Advertisement

Journal of Autism and Developmental Disorders

, Volume 38, Issue 9, pp 1697–1709 | Cite as

Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome

  • Sanna Kuusikko
  • Rachel Pollock-Wurman
  • Katja Jussila
  • Alice S. Carter
  • Marja-Leena Mattila
  • Hanna Ebeling
  • David L. Pauls
  • Irma Moilanen
Original Paper

Abstract

We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 ± 1.7 years) and 305 community subjects (M = 12.2 ± 2.2 years). Children and adolescents completed the SPAI-C and SASC-R, and their parents completed the CBCL Internalizing scale. Adolescents with HFA/AS scored higher than the community sample on all measures. Behavioural avoidance and evaluative social anxiety increased by age within the HFA/AS group, whereas behavioural avoidance decreased by age in control participants. Data support that HFA/AS in adolescents may be associated with clinically relevant social anxiety symptoms.

Keywords

Asperger syndrome High-functioning autism Social anxiety Social phobia 

Notes

Acknowledgments

The research was supported by The Alma and K. A. Snellman Foundation, Oulu, Finland (PI: S. Kuusikko); Child Psychiatric Research Foundation, Finland (PI: S. Kuusikko); Northern Ostrobothnia Hospital District Area, Finland (PI: S. Kuusikko); Emil Aaltonen Foundation, Finland (PI: H. Ebeling); the Rinnekoti Research Foundation, Espoo, Finland (PI: M-L. Mattila); National Alliance for Autism Research (NAAR, PI: D. Pauls); Thule Institute, University of Oulu (PI: I. Moilanen); and Juselius Foundation (PI: I. Moilanen). We want to thank the participants of the study and Ms Leena Joskitt for her help in statistical analyses.

