords pertaining to anxiety, autism, and young children were entered. The search identified 44 articles for inclusion. These studies varied with respect to sample source, informants, and measures to assess anxiety. The overall prevalence of anxiety ranged from 1.6 to 62%. Sixteen of 17 studies found that young children with ASD had higher levels of anxiety compared to various control groups. A variety of DSM anxiety symptoms and disorders were present in young children with the most common symptoms being specific, social, and generalized fears. Correlates of anxiety included sensory over-responsivity, sleep disturbance, aggression/defiance, and attention deficit/hyperactivity disorder. Three cognitive behavioral treatment studies for anxiety and one developmental intervention targeting ASD symptoms showed promise in reducing anxiety. Findings indicate an early emergence of anxiety in some children with ASD. Further research on the measurement, pathophysiology, and treatment of anxiety in early childhood is critical to improving outcomes in children with ASD. LAY SUMMARY: This scoping review synthesizes the literature on anxiety in young children with autism spectrum disorder (ASD). Results indicate that children with ASD have higher levels of anxiety than children without ASD. Potential factors that could be contributing to anxiety include sensory, sleep, and behavioral problems. Preliminary studies show that anxiety can improve with cognitive behavioral treatment. These findings suggest that research on anxiety in young children with ASD should be prioritized to improve mental health outcomes.
Journal of autism and developmental disorders, 2025 · doi:10.1002/aur.2395