Guest post by Emily Ansell Elfer, BA Hons, Dip.
It is well-known that many people on the autism spectrum experience symptoms of anxiety, especially around social situations and communication. In fact, previous research has demonstrated a significant overlap between symptoms of social anxiety disorder (SAD) and autism spectrum disorder (ASD). A large proportion of individuals with ASD also fulfill the criteria for SAD. Similarly, studies suggest elevated autistic traits are prevalent in individuals diagnosed with SAD.
What is social anxiety disorder?
Social anxiety disorder (SAD) is a psychiatric disorder characterized by intense fear of being scrutinized and negatively evaluated by others and excessive avoidance of social interaction.
Dr. Rachel Bédard, PhD, a licensed psychologist, further explains: “Social anxiety is viewed as an excessive level of fear or anxiety to social situations, including talking in class, talking in front of an audience, or attending social gatherings. Fears include making social mistakes, making blunders, embarrassing themselves or others, etc. Individuals with social anxiety tend to either suffer through the event (‘white knuckling life’) or find a friend/family/member/peer to lean on for support.”
Dr. Bedard says people with social anxiety are genuinely suffering, and the level of anxiety is quite high. There are a variety of treatment options to support people with SAD, including medications to lessen the anxiety, as well as talk therapy interventions.
“I tend to rely on Cognitive Behavioral Therapy (CBT), which includes looking at how a person talks to themselves about life/circumstances/success-failure, and how the person behaves in the world,” she adds. “We create mini-experiments to challenge the beliefs that the anxiety is warranted, and create a pathway to collect the data showing that the person can handle social events. A sense of humor is helpful when engaging in this type of therapy.”
What is autism spectrum disorder?
So, what exactly is autism spectrum disorder and how does it play out in the context of social skills?
These are Dr. Bedard’s top tips for defining autism spectrum disorder, although she emphasizes that ASD is complex and no definitive statements can be made about the autism experience:
- We know that from infancy people with ASD scan the environment for different data, code the data differently, and draw different conclusions than folks without ASD.
- We know that those on the spectrum tend to have high levels of loyalty, attachment, and strong feelings. They generally want to have friends, but aren’t always certain how to accomplish that goal.
- Diagnostically, ASD is linked with sensory differences, difficulties in the social realm, difficulty making friends. Practically, how these differences play out vary by person, by level of support, and by their personal level of stress/anxiety.
People on the autism spectrum often have high levels of anxiety, including social anxiety, but this is only one part of autism and ASD can present itself in different ways in different people—hence why it is called the autism spectrum.
Treatment and therapies for ASD can include:
- Treating co-occurring conditions such as anxiety, depression, and ADHD. These treatments can include medication.
- Treating sensory concerns via Occupational Therapy
- Talk therapy to lower stress, develop new strategies, referrals to other professionals
- Educational supports
- Access to a speech-language therapist
- One of the most important interventions is empathy and support from others, and a desire on the part of others to actually understand what is going on for the person with ASD, and to identify paths to that person’s version of success
Similarities between ASD and social anxiety disorder
It is clear from the above that social anxiety can often play a part in the life of someone on the autism spectrum.
Another psychologist specializing in autism, Dr. Debra Moore, PhD commented: “More than 30 studies of autistic children under the age of 18 found almost 40% had at least one associated anxiety disorder. Nearly 30% of them qualified for a diagnosis of social phobia, and 16.6% meet criteria for social anxiety disorder.”
The symptomatic overlap between ASD and SAD is mainly found in areas of social interaction and social skills, whereas restricted and repetitive behaviors and atypical social cognition may be unique to ASD. Learning disabilities and language impairments are prevalent in a large proportion of children and adolescents with ASD, but are typically not seen in SAD. Finally, social anxiety is more likely in older, high-functioning children and adolescents with ASD, suggesting that increased awareness of social difficulties may be a contributing factor.
Recognizing anxiety in people on the spectrum and offering support
Dr. Bedard has commented she is yet to meet a person on the autism spectrum who doesn’t have a high level of anxiety.
“We believe that folks with ASD are physiologically stressed and overwhelmed on a daily basis. Recognizing anxiety as a biological manifestation of ASD is often helpful (rather than as a person’s shortcoming or flaw),” she says.
“It is imperative that folks who treat, live with, and love folks with ASD recognize anxiety, and specifically recognize the ‘tells’ that their person demonstrates.”
Dr. Moore adds: “Anxiety can be caused/triggered by genetics, the environment (bullying, sensory assault, communication struggles, etc.), or it can be secondary to other conditions (depression or medical conditions associated with autism). A key sign of anxiety is changes in behavior.”
Changes in behavior might include withdrawing, repeating questions or topics, asking for reassurance, frequently saying “no,” trembling, fidgeting, sweating, crying, rocking, self-injury, and so much more.
Treatment can include many of the following elements:
- A daily routine
- Daily interventions to lessen stress, including exercise, deep breathing, adequate sleep, good nutrition, appropriate social contacts, alone time, time engaged in meaningful activities
- Identifying anxiety triggers and having a plan (preferably written) to manage stress and anxiety
- Companionship, including animals
- CBT therapy for self-regulation
- Mindfulness approaches
- Physical movement/activity approaches
Many people on the autism spectrum experience some form of social anxiety, and some people with an ASD diagnosis also have a diagnosis of SAD. However, it is important to note that the two conditions are not the same and there are differences in their symptoms.
As a parent, caregiver, or friend to anyone on the autism spectrum experiencing social anxiety, the most important thing to do is to show patience and support—and always seek the advice of a medical professional if you are concerned about your loved-one’s safety and wellbeing.
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