Peer-Reported Social Distance in Response to DSM-5 Symptomatology

Background: In their Reciprocal Effects Peer Interaction Model, Humphrey and Symes (2011) suggest two causal pathways for poor relationships between individuals with Autism Spectrum Disorder (ASD) and their peers: (1) social communication difficulties in individuals with ASD and (2) a limited understanding and acceptance of those difficulties among peers. While clinical interventions have been designed to address both causal pathways (e.g., social skills interventions, peer knowledge interventions), such interventions may be more efficacious if they target those clinical symptoms most disruptive to peer relationships.

Objectives: The aim of this exploratory study was to examine peer reports of social distance in response to autistic symptomatology and symptomatology consistent with other clinical diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013).

Methods: 226 undergraduate students completed a revised version of the Social Distance Scale (Gillespie-Lynch et al., 2015). Across 34 clinical symptoms, participants responded to five Likert-scale questions indicating their willingness to interact with (e.g., “move next door to”, “date or marry”) a person with that clinical symptom. Sixteen symptoms represented the DSM-5 diagnostic criteria for ASD, with 2-3 symptoms indexing each of the core diagnostic components (social-emotional reciprocity deficits, nonverbal communication deficits, relationship difficulties, stereotyped behaviors, insistence on sameness, restricted interests, sensory sensitivity; American Psychiatric Association, 2013). Eighteen symptoms represented the diagnostic criteria for other clinical diagnoses (oppositional defiant disorder, generalized anxiety disorder, major depressive disorder, attention deficit hyperactivity disorder, anorexia nervosa, specific learning disorder). Two repeated-measures ANOVAs were conducted to determine whether peer-reported social distance varied across (1) clinical diagnoses and (2) core diagnostic components of ASD. The Bonferroni correction was used for all post hoc pairwise comparisons.

Results: Peers significantly differed in their desire for social distance across the clinical diagnoses, F(6, 1350) = 297.70, p < 0.01, η²_p = 0.57. Among the seven diagnoses, peers were most reluctant to interact with others who showed symptoms of oppositional defiant disorder and second most reluctant to interact with others showing symptoms of ASD or generalized anxiety disorder (Figure 1). Peers also significantly differed in their desire for social distance across the core diagnostic components of ASD, F(6, 1350) = 28.30, p < 0.01, η²_p = 0.11. Peers were least willing to interact with others with deficits in social-emotional reciprocity or an insistence on sameness (Figure 2).

Conclusions: Peers modified their willingness to interact with others, depending on the specific autistic or clinical symptoms exhibited. ASD was among the top three clinical diagnoses that yielded the greatest social distance scores from peers. Across the autistic symptoms, peers responded most negatively to others with deficits in social-emotional reciprocity (e.g., initiating social interactions, sharing emotions) and insistence on sameness (e.g., difficulty adapting to change). As these autistic symptoms may be most disruptive to peer relationships, interventions that target these symptoms, both those that strengthen social-emotional reciprocity and cognitive flexibility in individuals with ASD and those that increase awareness and understanding of these symptoms in peers, may be most efficacious.