Are play behaviours in autism linked to anxiety or depression? 

Differences in play are one of the earliest and most recognisable features of autism, but recent research by Wang et al. (2024), published in Autism Research and conducted by an international team from the University of Cambridge, King’s College London, and Monash University, found that restricted and repetitive play behaviours are strongly linked with higher anxiety levels in autistic children and adults. Other reviews, including those in Frontiers in Psychology (2023), suggest that limited imaginative or social play can also contribute to depression and reduced emotional wellbeing.  

How autistic play supports emotional regulation 

Play is not just entertainment; it is a form of expression. Many autistic people use solitary or repetitive play to make sense of their surroundings and to manage stress. According to the NHS, repetitive actions, special interests, or predictable play routines can serve as stabilising tools when the world feels overwhelming. 

However, research published in Frontiers in Psychology and the Journal of Autism and Developmental Disorders has shown that when play becomes overly rigid or limited, it can reduce opportunities for imaginative or cooperative interaction. This lack of social play is linked with increased social isolation, a key factor that raises the risk of anxiety or depression in autistic people. 

The link between restricted play and anxiety 

Evidence from multiple systematic reviews and meta-analyses between 2023 and 2025 shows a strong relationship between repetitive play and anxiety in autism. Restricted and repetitive behaviours (RRBs), which often include specific play routines or object-focused activities, have been found to correlate with anxiety levels at around r = 0.4–0.7, a moderate to strong effect size (PMC8638349). 

These behaviours can serve both as a coping mechanism and a source of distress. In the short term, repetitive play can soothe and regulate emotions. Over time, overreliance on rigid routines may prevent the development of more flexible coping strategies, reinforcing cycles of anxiety and avoidance. 

What about depression? 

While the evidence linking play and depression is less robust, recent UK and international studies suggest that limited imaginative play and social isolation are contributing factors. Observational data published in Autism Research and Child Psychiatry & Human Development found that difficulties in symbolic or creative play were associated with reduced emotional resilience and higher depressive symptoms. 

Experts note that the association may be indirect. When play opportunities do not support social connection or mastery, self-esteem can suffer, and this may increase vulnerability to depression over time. 

What NICE guidelines recommend 

According to NICE CG142 (Autism in adults) and NICE CG128 (Autism in children and young people), clinicians should assess for anxiety and depression in all autistic individuals as part of ongoing care. The latest 2025 NICE surveillance update confirms these recommendations remain current, highlighting the importance of addressing mental health symptoms alongside autism support. 

NICE further advises that interventions be individualised and structured, taking into account communication style and sensory needs. Importantly, unproven interventions such as neurofeedback or restrictive diets are not recommended for emotional or behavioural management (Living Autism summary of NICE guidance). 

Effective interventions and therapies 

For autistic individuals with anxiety or depression linked to play behaviours, evidence supports a combination of behavioural and psychosocial interventions: 

• Adapted Cognitive Behavioural Therapy (CBT) – NICE-endorsed for treating anxiety and depression in autism. Sessions should be structured, visually supported, and focus on understanding the link between thoughts, emotions, and behaviour. 

• Play-based or social skills interventions – Guided or structured play therapy can help improve emotional expression and reduce isolation, particularly in children. 

• Parent-led behavioural programmes – For younger children, parent coaching helps families use play to build communication, predictability, and confidence. 

• Group-based support – For adults, social skills or activity-based groups can provide opportunities for connection and emotional regulation. 

These approaches are supported by NICE and NHS guidance, which emphasise the importance of adapting therapy methods for autistic communication styles and sensory profiles. 

Understanding the emotional message behind play 

Restricted or repetitive play does not always indicate distress; sometimes it is simply a preferred way of engaging. The key, experts say, is to look for changes: when a child’s play becomes narrower, less joyful, or increasingly self-isolating, it may reflect growing anxiety or low mood. 

Healthcare professionals often use play observation as a gentle way to assess emotional wellbeing, while adapted play therapy provides an accessible route for self-expression when words are difficult. 

Getting private support and diagnosis 

If you or your child are struggling with anxiety or mood changes related to autism or play patterns, an expert assessment can provide clarity and tailored guidance. 

You can explore private, NICE-aligned diagnostic options through Autism Detect, a UK provider offering CQC-rated “Good” autism assessments for both adults and children, along with dedicated aftercare services for long-term wellbeing. 

Key takeaway 

Play is a window into how autistic people experience and manage their emotions. When play becomes rigid or withdrawn, it can signal underlying anxiety or depression, but with early recognition and evidence-based support, outcomes can greatly improve. NICE and NHS guidance emphasise structured, personalised interventions that help autistic individuals use play not just as comfort, but as a pathway to emotional wellbeing.