Social anxiety in adults with autism: a qualitative study

ABSTRACT

Purpose

Many individuals with autism experience social anxiety (SA), yet, to date, this has almost exclusively been investigated using quantitative research methods. We know very little about why individuals with autism perceive they develop SA, what they view the impact and consequences of symptoms to be, and which coping strategies they find helpful.

Methods

Using a qualitative study design, six men with autism (aged 23–52 years old) participated in individual semi-structured interviews. Data were transcribed verbatim and analysed using thematic analysis.

Results

Seven overarching themes were identified: (1) causal influences for SA; (2) anxiety-provoking social situations; (3) symptoms of SA; (4) chronicity; (5) coping; (6) impact; and (7) interventions.

Conclusions

Further studies are needed to more fully establish why individuals with autism are vulnerable to developing SA, to inform development of targeted interventions.

KEYWORDS:

• Autism
• adults
• social anxiety
• social phobia
• qualitative study

Acknowledgments

DS was funded by a National Institute for Health Research (NIHR) Clinical Doctoral Research Fellowship between 2013 and 2018 (CDRF–2012–03-059). DS was previously part funded (2019) and FH is currently part funded by the NIHR Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust and King’s College London. This paper presents independent research funded by the NIHR. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Disclosure statement

There are no potential conflicts of interest reported.

Additional information

Funding

This work was supported by the NIHR and BRC.

Notes on contributors

Debbie Spain

Dr. Debbie Spain is a Cognitive Behaviour Therapist and Consultant Nurse, working in independent practice, and also in honorary clinical-academic posts at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London and in the NHS. She has worked clinically with adults with autism for 20 years in inpatient and outpatient settings. Her research interests include examining contributory mechanisms for mental health conditions in adults with autism and developing adapted psychological interventions for core and co-occurring symptoms. She has contributed to 70+ publications and co-edited A Clinician’s Guide to Mental Health Conditions in Adults with Autism Spectrum Disorders: Assessment and Interventions (with Eddie Chaplin and Jane McCarthy), published in 2019.

Esra Zıvralı Yarar

Dr. Esra Zıvralı Yarar is Assistant Professor at the Department of Psychology, Social Sciences University of Ankara. She is also Vice Dean of the Faculty of Humanities and Social Sciences. She completed her PhD at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London. She was also an honorary researcher at the Behavioural Genetics Clinic, Maudsley Hospital. Her research interests include mental health conditions in adults with and without autism. She is a supervisor at an Autism School in Ankara, Turkey and works with children, adolescents and adults with autism and their families. She has contributed to a number of publications about varied topics, including autism, ageing, mental health, suicide and health psychology.

Francesca Happé

Professor Francesca Happé is Professor of Cognitive Neuroscience at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London. Her research focuses on autism. She has explored social cognition and ‘mentalising’ difficulties. She is also actively engaged in studies of abilities and assets in autism, and their relation to detail-focused cognitive style. Some of her recent work focuses on mental health on the autism spectrum, and under-researched groups including women and the elderly. She is a Fellow of the British Academy and the Academy of Medical Sciences, a former President of the International Society for Autism Research, and has received the British Psychological Society (BPS) Spearman Medal, Experimental Psychology Society Prize, Royal Society Rosalind Franklin Award and, in 2019, the BPS President’s Award. She is co-author/editor of two recent books - Autism: A New Introduction to Psychological Theory and Debate (with Sue Fletcher-Watson), and Girls and Autism: Educational, Family and Personal Perspectives (with Barry Carpenter and Jo Egerton).