How do I help my child with autism spectrum disorder (ASD) who also has anxiety and ADHD?

ASD children have anxiety and ADHD This is not an uncommon occurrence, and both are closely related to subfunctions of "executive function."

That's why, when you have anxiety and ADHD together, the question, "How do I intervene?" is always difficult and troubling.

I found a Frontiers paper published very recently in 2025 that looked at what interventions are effective for children with autism who also have anxiety and ADHD.

Waters, D. K. et al (2025). Unique and shared influences of anxiety and ADHD on the behavioral profile of autism in early childhood. Frontiers in Child and Adolescent Psychiatry, 4.

This study examined 69 children with ASD (ages 3–5).

Research suggests that anxiety is primarily associated with difficulty shifting, while ADHD is primarily associated with difficulty inhibiting.

Wait a minute!

Shifting: Think of it as "shifting gears in your thinking/actions." It's the ability to easily adapt to changes in plans or circumstances.

- Inhibition: Think of it as a “brake in your head.” The power to temporarily stop an action you want to take.

Please remember that depending on which of the two forces is weaker, the child's behaviors (resistance to change, hypersensitivity, impulsivity, irritability, etc.) will manifest in different ways.

Subjects: N=69 children with ASD aged 3–5 years

What we saw: Coexistence of anxiety/ADHD, executive function (EF) subscales (switching and inhibition), autism-related behaviors (stubbornness, hypersensitivity, irritability, self-harm, etc.)

Key Results:

Anxiety ↔ Difficulty in transition → Resistance to change, insistence on the same thing, and hypersensitivity are likely to be prominent.

ADHD ↔ Difficulty in inhibition → Impulsivity, irritability, and self-harm are more likely to be prominent

So where should our child focus first?

1) Safety first!

- If you see safety issues such as self-attack or attacking others , you should first reduce environmental stimuli (reduce stimuli, provide close supervision) and start by cooperating with the medical/treatment team ( safety comes first , regardless of whether it is anxiety or ADHD).

2) Choose your first target

1. If you are very sensitive to change (great resistance when routines are broken), stubborn about sameness , and have more hypersensitivity →

Anxiety – Address the transition path first → Transition foreshadowing, visualization, and gradual exposure are key.

2. If there is more impulsive behavior , irritability/explosion , and difficulty stopping → ADHD – address the inhibitory pathway first →

The key is stop-think-act practice, short tasks + immediate reinforcement , and waiting (delayed reinforcement) training .

3) If both are strong, split them and use them in parallel.

Set transition and inhibition goals separately, and practice alternating between short, frequent (2–5 minutes) exercises. The key is to practice little by little and often!

Mini routines you can try right at home

A. If the transition (anxiety) comes first

- 3 steps of conversion : ① Preview schedule/conversion plan (photo/timer) → ② 30-second warning → ③ Conversion

<Visual schedule for announcing the transition ( link ) >

- Starting with small changes : “Getting used to change” games such as slightly changing block rules or changing the ending of a picture book

- Sensory protection : Prepare earplugs/coming-out corners in advance before going to noisy places.

B. If inhibition (ADHD) comes first

Stop-Life-Action Card : “Stop → Think → Act” with picture cards for 2-3 minutes each

- Wait Token : 1 sticker for 10 seconds → 2 stickers for 20 seconds… Short and frequent

- Short tasks + immediate praise/rewards : Build up your brain's brakes by building up success experiences.

C. Recording Tips (Very Brief)

- It is sufficient to write down the conversion success rate (%) , waiting time (sec) , and number of explosions/self-injuries once a day .

In this case, please consult an expert!

- If there is a safety issue such as self-injury/other harm ,

- When you have been doing it consistently at home for 2-4 weeks but there is no noticeable change ,

- When you want to use a strategy like daycare/kindergarten/school, but coordination is difficult .
In this case, please make a plan with a child psychiatrist, pediatrician, BCBA/SLP/OT !