This qualitative study investigates teachers’ perspectives on anxiety among autistic learners with intellectual disabilities (ID) in special school settings. Research in this area remains limited, with existing studies often overlooking the distinct ways anxiety manifests and interacts with ID in this population. Semi-structured interviews with eight teachers explored their views on anxiety presentation, triggers, and strategies for support. Reflexive thematic analysis provided nuanced insights into the findings. Teachers highlighted that anxiety often presents through behaviours misinterpreted as core features of autism, complicating identification and response to emotional needs. Environmental factors, including sensory stimuli, routine disruptions, and limited spaces for sensory breaks, emerged as significant triggers. Unpredictable staffing and incompatible pupil groupings further exacerbated anxiety, contributing to social withdrawal and self-regulation challenges. To address these issues, teachers described using proactive strategies, such as transition planning, building trust, or low-arousal environments. They emphasised the need for a whole-school, collaborative approach, alongside multidisciplinary support. However, teachers often felt overwhelmed due or limited access to external specialists or support. Participants advocated for neurodiversity-affirming practices focusing on environmental triggers and regulation. The study underscores the importance of increased teacher support, comprehensive planning, and integrating family and community resources to develop consistent anxiety management strategies.