Phenomenology and Presentation of Anxiety in Autism Spectrum Disorder

Anxiety has been recognized as a significant presenting feature associated with autism spectrum disorder (ASD) since the first clinical descriptions of ASD, with more recent prevalence studies confirming elevated rates of anxiety in this population across the lifespan compared with the general population. However, elevated anxiety symptoms do not form part of the core ASD diagnostic criteria and clinically significant anxiety is not universally present in all individuals with ASD. Clinically, practitioners working with people with ASD and anxiety have often noted that aspects of their clients’ anxiety presentations appear to be distinct to ASD and often different to presenting symptoms typically seen in anxious individuals without ASD. However, systematic research in investigating this was until recently lacking, leaving key questions unanswered. For example, which anxiety presentations are more/less common in ASD, and to what extent do these mirror or differ from those typically seen in clinically anxious individuals without ASD? Further, how might these qualitative differences inform assessment, formulation, and treatment? In this chapter, we summarize and draw upon the growing empirical literature to consider the similar and distinct ways in which anxiety presents in ASD and make recommendations for clinical practice and future research.