The Influence of Psychiatric Diagnoses upon Social Engagement, Social Skills, Problem Behaviors, and Loneliness Among Young Adults

Background: Research suggests psychiatric disorders are common in those with autism spectrum disorder (ASD), with some estimates revealing 70% of individuals with ASD have at least one comorbid diagnosis, and 41% have two or more (Simonoff 2008). These comorbidities often include attention-deficit/hyperactivity disorder (ADHD) (30-50%) and anxiety disorders (25-55%) (Leyfer 2006). While many of these individuals experience impaired social functioning as a consequence of their disorders, including poor social engagement, problem behaviors, and loneliness, little is known about the differences in symptom profile across these diagnostic groups.

Objectives: This study examines the influence of psychiatric diagnoses upon social engagement, social skills, problem behaviors, and loneliness among young adults with ASD, ADHD, and/or anxiety.

Methods: Participants included 165 young adults (74.5% male; mean age=22.44; SD=3.88) with ASD, ADHD, anxiety, or no diagnosis, presenting for social skills treatment through the UCLA PEERS® Clinic. 80 participants met clinical criteria for ASD and anxiety (ASD+ANX; 48.5%), 27 for ASD, anxiety, and ADHD (ASD+ANX+ADHD; 16.4%), 6 for ASD and ADHD (ASD+ADHD; 3.6%), 23 for ASD with no comorbidities (ASD; 13.9%), 20 for anxiety with no comorbidities (ANX; 12.1%), and 9 who did not meet clinical criteria for a developmental or psychiatric condition (NO DX; 5.5%). Diagnoses were assessed using caregiver-reports on the Social Responsiveness Scale-Second Edition (SRS-2; Constantino 2012) for ASD, the Swanson, Nolan, and Pelham Questionnaire-4th Edition (SNAP-IV; Bussing 2008) for ADHD, and the Social Anxiety Scale (SAS; La Greca 1999) for anxiety. Young adults completed the Social Skills Improvement System (SSIS; Gresham 2008) to measure overall social skills and problem behaviors, Quality of Socialization Questionnaire (QSQ; Laugeson 2010) to assess frequency of social engagement, and Social and Emotional Loneliness Scale for Adults (SELSA; DiTommaso 1993) to measure social loneliness and overall loneliness.

Results: One-way ANOVAs and post-hoc Tukey Tests revealed significant differences between groups related to social skills [F(5, 153)=17.11, p=.01] on the SSIS, suggesting that participants with ASD+ANX and ASD+ANX+ADHD demonstrate the greatest impairment in overall social skills across the six groups. Analyses further revealed significant differences between these two groups related to problem behaviors [F(5,155)=13.23, p=.01] on the SSIS, revealing that those with ASD+ANX and ASD+ANX+ADHD exhibit the highest levels of problem behaviors. Interestingly, Tukey Tests revealed young adults with ASD+ADHD presented with average levels of social skills, but the highest levels of problem behaviors (p=.01). Participants with ASD and no comorbidities presented with average levels of social skills and the lowest levels of problem behaviors, while those with anxiety only and those with no diagnosis presented with the least impairment in social skills and problem behaviors (p=.01). No significant differences were observed between groups related to social loneliness [F(5,146)=2.43, p=.04] and overall loneliness [F(5,145)=2.22, p=.05] on the SELSA, or frequency of social engagement [F(5,147)=.83, p=.53] on the QSQ.

Conclusions: Results suggest that diagnostic groups significantly differ in levels of social skills and problem behaviors, with individuals with ASD and comorbid anxiety (sometimes in combination with ADHD) having the poorest social profile. These findings may provide useful information for delivering targeted interventions with these vulnerable populations.