Social competence refers to effectively applying interpersonal skills to initiate and maintain positive social interactions.
Autism spectrum disorder and social anxiety disorder both involve deficits in social competence – difficulties perceiving social cues, interpreting others’ behaviors, adjusting one’s own verbal and nonverbal communication, or navigating group dynamics. These differences in social skills may increase anxiety surrounding social situations.
Stark, C., Groves, N. B., & Kofler, M. J. (2023). Is reduced social competence a mechanism linking elevated autism spectrum symptoms with increased risk for social anxiety?. British Journal of Clinical Psychology, 62(1), 129-145. https://doi.org/10.1111/bjc.12398
Key Points
- Elevated autism spectrum symptoms are associated with increased social anxiety symptoms, but the mechanism linking these symptoms is understudied.
- Findings from a large, clinically diverse sample indicate that reduced social competence accounts for approximately 20% of the shared variance between autism spectrum and social anxiety symptoms.
- These findings were robust to controls for mono-measure/informant bias, age, sex, SES, race/ethnicity, clinical comorbidities, and item overlap across measures.
- Improving social competence in children with elevated autism spectrum symptoms may reduce the risk for impairing social anxiety.
Rationale
Prior research shows that many children with autism spectrum disorder (ASD) develop comorbid social anxiety disorder, which is associated with poorer outcomes (Spain et al., 2018).
Both ASD and social anxiety involve difficulties with social competence and skills needed for successful social interactions.
However, it remains unclear whether reduced social competence explains the increased social anxiety risk associated with elevated autism symptoms (Chang et al., 2012).
Further, autism spectrum and social anxiety disorder symptoms likely exist along continuums in the general population rather than as discrete categorical diagnoses (Constantino & Todd, 2003; Fehm et al., 2008).
Given variability in social competence across the general population (Rose-Krasnor, 1997), social competence may link autism symptoms and social anxiety even among non-clinical groups. However, research on these relationships in non-clinical populations is limited.
Method
The study utilized a sample of 194 children ages 8-13 years (68 girls; 69% White/Non-Hispanic) with and without psychiatric disorders.
Multi-informant measures were collected, including child self-report, parent report, and teacher report on symptoms of autism spectrum disorder, social competence, and social anxiety. Variables were examined dimensionally rather than categorically.
Analyses tested a conditional process model to evaluate: (a) if elevated autism spectrum symptoms predicted reduced social competence and elevated social anxiety; and (b) if reduced social competence helped explain the autism-anxiety link.
Sample
- 194 children ages 8-13 years (M = 10.73 years)
- 68 girls (35.1%), 126 boys (64.9%) Majority White/Non-Hispanic (69.1%) 47.4% had at least one psychiatric diagnosis, 52.6% had no diagnosis
Statistical Analysis
A conditional process model was tested using bias-corrected bootstrapping procedures.
Autism spectrum symptoms, social competence, and social anxiety were treated dimensionally.
Parent-reported autism symptoms were modeled as the independent variable predicting (a) teacher-reported social competence and (b) child-reported social anxiety symptoms (the dependent variables). The indirect effect through social competence was tested.
Results
Elevated parent-reported autism spectrum symptoms predicted reduced teacher-reported social competence (β = -.21) and elevated child-reported social anxiety symptoms (β = .17).
The indirect pathway through reduced competence accounted for 20% of the autism-anxiety link (indirect β = .04). Reduced competence also independently predicted higher anxiety (β = -.16).
Insight
This study demonstrates that social competence is an important mechanism explaining increased anxiety among children with elevated autism traits, even after accounting for method biases and demographic factors.
The dimensional approach shows how this mechanism operates across the full range of autism and anxiety severity rather than only among clinical categories.
Strengths
- The use of multi-informant assessments (child self-report, parent-report, teacher-report) reduces issues with shared method variance that can artificially inflate correlations.
- Dimensional characterization of autism spectrum symptoms, social competence, and social anxiety provides a richer characterization of severity across the full continuum rather than discrete categorical diagnosis.
- The inclusion of both clinical (psychiatric diagnosis) and non-clinical participants enhances generalizability of findings across the range of functioning.
- Statistical controls for potentially confounding variables, including age, sex, socioeconomic status, race/ethnicity, and clinical comorbidities.
Limitations
- The cross-sectional study design precludes conclusions about temporal ordering or causal relationships between study variables.
- Limited generalizability due to predominantly White, non-Hispanic sample composition. Replication is needed in more diverse samples.
- Reliance on some subjective self-report measures from child participants may introduce biases related to insight or reporting accuracy.
