70%Have a co-occurring condition
50%Experience anxiety
40%Experience depression
30%Have co-occurring ADHD
Mental Health & Wellbeing
Anxiety is not the autism. Anxiety is what happens when autistic people are forced to live in a world not built for them. — Dr. Luke Beardon
Mental Health and Autism
Autistic people experience mental health challenges at significantly
higher rates than the general population. This is **not because
autism is inherently linked to mental illness** — it is because
living in a hostile environment takes a toll. Sensory overwhelm,
masking, social exclusion, bullying, and lack of accommodations all
contribute to poor mental health outcomes.
Common Co-Occurring Conditions
😦 Anxiety
Up to **50%** of autistic people meet criteria for an anxiety disorder.
Autistic anxiety has unique features:
- **Uncertainty intolerance** — not knowing what will happen causes extreme distress
- **Sensory anxiety** — dreading environments known to be overwhelming
- **Social anxiety** — fear of getting social rules "wrong"
- **Change anxiety** — routine disruption triggers panic
- **Demand anxiety (PDA)** — pathological demand avoidance as an anxiety response
- **Autistic-specific strategies**: visual schedules, advance preparation, sensory management, controlled environments, scripts for social situations
😢 Depression
Depression in autistic people may present differently:
- Withdrawal from even special interests (significant red flag)
- Increased sensory sensitivity
- Regression in skills (may be mistaken for burnout)
- Loss of capacity to mask
- Increased meltdowns or shutdowns
- Flat affect (hard to distinguish from alexithymia)
- **Key difference from burnout**: depression involves hopelessness; burnout involves exhaustion. Both can co-occur.
😓 PTSD & Complex Trauma
Autistic people are at higher risk of PTSD due to:
- **Bullying** — up to 63% of autistic children experience bullying
- **ABA and compliance-based therapies** — many autistic adults report trauma from childhood interventions
- **Medical trauma** — invasive assessments, dismissive healthcare
- **Masking** — long-term identity suppression
- **Autistic PTSD may look different** — triggers may be sensory, meltdown responses may be mistaken for behaviour problems
🔄 OCD (Obsessive-Compulsive Disorder)
OCD and autistic repetitive behaviours can look similar but have
different functions:
- **OCD rituals** are driven by anxiety and feel distressing
- **Autistic routines and stims** are comforting and regulatory
- Some autistic people have **both** — genuine OCD co-occurring with autism
- Treatment must distinguish between the two
- Exposure and Response Prevention (ERP) for OCD should not target autistic stims
⚡ ADHD
**Up to 30-50%** of autistic people also have ADHD (AuDHD).
This combination creates unique challenges:
- ADHD craves novelty; autism craves routine — internal conflict
- Executive dysfunction is compounded
- Hyperfocus can be both an asset and a barrier
- Medication may help ADHD symptoms but can increase sensory sensitivity
- Both conditions need separate management strategies
- Rejection Sensitive Dysphoria (RSD) is common in AuDHD
🍴 Eating Disorders & ARFID
Autistic people are at higher risk for eating disorders:
- **ARFID** (Avoidant/Restrictive Food Intake Disorder) — sensory-driven food avoidance
- **Anorexia** — up to 20-30% of anorexia patients may be autistic
- **Control** — food restriction as a way to manage overwhelming environments
- **Interoception** — poor hunger/fullness awareness
- Treatment must be autism-informed — standard ED treatment may not work
Finding the Right Therapist
What to Look For
Finding a therapist who understands autism is essential. Not all
therapists are autism-competent, even if they claim to be.
- **Autism-affirming** — they see autism as a difference, not a disorder
- **Neurodiversity-informed** — familiar with the social model of disability
- **Willing to adapt** — flexible communication, written summaries, adjusted pacing
- **Listens to your experience** — does not overrule your self-knowledge
- **Experienced with autistic adults** — not just children
- **Accommodating** — allows fidgeting, movement, reduced eye contact
- **Trauma-informed** — many autistic adults carry complex trauma
- "You do not seem autistic" — dismissing your diagnosis
- Goal is to make you "more normal" or "less autistic"
- Recommends ABA, social skills training focused on masking
- Uses functioning labels ("high-functioning" / "low-functioning")
- Does not understand masking, burnout, or meltdowns
- Focuses only on deficits, never strengths
- Will not make communication accommodations
- Confuses autistic traits with symptoms to be eliminated
Effective Therapy Approaches for Autistic People
- **CBT (adapted)** — modified for autistic thinking styles, visual aids, concrete examples
- **DBT** — Dialectical Behaviour Therapy, helpful for emotional regulation
- **ACT** — Acceptance and Commitment Therapy, values-based
- **EMDR** — for trauma processing (can be adapted for sensory needs)
- **Person-centred therapy** — non-directive, follows your lead
- **Art/music therapy** — non-verbal expression
- **Somatic therapy** — body-based, good for alexithymia
Crisis Resources
If You Are In Crisis
If you or someone you know is in immediate danger, please reach out.
You deserve support.
- **International**: Befrienders Worldwide — https://befrienders.org
- **UK**: Samaritans — 116 123 (free, 24/7)
- **UK**: Autism-specific — National Autistic Society helpline: 0808 800 4104
- **USA**: 988 Suicide and Crisis Lifeline — call or text 988
- **USA**: Crisis Text Line — text HOME to 741741
- **Australia**: Lifeline — 13 11 14
- **Canada**: 9-8-8 Suicide Crisis Helpline — call or text 988
- **New Zealand**: Lifeline — 0800 543 354
- **Ireland**: Samaritans — 116 123
- **South Africa**: SADAG — 0800 567 567
Autistic-Specific Support
- **Autistic Mutual Aid Society** — peer support by autistic people
- **ASAN** — Autistic Self Advocacy Network, crisis resources
- **Autscape** — autistic-run events and community
- **Online communities** — sometimes connecting with people who understand is the most helpful thing