Anxiety in autism is often misunderstood when compared with neurotypical experiences. It is not as simple as saying, “It’s okay, everyone gets anxious.” Anxiety in autism is not merely a transient experience but often a persistent and pervasive challenge shaped by both neurobiological differences and societal structures. While transient (state) anxiety is common in the general population, many autistic individuals can experience chronic (trait) anxiety, deeply intertwined with sensory sensitivities, social challenges, and the cumulative weight of past traumas. This article examines the complex nature of anxiety in autism, emphasizing how systemic barriers, stigma, and learned coping mechanisms contribute to sustained distress. It explores how societal pressures and internalized responses create self-reinforcing anxiety cycles, supported by psychological and neurobiological mechanisms. The article offers multilevel suggestions—spanning societal, community, professional, research, and individual levels—highlighting the need for inclusive, flexible approaches that account for the diversity of the autistic experience. Addressing both external barriers and internal challenges, these suggestions aim to promote well-being and reduce the burden of anxiety across the autism spectrum. Community Brief: Why is this topic important?: Anxiety in autism is often misunderstood, especially when compared with the anxiety non-autistic people experience. For many autistics, anxiety can be more intense and constant. It is shaped by both brain differences and social pressures, such as stigma and exclusion. Over time, these pressures make anxiety build up and become difficult to manage. At the same time, autistics have difficulty accessing mental health services to get the support they need. Reasons include high cost, shortage of services, and biases and misunderstandings from health care providers about who benefits from mental health support. What is the purpose of this article?: This article looks at how social factors and brain differences combine to influence anxiety in autistic individuals. It aims to give a clearer understanding of why anxiety in autism is unique and more complex compared with the anxiety experienced by non-autistic people. What personal or professional perspectives does the author bring to this topic?: The author brings personal experience as an autistic person with ADHD who deals with social anxiety, sensory issues, and spoken communication challenges, offering a lived understanding of anxiety in autism. The article also draws on the author’s academic research in autism, combining insights from neuroscience, psychology, and disability studies to provide a well-rounded perspective. As an disability advocate, serving on multiple disability boards, the author brings broader insights and has written extensively on autism and disability, promoting greater awareness and change. What is already known about this topic?: Anxiety is more common in autism than in the general population. Sensory sensitivities, social challenges, and co-occurring conditions such as ADHD and depression can intensify anxiety for autistics. However, most research focuses on anxiety in non-autistics, which doesn’t fully explain the constant, lifelong anxiety many autistic individuals experience. What does the author recommend?: The author recommends addressing anxiety in autism through several approaches. These include changes in society, improvements in professional care, new research priorities, stronger community support, and practical strategies that individuals can use. These recommendations are not one-size-fits-all. Instead they aim to support the diverse needs of autistics, including autistics with higher support needs. The author also encourages everyday strategies for mental health, to reduce dependence on costly or hard-to-access therapies. How will these recommendations help autistic adults now or in the future?: These recommendations aim to make mental health support easier to access, inclusive, and affordable. In addition, by promoting everyday strategies to autistics, we not only reduce dependence on expensive professional services but also enable autistics to have more control over their own health, following the disability principle of “Nothing about us, without us.” Mental health is fundamental for a good quality of life and autistics’ need to thrive and not just survive.

Loneliness is widely reported among autistic adults and is associated with adverse mental health outcomes. However, loneliness in autism is often framed as a consequence of social isolation, reduced social motivation, or individual social difficulty. This article argues that these framings—while consistent with general loneliness models—overlook a central feature of autistic loneliness: it frequently occurs amid ongoing social participation. Drawing on belonging theory, neurodiversity scholarship, epistemic justice, minority stress, and broader loneliness frameworks, this conceptual analysis introduces the Presence Without Belonging (PWB) framework. PWB distinguishes social presence from belonging and identifies three conditions required for belonging: recognition (being understood and taken seriously as a social subject), access (participation without extraordinary communicative, sensory, or temporal effort), and sustainability (participation that can be maintained over time without disproportionate cumulative cost). When one or more conditions are absent, participation may persist without belonging, producing loneliness despite contact. By reframing loneliness as a relational and structural outcome rather than an individual deficit, this analysis provides a foundation for more precise measurement, more accurate clinical formulation, and more responsible approaches to inclusion.