References

  1. Achenbach, T. M., & Eldelbrock, C. S. (1983). Manual for the child behavior checklist and revised child behavior profile. University of Vermont Department of Psychiatry, Burlington, VT.Google Scholar
  2. Albano, A. M., Dibartolo, P. M., Heimberg, R. G., & Barlow, D. H. (1995). Children and adolescents: Assessment and treatment. In: R. G. Heimberg, M. R. Liebowitz, D. A. Hope, & F. R. Schneier (Eds.), Social phobia: Diagnosis, assessment and treatment (pp 387–425). New York: The Guilford Press.Google Scholar
  3. American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders—fourth edition, text revision. Washington, DC: American Psychiatric Association.Google Scholar
  4. Attwood, T. (1998). Asperger’s syndrome: A guide for parents and professionals. London: Jessica Kingsley.Google Scholar
  5. Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., & Charman, T. (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in south themes: The special needs and autism project (SNAP). The Lancet, 368(9531), 210–215.CrossRefGoogle Scholar
  6. Beidel, D. C. (1991). Social Phobia and overanxious disorder in school-age children. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 545–552.PubMedCrossRefGoogle Scholar
  7. Beidel, D. C., Turner, S. M., & Fink, C. M. (1996). Assessment of childhood social phobia: Construct, convergent, and discriminative validity of the social phobia and anxiety inventory for children (SPAI-C). Psychological Assessment, 8, 235–240.CrossRefGoogle Scholar
  8. Beidel, D. C., Turner, S. M., & Morris, T. L. (1998). Social phobia and anxiety inventory for children (SPAI-C). User´'s manual. North Tonawanda, NY: Multi-Health Systems Inc.Google Scholar
  9. Beidel, D. C., Turner, S., & Morris, T. (1999). Psychopathology of childhood social phobia. Journal of American Academy of Child and Adolescent Psychiatry, 38, 643–650.CrossRefGoogle Scholar
  10. Bennett, M. (1989). Children’s self attribution of embarrassment. British Journal of Developmental Psychology, 7, 207–217.Google Scholar
  11. Bernstein, G. A., Layne, A. E, Egan, E. A., & Nelson, L. P. (2005). Maternal phobic anxiety and child anxiety. Journal of Anxiety Disorders, 19(6), 658–672.PubMedCrossRefGoogle Scholar
  12. Berument, S. K., Rutter, M., Lord, C., Picles, A., & Bailey, A. (1999). Autism screening questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444–451.PubMedCrossRefGoogle Scholar
  13. Bishop, D. V. (1998). Development of the children’s communication checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry, 39, 879–891.PubMedCrossRefGoogle Scholar
  14. Boyle, M. H., Offord, D. R., Racine, Y., Fleming, J. E., Szatmari, P., & Sanford, M. (1993). Evaluation of the revised Ontario child health study scales. Journal of Child Psychology and Psychiatry, 34(2), 189–213.Google Scholar
  15. Centers for Disease Control and Prevention. www.cdc.gov/od/oc/media/pressrel/2007/r070208.htm. Accessed September 2007.
  16. Chacrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285(24), 3093–3099.CrossRefGoogle Scholar
  17. Chalfant, A. M., Rapee, R., & Carrol, L. (2007). Treating anxiety disorders in children with high functioning autism spectrum disorders: A controlled trial. Journal of Autism and Developmental Disorders, 37, 1842–1857.PubMedCrossRefGoogle Scholar
  18. Constantino, J., Przybeck, T., Friesen, D., & Todd, R. D. (2000). Reciprocal social behavior in children with and without pervasive developmental disorders. Journal of Developmental Behavioral Pediatrics, 21, 2–11.Google Scholar
  19. Crozier, W. R., & Burnham, M. (1990). Age-related differences in children understanding of shyness. British Journal of Developmental Psychology, 8, 179–185.Google Scholar
  20. Ehlers, S., & Gillberg, C. (1996). Aspergerin syndrooma––yleiskatsaus. 1.painos. Helsinki: Suomen Autismiyhdistys, Yliopistopaino.Google Scholar
  21. Francis, G., Last, C. G., & Strauss, C. C. (1992). Avoidant disorder and social phobia in children and adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 31, 1086–1089.Google Scholar
  22. Fyer, A. J., Mannuzza, S., & Chapman, T. F. (1993). A direct interview family study of social phobia. Archives of General Psychiatry, 50, 286–293.Google Scholar
  23. Gadow, K. D., & Sprafkin, J. (1998). Adolescent symptom inventory-4 norms manual. Stony Brook, New York: Checkmate Plus.Google Scholar
  24. Gadow, K. D., & Sprafkin, J. (2002). Child symptom inventory-4 screening and norms manual. Stony Brook, New York: Checkmate Plus.Google Scholar
  25. Gillott, A., Furniss, F., & Walter, A. (2001). Anxiety in high-functioning children with autism. Autism, 5(3), 277–286.PubMedCrossRefGoogle Scholar
