Objective:

To examine anxiety in children with Autism Spectrum Disorder (ASD) as part of a two-part narrative overview addressing internalizing symptoms, focusing on shared and distinct modifiable risk and protective factors.

Approach:

• Methodology: A structured narrative overview synthesizing evidence from systematic reviews, meta-analyses, and clinical studies, organized across biological, psychological, and environmental domains.

Key Findings:

• Anxiety in ASD is linked to factors such as sensory hypersensitivity, intolerance of uncertainty, social challenges, and neurobiological vulnerability.
• Protective factors such as cognitive-behavioral therapy (CBT), structured physical activity, and supportive environments may mitigate anxiety symptoms and promote adaptive functioning.
• Variability in study design and population characteristics limits the generalizability of findings.

Interpretation:

A comprehensive, multidisciplinary strategy is necessary to address anxiety in ASD, integrating risk reduction with resilience-building interventions.

Limitations:

• Existing research is fragmented and predominantly risk-oriented.
• Protective influences related to rehabilitation and lifestyle strategies remain underexplored.

Conclusion:

The findings support a transdiagnostic and personalized approach to mental health in children and adolescents with ASD.