The comorbid reality
Anxiety is the most common co-occurring condition in autism — yet Ontario's system rarely treats both at once.
Registered
88,175Children registered
Total in the Ontario Autism Program queue
CBC FOI Jan 2026
Funded
20,666Have active funding
Just 23.4% of registered children
CBC FOI Jan 2026
Waiting
67,509Still waiting
Registered. Diagnosed. Un-funded.
CBC FOI Jan 2026
Verified — CBC FOI Jan 2026
| Metric | Value |
|---|---|
| Children registered | 88,175 |
| Have active funding | 20,666 |
| Still waiting | 67,509 |
Anxiety is the most common co-occurring condition in autism. Research estimates that 40-50% of autistic children and adults have a clinically significant anxiety disorder, compared to approximately 20% in the general population. This is not a coincidence — there are specific reasons why autism and anxiety frequently co-occur.
The world is, for many autistic people, genuinely more threatening and unpredictable than it is for neurotypical people. Sensory sensitivities mean that environments others find comfortable can be genuinely overwhelming — flickering lights, background noise, crowded spaces all carry a physiological cost. Social situations are less predictable and more cognitively demanding. Repeated experiences of social mismatch, bullying, and not fitting in take a toll.
Additionally, many autistic people have a nervous system that is more reactive — with a lower threshold for the stress response and a slower return to baseline. This biological difference makes anxiety more likely to develop and harder to shift once established.
One of the most important — and underrecognized — aspects of autism-anxiety is that it often does not look like textbook anxiety. Parents and clinicians who expect verbal worry ("I am scared about school") may miss significant anxiety that is expressing itself differently:
Understanding what triggers anxiety in a specific autistic individual is essential for effective support. Common patterns include:
The most studied intervention for anxiety in autism is adapted Cognitive Behavioral Therapy (CBT). Standard CBT is modified to work with autistic cognitive and communication styles:
Programs such as the Facing Your Fears curriculum have been specifically developed and tested for autistic children. Multiple randomized controlled trials support the effectiveness of adapted CBT for autism-related anxiety.
Environmental modifications are equally important and often more immediately accessible:
For severe anxiety, medication — typically SSRIs — may be considered alongside therapy. This should always be under the supervision of a physician familiar with autism.
See also: Autism Burnout | Autism Meltdowns | Autism and Sleep
Seek assessment and support for anxiety when:
Start with your pediatrician, who can provide a referral to a psychologist or psychiatrist with autism expertise. In Ontario, some children's mental health centers offer specialized autism and anxiety programs, though wait times can be significant.
If your child is enrolled in the Ontario Autism Program, behavior services or clinical supervision through OAP may be able to incorporate anxiety-related goals into the treatment plan.
Several factors make anxiety more likely in autism. Sensory sensitivities mean the environment is often genuinely threatening or overwhelming. Social demands — navigating complex, unpredictable social situations — are a major source of chronic stress. Many autistic people experience the world as less predictable than neurotypical people do, and unpredictability is a core anxiety trigger. Additionally, autistic people are often aware they process the world differently, which can contribute to social anxiety and feelings of not fitting in.
Anxiety in autism often does not look like the verbal worry and rumination typical of anxiety in neurotypical people. Instead, it may manifest as increased rigidity and demand for sameness, meltdowns or shutdowns, increased stimming (self-stimulatory behavior), physical complaints (stomachaches, headaches), refusal of previously tolerated activities, or aggression. These presentations are often mistakenly attributed to autism itself rather than recognized as anxiety symptoms.
Yes. When anxiety is high, many autistic people show more pronounced autistic traits — more rigidity, more sensory sensitivity, more social withdrawal, more stimming. This can make it genuinely difficult to distinguish between autism and anxiety. It also means that when anxiety is successfully treated, some behaviors that were attributed to autism may reduce. This is why comprehensive assessment by a clinician experienced in co-occurring conditions is important.
Adapted Cognitive Behavioral Therapy (CBT) — modified to be more concrete, visual, and focused on the specific anxiety triggers and cognitive patterns common in autism — has the strongest evidence base. Environmental modifications (reducing sensory demands, increasing predictability and routine) are equally important and often more accessible. Exposure therapy, when done sensitively and collaboratively, can also help. Medication (typically SSRIs) may be appropriate for severe anxiety, in combination with therapy.
This distinction is genuinely difficult and often requires assessment by a psychologist or psychiatrist experienced in both conditions. A useful heuristic: if the behavior is new or has escalated, or if it consistently follows identifiable triggers (social situations, sensory environments, transitions), anxiety is likely playing a role. A functional behavioral assessment can help map behavior to its antecedents. Do not assume that all distressing behaviors are simply autism — anxiety is treatable and quality of life can improve significantly with appropriate support.
Verified Facts
1 in 50 — According to the 2019 Canadian Health Survey on Children and Youth, about children and youth aged 1 to 17 in Canada had an autism diagnosis
88,175 — children are registered in the Ontario Autism Program
WHO recommends accessible, community-based early interventions for children with autism — timely evidence-based psychosocial interventions improve communication and social engagement
23.4% — Only 20,666 children have active funding agreements () — less than one in four