July 2026
Worsening anxiety seen in middle-aged and older adults with autistic traits
By Melanie Hinze
Middle-aged and older adults with high autistic traits are at increased risk of worsening anxiety with age and more than four times more likely than their peers without these traits to follow a ‘mild-to-clinical’ anxiety trajectory, according to new research.
The longitudinal study, published in Nature Mental Health, analysed eight years of annual follow-up data from 5270 adults aged 50 to 91 years (median age, 62 years; 75% female) participating in the UK-based PROTECT study.
Participants completed the Autistic Spectrum Traits (AST) Questionnaire and the Generalised Anxiety Disorder-7 (GAD-7) questionnaire, with 66 (about 1.3%) identified as having high autistic traits (the AST group) and 3874 (about 73.5%) reporting none (comparison adults). No participant in the sample had a formal diagnosis of autism.
Growth mixture modelling identified three anxiety trajectory classes over the eight-year period: a ‘lower-range minimal’ class (85.6% of the sample); an ‘upper-range minimal’ class (12.4%); and a ‘mild-to-clinical’ class (2%), in which anxiety symptoms gradually rose from mild to clinical levels.
AST participants were over-represented in the two higher-anxiety classes. After adjustment for sex, age and baseline depression, AST participants were 4.41 times more likely than comparison adults to follow the mild-to-clinical trajectory (95% confidence interval, 1.70 to 11.44) and 2.26 times more likely to follow the upper-range minimal trajectory.
Lifetime diagnoses of social anxiety, panic disorder and obsessive-compulsive disorder were also more common in the AST group at baseline.
Commenting on the findings, Professor Dawn Adams, Endowed Chair at the Olga Tennison Autism Research Centre, La Trobe University, Melbourne, told Medicine Today that anxiety was common among autistic people across the lifespan, but it was not always recognised or understood in context.
‘We already have substantial evidence that autistic children and young people experience markedly elevated rates of anxiety, and that this anxiety can lead to challenges at home, school or in the community,’ she said. ‘This new study suggests that anxiety in autistic people is not confined to childhood or adolescence – it can persist, emerge or worsen into midlife and older age.’
Professor Adams said mental health challenges in autistic people might present differently, be driven by different factors and required different supports.
‘Sensory distress, uncertainty, social experiences, masking, communication barriers, loneliness, trauma and previous negative healthcare experiences can all contribute to a person’s presentation,’ she said.
‘Therefore, we cannot assume that anxiety support designed for the general population will be equally effective without adaptation,’ she said. ‘Autism-informed care is essential if we want to prevent or reduce anxiety and improve outcomes for autistic people across the lifespan.’