"It is Just Too Overwhelming and Constant": Environmental Influences on Anxiety and Depression in Autistic Young...

Autistic people experience high rates of anxiety and depression, yet an evidence-based understanding of how and why these difficulties first develop is lacking. By centring autistic young people's accounts, this study aims to understand how interactions between autistic people and their environment throughout childhood and adolescence give rise to anxiety and depression.

Twenty autistic young people aged 10-18 and 30 parents of autistic young people aged 5-18 completed semi-structured qualitative interviews about experiences of anxiety and depression.

Framework Analysis identified three themes. External demands and pressures: Participants described the weight of pressures to meet non-autistic standards within school, social and sensory environments. Autonomy and control: Young people struggled with environments not under their control. They benefited from a balance of structure and autonomy within home and school settings. Safety, trust and predictability: Trust and acceptance from others (such as family, peers, teachers and professionals), access to safe places (such as home and nature), and engaging in interests were important protective factors.

Autistic young people can feel pressure to meet non-autistic demands, impacting mental health. Factors such as academic expectations, parenting styles, understanding of autism among family, teachers and peers, and low sensory demand spaces may be important targets for intervention.