Autism, Anxiety, or a Common Human Experience? Understanding ASD, Anxiety, and Normal Human Differences

Relating to an Autism Trait Is Not the Same as Meeting the Criteria for Autism

Perhaps you have watched a video about autism and thought, “I do that.” You may struggle to maintain eye contact, feel more comfortable following a routine, become deeply interested in particular subjects, or need time alone after socializing.

These experiences are real, and they may be worth exploring. However, experiencing an autism-related trait does not necessarily mean that you have autism spectrum disorder, or ASD.

Many behaviors associated with autism also occur among people who are not autistic. Some may be related to social anxiety, generalized anxiety, attention-deficit/hyperactivity disorder, obsessive-compulsive symptoms, trauma, temperament, culture, habit, or ordinary differences in personality. In other cases, a person may be both autistic and experiencing another mental health concern.

The goal should not be to dismiss your experiences or talk you out of seeking an evaluation. Instead, it may be helpful to approach the question with curiosity and consider the complete picture.

What Does the DSM-5-TR Say About Autism?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, commonly called the DSM-5-TR, is one of the primary manuals clinicians use to classify and diagnose mental health and developmental conditions.

According to the DSM-5-TR, autism is not diagnosed based on one isolated behavior. A person must demonstrate a broader pattern involving persistent differences or difficulties in social communication and social interaction. The DSM-5-TR requires evidence in all three social-communication areas, along with at least two categories of restricted or repetitive behavior, interests, or activities (American Psychiatric Association [APA], 2022).

The social-communication criteria broadly involve:

• Social and emotional reciprocity, such as the back-and-forth quality of interactions

• The use and understanding of nonverbal communication

• Developing, maintaining, and understanding relationships

The restricted or repetitive behavior criteria may involve:

• Repetitive movements, speech, or use of objects

• Significant inflexibility or distress surrounding changes and routines

• Interests that are unusually restricted or intense

• Heightened or reduced responses to sensory experiences

The DSM-5-TR also specifies that characteristics must be present during the early developmental period, although they may become more noticeable as life demands increase. A person may also learn to mask or compensate for their differences, making them less obvious to others. Finally, the characteristics must cause clinically significant difficulty in social, occupational, or other important areas of functioning (APA, 2022).

This is important because a single experience can resemble one part of the criteria without meeting the complete clinical threshold.

Does Avoiding Eye Contact Mean You Have Autism?

Reduced or inconsistent eye contact is commonly discussed as a sign of autism. It can be one aspect of nonverbal communication differences, but it is not unique to ASD.

Someone may avoid eye contact because they:

• Feel self-conscious or fear being judged

• Were raised in a culture or family in which prolonged eye contact was discouraged

• Find eye contact distracting

• Feel intimidated by authority figures

• Have experienced trauma

• Are shy or socially anxious

• Simply communicate more comfortably without sustained eye contact

Research has found that autistic traits and social anxiety can both be associated with differences in attention to other people’s eyes. However, the underlying processes may not be identical (Kleberg et al., 2017).

For example, a person with social anxiety may understand the social expectation surrounding eye contact but avoid it because they fear embarrassment, rejection, or scrutiny. An autistic person may experience eye contact as distracting, uncomfortable, overly intense, or difficult to coordinate naturally with speech.

These are only examples, not diagnostic rules. Some autistic people make frequent eye contact, while some non-autistic people rarely do. A clinician would consider eye contact alongside many other aspects of communication, development, sensory processing, behavior, and functioning.

Does Having a Routine or Nightly Ritual Mean You Are Autistic?

Most people have routines.

You may drink coffee from the same mug, follow the same bedtime sequence, take a preferred route to work, or feel irritated when your plans change unexpectedly. Routines reduce the number of decisions we need to make and can make life feel more predictable.

A preference for routine is therefore not enough to establish ASD.

The autism criteria refer to more substantial patterns of inflexibility, insistence on sameness, or ritualized behavior. Clinicians may consider the intensity of the response, how difficult it is to adapt, whether the behavior has been present since childhood, and how significantly it interferes with daily life (APA, 2022).

Consider the difference between these examples:

“I enjoy completing my nighttime routine in the same order because it helps me relax.”

and:

“If I cannot complete my routine in the exact order, I become so overwhelmed that I cannot sleep, regulate my emotions, or continue with the rest of my evening.”

Neither statement confirms or rules out autism. However, the second may be more clinically significant and would likely lead to additional questions.

Routines can also be associated with anxiety. A person who worries frequently may use predictability to feel safer or more in control. Ritualized behavior can occur with obsessive-compulsive disorder as well, although the function and subjective experience of compulsions may differ from autistic routines.

Does Having a Passionate Interest Mean You Have Autism?

Many people have subjects they love.

You might know nearly everything about gardening, history, airplanes, mental health, sports, trains, languages, video games, or a particular television series. Being enthusiastic, knowledgeable, or highly committed to a hobby is not inherently a symptom.

The DSM-5-TR criterion concerns interests that are highly restricted or unusually intense in focus. A clinician may explore:

• How much time and attention the interest occupies

• Whether it limits participation in other areas of life

• How flexible the person is when discussing or engaging with other subjects

• Whether the interest helps with emotional regulation

• Whether similar patterns were present during childhood

• How the interest fits with the person’s broader social and behavioral history

Autistic interests can also be meaningful sources of pleasure, expertise, identity, connection, and professional success. The purpose of assessment is not to label enthusiasm as pathological. It is to understand the person’s overall pattern and support needs.

