Are Social and Communication Difficulties a Risk Factor for the Development of Social Anxiety?

Background:  Social Anxiety (SA) disorder is elevated in Autism Spectrum Disorder (ASD), a neurodevelopmental condition characterised by social and communication (SC) difficulties. In typically developing children, greater SC difficulties are commonly associated with heightened SA symptoms, both at a clinical and subclinical level. Whether SC difficulties place children at an increased risk of developing SA is unclear.

Objectives: Using a longitudinal design, this study aimed to disentangle the relationship between SC difficulties associated with ASD and SA symptoms in a population-based sample of children from the Avon Longitudinal Study of Parents and Children (ALSPAC).

Methods: Parent-reported data (n=9,491) on SC difficulties and SA symptoms was collected at age 7, 10 and 13. A cross-lagged panel design explored the stability and predictive relationship between latent SC difficulties and SA constructs over time. The specificity of these relationships was examined whilst controlling for generalised anxiety at all ages. Model comparisons were conducted to explore sex differences in these relationships.

Results: A significant relationship was observed between SA symptoms and SC difficulties at all ages. Earlier SC difficulties (age 7/10) predicted a significant amount of variance in later SA symptoms (age 10/13), but the reverse relationship from SA to SC difficulties was not observed. The relationship from SC difficulties to SA was strongest from 7 to 10 years old. The specificity analyses controlling for generalised anxiety revealed an identical pattern of results, with SC difficulties predicting SA, but not the reverse relationship. No sex differences in the directional relationships between SC difficulties and SA were observed.

Conclusions: The results indicate a directional and asymmetrical relationship with SC difficulties associated with ASD in mid-childhood predicting SA symptoms in late childhood. This suggests that SC difficulties may be an important and specific risk factor for the development of SA. A stronger contribution of SC difficulties to SA symptoms was observed in earlier childhood, suggesting that this may be a critical developmental period to target with earlier interventions. These findings indicate the importance of incorporating social skills training alongside effective interventions to alleviate symptoms of SA in children, as well as developing preventative approaches to foster SC development in those at a greater risk of developing clinical SA.