Treatment of anxiety in autistic adults: A systematic review

Background: Autistic adults are more likely than adults without autism spectrum disorder (ASD) to experience clinically significant anxiety. In addition, anxiety in autistic adults is associated with poorer quality of life and myriad negative outcomes (e.g., unemployment, suicidality). Therefore, this systematic review aimed to summarize and evaluate the literature on the psychotherapeutic and psychopharmacological treatment of anxiety in autistic adults to inform clinical decision-making. Method: Several online databases were searched for peer-reviewed journal articles with any combination of the following terms in the abstract: (1) autism, autistic, Asperger, Asperger's, or “pervasive developmental disorder” (2) anxiety, anxious, phobia, mutism, panic, agoraphobia, or worry and (3) treatment, intervention, trial, therapy, psychotherapy, pharmacotherapy, medication, drug, antidepressant, sedative, or anti-anxiety. Data were extracted from articles meeting the inclusion criteria, and the strength of the evidence was assessed for treatments. Results: Fifteen psychosocial treatment studies, one pharmacological treatment study, and one combined psychosocial and pharmacological treatment study met the inclusion criteria. The most investigated treatment for anxiety in adults with ASD was cognitive behavioral therapy (CBT). Conclusions: Few studies have investigated the treatment of anxiety in autistic adults. Additionally, findings have been inconsistent across studies regarding the potential effectiveness of particular psychosocial and pharmacological treatments. More research is certainly needed before clinically useful conclusions can be made.