Symptoms of Psychiatric Comorbidity and Social Functioning in Adolescents with ASD

Background:

Youth with autism spectrum disorders (ASD) frequently present with psychiatric comorbidities that can exacerbate existing social challenges, such as increased feelings of loneliness, dissatisfactory interpersonal relationships, and decreased social competence. Examining the relationship between psychiatric comorbidites and the social functioning of adolescents with ASD may guide the development of effective interventions.

Objectives:  

Investigate the relationship between symptoms of psychiatric disorders and social functioning in adolescents with ASD.

Methods:

Data were collected from an outpatient clinic sample of 76 adolescents with ASD (12-18 years old) and their parents referred for a parent-assisted social skills treatment. Baseline symptoms of attention-deficit/hyperactivity disorder (ADHD), depression, and social anxiety disorder (SAD) were obtained from parent- and adolescent self-report measures. ADHD symptoms were measured using the Swanson, Nolan, and Pelham-IV (SNAP-IV; parent-report), SAD from the Social Anxiety Scale-Adolescents (SAS-P; parent-report) and the Social Anxiety Scale-Adolescents (SAS-A; self-report), and depression based on the Children’s Depression Inventory (CDI; self-report). Social functioning was assessed using the Social Responsiveness Scale (SRS; parent-report),Social Skills Improvement System-Parent (SSIS-P), and Friendship Qualities Scale (FQS; self-report). Correlations between baseline psychiatric symptoms and social functioning were examined.

Results:  

Overall, symptoms of ADHD, SAD, and depression were associated with poorer social functioning. Inattention was related to impairments in overall social functioning [r (66) = .332, p < .01], such as social awareness [r (66) = .365, p < .01], social cognition [r (67) = .299, p < .05], more pronounced autistic mannerisms [r (66) = .324, p < .01],  and responsibility skills ([r (40) = -.384, p < .05]. Hyperactivity/impulsivity and oppositionality were associated with similar challenges, including impaired social awareness ([r (66) = .396, p < .01]. Inattention was related to better companionship quality [(r (69) = .248, p< .05].

Social anxiety was related to impairments in social functioning and some prosocial behaviors. Higher parent-reported social avoidance/distress to new situations/unfamiliar peers was related to greater overall social difficulties [r (68) = .373, p < .05]. Social avoidance/distress generally experienced with peers was associated with poorer companionship quality [r (67) = -.241, p < .05], overall social impairment [r (68) = .474, p < .01], and engagement skills [r (40) = -.397, p < .05]. Alternatively, greater symptoms were linked with better cooperation [r (40) = .481, p < .05] and responsibility skills [r (40) = .362, p < .05]. Adolescent-report of SAD indicated similar findings of less satisfactory friendship quality and poorer social skills, but greater social awareness [r (68) = -.315, p< .05].

Depressive symptoms were associated with less satisfactory friendship quality. Higher ratings were related to decreased self-reported companionship quality [r (67) = -.254, p < .05], peer conflict [r (68) = .255, p < .05], and helpfulness with friendships [r (67) = -.259, p < .05].

Conclusions:  

Comorbid symptoms of ADHD, anxiety, and depression were correlated with impaired social functioning and poorer friendship quality. Some aspects of anxiety were related to positive social behaviors. Further research exploring the connection between co-occuring psychiatric symptoms and social functioning in ASD is needed.