Who Are You Afraid of?: Stress Response to Performance Evaluation in Young Adults Diagnosed with ASD

Background:   Epidemiological studies have found high co-morbidity of ASD and social anxiety disorder (SAD) (White, Oswald, Ollendick and Scahill; 2009). Some theories propose that the social anxiety exhibited in ASD has a similar biopsychological basis as SAD, and that individuals with ASD have a difficulty with social interaction because they are hyperaware of their lack of social skills (Monk et al., 2010). Others claim that the social ineptitude of individuals with ASD stems from a lack of awareness and motivation to act in socially acceptable ways (Dawson, 2005). In this study, we used psychophysiological measures of arousal to characterize reactivity in ASD during socially stressful (i.e. explicit performance evaluation) task trials compared to unevaluated trials. 

Objectives:  We aimed to understand how anxiety in people with ASD is mediated by fear of negative social evaluation.  In light of previous work in our lab on non-social stress, we hypothesized that ASD group would show elevated stress to both types of threat while the control group (CON) would be more affected by social evaluation than non-social (evaluative) contexts. 

Methods:   Twenty adults aged 18-29 diagnosed with ASD were compared to age- and IQ-matched healthy controls on modified Stroop and Multi-Sensory Integration tasks developed by Gianaros and colleagues (Sheu, Jennings and Gianaros, 2012). We measured stress response with impedance cardiography and skin conductance response. Participants completed the computerized task in one room, while research assistants in another room communicated via speakers. Participants were instructed at the beginning of each alternating block, whether they would or would not be evaluated for that block, by the research assistant watching through cameras and by the computer recording their responses. We examined within subjects differences over evaluated and unevaluated trials, as well as between subjects with ASD and CON groups.

Results:  We found that adults with ASD had higher overall autonomic physiological responses, relative to controls, during stress conditions. Parasympathetic activity during recovery periods was likewise reduced in the ASD group. There were significant group x evaluation condition interactions, with the evaluated trials adding substantially more to the stress response in the CON but not the ASD group, which was already near ceiling. Response to social evaluation was significantly correlated with scores on the Fear of Negative Evaluation and the Social Anxiety Questionnaire in both groups.

Conclusions:  This is the first study we know of to use measures of impedance cardiography in an autism sample. Findings of increased sympathetic activity during stress and decreased parasympathetic activity during rest confirm suggestions from other recent studies that ASD adults are out-of-sync with fear versus safety contexts, which may underlie a great deal of everyday anxiety. This elevated overall stress level may mitigate any extra stress that performance evaluation brings. Interventions for anxiety in ASD should focus on helping individuals to recognize physiological responses to stress and develop specific coping skills for such situations.