Current options for the treatment of anxiety in adults with autism spectrum disorder.

INTRODUCTION

Anxiety affects approximately 30-40% of adults with autism spectrum disorder (ASD), yet its diagnosis and treatment remain underrepresented in the literature. Autism is a lifelong condition and addressing it across lifespan while considering its developmental stage is essential. Tailored clinical approaches are needed to accommodate communication, cognitive, and sensory differences.

AREAS COVERED: This expert review examines the clinical assessment and evidence-based pharmacological treatment for adults with anxiety disorders.

EXPERT OPINION: Clinicians should redesign workflows to allow developmentally appropriate interviews. Self-reported validated tools, such as HADS-A (Hospital Anxiety and Depression Scale - Anxiety) and Anxiety Scale for Autism-Adults (ASA-A), and adapted versions of Generalized Anxiety Disorder 7-item scale (GAD-7) and Patient Health Questionnaire 9-item scale (PHQ-9) improve diagnostic accuracy, except when caregiver input is necessary. Pharmacological treatments show mixed results: fluvoxamine and clomipramine have shown promise, while citalopram, propranolol, and intranasal oxytocin yielded limited efficacy. Effective treatment of anxiety can improve quality of life, reduce functional impairment, and enhance health outcomes. Equity in care critical to improving access for this underserved population and requires comprehensive education in neurodevelopmental disorders for researchers and clinicians. Further research and innovation are needed to validate tools and optimize treatment strategies for this often-excluded population.