Anxiety Is Part of Neurodivergence

Anxiety and neurodivergence: Understanding the Connection

Anxiety and neurodivergence, particularly autism and ADHD, are often discussed together. This connection is significant. A growing body of research indicates that anxiety is not just an additional concern; it frequently arises from the lived experiences, cognition, and sensory world of neurodivergent individuals. This post combines peer-reviewed findings and clinically useful insights. My aim is to help practitioners, families, and neurodivergent individuals themselves understand why anxiety is so prevalent, how it manifests, and what effective, neurodiversity-affirming supports look like.

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How Common is Anxiety in Neurodivergent Groups?

Research consistently finds elevated rates of anxiety disorders among autistic and ADHD populations. A meta-analysis of children with autism revealed that approximately 80% have at least one anxiety disorder. This rate is significantly higher than that of the general population.

Similarly, large reviews of adults with ADHD report high rates of co-occurring anxiety disorders. Estimates vary based on methods and samples, but many studies suggest that comorbidity falls within the 50–80% range. It's important to note that many individuals diagnosed with anxiety are later identified as having other forms of neurodivergence. This can complicate understanding which condition appeared first or contributed to the other.

Why is Anxiety So Common in Neurodivergence?

Research highlights several overlapping explanations—biological, cognitive, and environmental—that help clarify why anxiety is so prevalent among neurodivergent individuals.

1. Intolerance of Uncertainty (IU)

Intolerance of uncertainty refers to a low threshold for ambiguous or unpredictable situations. This phenomenon is strongly linked to anxiety among autistic individuals. Studies show that autistic participants report higher levels of IU. Moreover, IU mediates the relationship between autistic traits and anxiety symptoms across multiple samples. This connection helps explain why changes, transitions, and novel experiences often provoke intense distress.

2. Sensory Sensitivity and Overload

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

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, this can lead to exhaustion, decreased well-being, and heightened anxiety. Research into the experiences of adult autistic individuals consistently identifies the mental health costs associated with continuous social camouflaging.

4. Anxiety-Driven Behavioral Profiles (Example: PDA)

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

5. Structural and Environmental Contributors

Bullying, exclusion, inaccessible environments, and a lack of reasonable adjustments contribute to chronic stress and increase the risk of anxiety. Social determinants and repeated experiences of invalidation or misunderstanding play a significant role in this context, serving as important causal contributors rather than mere coincidental comorbidities.

How Anxiety Looks Different in Neurodivergent People

Anxiety presentations can diverge from traditional descriptions:

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

• Overlapping symptoms, such as restlessness and difficulty concentrating, can blur the lines between ADHD and anxiety, complicating diagnosis.

• Internal experiences, including catastrophic thinking about social situations, sensory dread, and anticipatory panic, are often under-recognized 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 for several reasons:

• The world is unpredictable.

• Sensory input can be overwhelming.

• Social rules often appear confusing.

• Executive functioning can feel pressured.

• Demands can accumulate faster than one’s capacity to cope.

• Autonomy may feel restricted.

• Past experiences can create fear.

• Environments often do not meet neurodivergent needs.

  
  

When you combine these factors, anxiety becomes an adaptive response. It's a way of trying to stay safe, maintain control, and navigate a world that is not designed for your brain. Understanding this perspective helps shift the conversation from “How do we fix the anxiety?” to “How do we change environments, expectations, and support systems so that anxiety no longer needs to exist?”

Evidence-Based and Neurodiversity-Affirming Approaches to Support Anxiety

Effective practice combines evidence-based treatments with neurodiversity-affirming adaptations and environmental changes.

Psychological Treatments That Support Adapting, Not Forcing

Cognitive Behavioral Therapy (CBT) is effective for many forms of anxiety. It has been successfully adapted for autistic children and adolescents. These adaptations—such as providing more visual structure, using concrete examples, creating sensory-aware settings, and pacing according to processing speed and communication differences—improve engagement and outcomes. Reviews and randomized controlled trials support the clinical utility of adapted CBT for autistic youth.

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

Target the Mechanisms

Since intolerance of uncertainty and sensory overload are frequent drivers of anxiety, interventions that directly address these issues can be more effective than those focusing solely on symptoms. For example, graded exposure to uncertainty, sensory regulation strategies, predictable routines, and environmental adaptations can provide meaningful support.

Environmental and Systemic Adjustments

Implementing reasonable adjustments—such as creating sensory-friendly spaces, establishing clear schedules, reducing multitasking demands, and allowing choice and control over tasks—can significantly reduce the drivers of anxiety. Neurodiversity-affirming care emphasizes practical adaptations, respects autonomy, and incorporates trauma-informed principles. Professional guidance increasingly recommends these adjustments as standard practice.

Medication and Multidisciplinary Planning

For some individuals, pharmacological options may be appropriate. Medication decisions should be personalized and consider co-occurring conditions. These decisions should be combined with psychological and environmental supports. Shared decision-making and multidisciplinary care represent best practices in this context.

Practical Tips for Clinicians, Parents, and Workplaces

1. Validate First. Recognize anxiety as a real, functional response to sensory, social, and uncertainty-based stressors. Validation reduces shame and fosters collaboration.

   
   

2. Assess Drivers, Not Just Symptoms. Screen for intolerance of uncertainty, sensory triggers, and masking. Utilize adapted tools or qualitative interviews to gather comprehensive insights.

   
   

3. Co-Design Supports. Offer choices, create predictable routines, reduce unnecessary demands, and include sensory adjustments. Small environmental changes can yield significant benefits.

   
   

4. Adapt Therapy. Use adapted CBT principles, such as visuals, slower pacing, and concrete tasks, or ADHD-focused CBT where appropriate. Monitor overlapping symptoms and adjust treatment targets accordingly.

   
   

5. Think Long Term. Support should aim to reduce chronic stress, avoid overemphasis on “fixing” neurodivergence, and focus on enhancing quality of life, autonomy, and well-being.

   
   

Conclusion

Anxiety is a significant aspect of neurodivergence, both in isolation and when co-occurring with other diagnoses. Research identifies clear mechanisms—such as intolerance of uncertainty, sensory overload, masking, and social stress—and highlights effective, adapted interventions. The combination of evidence-based therapy, targeted supports for the mechanisms driving anxiety, and practical environmental adjustments, delivered in a neurodiversity-affirming and trauma-informed manner, offers the best chance for meaningful improvement.

By embracing these insights, we can foster environments where neurodivergent individuals thrive, free from the constraints of anxiety.