Social Impairment, Social Anxiety, and Loneliness In High-Functioning Adolescents with Autism and Social Phobia

Background: Social anxiety is a commonly reported problem among adolescents with high-functioning autism spectrum disorder (HFASD; Bellini, 2004). The relationship between social anxiety and social impairment in adolescents with HFASD, however, is not fully understood. Some research suggests that greater social skills deficits lead to increased anxiety due to experiences of rejection and social isolation (Tantam, 2000). Other researchers emphasize that awareness of social difficulty, not actual degree of social disability, may be the impetus for the development of social anxiety, which is consistent with findings that higher functioning youth with ASD experience more anxiety than lower functioning youth with ASD (Sukhodolsky et al., 2008). This relationship has not yet been explored in individuals with HFASD and diagnosed comorbid Social Phobia (SoP).

Objectives: The purpose of this study was to investigate the relationship between generalized (i.e., interaction-based) social anxiety and degree of social impairment in a sample of adolescents with HFASD and comorbid SoP. A related purpose was to explore if greater social interaction-based anxiety is related to greater feelings of loneliness. Self-reported loneliness may reflect cognitive awareness of one’s social impairments by portraying insight into the consequences of social rejection and isolation (Bauminger & Kasari, 2000).

Methods: Twenty-three adolescents (12-17 years old; 7 females) with confirmed ASD diagnoses, based on the ADOS (Lord et al., 2002) and the ADI-R (Lord et al., 1994), met diagnostic criteria for SoP, based on the ADIS-C/P (Silverman & Albano, 1996). The adolescents completed self-report measures of anxiety (MASC-C; March, 1997) and loneliness (Loneliness Questionnaire; Bauminger et al., 2003). All participants were cognitively higher functioning (i.e., IQ > 70). 

Results: Bivariate correlations among social interaction-based anxiety (MASC-C Humiliation/ Rejection subscale score), social impairment (Reciprocal Social Interaction ADOS score), and loneliness (Emotional and Social subscale scores of the Loneliness Questionnaire) were examined. A significant negative relationship was found between clinician-rated social impairment and youth-reported social interaction-based anxiety (r = -.416, p < .05). Youth-reported social interaction-based anxiety was also related to youth-reported emotional loneliness (r = .556, p < .01) and social loneliness (r = .475, p < .05). 

Conclusions: In this sample of adolescents with HFASD, adolescents who were less socially impaired tended to report more social anxiety, and those with more social anxiety tended to report more loneliness. This finding suggests that, among higher functioning adolescents on the spectrum, those with less ASD-related social impairment may be more aware of their social deficits, and consequently feel more anxious in social interactions. Although more socially impaired adolescents may objectively experience greater interpersonal difficulties, they may lack the insight to self-report on anxiety. The results are consistent with previous research showing that youth with ASD and elevated anxiety experience greater loneliness (White & Robertson-Nay, 2009), which may reflect a greater degree of insight into their personal difficulties related to ASD-related social deficits.