Managing Anxiety and Workplace Accommodations

Finishing high school and college can be an exciting developmental milestone, but it can also be stressful. Transition programming and/or employment can be a scary next step in the uncertain path towards adulthood and the increasing amount of independence that comes with it for young autistic adults. Reduced support following secondary school can exacerbate already high anxiety (Wei et al., 2014).

High levels of anxiety may make it hard to get and keep a job. The process of interviewing, onboarding, training, and adjusting to a new job, work expectations, and co-workers can be difficult. It is not surprising that anxiety contributes to the significantly lower employment rates experienced by autistic young adults relative to young adults with other disabilities (National Autism Indicators Report, 2021).

Employment is a key social determinant of health (Gmitroski, et al., 2018). Therefore, it is important to support autistic young adults’ management of anxiety during post-secondary transition periods as a means of preparing for and sustaining competitive integrated employment. It is just as critical to address organizational factors that can foster positive work culture and promote neurodiversity-affirming supports. Anxiety is best managed with an interesting job and a job site that recognizes each employee’s capacity for unique contribution.

Considerations for Employers

Job sites that affirm diversity tend to have greater success hiring and retaining autistic employees (Hedley et al., 2018; Roehrich et al., 2016). These suggestions can help employers better support autistic employees, building a better and more inclusive workplace for all.

1. Support autistic adults in the workplace through accommodations. These accommodations are often legally required by the Americans with Disabilities Act and are typically “natural supports” that are sustainable, cost-effective, and may benefit other employees in the workplace (Waisman-Nitzan et al., 2021). Examples of potential accommodations for an autistic young adult with anxiety include short breaks to go to a quiet space, working with one earbud in to listen to music, and providing clear expectations regarding work. Accommodations may change over time, especially as job duties and support needs change.
2. Allow for and support assistive technology devices. These can be either everyday technology like tablets and smartphones or specialized technology like augmentative and alternative communication devices (Alshamrani et al., 2023).
3. Emphasize workplace education. As mentioned previously, it is important for job sites to take the initiative in meeting the needs of diverse employees who can bring a range of strengths and innovation to the workplace. As an employer and/or ally of neurodiverse employees, seek out training opportunities to create a safe and supportive workplace.
4. Build inclusive work environments and champion universal design policies. One simple strategy is to celebrate National Disability Employment Awareness Month, which occurs every October. The Department of Labor offers suggestions on how to build inclusive workplaces such as offering disability-focused training and reviewing employer policies for inclusivity.

Considerations for Autistic Employees

Managing anxiety may be a useful tool in supporting employment, which then has a range of cascading positive health outcomes such as improving overall mental health, well-being, and access to financial and insurance supports (Gmitroski, et al., 2018). These practical strategies are useful in managing employment-related anxiety and enhancing workplace supports.

1. Be aware of common anxiety symptoms. Common anxiety symptoms may include worry about sensory differences (e.g., fear of loud noises), generalized worries (e.g., fear of making mistakes, taking public transit, worry about stigmatized status), and social fears (e.g., fear of talking to new people, asking for help, and connecting with co-workers). Variations of these fears often manifest early in life and can provide opportunities to practice coping with caregiver support. Being aware of these fears can help to anticipate challenges associated with these worries and then generate strategies to manage anxiety.
2. Request workplace accommodations. Accommodations can alleviate workplace anxiety by supporting sensory and workplace needs. Negotiations for workplace accommodations can be done with supports such as a job coach. When your sensory experience is appreciated and respected through accommodations, it is easier to focus on important employment matters. Common accommodations include:
   • Careful overview of orientation and onboarding expectations
   • Requesting clear communication of work tasks and deadlines via preferred communication mediums (e.g., email, spoken, and written instruction)
   • Flexible working hours or location
   • Notification of upcoming changes in schedule
   • Careful overview of technology and supports
   • Regularly scheduled meetings to receive feedback on workplace performance etc.
3. Access evidence-based mental health supports. Generalized and social worries are the most common fears that create interference for autistic teens and young adults. These worries are consistent with the most prevalent symptoms in non-autistic adult populations. This points to the usefulness of evidence-based, cognitive behavioral therapy (CBT) treatment that incorporates:
   • Somatic management (managing your body’s physical symptoms)
   • Skill building (problem solving the steps needed to accomplish a stated task)
   • Helpful thoughts (brief and repetitive reminders that you can cope with hard things and that you have done hard things before)
   • Exposure (facing fears a little bit at a time)

   A mental health professional with expertise in autism is not always available. Speak to your primary care doctor, school, transition team, or your local autism society to find mental health professionals with anxiety experience.

4. Create your own “plan to get to green.” We discuss a “plan to get to green” in the Facing Your Fears CBT program for autistic youth with anxiety; this is a plan that systemically lays out strategies for managing the red zone (high anxiety) and yellow zone (medium anxiety) and maintaining the green zone (calm). It’s important to have strategies in place prior to starting a job that address each zone; we all experience red-zone periods, so there is a high probability you will too at work. Making a preemptive plan of where to go and what do at your job site when in the red/yellow zone is important as it is difficult to create solutions and solve problems when anxious. Managing the red zone might include strategies to manage your body’s anxiety reaction and your mind. For example, you can tell colleagues “I’ll be right back” and then take space in a quiet place, practice deep breathing hourly so anxiety doesn’t mount, and remind yourself that you are brave and capable.
5. Eat and drink regularly. Anxiety can make it hard to read your body’s physical cues, so schedule regular times to eat and drink over the course of the day to stay emotionally regulated.
6. Seek mentorship and then become a mentor. Connecting with other neurodiverse individuals or mentors at the job site can be helpful. Seek them out for guidance on the unwritten rules of the workplace to clarify expectations surrounding certain tasks or events and to reduce anxiety. In addition, it can be helpful to have a mentor who can provide encouragement and feedback on managing stressors. Consider being a mentor to others.
7. Discuss caregiver involvement. Many autistic young adults continue to reside with their parents during their young adult years. However, the role of parents naturally changes after post-secondary school for a range of developmental, psychological, and legal reasons. Discuss the level of parental contact and support that is needed and/or who the best source of support might be for workplace issues.
8. Access formalized job site supports. Consult with vocational rehabilitation agencies to determine qualification for employment-related resources and job coaching.
9. Explore volunteer and shadowing opportunities. Observing a range of potential jobs can help you to understand job responsibilities and work expectations and can be useful in determining if the job is a fit for you. In addition, volunteering and shadowing can be a good step when facing fears tied to employment.

Audrey Blakeley-Smith, Ph.D., is a clinical psychologist and an associate professor in the Department of Psychiatry at JFK Partners, University of Colorado Anschutz Medical Campus. Dr. Blakeley-Smith is the director of the Adult Autism Clinic within JFK. Together with Dr. Judy Reaven, Dr. Blakeley-Smith co-authored a CBT group intervention entitled Facing Your Fears and Facing Your Fears in Schools to treat anxiety in autistic youth.

Aryn Taylor, Ph.D., CRC, LPCC, is an assistant professor at the University of Northern Colorado in the Department of Rehabilitation Counseling and Sciences. Her current research focuses on transition-aged youth and interagency collaboration around transition points such as school-to-work and the pediatric-to-adult healthcare transition. She is involved in state-wide initiatives to support all people with disabilities to achieve competitive integrated employment and gain greater independence and full inclusion in society.

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