Autism is a “lifelong disability which affects how people communicate and interact with the world (National Autistic Society, 2024). Experiencing anxiety as an autistic student is a common experience and can have a profound effect on academic, social and emotional well-being (Kuder & Accardo et al., 2020; Accardo et al., 2018). In the general population, approximately 40% of autistic people also have an anxiety disorder (Zaboski & Storch, 2018).
“Anxiety is a feeling of worry or fear that we experience when we expect a situation to have adverse consequences on our psychological or physical well-being” (Autism Research Group, 2018, p.5). A recent survey found that half of autistic people fell into the severe anxiety category, which was exacerbated by feelings of loneliness (National Autistic Society & Mind, n.d). Over 50% of autistic people report having a comorbid mental health condition, of which anxiety is the most reported (Cage et al., 2017; Kuder & Accardo et al., 2020; McLeod et al., 2019).
Autistic traits and symptoms of anxiety can overlap, which means diagnosing either of these conditions can be complex (Autism Research Group, 2018; Zaboski & Storch, 2018). However, both conditions are distinct and may require different supports to improve quality of life (Autism Research Group, 2018). Generalised anxiety can include both psychological and physical symptoms (see below) and impacts on daily living, work, university, or social life (NHS, 2022).
High levels of anxiety in autistic adults have been linked to different aspects of the autistic experience (see Figure 1), such as alexithymia and intolerance of uncertainty. Therefore, the function of or understanding of anxiety may be different than their allistic peers. Autistic students may worry excessively about disrupted routines or mismatched in their sensory predictions. As autistic people more frequently perceive the world as unpredictable rather than adapting to new situations, anxiety is likely to be enduring (Autism Research Group, 2018). Secondly, anxiety may also be onset by alexithymia and having difficulty identifying and describing emotions. Considering how these processes are linked to anxiety in autism, can help facilitate better mental health.
Figure 1. Overview of contributors to anxiety in autism
Autism Research Group & West Sussex County Council (2018)
Stressors to autistic anxiety can also include communication differences between autistic people and society or needing to mask autistic traits. When an autistic person feels anxiety, they may seek reassurance, avoid situations, overthink, be stuck in their worry, melt down, engage in repetitive movements (stimming), hyper fixate on routines, run away, or self-harm (Autistica, 2014).
Anxiety in autistic students can create difficulties in managing the demands and pressures of university life, such as maintaining a balance between studying, student life, and daily living (Van Hees et al., 2015). For example, autistic students may have difficulty socialising and communicating with others, self-advocating, being intrinsically motivated, regulating their sensory experience, and completing tasks that exhaust their executive functioning (Hillier et al., 2018).
What can universities do?
With increasing numbers of autistic students starting higher education, it is important that autistic students are supported to overcome organisational, social/emotional, and academic challenges (Hillier, et al., 2018). Overall, there is a lack of evidence evaluating interventions within a university context for autistic students (Hillier et al., 2018; Pugliese & White, 2014). However, the most common approaches include support groups, mentoring programs and specialist tutoring which show promise, particularly from the perspective of students.
For example, students found an adaptive group-based cognitive behavioural therapy intervention helpful in improving problem-solving and enjoyed connecting with autistic peers (Pugliese & White, 2014). Further, Hillier et al. (2018) found that a group program which supports autistic students with introductions to university, academic skills, time management, future planning, and interpersonal communication significantly increased self-esteem, reduced loneliness, and lowered generalised anxiety (Hillier et al., 2018).
University disability services were less effective for students with complex and enduring mental health conditions. Therefore, widescale systemic tailored interventions are required to overcome this issue, which also include university faculty and autistic students (Kuder & Accardo et al., 2020).
To accommodate autistic adults, adaption to general wellbeing services and communication is required and could include:
(National Autistic Society & Mind, 2024).
Within the university context, providing organisational and executive functioning support, teaching how to set and meet goals, study skills, improving social understanding, and supporting time management by breaking tasks down into manageable chunks and spacing out deadlines could be helpful. However, autistic students will likely need broader support to help them thrive academically—for example, budgeting and managing relationships (Hillier et al., 2018). The first semester is a critical period in which mental health support should be prioritised (VanBergeijk et al., 2008) because it is a significant transition.
