Social Anxiety Disorder In Adults with High-Functioning Autism Spectrum Disorders

Background: Psychiatric co-morbidity occurs commonly in Autism Spectrum Disorder (ASD). High rates of social anxiety are consistently found in children and adolescents with ASD. Few studies have sought to investigate whether this is also the case for adults with ASD, despite the fact that social anxiety disorder (SAD) can be chronic and debilitating. Furthermore, adults with high-functioning ASD are known to be at risk of developing anxiety disorders, which likely impede on social functioning and quality of life.

Objectives: The primary objective of this study was to determine the point prevalence of SAD in adult males with high-functioning ASD. Secondary aims included exploring whether there were associations between SAD and low mood, SAD and general anxiety, and severity of ASD and social anxiety.

Methods: An observational, cross-sectional study design was used. A community sample of adult males with high-functioning ASD was recruited. Participants and their informants (a parent) completed several validated self-report questionnaires via a postal survey.

Results: Fifty-one individuals participated in the study. Point prevalence of SAD was 52%. Sample characteristics did not differ significantly between groups scoring above and below the SAD clinical threshold. Higher rates and levels of low mood and general anxiety were found in the group scoring above the SAD clinical threshold. Significant associations were found between SAD and low mood, and SAD and general anxiety. Correlations between severity of ASD and social anxiety were not significant.

Conclusions: SAD appears to be highly prevalent in this population. Anxiety symptoms may be ‘masked’ due to relatively high-functioning abilities, and core ASD symptoms may render it difficult for individuals to seek support spontaneously. A more proactive approach to the assessment of SAD is indicated, which could include the use of self-report questionnaires. Further research is needed into understanding the phenomenology and aetiological factors associated with social anxiety in this population, with a view to informing the development of evidence-based interventions.