Anxiety is one of the most common reasons parents first seek help for their daughter. Sometimes the anxiety is the whole story. But for many girls, anxiety sits alongside autism that hasn't yet been recognised, and treating the anxiety alone doesn't fully help.
How common is anxiety in autistic young people?
Very common. A large review of studies found that around 40% of autistic children and teenagers had at least one anxiety disorder. The most frequent were specific phobias, obsessive-compulsive disorder and social anxiety. That is much higher than in young people generally.
Why are autistic girls so often anxious?
Many everyday experiences that other children manage without thinking take real effort for an autistic girl:
Uncertainty. Not knowing what will happen next, or a sudden change of plan, can feel genuinely distressing.
Sensory overload. Noise, bright lights, smells and crowds can be overwhelming, and anticipating them causes worry.
Social effort. Working out unwritten social rules, and worrying about getting them wrong, is tiring and stressful.
Masking. Constantly monitoring and adjusting how she comes across leaves little room to relax. Research has linked heavier camouflaging with higher anxiety.
Being misunderstood. Girls who are told they are "fine" or "just shy" while struggling inside often become more anxious over time.
How autism and anxiety can be mistaken for each other
Because they overlap, one can hide the other:
Social anxiety or autism? A girl who avoids parties may be afraid of being judged (social anxiety), or may find unstructured socialising confusing and draining (autism), or both. A key question is whether she understands the social situation but fears it, or finds it hard to read in the first place.
Rigid routines. Needing things done in a certain way can come from anxiety or obsessive-compulsive disorder, or from an autistic need for predictability. The reasons behind the behaviour matter more than the behaviour itself.
School avoidance. Many anxious girls struggle to attend school. For autistic girls, the cause is often the sensory and social demands of the school day.
Diagnostic overshadowing. When anxiety is obvious, autism can be missed. Many autistic women describe years of treatment for anxiety or depression before anyone recognised they were autistic.
This is why a careful assessment looks at a girl's development from early childhood, how she manages in different settings, and what lies behind her anxiety, not just the anxiety itself.
What helps
Understanding the cause. Knowing whether anxiety is linked to autism changes how best to help. Adjusting the environment may do more than trying to talk her out of worries.
Predictability. Visual schedules, advance warning of changes, and clear plans for new situations reduce uncertainty.
Sensory adjustments. Quiet spaces, ear defenders and planned breaks lower the background stress.
Room to unmask. Time at home to recover, without pressure to appear "typical".
Adapted therapy. NICE guidance on autism in under-19s recommends that anxiety and other mental health difficulties in autistic young people are treated, with therapies such as cognitive behavioural therapy (CBT) adapted to autistic ways of thinking: more structured, more visual, more concrete, and often involving parents.
Working with school, so that adjustments are consistent across home and school.
When to seek help
Talk to your GP if anxiety is affecting your daughter's daily life, school attendance, sleep or eating. If you think she may also be autistic, mention this, as it can change which assessment and support is right for her.
If you are worried about her immediate safety, call 999 or go to A&E. For urgent advice, contact NHS 111 and choose the mental health option. Young people can contact Childline on 0800 1111 or text SHOUT to 85258.