Social and Emotional Functioning in Autism and Anxiety: Participation in a Social Competence Intervention in a Private Clinical Setting

Background:  In the development of evidence-based intervention programs, efforts must be made to lessen the gap between clinical and research practice (Kazdin, 2008). Child research samples from controlled laboratory settings are not necessarily representative of populations typically receiving services in community settings. Indeed, research finds that youth treated in clinical service settings, as compared to youth treated in academic research settings, have greater diagnostic heterogeneity and greater severity of symptoms (Ehrenreich-May et al., 2011).  As a precursor to understanding the impact of psychotherapeutic interventions, it is essential to first understand the populations of children receiving such services in clinical settings. This need to better define youth receiving therapy is particularly acute in children with high functioning autism spectrum disorders (HFASD), given that they are frequently treated in community settings and present with prominent comorbidity, in particular anxiety disorders (AD; Leyfer et al., 2006).

Objectives: To understand manifestations of anxiety in children with HFASD (and in comparison to children with AD) in regard to social and emotional functioning in order to better predict outcomes of targeted interventions in clinical service settings.  

Methods:   14 children with HFASD (mean age, 10.96 years) and 23 children with AD (mean age, 10.31 years) with significant social impairments were treated in a large private practice with the Resilience Builder Program®, a manualized group therapy that targets social competence and resilience-based skills. Pre-treatment parent- and child-report included the Behavior Assessment System for Children, 2^ndEdition (BASC-2; Reynolds and Kamphaus 2006), which measured social, emotional and behavioral functioning, and The Social Skills Improvement System-Rating Scales (SSIS-RS; Gresham and Elliot, 2008), which measured social functioning. 

Results: HFASD and AD youth had comparable levels of child- and parent-reported anxiety symptomatology (t=-0.78, p=0.44 and t=-1.45, p=0.16 respectively), however, HFASD youth reported significantly greater social deficits than AD youth (t=2.12, p=0.04).  Child-reported anxiety symptoms were strongly related to child-reported social stress in both groups (HFASD: r = 0.66, p= 0.01; AD: r = 0.57, p < 0.01).  Finally, while child-reported social stress was associated with parent-reported emotion dysregulation in the HFASD group (r = -0.54, p= 0.04), there was no such relationship in the AD group (r = -0.24, p = 0.27).

Conclusions:   In this population of children presenting in a private practice for a resilience-based manualized group therapy, similar behavior profiles emerged between children with HFASD and AD in terms of anxiety and social stress. However, whereas greater social stress was associated with emotional regulation deficits in HFASD youth, AD youth did not display such a relationship.  These results suggest that emotion dysregulation may play a prominent role in the social distress seen in HFASD youth and thus is a worthy target of intervention. In order to lessen the gap between clinical and research practice, characterization of populations of children obtaining services in clinical settings is important in order to best tailor interventions to underlying maladaptive motivations and behaviors.