The Impact of Social Skills Development on Fear of Negative Evaluation and the Prediction of Positive Mental Health Outcomes Among Adolescents with ASD

Background:  Fear of negative evaluation (FNE) is defined as a fearfulness of being viewed poorly by others (Winton, Clark, & Edelmann, 1995). FNE often results in hypervigilance during and avoidance of social situations (Mogg, Bradley, De Bono, & Painter, 1997; Wieser, Pauli, Weyers, Alpers, & Mühlberger, 2009). Although this pattern is most common among individuals with social anxiety, research suggests that social anxiety and autism spectrum disorder (ASD) often co-occur, and therefore vigilance-avoidance merits examination in ASD (Bellini, 2004, 2006; Kuusikko et al., 2008). Specifically, research demonstrates that social skills deficits in ASD may significantly influence the development of a fearful response in social situations for these individuals (Bellini, 2003).

Objectives:  The primary objectives of this study were to examine if self-report of FNE symptoms significantly decreased over the course of an empirically validated social skills intervention and whether such changes were predictive of improved mental health.

Methods:  Seventy-two adolescents (N = 72; 10 female) between the ages of 11 and 16 with high-functioning ASD participated in this study. Participants included in this analysis represent those in the experimental treatment group from a randomized controlled trial. Adolescents received the Program for the Education and Enrichment of Relational Skills (PEERS^®), a 14-week social skills intervention demonstrated to be effective at improving social competence among teens with ASD (Laugeson, Frankel, Mogil, & Dillon, 2009). Adolescents completed the Social Anxiety Scale (SAS; La Greca, Dandes, Wick, Shaw, & Stone, 1988), the Social Interaction Anxiety Scale (SIAS; Mattick & Clarke, 1998), and the Short Mood and Feelings Questionnaire (SMFQ; Sharp, Goodyer, & Croudace, 2006) at pre-test, post-test, and six months following post-test.

Results:  Participants demonstrated a significant decrease in their self-report of FNE (SAS-FNE) from pre-test to six-month follow up (F(2, 78) = 7.83, p = .001, partial η² = .167). Furthermore, scores on the SAS-FNE were significantly correlated with lower scores on the SIAS (r(38) = .36, p = .022) and SMFQ (r(20) = -.538, p = .010) at six-months follow up.

Conclusions:  Results suggest that, with the improvement of social skills, adolescents with ASD demonstrate significant declines in symptoms of FNE. These declines are demonstrated, not only from pre- to post-intervention, but also six-months after the treatment period ends. In addition, these improvements predicted lower levels of overall social anxiety and decreased depressive symptoms at six-month follow up. This is consistent with existing literature on social anxiety and ASD that describes a cycle of fear and avoidance that results in a lack of development of social skills which only perpetuates fear and avoidance of social stimuli (Bellini, 2006). This is the first study, to our knowledge, to provide empirical support for the development and maintenance of social skills as functioning to break this cycle and promote lower social anxiety and depressive symptoms among adolescents with ASD.