Behavioral Indicators of Social Fear in Preschool-Aged Children with ASD and Siblings of Children with ASD

Background: Social anxiety is one of the most common comorbidities of autism spectrum disorder (ASD), with at least 20% of children with ASD meeting diagnostic criteria for social anxiety disorder (for review, see White et al., 2009). Though there is some evidence that social anxiety develops in early childhood in both typically developing children and children with ASD (Davis et al., 2011), very few studies have sought to characterize early behavioral indicators of social anxiety in young children with ASD. Because elevated symptoms of social anxiety are associated with poorer social and academic outcomes in ASD as well as typical populations, identifying early behavioral indicators of social anxiety (e.g., social fear) is of critical importance for early treatment of anxiety symptoms and optimization of outcomes. This study examined social fear in preschool-aged children with ASD and typically developing controls.

Objectives:   To examine social fear in preschool-aged children with ASD and younger siblings of individuals with ASD, contrasted with typically developing controls.

Methods: The study included 75 children (24 ASD, 10 siblings without ASD, and 41 TD), aged 23 to 70 months. The Stranger Approach epoch of the Laboratory Temperament Assessment Battery (Lab-TAB; Goldsmith & Rothbart, 1996) was used to elicit behavioral indicators of social fear (e.g., gaze). ASD symptoms were assessed concurrently using the Autism Diagnostic Observation Scale - 2 (ADOS-2) and/or the Childhood Autism Rating Scale (CARS). Results include the first videos coded (24 ASD and 41 TD).

Results: Preliminary results indicated that groups differed on avoidant gaze (i.e., averting gaze away from the stranger), p < .05. More specifically, children with ASD demonstrated more avoidant gaze relative to TD controls. ASD symptom severity, as measured by the CARS, was correlated with proportion of time looking away from the stranger, r = .33, p< .01. In sum, findings suggest that early behavioral signs of social anxiety are present at elevated levels in children with ASD by the time they reach preschool age. These data are being extended by inclusion of additional participants, a high-risk sibling group, and integration of the ADOS-2.

Conclusions: Findings suggest that early behavioral signs of social anxiety (e.g. avoidant gaze behavior when approached by a stranger) are present at elevated levels in children with ASD by the time they reach preschool age.