- Teachers may have had limited exposure to observe or accurately rate children’s social competence relative to parents.
- Did not evaluate subdomains of social competence or potential bidirectional relationships.
Implications
- Improving social skill development through targeted, empirically-supported interventions could mitigate the risk of later onset of impairing social anxiety disorder among children presenting with elevated autism spectrum symptoms.
- Treatment planning and support for autistic children should be personalized and tailored based on dimensionally-assessed autism profiles rather than one-size-fits-all categorical diagnosis.
- Parent training programs focused on fostering social competence at home through modeling, shaping, and positive reinforcement hold promise for better outcomes.
- Universal screening for social skill delays and anxiety problems should be considered for integration into standard pediatric practice.
In schools, adapting curricula and teacher training practices to ensure an emphasis on explicit social skill instruction could have preventative and remedial effects for vulnerable children. This may have broader impacts on school climate and peer dynamics as well.
Other considerations
- Improving social skill development could mitigate anxiety but also risks promoting masking behaviors among autistic individuals to fit rigid societal expectations at the expense of authentic self-expression.
- Masking has been linked to several adverse outcomes, including depression, anxiety, burnout, and diminished well-being, so social skills training must emphasize acceptance rather than forced normalization.
- Interventions should focus on providing autistic youth agencies with the ability to use social skills flexibly across contexts rather than demanding rigid conformity or compliance.
- Working to increase social awareness, inclusion, and accommodation of neurological differences across education, workplace, and community settings may reduce distress and decrease the need for masking.
The goal should be supporting autistic individuals in developing greater social awareness and competence on their own terms, if desired, while fostering more accepting and inclusive environments that embrace neurological diversity.
Expecting social skills acquisition to rest solely with the autistic person risks further marginalization without dismantling broader barriers.
Conclusions
These findings demonstrate social competence deficits constitute a mechanism linking autism spectrum symptoms to increased risk for social anxiety in childhood.
The dimensional approach highlights how this process manifests across varying levels of symptom severity in the general population.
Longitudinal research is needed to clarify directional and causal pathways. Ultimately, supporting social skill development early on may prevent later anxiety difficulties.
References
Primary paper
Stark, C., Groves, N. B., & Kofler, M. J. (2023). Is reduced social competence a mechanism linking elevated autism spectrum symptoms with increased risk for social anxiety?. British Journal of Clinical Psychology, 62(1), 129-145. https://doi.org/10.1111/bjc.12398
Other references
Chang, Y. C., Quan, J., & Wood, J. J. (2012). Effects of anxiety disorder severity on social functioning in children with autism spectrum disorders. Journal of Developmental and Physical Disabilities, 24(3), 235–245. https://doi.org/10.1007/s10882-012-9268-2
Constantino, J.N., & Todd, R.D. (2003). Autistic traits in the general population: A twin study. Archives of General Psychiatry, 60(5), 524–530. https://doi.org/10.1001/archpsyc.60.5.524
Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: Prevalence, comorbidity and impairment in the general population. Social Psychiatry and Psychiatric Epidemiology, 43(4), 257–265. https://doi.org/10.1007/s00127-007-0299-4
Robinson, E. B., Koenen, K. C., McCormick, M. C., Munir, K., Hallett, V., Happé, F., Plomin, R., & Ronald, A. (2011). Evidence that autistic traits show the same etiology in the general population and at the quantitative extremes (5%, 2.5%, and 1%). Archives of General Psychiatry, 68(11), 1113–1121. https://doi.org/10.1001/archgenpsychiatry.2011.119
Rose-Krasnor, L. (1997). The nature of social competence: A theoretical review. Social Development, 6(1), 111-135. https://doi.org/10.1111/j.1467-9507.1997.tb00097.x
Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018). Social anxiety in autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 52, 51–68. https://doi.org/10.1016/j.rasd.2018.04.007
Learning Check
- How might we design interventions or educational curricula to improve social competence among children with elevated autism spectrum symptoms? What key social skills should be targeted?
- What are some reasons why social anxiety tends to emerge later in development compared to the early onset of autism spectrum symptoms? How might trajectories differ across various autism subtypes?
- In what ways might social competence influence functional outcomes for autistic individuals across various life stages, including transitions to adulthood, employment, independent living, and relationships?
- What role might other mechanisms such as emotion regulation, sensory sensitivities, or intolerance of uncertainty play in the autism-anxiety link? How could we test the relative contribution of these additional factors?
- How might we adapt psychotherapies and educational supports for autistic children to better promote social skill development and prevent later mental health problems like social anxiety? What key treatment elements could be incorporated?
