Ratings of Social Functioning and Participation in Employment and Postsecondary Education Among Adults with Autism and Schizophrenia

Background: Interpersonal skills are critical to success in meeting the demands of adulthood, including participation in continued education or employment. Social impairment is a core deficit of autism spectrum disorder (ASD) and an associated feature of schizophrenia (SZ) that may contribute to difficulties attaining successful adult outcomes. Adolescents with ASD tend to have more positively biased self-perception of their interpersonal self-efficacy than their typically developing peers, but little is known about the self-perception of adults with ASD. Findings regarding self-awareness among individuals with schizophrenia indicate that awareness of the illness along with minimal internalized stigma are related to improved social functioning. Thus, self-perception of one’s skills may be an important factor in predicting adult outcomes.

Objectives: This study aims to investigate: 1) the relationship between subjective self-perception of social functioning and clinician-rated levels of social functioning and 2) the relationship between these indicators and participation in postsecondary education and/or employment in adults with ASD, SZ, and typical controls.

Methods: The sample for this study comprises 18 adults with ASD (15 males, 3 females; Mean age=24.6), 18 individuals with schizophrenia (14 males, 4 females; Mean age=28.0) and 6 neurotypical adults (4 males, 2 females; Mean age=25.8); data collection is ongoing. The ASD and the SZ groups were matched on age and IQ (WASI-II FSIQ), and all three groups were matched on age and nonverbal IQ (WASI-II PRI). Subjective self-perception of social functioning was assessed using the Social Communication Interaction (SCI) Total score of the Social Responsiveness Scale- Second Edition – Adult Self-Report form (SRS-2). Clinician-rated levels of social functioning were measured using the ADOS-2, Module 4Social Affect Algorithm Total score. Information regarding school and employment status was obtained during the ADOS-2 assessment.

Results: Both ASD [F(1,22) = 7.05, p<.001] and SZ [F(1,22) = 6.08, p=.02] groups reported greater deficits in social interaction than typical controls. A negative correlation between self and clinician rating of functioning was observed in the ASD group [r = -.61, p=.007] but not the SZ group. Additionally, a significant relationship between self-perceived severity of social impairment and participation in school/employment was found for the SZ group [X²(3, N = 18) = 9.36, p<.05], such that decreased school/employment participation was associated with increased levels of self-reported social impairment. Self-reported social ability and school/employment outcomes were not associated for the ASD participants. No significant relationship between clinician ratings of social functioning and school/employment participation was observed in either group.

Conclusions: The present findings add to our understanding of self-perception and social functioning of adults with ASD and schizophrenia. While self-reported social impairment appears related to employment/school outcomes in individuals with SZ, no relationship was found for the ASD group suggesting that adults with ASD may have decreased insight into how their social impairment affects their employment/school outcomes.