Treating Anxiety in Autistic Children: What Happens When ADHD is Also Present?

Autistic children face higher rates of mental health challenges compared to their non-autistic peers, with anxiety and ADHD being widespread. When these conditions occur together, parents and clinicians often wonder whether standard treatments will still be effective. A new study provides reassuring answers about cognitive behavioural therapy for anxiety in autistic children who also have ADHD.

The Challenge of Multiple Conditions

Mental health conditions rarely occur in isolation, and this is especially true for autistic children. Research shows that approximately 40% to 50% of autistic children have two or more co-occurring mental health conditions, compared to less than 15% of non-autistic children. Anxiety and ADHD represent the most frequent combination, creating complex challenges for families and treatment providers.

When multiple conditions are present, questions naturally arise about treatment effectiveness. Will therapy designed for anxiety work as well when ADHD symptoms like difficulty concentrating and hyperactivity are also present? This study set out to answer that question.

Understanding the Research

Researchers analyzed data from 167 autistic children aged 7 to 13 who participated in anxiety treatment trials. These children received either standard cognitive behavioural therapy, autism-adapted CBT, or treatment as usual. What made this study particularly valuable was its focus on children who had both anxiety and ADHD, which represented 62% of the participants.

The researchers wanted to understand three key questions: whether ADHD would make anxiety treatment less effective, whether treating anxiety might also help ADHD symptoms, and whether improvements in one condition were related to improvements in the other.

The results were encouraging for families dealing with both conditions. ADHD did not predict worse outcomes for anxiety treatment. Children with ADHD responded just as well to cognitive behavioural therapy as those without ADHD, whether they received standard CBT or autism adapted versions.

This finding challenges concerns that ADHD symptoms might interfere with a child's ability to engage with and benefit from anxiety treatment. The structured approach of CBT, which teaches specific coping strategies and employs gradual exposure to fears, appears robust enough to work effectively even when attention and hyperactivity challenges are present.

Unexpected Benefits for ADHD

A surprising finding is that treating anxiety also led to improvements in ADHD severity. When children received CBT for their anxiety, evaluators noticed reductions in ADHD related impairment, though parent reports of ADHD symptoms didn't show the same pattern.

This difference between evaluator and parent perspectives might reflect how CBT helps families manage challenges more effectively, even if core symptoms remain present. The therapy process may equip parents and children with better strategies for navigating ADHD related difficulties, reducing their overall impact on daily functioning.

The Connection Between Conditions

The study revealed a  relationship between improvements in anxiety and ADHD. As children's anxiety symptoms decreased through treatment, their ADHD symptoms and severity also tended to improve. This suggests the conditions may influence each other in important ways.

For autistic children, executive functioning difficulties that affect planning, attention, and emotional regulation may represent a common pathway linking anxiety and ADHD. When anxiety treatment helps children develop better coping strategies and emotional regulation skills, these improvements may naturally extend to managing ADHD related challenges.

What This Means for Families

These findings offer hope for families navigating the complexity of multiple conditions. Parents can feel confident that existing CBT programs designed for anxiety are appropriate and effective for their autistic children, even when ADHD is also present. The treatment doesn't become less effective because of ADHD, and it may provide unexpected benefits for attention and hyperactivity concerns.

The research also suggests that addressing anxiety first, rather than trying to treat all conditions simultaneously, can be a reasonable approach. The improvements in ADHD that occurred alongside anxiety treatment indicate that focusing on one condition may create positive ripple effects for others.

Implications for Treatment Planning

For clinicians and families making treatment decisions, this research supports the use of established anxiety treatments without major modifications for ADHD. Both standard CBT and autism adapted versions showed similar effectiveness for children with co-occurring ADHD.

The study participants had anxiety as their primary concern, with ADHD as a secondary condition. For families where ADHD is the main challenge, additional research is needed to understand how these findings might apply.

This research contributes to growing understanding of how mental health conditions interact and respond to treatment. The finding that anxiety treatment can positively impact ADHD symptoms opens questions about the mechanisms behind these improvements.

Future research may help identify which specific aspects of CBT create benefits for ADHD, potentially leading to more targeted and effective treatments. Understanding whether certain ADHD symptoms are more responsive to anxiety treatment could also help personalize treatment approaches.

The study also highlights the importance of considering how conditions interact with one another, rather than viewing them as completely separate challenges. For autistic children, who often face multiple mental health conditions, this interconnected perspective may lead to more effective and efficient treatment strategies.

Ng‐Cordell, E., Storch, E. A., Kendall, P. C., Wood, J. J., Mikami, A. Y., & Kerns, C. M. (2025). Implications of cooccurring ADHD for the cognitive behavioural treatment of anxiety in autistic children. Journal of Child Psychology and Psychiatry.

For now, families can take comfort in knowing that effective anxiety treatment remains available and beneficial for autistic children, regardless of whether ADHD is also present. The therapy process may offer broader benefits than originally expected, helping children develop skills that support their overall wellbeing and functioning across multiple areas of their lives.