Research on the broader autism phenotype also suggests that autism-related characteristics can appear in milder or subclinical forms among people who do not meet the diagnostic criteria for ASD (Gerdts & Bernier, 2011).

In other words, traits can exist along a continuum. A clinical diagnosis still requires a specific combination, history, severity, and impact.

Autism or Social Anxiety?

Autism and social anxiety can sometimes look similar from the outside.

Someone with either condition might:

• Avoid social gatherings

• Have difficulty making eye contact

• rehearse conversations beforehand

• feel exhausted after socializing

• struggle to initiate conversations

• worry about making social mistakes

• have difficulty forming relationships

The reasons behind these experiences may differ.

Social anxiety disorder primarily involves significant fear of being watched, judged, embarrassed, or rejected in social situations. The person may generally understand social cues but become highly anxious when trying to respond to them.

Autism is a neurodevelopmental condition involving a broader developmental pattern of social-communication differences and restricted or repetitive behaviors. Autistic social difficulties are not necessarily caused by fear, although repeated misunderstandings, rejection, bullying, or pressure to mask can contribute to anxiety.

It is also not always autism or anxiety. Social anxiety and other anxiety disorders commonly co-occur with autism (Spain et al., 2018; Nimmo-Smith et al., 2020).

A thoughtful assessment therefore considers at least three possibilities:

1. The experiences are primarily related to autism.

2. They are better explained by anxiety or another concern.

3. Autism and anxiety are both present.

There is also another valid possibility: the person may not have a diagnosable condition. They may simply be describing part of the wide range of human behavior.

Online Checklists Can Begin a Conversation, but They Cannot Complete an Evaluation

Online autism questionnaires and educational videos can help people find language for experiences they have struggled to understand. They can also encourage people who were overlooked during childhood to seek appropriate support.

At the same time, a checklist cannot fully evaluate developmental history, context, severity, masking, functioning, cultural influences, alternative explanations, or co-occurring conditions.

Diagnosing autism in adults can be particularly complicated because autism-related experiences may overlap with anxiety, ADHD, and other mental health conditions. A comprehensive adult evaluation may explore social communication, sensory experiences, repetitive behavior, restricted interests, and early developmental history.

Questions that may be useful to consider include:

• Were these characteristics present during childhood?

• Do they occur across several settings and relationships?

• Are there social-communication differences beyond eye contact?

• Are sensory differences or repetitive behaviors also present?

• Do these experiences significantly affect relationships, work, education, or daily functioning?

• Do anxiety, trauma, ADHD, OCD, or another concern offer a better or additional explanation?

• Have you learned to conceal or compensate for the characteristics?

These questions are not a substitute for assessment, but they provide more information than asking whether you relate to one isolated trait.

You Do Not Need a Diagnosis for Your Experiences to Matter

One concern people sometimes have is that, without a diagnosis, their struggles will not be taken seriously.

You do not have to meet the criteria for autism for social discomfort, sensory sensitivity, loneliness, anxiety, or difficulty adapting to change to be meaningful. Therapy does not require you to prove that your experiences belong to a particular diagnostic category before you can work on them.

A diagnosis can provide clarity, self-understanding, accommodations, community, and access to services. For some people, an autism evaluation is an important and affirming step. For others, a different explanation may ultimately make more sense.

Either result can be useful. The goal is not to collect or avoid a label. The goal is to understand what you are experiencing and determine what kind of support may help.

Online Therapy for Autism-Related Concerns and Anxiety in Washington State

I provide online therapy for adults throughout Washington State, including people who are autistic or are exploring questions about neurodivergence. I also work with clients experiencing social anxiety, generalized anxiety, chronic stress, relationship difficulties, trauma, and major life transitions.

At this time, I do not provide formal autism diagnostic evaluations. However, therapy can offer a supportive place to explore your experiences, identify patterns, build self-understanding, manage anxiety, and develop strategies that work for you.

Whether you are autistic, anxious, both, or neither, you deserve to have your experiences approached with curiosity and respect.

This article is for educational purposes and should not be used to diagnose yourself or another person.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Association Publishing. doi:10.1176/appi.books.9780890425787

Gerdts, J., & Bernier, R. (2011). The broader autism phenotype and its implications on the etiology and treatment of autism spectrum disorders. Autism Research and Treatment, 2011, Article 545901. doi:10.1155/2011/545901

Kleberg, J. L., Högström, J., Nord, M., Bölte, S., Serlachius, E., & Falck-Ytter, T. (2017). Autistic traits and symptoms of social anxiety are differentially related to attention to others’ eyes in social anxiety disorder. Journal of Autism and Developmental Disorders, 47, 3814–3821. doi:10.1007/s10803-016-2978-z

National Institute of Mental Health. (n.d.). Autism spectrum disorder. National Institutes of Health.

Nimmo-Smith, V., Heuvelman, H., Dalman, C., Lundberg, M., Idring, S., Carpenter, P., Magnusson, C., & Rai, D. (2020). Anxiety disorders in adults with autism spectrum disorder: A population-based study. Journal of Autism and Developmental Disorders, 50, 308–318. doi:10.1007/s10803-019-04234-3

Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018). Social anxiety in autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 52, 51–68. doi:10.1016/j.rasd.2018.04.007

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