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Autistic people are more likely to experience social anxiety than non-autistic people.
The difference might be because some behaviours linked to social anxiety disorder (such as avoidance of a social situation due to fear or anxiety) overlap with the social features of autism (such as avoidance of a social situation due to the overwhelming demands of the sensory environment).
Therefore, measurement of social anxiety in autistic people is fraught with difficulty. Our researchers were part of a team that evaluated one way of measuring a person’s social anxiety, the Severity Measure for Social Anxiety Disorder.
Their results have been published in journal Autism. Access the article.
This is the first ever study to ask autistic adults directly how they understood questions used in the Measure. The results reveal there is more work to do to make sure measures of social anxiety work well for autistic people.
We asked lead researcher Simon Brett to tell us more about the research.
What is the Severity Measure for Social Anxiety Disorder?
The Severity Measure for Social Anxiety Disorder is a self-report questionnaire used by health professionals to assess the severity of a person’s social anxiety.
The Measure presents people with 10 questions relating to social situations covering thoughts, feelings, behaviours, and physical sensations.
People are asked to rate how frequently these different experiences occurred over the preceding week. For example, people are asked how frequently over the last 7 days they left social situations early, or participated only minimally (eg said little, avoided eye contact).
The Measure is an important tool for diagnosing a person’s levels of social anxiety, and whether treatment may be needed.
What did you do in your research?
We evaluated how well the Severity Measure for Social Anxiety Disorder gauges social anxiety in autistic adults.
We asked 284 autistic adults and 80 non-autistic adults to complete the questionnaire.
We then selected 5 of the questions that were possibly ambiguous, in that they asked about things that could be characteristics of autism rather than social anxiety.
The five questions chosen for follow-up were evaluated by an advisory panel made up of autistic people for their suitability.
We then asked all 284 autistic adults and 80 non-autistic adults their responses to these five ambiguous questions were due to fear or anxiety, or if there was some other reason.
What did you find?
We found that for non-autistic participants, the questionnaire reliably measured social anxiety.
This was not the case for our autistic participants. Instead, we found that for over half our sample of autistic adults, they attributed their answer on at least one question to something other than anxiety.
The most common reason other than anxiety given by autistic participants for their responses to questions related to ‘fatigue’. Other reasons included ‘sensory overwhelm’ and ‘masking’.
We tried adapting the measure based on the inaccuracies revealed by participant responses. However, our adaptations did not improve the accuracy of the measurement for autistic adults.
What are the implications of your findings?
Our findings suggest that the Severity Measure for Social Anxiety Disorder isn’t an accurate measure of social anxiety for autistic adults because it measures factors that could be due to autistic characteristics, rather than a measure of social anxiety.
These results suggest we may need to look beyond measurement based on the neurotypical conceptualisation of social anxiety: these measures fail to capture the nuance and complexity of social anxiety for autistic people.
What are your hopes for the future?
We hope our findings highlight the importance of asking autistic people about their symptoms of social anxiety to assess them more accurately.
Our research also suggests that adapting existing questionnaires for use with the autistic population may be of limited value.
We hope that the contributions from the autistic people in our study can serve as building blocks for developing new, autism-specific measures of social anxiety in collaboration with the autistic community.
