Exploring the nature of anxiety in young adults on the autism spectrum: A qualitative study

Background: Research exploring the nature of anxiety symptoms in autism spectrum disorder (ASD) has thus far focused on children and adolescents, providing evidence for both typical and atypical anxiety symptom presentations associated with ASD. This study builds on previous research by focusing on young adults, and comparing anxiety presentation between individuals with ASD and non-ASD individuals with anxiety disorders. We anticipated that while the non-ASD group would report only typical anxiety symptoms, and the ASD group would report both typical and atypical presentations of anxiety symptoms. Method: Ten individuals with ASD and anxiety (M = 21.8 years, SD = 6,76), and 10 individuals with anxiety (M = 24.4 years, SD = 4.17) participated in focus groups. Participants responded to semi-structured interview questions specifically developed using the DSM-5 criteria for each of the anxiety disorders, Illness Anxiety Disorder, and Obsessive-Compulsive Disorder. These questions focused on carefully elucidating experiences of anxiety including DSM-5 anxiety symptomatology and ASD-specific anxiety symptomatology. Results: Thematic analysis revealed a theme structure for the ASD group composed of both DSM5-related (e.g., social anxiety themes) and ASD-specific anxiety presentations (i.e., related to core ASD symptomatology). In contrast, the non-ASD group described predominantly DSM-5-related anxiety symptomatology. Conclusions: Our findings support the predicted outcome that there are both ASD-specific anxiety and DSM-5-related anxiety symptomatology in young adults with ASD, compared with young adults with anxiety who show only DSM-5 symptomatology. Future research elucidating the relationship between ASD symptomatology and anxiety in ASD, utilising both quantitative and qualitative measures, is crucial to enable a more comprehensive understanding of the nuances of anxiety in ASD. Gaining this knowledge is a crucial step for the development of more accurate and appropriate assessment and treatment tools that can target their specific anxiety experiences.