Autism spectrum disorder (ASD) and social anxiety disorder (SAD) are often difficult to distinguish in individuals.
One reason they are sometimes confused is that some symptoms appear the same.
While both can result in difficulty navigating social situations, social anxiety stems from fear of negative evaluation, whereas autism involves innate differences in understanding and processing social information.
This article will discuss some similarities and differences between SAD and ASD. It is worth noting that the traits discussed are not an exhaustive list.
Likewise, not everyone with these disorders will act or present similarly. Autism, especially, is a spectrum disorder, meaning that the traits can differ from person to person, and no two Autistic individuals are the same.
Social Anxiety Disorder
Social anxiety disorder, also known as social phobia, is an anxiety disorder characterized by intense fear and anxiety in social situations.
People with SAD often experience excessive worry about being judged or scrutinized by others, and may avoid social situations altogether or endure them with extreme discomfort. This disorder can significantly impair daily functioning and negatively impact quality of life.
Autism?
Autism is a complex neurodevelopmental disorder that affects communication, behavior, and social interaction. It is typically diagnosed during early childhood and can vary in support needs.
People with Autism may experience difficulties with verbal and nonverbal communication, exhibit repetitive behaviors or have limited interests, and struggle with social interactions. However, each individual with Autism is unique and may have a range of strengths and challenges.
How are Autism and Social Anxiety similar?
Some of the overlapping traits between ASD and SAD can include the following:
Social skills
A key trait of ASD is differences in social interaction, such as difficulty maintaining eye contact, different body posture, and speech qualities such as tone, volume, and rate.
Although this is not the case for all people with ASD, many with this disorder prefer limited social communication and might appear quiet or withdrawn in social situations.
Although the cause of social difficulties in both ASD and SAD differs, many of the same symptoms are present in both disorders. People with both ASD and SAD may have differences in social competence.
Due to those with SAD being anxious in social situations, they are also likely not to speak so much, talking quietly, and may present with a less confident posture.
Spending time alone
Those with ASD and SAD may be more likely to want to spend time alone than be in social situations, although the reasons for avoiding these situations are different.
They are likely to avoid situations requiring social interaction and may actively avoid people at times, especially those who are unfamiliar.
They may prefer and be happier when isolating themselves from others, spending more time alone than with anyone else.
Some of the questions or statements on tests for ASD and SAD can be very similar, such as asking whether the individual wants to avoid social situations and whether they prefer spending time alone.
These kinds of overlaps in testing can make it difficult to distinguish whether someone has ASD or SAD.
Anxiety
An obvious trait of SAD is severe anxiety symptoms, especially in social situations. It is also common for people with ASD to experience extreme anxiety in social situations, such as feeling nervous or only being comfortable around a few certain people.
Those with ASD may have difficulty recognizing and regulating their emotions, so it is not uncommon for people with ASD to develop mental health issues alongside their Autism.
Likewise, Autistic individuals can become so overwhelmed that they completely withdraw or find they are unable to talk (also known as shutdowns), which others may confuse as being socially anxious.
People with Autism may have realistic worries about social failure, social rejection, and negative evaluations from others, which all contribute to anxiety (Kreiser & White, 2014)
Difficulty building friendships
Those with ASD and SAD may also find trouble building and maintaining friendships. Reasons for this can include all the above difficulties associated with their social skills, wanting to spend time alone, and anxiety they may experience in social settings.
Combined, it can be very challenging for someone with ASD or SAD to form friendships, especially with people they are not as familiar with. However, it is worth noting this is not always the case, as many people with SAD and ASD can form strong relationships with few or many people.
What are the differences?
While ASD and SAD share a lot of similarities with each other, they are distinct conditions in many ways.
The main difference is that ASD is a neurodevelopmental condition while SAD is a mental health condition.
Below are some of the other key differences between these disorders:
Differences in symptoms
Although those with ASD and SAD may prefer to avoid social situations, the reasoning behind their avoidance is where the differences lie:
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Those with ASD may experience confusion and sensory overstimulation in social situations and may be less inclined to seek out a social activity.
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Those with SAD do not usually experience sensory issues, choosing to withdraw from social situations for fear of being judged.
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Those with ASD can struggle to guess what others are thinking, which can be stressful and could result in social mistakes and bullying, and they may display nervousness because they have had bad social experiences in the past.
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Those with SAD may not have difficulty reading facial expressions and body language but may experience cognitive distortions (e.g., using mental filters or catastrophizing) in social situations.
