Anxiety Is Part of Neurodivergence

Anxiety and neurodivergence, especially autism and ADHD, are frequently discussed together, and for good reason. A growing body of research shows anxiety is not merely a separate “add-on”; it often emerges from the lived experience, cognition and sensory world of neurodivergent people. This post brings together peer-reviewed findings and clinically useful insights so practitioners, families and neurodivergent people themselves can better understand why anxiety is so common, how it shows up, and what helpful, neurodiversity-affirming supports look like.

anxiety books on neurodivergence

How common is anxiety in neurodivergent groups?

Research consistently finds elevated rates of anxiety disorders in autistic and ADHD populations. A meta-analysis of children with autism reported that roughly 80% have at least one anxiety disorder. This is far higher than general-population rates.

Similarly, large reviews of adults with ADHD report high rates of co-occurring anxiety disorders; estimates vary with methods and samples, but many studies place comorbidity in the 50–80% range. Many people diagnosed with anxiety are also later diagnosed with other types of neurodivergence resulting in difficulty with what presented first or contributed to the other.

Why is anxiety so common in neurodivergence? (mechanisms the research highlights)

Research points to several overlapping explanations — biological, cognitive and environmental — that together help explain why anxiety is so frequent.

1. Intolerance of uncertainty (IU)

Intolerance of uncertainty is a low threshold for ambiguous or unpredictable situations. This is strongly implicated in anxiety among autistic people. Studies show autistic participants report higher IU, and IU mediates the relationship between autistic traits and anxiety symptoms in multiple samples. This helps explain why changes, transitions and novelty often provoke intense distress.

2. Sensory sensitivity and overload

Many autistic and some ADHD individuals experience heightened sensory sensitivity (sounds, lights, touch). Repeated or intense sensory input can trigger physiological stress and hypervigilance, creating a chronic anxiety load. Sensory factors interact with IU and social uncertainty to magnify anxiety.

3. Masking, social expectation and chronic social stress

Masking (consciously or unconsciously hiding autistic traits to fit in) requires sustained cognitive and emotional effort; over time it contributes to exhaustion, lowered wellbeing and anxiety. Research into adult autistic experience repeatedly identifies the mental health cost of continuous social camouflaging.

4. Anxiety-driven behavioural profiles (example: PDA)

Some profiles associated with neurodivergence, for example Pathological Demand Avoidance (PDA), are conceptualised as anxiety-driven responses to perceived threats to autonomy or control. Reviews and expert summaries characterise PDA behaviours as attempts to manage intense anxiety by avoiding demands and seeking predictability and control.

5. Structural and environmental contributors

Bullying, exclusion, inaccessible environments and lack of reasonable adjustments increase chronic stress and risk of anxiety. Social determinants and repeated experiences of invalidation or misunderstanding are important causal contributors, not merely coincidental comorbidities.

How anxiety looks different in neurodivergent people

Anxiety presentations can diverge from textbook descriptions:

• It may show as sudden shutdowns, meltdowns or intense avoidance rather than classical “worry” speech.

• Overlapping symptoms (e.g. restlessness, difficulty concentrating) can blur the lines between ADHD and anxiety, complicating diagnosis.

• Internal experiences (catastrophic thinking about social situations, sensory dread, anticipatory panic) are often under-recognised by standard screening tools unless those tools are adapted.

So, is anxiety part of neurodivergence?

Yes, and not because neurodivergent brains are faulty or fragile.

Anxiety is part of neurodivergence because:

• The world is unpredictable

• Sensory input is intense

• Social rules are confusing

• Executive functioning is pressured

• Demands pile up faster than capacity

• Autonomy is restricted

• Past experiences create fear

• Environments don’t meet neurodivergent needs

When you combine these factors, anxiety becomes an adaptive response. It's a way of trying to stay safe, stay in control and navigate a world not built for your brain.

Understanding this helps shift the conversation from “How do we fix the anxiety?” to “How do we change environments, expectations and support systems so the anxiety no longer needs to exist?”

Evidence-based and neurodiversity-affirming approaches to support anxiety

Good practice blends evidence-based treatments with neurodiversity-affirming adaptations and environmental change.

Psychological treatments that support adapting, don’t force

Cognitive Behavioural Therapy (CBT) is effective for many forms of anxiety and has been adapted successfully for autistic children and adolescents; adaptations (more visual structure, concrete examples, sensory-aware settings, pacing around processing speed and communication differences) improve engagement and outcomes. Reviews and RCTs support adapted CBT’s clinical utility for autistic youth.

CBT-informed programmes and group formats also show benefit for adults with ADHD, particularly when therapy explicitly addresses executive function challenges and emotional regulation alongside anxiety. Meta-analyses report medium effect sizes for CBT-based interventions reducing emotional symptoms in adult ADHD.

Target the mechanisms

Because intolerance of uncertainty and sensory overload are frequent drivers, interventions that directly target these (e.g. graded exposure to uncertainty, sensory regulation strategies, predictable routines, environmental adaptations) can be more meaningful than symptom-only approaches.

Environmental and systemic adjustments

Reasonable adjustments, including sensory-friendly spaces, clear schedules, reduced multitasking demands, choice and control over tasks, reduce the drivers of anxiety. Neurodiversity-affirming care emphasises practical adaptations, respecting autonomy and embedding trauma-informed principles. Professional guidance increasingly recommends these adjustments as standard practice.

Medication and multidisciplinary planning

Pharmacological options may be indicated for some individuals; medication decisions should be personalised, consider co-occurring conditions, and be combined with psychological and environmental supports. Shared decision-making and multidisciplinary care are best practice.

Practical tips for clinicians, parents and workplaces

1. Validate first. Recognise anxiety as a real, functional response to sensory, social and uncertainty-based stressors. Validation reduces shame and opens collaboration.

2. Assess drivers, not just symptoms. Screen for intolerance of uncertainty, sensory triggers and masking. Use adapted tools or qualitative interviews.

3. Co-design supports. Offer choices, build predictable routines, reduce unnecessary demands, and include sensory adjustments. Small environmental changes often yield big gains.

4. Adapt therapy. Use adapted CBT principles (visuals, slower pacing, concrete tasks) or ADHD-focused CBT where appropriate. Monitor overlap of symptoms and adjust treatment targets.

5. Think long term. Support should reduce chronic stress, avoid overemphasis on “fixing” neurodivergence, and focus on quality of life, autonomy and wellbeing.

Takeaway

Anxiety is a type of neurodivergence in isolation and when co-occurring with other diagnoses. Research points to clear mechanisms (intolerance of uncertainty, sensory overload, masking and social stress) and also to effective, adapted interventions. The combination of evidence-based therapy, targeted supports for the mechanisms that drive anxiety, and practical environmental adjustments, delivered in a neurodiversity-affirming, trauma-informed way, gives the best chance of meaningful improvement.