“It seems completely reasonable to me that a person with Asperger Syndrome should be depressed or anxious. There’s a constant possibility of failing in large and small ways and also a constant lack of real recognition from others, creating a persistent sense of isolation or lack of identity” – male with Asperger Syndrome (personal communication, 2007).
Although anxiety is not part of the defining diagnostic criteria of Autism Spectrum Conditions, we can see that the characteristics briefly outlined above can reasonably be expected to cause high levels of anxiety, stress and depression in those who experience them, but what about further evidence of a connection?
Tony Attwood, a leading authority on Asperger Syndrome, sees those with Asperger Syndrome managing anxiety as an everyday part of their lives and subsequently some of these people go on to develop anxiety disorders, including social anxiety disorder. He suggests that current research shows that around 65% of adolescents with Asperger Syndrome have a secondary mood or affective disorder (such as depression or anxiety) (Attwood, 2006).
Schneier (2002) sees an overlap between social anxiety and other disorders which are marked by social inhibition. He names Asperger Syndrome, autism and alcoholism as three of these alongside depression, eating disorders and social avoidance.
Berney (2004) also cites a strong predisposition for those with Asperger Syndrome to exhibit co-morbidity with a range of anxiety states and conditions including social phobia, panic disorder, obsessive compulsive disorder and others.
“I am anxious all the time because I don’t know what’s going to happen. I have a lot of sensory hypersensitivities, which I cope with through sensory routines (similar to OCD or Tourette’s). I find it hard to tell how I feel or what I want, so I make arbitrary decisions. I feel isolated in social situations” – female with Asperger Syndrome.
“I have had panic attacks in the past when I was in unfamiliar places without a familiar person to make me feel normal” – female with Asperger Syndrome.
Interestingly enough, social anxiety (sometimes known as social phobia) is sometimes said to first appear in adolescence, when the young person becomes aware that they are ‘on their own’ socially and that their performance will have an impact on their ability to attract friends and partners.
This is also often the time at which the Autism Spectrum Condition becomes particularly noticeable and difficult as the safe environment of junior school is exchanged for the more complicated, variable and larger world of secondary education. Both coincide with the onset of puberty and other internal and external changes in the body.
Whilst not suggesting that Autism Spectrum Conditions and social anxiety disorders are the same thing, we suggest that some people diagnosed with social anxiety may in fact have an Autism Spectrum Condition and that their social fears are not entirely unjustified. Or that it is social anxiety rather than the Autism Spectrum Condition which leads a person to drink or drugs to self-medicate against these feelings of anxiety.
Anxiety is a necessary characteristic for social anxiety disorder, but anxiety is not part of the diagnostic criteria for Autism Spectrum Conditions; it just happens to be a by-product for large numbers of those with these conditions. The person with an Autism Spectrum Condition may have a legitimate fear of social errors as they may be aware that their skills in this area have let them down in the past.
Social anxiety disorder is a recognised condition and is included in diagnostic manuals, such as Diagnostic Statistical Manual IV (DSM IV, 1994).
It is different to Autism Spectrum Conditions in that it is not necessarily a life-long condition – its onset tends to be during teenage years - and does not necessarily affect an individual’s innate communication and language processing, but there can be similarities in outcome – isolation, anxiety, low self esteem and avoidance of social situations.
Ghaziuddin (2005) states that the DSM IV says that diagnosis of Social anxiety disorder should not be made if a pervasive developmental disorder (Autism Spectrum Conditions are described as such) is present.
He suggests that this implies that the symptoms of social anxiety must thus already be symptoms of these developmental disorders. Both those with Autism Spectrum Conditions and Social Anxiety Disorder will avoid social situations for fear of humiliation and/or embarrassment at ‘getting it wrong’. One adult with Asperger Syndrome explains this: