The Hidden Family Challenges When Anxiety Meets Autism
Research reveals how families navigate different struggles when children have anxiety alone versus anxiety combined with autism spectrum disorder.
When Emma's 10-year-old son Jake was diagnosed with both autism spectrum disorder and anxiety, she thought she understood what lay ahead. After all, her older daughter had been successfully treated for anxiety disorders a few years earlier with cognitive behavioural therapy. But as months passed, Emma began to notice that their family dynamics felt different this time around. The strategies that had worked before seemed less effective, communication felt more strained, and the whole family seemed to be operating under more stress than they had experienced with their daughter's anxiety treatment.
Emma's experience reflects findings from new research that reveals differences in how families function when children have anxiety disorders alone compared to when anxiety occurs alongside autism spectrum disorder. The study offers insights for families and healthcare providers regarding the challenges and needs associated with various family situations.
Understanding Family Functioning
Family functioning refers to how well families communicate, handle daily routines, and maintain positive relationships with each other. Researchers typically look at two main dimensions:
Family Relational Functioning: This includes how cohesive, expressive, and supportive a family is. Families with good relational functioning tend to be more connected, communicate openly, and provide emotional support to each other.
System Maintenance: This involves how organized and structured a family is, including things like rules, hierarchy, and control. While some structure is helpful, very high levels can indicate a more rigid, authoritarian family environment.
When family functioning is poor, it often contributes to increased stress for parents, more behavioural problems in children, and greater difficulty managing mental health conditions like anxiety.
The Research Landscape
Previous research has consistently shown that families of children with anxiety disorders often experience challenges in family functioning compared to families with typically developing children. Similarly, studies have found that families of children with autism spectrum disorder face unique stresses that can impact how the family operates as a unit.
However, to date, no research has specifically examined what happens in families where children have both conditions. Given that anxiety disorders are common in children with autism (affecting up to 40-50% of this population), understanding these family dynamics is important for providing effective support and treatment.
A Comprehensive Study
Researchers conducted a comprehensive study involving 264 children aged 7 to 18 and their parents. The participants were divided into three groups:
- 95 children with anxiety disorders but not autism
- 79 children with both autism spectrum disorder and anxiety disorders
- 90 typically developing children without mental health diagnoses
The researchers wanted to answer three key questions:
- How does family functioning differ among these three groups?
- Does family functioning improve after children receive cognitive behavioural therapy for anxiety?
- Can family functioning at the start of treatment predict how well children will respond to anxiety treatment?
Striking Differences in Family Experiences
The results revealed important differences between the groups that have implications for families and treatment providers.
Families with autism plus anxiety faced the greatest challenges: These families reported lower levels of supportive, cohesive relationships compared to families with typically developing children. They also reported higher levels of rigid structure and control compared to both other groups.
Families with anxiety alone functioned more like typical families: Surprisingly, families of children with anxiety disorders alone didn't show significantly different functioning compared to families with typically developing children. This was unexpected, as previous research had suggested these families would show more challenges.
Both parents and children reported similar patterns: The findings were consistent whether researchers asked children, mothers, or fathers about family functioning, suggesting these differences reflect real family experiences rather than just one person's perspective.
What This Means for Daily Life
These research findings translate into real differences in how families experience daily life:
For families dealing with autism plus anxiety:
- Parents may need to maintain more structured routines and clearer rules
- Family communication might be more challenging
- There may be less flexibility in family activities and interactions
- Parents might feel more stressed about managing both conditions simultaneously
For families dealing with anxiety alone:
- Family functioning may remain relatively stable
- The anxiety symptoms might be the primary challenge rather than broader family dynamics
- Treatment focused on the child's anxiety might be sufficient to improve overall family wellbeing
The Therapy Question
One of the most significant findings related to treatment outcomes. The researchers tracked families through cognitive behavioral therapy for anxiety and found that:
Therapy helped reduce anxiety symptoms but didn't change family functioning: While children in both clinical groups showed significant improvement in their anxiety levels after therapy, their family functioning scores remained stable. This was true even two years after treatment ended.
Family functioning didn't predict treatment success: Contrary to expectations, families with better functioning at the start of treatment weren't more likely to see greater improvements in their children's anxiety symptoms.
These findings challenge some assumptions about how family-focused treatment approaches should be designed and implemented.
Understanding the Autism Plus Anxiety Challenge
The research suggests several possible explanations for why families with children who have both autism and anxiety face greater challenges:
Compounding Effects: Having two conditions may create more complex daily management challenges than having either condition alone.
Different Needs: Children with autism may benefit from more structured, predictable family environments, which might appear as "higher system maintenance" in research measures but could actually be adaptive for these families.
Parental Stress: Parents may experience greater stress when managing both conditions, which could impact overall family dynamics.
Limited Treatment Focus: Current anxiety treatments may not address the broader family needs when autism is also present.
Rethinking Family Support
These findings have important implications for how healthcare providers and families approach treatment and support:
One Size Doesn't Fit All: Families dealing with anxiety alone may need different types of support than families dealing with both autism and anxiety.
Beyond Child-Focused Treatment: While cognitive behavioural therapy for anxiety is effective for reducing anxiety symptoms, families dealing with autism plus anxiety may need additional support to address broader family functioning challenges.
Redefining "Problems": Higher structure and control in families with autism plus anxiety might not always be problematic; it could represent adaptive responses to the unique needs of children with autism.
Long-term Perspective: Since family functioning remained stable even after successful anxiety treatment, families may need ongoing support rather than expecting that treating the child's anxiety will resolve all family challenges.
Practical Implications for Families
For families currently navigating these challenges, the research offers several insights:
Normalize Your Experience: If you're dealing with both autism and anxiety in your family, know that experiencing greater family stress and needing more structure is a common and understandable response.
Seek Comprehensive Support: While anxiety treatment is important and effective, you may also benefit from family therapy, parent training, or other supports that address broader family dynamics.
Don't Assume Therapy Will Fix Everything: Successful anxiety treatment is valuable and important, but it may not resolve all family challenges, especially when autism is also present.
Consider Individual Family Needs: What works for other families may not work for yours, and that's okay. Some families thrive with more structure and clear expectations.
Looking Forward
This research opens up important questions for future investigation:
Tailored Interventions: How can treatment approaches be modified to better support families dealing with both autism and anxiety?
Measurement Matters: Current ways of measuring family functioning may not capture what's truly helpful or problematic for families with autism.
Individual Differences: Rather than looking at group averages, researchers might need to examine what works for individual families.
Broader Family Factors: Other elements like socioeconomic status, parental mental health, and social support likely influence family functioning and deserve investigation.
A Message of Hope
While this research identifies real challenges faced by families dealing with autism plus anxiety, it also provides hope. The study confirmed that cognitive behavioral therapy is effective for reducing anxiety symptoms in children with autism, just as it is for children without autism. This means that evidence-based treatments can help children regardless of their autism diagnosis.
The research also suggests that families naturally adapt to meet their children's needs. What might look like "dysfunction" on a research measure might actually represent a family's successful adaptation to supporting a child with complex needs.
Supporting All Families
For healthcare providers, this research emphasizes the importance of:
Assessing Family Needs: Understanding not just the child's symptoms but how the family as a whole is functioning and what support they need.
Providing Comprehensive Care: Offering treatment that addresses both the child's specific symptoms and broader family dynamics when needed.
Avoiding One-Size-Fits-All Approaches: Recognizing that families with different combinations of conditions may need different types of support.
Validating Family Experiences: Acknowledging that families dealing with multiple conditions face unique challenges that require understanding and support.
The research reminds us that children don't exist in isolation; they're part of family systems that both influence and are influenced by their mental health and developmental conditions. By understanding these family dynamics better, we can provide more effective, compassionate support to children and families facing these complex challenges.
For families like Emma's, this research provides validation that their experiences are real and understandable, while also pointing toward more targeted and effective ways to support both children and families in thriving despite the challenges they face.
Hagen, A., Klein, A. M., Bögels, S. M., & van Steensel, B. F. (2025). Family Functioning in Families of Children with an Anxiety Disorder, with and without Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 1-14.
