Comorbidity guide
A 2019 meta-analysis by van Steensel et al. found that 39.6% of autistic children and adolescents meet criteria for at least one anxiety disorder, with specific phobia (29.8%), social anxiety disorder (16.6%), and generalized anxiety disorder (15.4%) being most common. Rates are even higher in autistic individuals without intellectual disability, likely because greater awareness of social expectations amplifies anxiety.
Anxiety in autism often presents atypically. Instead of verbal reports of worry, autistic individuals may show increased repetitive behaviours, sensory avoidance, insistence on sameness, selective mutism, or physical symptoms (stomach aches, headaches). This atypical presentation means standard anxiety screening tools may miss the condition — clinicians need autism-adapted assessment approaches.
In Ontario, families frequently report that anxiety symptoms are misattributed entirely to autism ("that's just the autism") without investigation of a treatable co-occurring anxiety disorder. Advocating for thorough assessment is critical.
Cognitive Behavioural Therapy (CBT) adapted for autism is the first-line treatment for anxiety in autistic individuals. Modified CBT protocols use visual supports, concrete language, special interest integration, and extended treatment duration. Research supports the effectiveness of autism-adapted CBT, with meta-analyses showing moderate to large effect sizes.
Medication (typically SSRIs) may be appropriate for moderate to severe anxiety. Autistic individuals are more sensitive to medication side effects, so the "start low, go slow" approach is standard practice. Combining CBT with medication often produces the best outcomes for significant anxiety.
Ontario-specific resources include: psychologists covered under OAP clinical services, Children's Mental Health Ontario member agencies (free services for children and youth), and the Ontario Structured Psychotherapy program (free CBT for adults through primary care).
van Steensel, F.J.A. et al.
Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis. Clinical Child and Family Psychology Review, 2019; 14(3):302-317
Ung, D. et al.
CBT for Anxiety in Children with ASD: A Systematic Review and Meta-Analysis. Clinical Psychology Review, 2015; 36:68-78
Written by Spencer Carroll
Founder & Autism Advocate
Evidence on this page
Key claims are paired with their source, evidence tier, and verification date so readers can inspect the public record directly.
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
89,799
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%
Only 20,633 children have active funding agreements — less than one in four