When Autism Includes Anxiety: Why Regulation-Based Support Is Essential

Service dog practicing deep pressure therapy

A groundbreaking new study has just reshaped how we understand autism—offering hope for more personalized, biologically-aligned care. Researchers analyzed data from over 5,000 autistic children and nearly 2,000 non-autistic siblings and identified four distinct subtypes of autism, each with unique genetic signatures and developmental profiles.

But one finding stood out: two of these four subtypes—representing over 70% of autistic children in the study—showed significantly higher rates of co-occurring anxiety, depression, and emotional dysregulation. This is more than a statistic—it’s a call to action for how we support, regulate, and empower neurodivergent individuals, especially those whose experiences include both sensory and emotional vulnerability.

As a somatic trainer and service dog educator focused on nervous system regulation, this study validated what I’ve long seen in my work: supporting the body is often the most effective way to support the mind.

The Four Subtypes, in Brief:The researchers grouped autistic children into four biological and behavioral clusters:

1. Social & Behavioral Challenges (~37%)

   • Strong traits like social difficulty, restricted interests, and stimming

   • High co-occurrence of anxiety and depression

   • Genetic mutations often expressed in later childhood meaning these children are more likely to recieve a later diagnosis.

2. Mixed ASD with Developmental Delay (~19%)

   • Speech/motor delays alongside classic autism traits

   • Lower rates of mental health challenges

   • More likely to inherit rare gene variants from parents

3. Moderate Challenges (~34%)

   • Milder presentation overall

   • Typical developmental timelines

   • Minimal psychiatric co-diagnoses

4. Broadly Affected (~10%)

   • High developmental delays and behavioral symptoms

   • Severe emotional dysregulation

   • Highest rate of depression, anxiety, and emotional fragility

   • Linked to damaging de novo mutations

Put together, the Social & Behavioral subtype (37%) and the Broadly Affected subtype (10%) account for roughly 47% of all autistic children in the study. Both groups showed high rates of emotional dysregulation, internalized distress, and psychiatric diagnoses like anxiety and depression.

What This Means for Support & Intervention Historically, autism support has prioritized observable behaviors: language, social interaction, and learning. But what about the internal experience? What happens when someone’s body is chronically in fight-or-flight—or worse, shut down entirely?

Anxiety and depression aren’t just comorbidities—they’re nervous system states. They change how a person breathes, sleeps, thinks, digests, and relates. And when these internal dysregulations go unaddressed, they can worsen sensory overwhelm, delay recovery from meltdowns, and erode a person’s trust in their own body.

Why Nervous System Work Is Crucial for These Subtypes This is where somatic-based, nervous-system-informed approaches shine.

For the nearly 1 in 2 autistic children who fall into these two subtypes, emotional regulation is not just a therapeutic add-on—it’s core to functioning and well-being. The techniques I teach—whether through canine-assisted regulation, somatic touch, breathwork, or gentle movement—are designed to:

• Restore a felt sense of safety Anxiety isn’t just mental—it’s a physiological signal that the environment feels unsafe. Gentle co-regulation (with a person or dog) can help cue safety from the inside out.

• Interrupt chronic fight-or-flight patterns Many autistic individuals cycle rapidly between hyperarousal and hypoarousal. Nervous system training helps widen the window of tolerance and produce more time in a regulated place- feeling safe and secure.

  Enhance interoception and sensory clarity When the body feels disorganized, so does the mind. Helping someone track hunger, fatigue, heart rate, or muscle tone builds resilience and regulation.

• Empower communication without words Some of the individuals I work with are non-speaking. Somatic and sensory-based regulation gives them tools to self-advocate in embodied, non-verbal ways. ABA therapy often relies on Pavlovian methods—using rewards or consequences to condition behaviors—whereas my approach empowers children to tune into their own bodies and choose nervous system regulation as a form of self-advocacy.

• Build emotional fluency through the body Nervous system literacy helps people name and navigate states like freeze, collapse, or shutdown—not as failures, but as adaptive responses we can gently work with.

The Role of Service Dogs in Regulation For many clients, especially children, co-regulation with a trained dog can bypass resistance and ignite safety in a way human interaction sometimes cannot. Dogs offer rhythmic breathing, consistent warmth, pressure input, and a nonjudgmental presence that can cue regulation when words fail.

For those in the Social & Behavioral subtype—who often appear “high functioning” but carry deep internal distress—having a canine partner can be transformative. And for the Broadly Affected group, where traditional therapy may not always reach the emotional layers, body-first support like this is not just helpful—it’s essential.

What This Means for the Future This new subtyping model brings nuance, but also tremendous opportunity. We’re entering an era where support can be personalized not just by age or behavior—but by how the body processes emotion, stress, and connection.

If nearly half of all autistic children are navigating anxiety and depression as part of their subtype, then nervous system support is no longer a niche—it’s foundational.

Closing Thoughts: I’ve always believed that regulation is a birthright—not a reward. This study doesn’t just confirm that anxiety and depression are common in autism—it offers a biological basis for why nervous system-centered support is so desperately needed.

If you or someone you love is autistic and struggles with emotional overwhelm, shutdowns, or chronic anxiety, I invite you to explore a different path—one that honors the body as the first language of healing.

Because every child deserves to feel safe inside their own skin.