Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis.

Abstract

Co-occurring anxiety in children on the autism spectrum is associated with greater social challenges, including poorer social skills and relationships, which may influence the severity and presentation of anxiety symptoms, particularly social anxiety. The current study used Bayesian network analytics (Williams & Mulder, 2020) and a multimethod approach to examine (a) how different facets of social functioning relate to one another and to anxiety severity and comorbidity, (b) which facet(s) are most influential and thus may represent optimal targets for intervention, and (c) how social functioning relates to the presentation of social fears in a large treatment-seeking sample of autistic children with anxiety disorders (n = 191, 7-13 years). Results indicated strong associations among measures of social ability (i.e., theory of mind [ToM], social motivation, friendship attainment) and among measures of social integration (i.e., bullying, interpersonal and peer difficulties), with only bullying demonstrating a significant association with anxiety. ToM was the most interconnected variable in the network, and social motivation demonstrated the strongest individual connections with other variables, particularly with other facets of social ability. Socially anxious children with impaired ToM were less likely to express fears of negative evaluation, resulting in a distinct diagnostic presentation of social fears. Findings suggest that social motivation and ToM may represent important targets for intervention for autistic children with co-occurring anxiety. Further, social-cognitive difficulties associated with autism, like ToM, may play a role in distinct manifestations of anxiety in these youth. General Scientific SummaryAutistic children with co-occurring anxiety disorders tend to experience significant difficulties with social skills (e.g., perspective taking, social communication) and interpersonal relationships (e.g., friendships, bullying), and those social difficulties may in turn influence how anxiety, particularly social anxiety, is expressed in these youth. This study demonstrates that autistic children with difficulties in one area of social well-being are likely to have difficulties across many other, related areas of social well-being; in particular, children with more limited perspective-taking ability and/or less interest in social interaction are likely to have fewer reciprocal friendships and greater difficulty with social communication. Findings also suggest that differences in perspective-taking ability might explain a unique presentation of social anxiety in autistic individuals, whereby socially anxious children who have more difficulty understanding the thoughts, feelings, and intentions of others might become anxious due to confusion and uncertainty in social situations rather than fear of being judged (the key criteria for a diagnosis of social anxiety disorder).

Anxiety in autistic preschool children: Phenomenology and a network analysis of correlates

“…Other social fear, a distinct anxiety presentation, was the second most common anxiety presentation observed. This finding may reflect an evolving social anxiety disorder in children who are not yet able to articulate fears of social ridicule or a distinct type of social fear that manifests in children with more limited social awareness or theory of mind abilities, which may persist as observed in a prior study of school‐age autistic youth (Hunsche et al, 2022). We also found that generalized anxiety disorder, a disorder characterized by chronic worry, manifested in children without ID, which suggests that some autistic preschool children can hold cognitive representations of threat, which are foundational for the development of worry (Broeren & Muris, 2009).…”

Autism severity and its relationship to disability

“…For instance, both social-communication deficits as well as anxiety and depression can lead to impaired social functioning and social withdrawal (Duvekot et al, 2018;Hunsche et al, 2022). This makes it difficult to distinguish which condition is the cause for behaviors such as social isolation and avoidance.…”

The Selective Social Attention task in children with autism spectrum disorder: Results from the Autism Biomarkers Consortium for Clinical Trials (ABC‐CT) feasibility study

“…Second, the stimulus could be perceived by some individuals as infantilizing and, given high prevalence rates of co‐occurring psychiatric conditions (including disruptive behaviors) in 6‐to‐12‐year‐old children with ASD (de Bruin et al, 2007; Gadow et al, 2005; Kaat & Lecavalier, 2013), could lead to non‐compliance or off‐task behaviors impacting data acquisition. Third, and relatedly, some children with ASD exhibit social‐evaluative fears, especially when they possess higher IQ or intact Theory of Mind skills (Hunsche et al, 2022; Pugliese et al, 2013). Concerns regarding viewing of video content perceived as developmentally juvenile relative their current age, especially in the presence of strangers, could lead to challenging or avoidant behaviors leading to lost data.…”