People with ASD and SAD also have differences in their social skills:
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Those with ASD may struggle in social situations since they may not have some of the same social skills as neurotypicals. However, many Autistic people are skilled at ‘masking’ their traits of ASD, meaning they can learn social skills (e.g., through observing or mirroring others) to present themselves as more neurotypical.
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Those with SAD may have the socially accepted social skills but are too scared to use them – their fear of socializing makes it difficult to use these skills.
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SAD often causes people to stutter, blush, or make their minds go ‘blank’ in social situations, making it difficult to execute a conversation. Consequently, they appear to have poor social skills when anxious. When the person with SAD is in a comfortable situation, these symptoms will likely cease.
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A person with ASD may fidget or use repetitive movements (e.g., ‘stimming’) in social situations; however, this is often a way to help them self-regulate, and they will continue to do it outside of social situations. Someone with SAD may also fidget or use repetitive movements in social situations, but this may just be because they are nervous and will stop when out of the social situation.
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Many people with ASD are not withdrawn and quiet – they can speak loudly, stand too close to another person, and can appear rude without meaning to.
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In comparison, those with SAD may speak quietly or too softly, prefer to stand far away from others, and avoid eye contact out of fear.
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Those with ASD are not necessarily avoiding eye contact out of fear; they may find it uncomfortable or overstimulating to do so. Overall, those with SAD tend to be quicker at orienting away from eye contact while Autistic people are slower at making eye contact (Kleberg et al., 2017).
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Autism is a spectrum, and people may communicate differently – some may not speak at all, while others may engage in one-sided conversations or miss social cues. In comparison, those with SAD may intentionally avoid conversations because of fear of embarrassment or negative judgment.
Other symptoms are present in ASD, which are not common in those with SAD. People with ASD may:
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Have atypical development, such as hitting milestones differently.
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Present with repetitive movements and noises – stimming.
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Have passionate special interests.
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Have sensory differences (e.g., finding bright lights overstimulating or preferring to wear certain fabrics over others).
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Have motor skill delays or difficulties.
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Miss social cues or understand certain humor.
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Have meltdowns and/or shutdowns when overwhelmed.
There are also physical symptoms that are present in SAD when in social situations but are not common in those with ASD:
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Sweating
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Rapid heartbeat
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Feeling breathless
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Shaking or trembling
Differences in diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes a set of criteria that an individual must meet before being diagnosed with ASD and SAD.
The diagnostic criteria for both disorders are very different. For ASD, the DSM includes:
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Persistent difficulties in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact.
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Repetitive patterns of behavior.
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Symptoms were present in early development, even if they went unnoticed.
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The symptoms interfere with daily functioning.
For SAD, the DSM includes the following:
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Fear of judgment in social situations.
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Consistent anxiety in social situations that do not fit the context.
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Avoidance of social interaction.
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A fear of social interaction that impedes day-to-day life.
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The fear must be present for at least six months and not attributed to another mental health condition.
It is important to note the age of onset for these conditions. SAD can develop at any age, in childhood, or with adults who have never experienced social anxiety before.
It can be influenced in some way by genetics, but SAD can also be triggered by trauma or stressful life events.
Autism, on the other hand, is not triggered by environmental factors and has been persistent since birth. Autism is also a lifelong condition that cannot be ‘cured,’ whereas SAD can be effectively treated.
Even those with ASD who were diagnosed late can look back and recognize signs of Autism in their childhood.
Social anxiety vs Autism
| Social Anxiety Disorder | Autism |
|---|---|
| An anxiety disorder characterized by excessive fear of social situations and fear of being judged or evaluated by others | A neurodevelopmental disorder characterized by difficulty in social communication and interaction, and restrictive and repetitive patterns of behavior |
| Typically develops in adolescence or early adulthood | Usually diagnosed in early childhood |
| Fear and avoidance of social situations, but desire to connect with others | Difficulty with social communication, understanding social cues, and maintaining relationships |
| May have typical emotional expression, but may experience heightened anxiety in social situations | May have difficulty with emotional expression, including difficulty identifying and understanding emotions in others |
| May have a variety of interests and hobbies | May have intense, narrow interests |
| May be hypersensitive to criticism or negative evaluation from others | May have sensory processing issues, including hypersensitivity or hyposensitivity to sensory stimuli |
Do All People With ASD Have Anxiety?
