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Living in Fear: Anxiety in Adolescents with Autism Spectrum Disorders

Contributed by Dr. Scott Bellini

Individuals with autism spectrum disorders may experience symptoms of anxiety at a greater level than the general population according to an IRCA research project recently published in the journal, Focus on Autism and other Developmental Disabilities. Forty-one verbal individuals with autism spectrum disorders and their families participated in the study. The individuals in the study exhibited a broad range of anxious symptoms on both parent and self-report measures, including physiological arousal, separation anxiety, panic, and social anxiety. The findings of the study are consistent with the growing body of recent research detailing high levels of anxiety in individuals with autism spectrum disorders. In addition, this research project was the first to systematically study the relationship between social skill deficits and social anxiety. Correlational analyses revealed that poor social skills were associated with social anxiety in this group of adolescents.

Social Anxiety

Results of this study demonstrate that many individuals with autism spectrum disorders exhibit excessive fear and worry regarding social situations. Furthermore, this distress may impede social performance in the same way that excessive anxiety impedes athletic, dance, and public speaking performances. Or worse yet, it may lead to complete withdrawal and avoidance of social situations, creating a world of social isolation. The relationship between social skill deficits and social anxiety is likely reciprocal in nature. That is, poor social skills could lead to social anxiety, and conversely, social anxiety could contribute to poor social skills. For instance, individuals with poor social skills are likely to experience negative peer interactions. These negative social interactions may then lead to excessive fear and distress regarding subsequent social interactions, resulting in avoidance and withdrawal from social situations. This avoidance and withdrawal limits the opportunity for the individual to acquire social skills through exposure to social situations (which is the avenue by which most children learn social skills), thereby leading to social skill deficits.

Clinical Implications

The results of the study have valuable implications for parents and professionals working with individuals with autism spectrum disorders. First, the relatively high level of anxiety experienced by individuals with autism spectrum disorders makes it imperative that school professionals and private practitioners check for the presence of anxiety and perhaps other mood disorders when working with an adolescent with an autism spectrum disorder. A thorough assessment of anxiety would add valuable information to psycho-educational evaluations and intervention plans. Because of the broad range of anxiety experienced by this population, it would be helpful to assess the individual’s specific symptomatology when implementing intervention programs for anxiety. For instance, it would be beneficial to know whether the person was experiencing physical symptoms, such as trembling hands and increased heart rate, or whether the person was experiencing cognitive symptoms, such as excessive worry and fears. Knowledge of the specific symptomatology would enable professionals to design treatment plans that match the particular treatment modality with the specific type of anxiety exhibited by the individual. Secondly, the results of this study suggest that professionals implementing social skill intervention programs for individuals with autism spectrum disorders should examine the role social anxiety plays in the social interaction difficulties of their clients. Teaching social skills without addressing social anxiety could significantly lesson the effectiveness of the intervention. These results highlight the need for effective social programming.


Anxiety can be a debilitating disorder, often associated with excessive worry and fear, isolation, depression, substance abuse, suicidal ideation, and other forms of psychopathology. If your child is exhibiting signs of anxiety (trembling hands, difficulty breathing, panic, excessive worry, fear, withdrawal, etc.), please contact your physician or mental health provider to learn more about assessment and treatment options. Individuals with autism spectrum disorders need not live in fear of social situations. There are a number of treatment options for individuals experiencing social anxiety (e.g., cognitive, behavioral, or psycho-pharmacological interventions). Through awareness, assessment, and treatment, we can begin to lift the cloud of fear that envelopes and isolates too many individuals with autism spectrum disorders.


Bellini, S. (2004). Social skill deficits and anxiety in high functioning adolescents with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19 (2), 78-86.

A SPECIAL NOTE OF GRATITUDE is extended to the parents in the state of Indiana who volunteered to participate in this research project. Outcomes of this study have been presented at state and national conferences and will serve as the foundation for future research projects. The results of the study have also been infused within training modules and a recently developed social skills training model. You can be assured that your generous participation in this project will certainly make a difference in the lives of children with autism spectrum disorders throughout the state and country.

Thank You!

Bellini, S (2004) Living in fear: Anxiety in adolescents with autism spectrum disorders. The Reporter, 9(3) , 1-2.

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