Does Greater Social Cognition Lead to More Social Anxiety? Effects of Cognitive Level, Symptom Severity, and Self-Reports of Loneliness on Social Behavior in Adolescents with ASD

Background: Autism Spectrum Disorder (ASD) is a persistent and debilitating condition accompanied by comorbid disorders.  Problems with comorbid psychopathology are prevalent in individuals with ASD, specifically anxiety (While et al., 2009). High-functioning children with ASD have higher levels of anxiety than typically developing individuals (American Psychiatric Association, 2013). Previous research found children with ASD who self-reported high levels of anxiety reported experiencing more loneliness (White & Roberson-Nay, 2009).

 Objectives: This study examined associations between intelligence, level of impairment, and symptoms of anxiety. Additionally, associations between observed behaviors (e.g., silence, questions asked) and parent- and self-report of symptoms were examined.

 Methods: Thirty-seven adolescents with ASD (78% male; 97% Caucasian) between the ages of 13- and 18-years-old (M=14.57, SD=1.37) were enrolled in a social skills intervention. Adolescents were assessed for verbal intelligence using the Kaufman Brief Intelligence Test, Second Edition (KBIT 2; M=104.03, SD=19.68). Parent-report of social impairment (Social Responsiveness Scale; SRS), adolescent-report of loneliness (Loneliness Questionnaire), and parent- and adolescent-report of psychopathology symptoms (Strengths and Difficulties Questionnaire; SDQ) were collected prior to the start of the intervention. Additionally, five-minute conversations between the participants and a same-age peer were collected prior to the intervention and were coded for seconds of silence and number of questions asked.

 Results: If a participant had a verbal intelligence equal to or below 92, higher SRS scores associated with less seconds of silence. Specifically, higher scores on social cognition (r= -.68, p< .05), social communication (r= -.65, p< .05), autistic mannerisms (r= -.78, p< .01), and the total SRS score (r= -.81, p< .01) were associated with less seconds of silence. Additionally, a higher parental report of overall psychopathology associated with less seconds of silence during the behavioral observation (r= -.60, p< .05).

 If a participant had a verbal intelligence in the average range (i.e., standard score between 93 and 112), higher SRS scores associated with less seconds of silence. Specifically, higher scores on social communication (r= -.63, p< .05), social motivation (r= -.66, p< .01), and the total SRS score (r= -.72, p< .01) were associated with less seconds of silence.

 Finally, if a participant had a verbal IQ in the high average range (i.e., standard score above 112), higher social motivation scores on the SRS associated with more seconds of silence (r= .62, p< .01). Additionally, for this group higher self-reported loneliness was associated with asking less questions (r= -.67, p< .01). Finally, higher parent-reported anxiety (r= .75, p< .01) and overall psychopathology (r= .84, p< .01) associated with more second of silence.

Conclusions: Anxiety is highly comorbid with ASD.  Cognitive level and ASD symptom severity may influence the presentation of anxiety symptoms.  In this sample, those with the highest IQ’s displayed the most overt signs of anxiety (silence during a social conversation) perhaps reflecting greater levels of insight into their challenges.  Those with lower IQ’s and greater ASD symptom severity demonstrated less overt symptoms of anxiety. This might reflect less self-awareness or less ability to regulate their behavior while anxious.