What can students do?
Autistica (2024).
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Chelsea Cade
Specialist ADHD & Mental Health Mentor at The Learning Support Centre
BSc. Criminology & Psychology
MSc. Psychological Approaches to Health
Level 3 Diploma in Therapeutic Childcare and Reflective Practice
DClinPsy. Clinical Psychologist in Training (Current)
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References:
Accardo, A. L., Kuder, S. J., & Woodruff, J. (2018). Accommodations and support services preferred by college students with autism spectrum disorder. Autism, 23(3), 574–583. https://doi.org/10.1177/1362361318760490
Anxiety. (n.d.). National Autistic Society. Retrieved August 1, 2024, from https://www.autism.org.uk/advice-and-guidance/topics/mental-health/anxiety#Links,%20resources%20and%20article%20sources
Autism Research Group & West Sussex County Council. (2018). An Evidence Based Guide to Anxiety in Autism. In www.city.ac.uk. Retrieved August 1, 2024, from https://www.city.ac.uk/__data/assets/pdf_file/0020/557201/Anxiety-in-Autism-Guide-021219.pdf
Autistica. (2024). Anxiety and autism. Retrieved August 1, 2024, from https://www.autistica.org.uk/what-is-autism/anxiety-and-autism
Cage, E., Di Monaco, J., & Newell, V. (2017). Experiences of autism acceptance and mental health in autistic adults. Journal of Autism and Developmental Disorders, 48(2), 473–484. https://doi.org/10.1007/s10803-017-3342-7
Hillier, A., Goldstein, J., Murphy, D., Trietsch, R., Keeves, J., Mendes, E., & Queenan, A. (2018). Supporting university students with autism spectrum disorder. Autism, 22(1), 20–28. https://doi.org/10.1177/1362361317699584
Kuder, S. J., Accardo, A. L., & Bomgardner, E. M. (2020). Mental Health and University Students on the Autism Spectrum: a Literature Review. Review Journal of Autism and Developmental Disorders, 8(4), 421–435. https://doi.org/10.1007/s40489-020-00222-x
McLeod, J. D., Meanwell, E., & Hawbaker, A. (2019). The experiences of college students on the autism Spectrum: A comparison to their neurotypical peers. Journal of Autism and Developmental Disorders, 49(6), 2320–2336. https://doi.org/10.1007/s10803-019-03910-8
National Autistic Society & Mind. (n.d.). Good practice guide: For professionals delivering talking therapies for autistic adults and children. In www.autism.org.uk. Retrieved August 1, 2024, from https://s2.chorus-mk.thirdlight.com/file/24/asDKIN9as.klK7easFDsalAzTC/NAS-Good-Practice-Guide-A4.pdf
NHS. (2022, October 5). Overview – Generalised anxiety disorder in adults. www.nhs.uk. Retrieved August 1, 2024, from https://www.nhs.uk/mental-health/conditions/generalised-anxiety-disorder/overview/
Pugliese, C. E., & White, S. W. (2013). Brief Report: Problem Solving Therapy in College Students with Autism Spectrum Disorders: Feasibility and Preliminary Efficacy. Journal of Autism and Developmental Disorders, 44(3), 719–729. https://doi.org/10.1007/s10803-013-1914-8
VanBergeijk, E., Klin, A., & Volkmar, F. (2008). Supporting more able students on the autism spectrum: college and beyond. Journal of Autism and Developmental Disorders, 38(7), 1359–1370. https://doi.org/10.1007/s10803-007-0524-8
Van Hees, V., Moyson, T., & Roeyers, H. (2015). Higher education experiences of students on the autism spectrum: challenges, benefits and support needs. Journal of Autism and Developmental Disorders, 45(6), 1673–1688.
Zaboski, B. A., & Storch, E. A. (2018). Comorbid autism spectrum disorder and anxiety disorders: a brief review. Future Neurology, 13(1), 31–37. https://doi.org/10.2217/fnl-2017-0030
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