In autism, social difficulties may set the stage for anxiety

Poor social skills are a risk factor for social anxiety, but the reverse — anxiety foreshadowing social problems — is not necessarily true, according to a large new analysis of typical children¹.

The study has implications for understanding social anxiety, which is common in people with autism. It suggests that treatments for social anxiety must include building social skills. Poor social skills are a core feature of autism.

Social anxiety is a defined as an intense fear of either specific social situations, such as public speaking, or of social interactions in general. Apart from individuals with autism, typical individuals who score high on measures of autism traits also tend to feel anxious about social situations.

But it has been unclear whether social difficulties cause social anxiety or the reverse. For example, social anxiety could lead to a decline in social skills by causing people to shy away from social interactions.

The new results are “quite supportive of the idea that the autistic traits came first,” says William Mandy, senior lecturer in clinical psychology at University College London, who co-led the study.

Longitudinal clues:

Mandy and his colleagues analyzed data from 9,491 children enrolled in the Avon Longitudinal Study of Parents and Children, a long-term study of children born in southwestern England in 1991 and 1992. Mothers filled out questionnaires about their children’s social communication skills and anxiety symptoms at ages 7, 10 and 13.

Mandy’s team found that problems with social interactions predict social anxiety: Children with relatively poor social skills at age 7 had more social anxiety symptoms at age 10. And those with poor social communication at age 10 tend to have more anxiety about social situations at age 13. But social anxiety symptoms do not predict poor social communication skills later on.

Poor social skills contribute to social anxiety in both boys and girls, who are equally represented in the study. The relationship is specific to social anxiety. The researchers found no evidence that children with poor social skills are more anxious in general.

The findings provide “pretty clear evidence” that poor social skills lead to social anxiety but not the other way around, says Susan White, co-director of the Virginia Tech Autism Clinic in Blacksburg, Virginia, who was not involved in the work. “It’s the first time we’ve had longitudinal evidence to demonstrate it’s not just reciprocity, it’s directionality,” she says.

Distinct difficulties:

Because the analysis does not distinguish between children with and without an autism diagnosis, scientists must confirm that social deficits cause social anxiety even in people with autism.

The researchers also addressed a concern of many scientists: that having autism inflates scores on tests of social anxiety. For instance, people with autism often avoid social situations, which could result from indifference rather than social anxiety.

The researchers found evidence that this is not the case. Instead, the pattern of replies to items on the questionnaires suggests that social communication difficulties and anxiety are distinct problems.

This indicates that scientists should not dismiss social anxiety in people with autism, Mandy says. “I think we need to take the notion of social anxiety in autism very seriously,” he says.

Overall, the study adds to mounting evidence that mild autism traits can pose challenges even when people do not meet diagnostic criteria for the condition, Mandy says. He and his colleagues are studying how autism traits up the risk for social anxiety. Eventually, this knowledge could lead to better therapies for social anxiety.