Background: Structural ableism, defined as the processes, policies, and institutions that privilege able-bodied people over disabled people, is a root cause of health inequalities faced by the disability community. Unlike other forms of structural oppression, there are currently no adequate measurements for structural ableism and its impacts. Therefore, a necessary first step to addressing health inequities that impact the disability community is to create validated measures of structural ableism. Objective: This paper outlines the methods of an ongoing project that aims to develop and validate measures of structural ableism. The resulting measures will facilitate the identification of relationships between structural ableism and health outcomes at both an individual and community level. Methods: This project will take place across 3 phases. In Phase I, we will characterize the multiple factors that comprise the construct of structural ableism. We will begin by analyzing texts that discuss historical events, ideologies, and the lived experiences of disabled people to inform our understanding of contemporary dimensions of structural ableism. Simultaneously, key informant interviews with advocates and activists from the disability rights and disability justice movements will be conducted to further characterize the dimensions of structural ableism. In Phase II, the findings of Phase I will be used to inform the creation of an individual-level measure of structural ableism. Phase III will result in community-level measures of structural ableism, which will be developed using community-engagement studios with members of the disability community and publicly available datasets. This phase will build on the findings of the first 2 phases. Our methods purposefully include disabled people across all phases of this work, with a focus on maximizing the diversity of disability perspectives by including people across disability types and intersecting identities (eg, race and ethnicity, gender identity, geographic location, and other identities and demographics). Most importantly, our approach is deeply community-informed, drawing on multiple community partnerships from local and national organizations, a diverse advisory committee of disabled activists, advocates, and scholars, as well as researchers with expertise in developing measures of structural oppression, such as structural racism. Results: This project was funded in August of 2024. As of October 2025, our team has read more than 50 texts as part of our historical and policy analysis of the factors that characterize structural ableism. We plan to complete our characterization of structural ableism in the spring of 2026, with individual-level measures of structural ableism being developed by the Winter of 2028 and community-level measures created by the Winter of 2029. Conclusions: The measures developed by this work will lay the foundation for identifying and evaluating novel interventions aimed at dismantling structural ableism, which should be cocreated with the disability community. International Registered Report Identifier (IRRID): DERR1-10.2196/86976

Growth mindset has reshaped how educational psychology explains persistence under challenge by showing that self-change beliefs influence how students interpret difficulty and respond to setbacks—particularly when learning conditions make improvement feasible. For disabled and neurodivergent learners, however, effort and strategy often cannot fully remove high-impact barriers, raising questions about how motivation operates under enduring constraint. This article introduces possibility mindset as a complementary construct for understanding motivation in such contexts. Possibility mindset is defined as a learner’s context-specific appraisal of “room to move,” grounded in three belief dimensions: self-change beliefs (can I develop in ways that matter here?), environment-change beliefs (will this setting adapt reliably in practice?), and pathway-flexibility beliefs (are there multiple legitimate routes to valued goals?).Although especially salient for disabled and neurodivergent learners, the framework applies more broadly to educational contexts where effort alone cannot reliably secure access. The central claim is one of translation: self-change beliefs sustain engagement most reliably when learners also expect environments to respond and pathways to remain viable. The article specifies predicted belief configurations, outlines a staged research agenda for measurement and incremental validity testing, and proposes “aligned” interventions that combine psychological messages with visible structural flexibility. Drawing on attributional traditions, the contribution is not to displace existing motivation theory, but to specify how attributions about systems—rather than solely about the self—shape motivational decisions under enduring constraint.