25 Mar


Social withdrawal and social skills deficits are common signs of autism spectrum disorder (ASD). But, are they also signs of a co-occurring anxiety disorder?

The most common form of anxiety is social anxiety, also known as social phobia. Signs of social phobia are fear or anxiety in relation to people (being near or having to interact with others); fear of judgment or criticism by others; dread and panic before certain situations and ruminating on the event afterwards, and physical symptoms such as shaking, nausea and increased heart rate.

Social anxiety often first appears in adolescence, when the young person becomes aware that their performance will have an impact on their ability to handle social relationships. Social anxiety can affect as many as 65% of teenagers with the high-functioning form of ASD.

Social anxiety can have reciprocal effects vis-à-vis social skills – poor social skills can lead to social anxiety, and conversely, social anxiety can lead to poor social skills.

Anxiety is not a central feature of ASD, is not necessarily life long, and does not affect the individual’s innate communication skills. It is a separate condition from ASD, but there can be similarities in behavioral outcomes – isolation, low self-esteem, and avoidance of social situations.

Anxiety has neurobiological and as well as psychological elements that can impact social and cognitive functioning. Professionals working with persons with ASD should check for the co-occurrence of anxiety. Parents’ and other family members’ help should be asked to detect the presence of any of the broad range of anxiety symptoms, including physical symptoms such as trembling hands and increased heart rate, or cognitive symptoms such as excessive fears and worry. Recognizing which specific anxiety symptoms are involved is important in order to design the specific type of treatment appropriate to the specific anxiety symptom.

Interventions for alleviating social skills deficits, a core feature in high functioning ASD, referred to as Asperger’s syndrome, should consider and assess the contribution of anxiety in the social difficulties of the patient.

Treatment options for anxiety include cognitive, behavioral, and psychopharmacological interventions.

Reference: Bellini, S (2004) Living in fear: Anxiety in adolescents with autism spectrum disorders. The Reporter, 9 (3), 1-2.

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