A considerable proportion of individuals with ASD also fulfill the criteria for SAD, meaning it is possible to have both disorders. It is thought that up to 50% of Autistic individuals qualify for a diagnosis of social phobia, compared to 7-13% in non-ASD individuals (Spain et al., 2018).
This may be because those with ASD often struggle socially and are at risk of being bullied. As a result of the trauma of being bullied and fear of this happening again, these individuals may develop social anxiety as a result.
It is not just SAD, which is common in those with ASD – in a review of around 30 studies of Autistic children, almost 40% had at least one associated anxiety disorder.
Due to the struggles of trying to navigate a neurotypical world, those with ASD may find life very anxiety-inducing, which may be why so many of them develop anxiety disorders.
Although a lot of people with ASD experience anxiety, not all of them do and find that they can navigate their way through the world in a way that is comforting to them.
Can ASD be Misdiagnosed as SAD?
Often due to similarities in socially related traits in both ASD and SAD, a misdiagnosis of SAD may be given when it could be, in fact, Autism.
This is most likely to happen for girls and women with ASD who present struggles with social situations.
There are a number of reasons why females are more likely to be diagnosed with SAD than ASD. The first is that Autism has typically been viewed as a mostly male disorder.
Much early research and theorists, which helped develop our understanding of autism, used primarily male individuals with ASD in their studies.
The way that Autism is conceptualized, measured, and diagnosed probably revolves around a male-centric presentation (Hiller et al., 2016).
Autistic females may be more likely to experience bullying from their peers for acting ‘socially inappropriate’ in conversations, so many females with Autism have learned to mask (or camouflage) their Autistic traits to fit in (Head et al., 2014).
This means that they have learned to hide their autistic traits by forcing eye contact, using learned phrases, mirroring others’ social behavior, and imitating facial expressions.
Since females with autism can be good at hiding their autistic traits, this can make it harder for others to notice that they are Autistic. This may result in the anxiety in social situations escalating, meaning they can be more likely to be diagnosed with SAD than ASD.
Social anxiety may be more likely to be flagged before Autism. Carly Jones MBE, an Autistic woman who is a British Autism Advocate, describes her experience of misdiagnosis:
‘They thought I had a social anxiety disorder. I was medicated, which made me feel like a zombie. I don’t have a social anxiety disorder. I’m just socially anxious because I’m Autistic… the root cause of my social anxiety, previous eating disorders… was Autism.’
Source: Autism: In conversation with auticon Podcast
Is It Autism Or Social Anxiety?
The best way to differentiate between SAD and ASD is through a formal diagnosis from a healthcare professional such as a psychologist or neurologist.
The screening for Autism can be a lengthy process that may involve observations of the individual and interviews with teachers, caregivers, and the person being evaluated.
ASD is typically diagnosed in childhood, but some Autistic adults may have never received a formal evaluation. It can be a lot more difficult to receive an Autism diagnosis in adulthood, which leads many to self-diagnose.
A diagnosis of SAD is usually easier as this may involve a doctor talking through the symptoms with the individual and assessing whether they meet the diagnostic criteria. When diagnosing, it is important not to rule out the possibility that the individual may have both disorders.
References
American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. Washington, D.C.; 2022
Grant, C. (Host). (2023, March 8). Autism and Female Diagnosis [Audio Podcast Episode]. Autism: In conversation with auticon. Auticon UK.
Head, A. M., McGillivray, J. A., & Stokes, M. A. (2014). Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular autism, 5(1), 1-9.
Hiller, R. M., Young, R. L., & Weber, N. (2016). Sex differences in pre-diagnosis concerns for children later diagnosed with autism spectrum disorder. Autism, 20(1), 75-84.
Jefferson, J. W. (2001). Social anxiety disorder: More than just a little shyness. Primary care companion to the Journal of clinical psychiatry, 3(1), 4.
Kleberg, J. L., Högström, J., Nord, M., Bölte, S., Serlachius, E., & Falck-Ytter, T. (2017). Autistic traits and symptoms of social anxiety are differentially related to attention to others’ eyes in social anxiety disorder. Journal of autism and developmental disorders, 47, 3814-3821.
Kreiser, N. L., & White, S. W. (2014). Assessment of social anxiety in children and adolescents with autism spectrum disorder. Clinical Psychology: Science and Practice, 21(1), 18.
Maddox, B. B., & White, S. W. (2015). Comorbid social anxiety disorder in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(12), 3949-3960.
Spain, D., Sin, J., Linder, K. B., McMahon, J., & Happé, F. (2018). Social anxiety in autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders, 52, 51-68.