  26. Green, J., Gilrichrist, A., Burton, D., & Cox, A. (2000). Social and psychiatric functioning in adolescents with Asperger syndrome compared with conduct disorders. Journal of Autism and Developmental Disorders, 30(4), 279–293.PubMedCrossRefGoogle Scholar
  27. Hayward, C., Killen J. D., Kraemer, H. C., & Taylor, C. B. (1998). Linking self-reported childhood behavioural inhibition to adolescent social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1308–1316.Google Scholar
  28. Ivanova, M.Y, Dobrean, A., Dopfner, M., Erol, N., Fombonne, E., Fonseca, A. C., et al. (2007). Testing the 8-syndrome structure of the child behavior checklist in 30 societies. Journal of Clinical Child Adolescent Psychology, 36(3), 405–417.Google Scholar
  29. Kielinen, M., Linna S. L., & Moilanen, I. (2000). Autism in Northern Finland. European Child & Adolescent Psychiatry, 9, 162–167.CrossRefGoogle Scholar
  30. Kim, J.A, Szatmari, P., Byrson, S. E., Streiner, D. L., & Wilson, F. J. (2000). The prevalence of anxiety and mood problems among children with autism and Asperger syndrome. Autism, 4(2), 117–132.CrossRefGoogle Scholar
  31. Kuusikko, S., Pollock-Wurman, R., Ebeling, H., Hurtig, T., Joskitt, L., Mattila, M.-L., Jussila, K., & Moilanen, I. Psychometric evaluation of social phobia and anxiety inventory for children (SPAI-C) and social anxiety scale for children-revised (SASC-R). Submitted in European Child & Adolescent Psychiatry.Google Scholar
  32. La Greca, A. M., & Stone, W. L. (1993). Social anxiety scale for children-revised: factor structure and concurrent validity. Journal of Clinical Child Psychology, 1, 17–27.Google Scholar
  33. Leyfer, O.T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., Tager-Flushberg, H., & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849–861.PubMedCrossRefGoogle Scholar
  34. Lord, C., Rutter, M., DiLavore, P. C., & Risin, S. (2003). Autism diagnostic observation schedule. Manual (3rd edn.). Los Angeles: Western psychological services.Google Scholar
  35. Lord, C., Rutter, M., & LeCouter, A. (1995). Autism diagnostic interview -revised (3rd edn.). Los Angeles: Western psychological services.Google Scholar
  36. Mannuzza, S., Fyer, A. J., Liebowitz, M. R., & Klein, D. F. (1990). Delineating the boundaries of social phobia: its relationship to panic disorder and agoraphobia. Journal of Anxiety Disorders, 4(1), 41–59.Google Scholar
  37. Mattila, M. L., Kielinen, M., Jussila, K., Linna, S. L., Bloigu, R., Ebeling, & H., Moilanen, I. (2007). An epidemiological and diagnostic study of asperger syndrome according to four sets of diagnostic criteria. Journal of the American Academy of Child and Adolescent Psychiatry, 46(5), 636–646.Google Scholar
  38. Melfsen, S., Florin, I., & Warnke, A. (2001). Das Sozialphobie und -angsinventar für Kinder (SPAIK). Göttingen: Hogrefe.Google Scholar
  39. Melfsen, S., Walitza, S., & Warnke, A. (2006). The extent of social anxiety in combination with mental disorders. European Child & Adolescent Psychiatry, 15(2), 111–117.CrossRefGoogle Scholar
  40. Piven, J., & Palmer, P. (1999). Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-indicence autism families. American Journal of Psychiatry, 156, 557–563.PubMedGoogle Scholar
  41. Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. Australian and New Zealand Journal of Psychiatry, 39(7), 633–638.PubMedCrossRefGoogle Scholar
  42. Rutter, M., Lecouter, A., Lord, C., MacDonald, H., Rios, P., & Folstein, S. (1988). Diagnosis and subsclassification of autism: Concepts and instrument development. In: E. Shcopler & C. B Mesibov (Eds.), Diagnosis and assessment in autism (pp. 239–259). New York: Plenum Press.Google Scholar
  43. Schneier, F. R., Spitzer, R. L., Gibbon, M., Fyer, A. J., Liebowitz, M. R., & Weisman, M. M. (1992). Social phobia. Comorbidity in an epidemiological sample. Archive of General Psychiatry, 49, 282–288.Google Scholar
  44. Stein, M. B., Walker, J. R., & Forde, D. R. (1994). Setting diagnostic thresholds for social phobia: Considerations from a community survey of social anxiety. American Journal of Psychiatry, 151, 408–412.PubMedGoogle Scholar
  45. Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., McCracken, J. T., Tierney, E., Williams White, S., Lecavalier, L., & Vitiello, B. (2007). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology (Epub ahead of print).Google Scholar
  46. Tantam, D. (2000). Psychological disorder in adolescents and adults with Asperger syndrome. Autism, 4(1), 47–62.CrossRefGoogle Scholar
  47. Towbin, K. E., Pradella, A., Gorrindo, T., Pine, D., & Leibenluft, E. (2005). Autism Spectrum traits in children with mood and axiety disorders. Journal of Child and Adolescence Psychopharmacology, 15(3), 452–464.CrossRefGoogle Scholar
  48. Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448–457.PubMedCrossRefGoogle Scholar
  49. Wechsler, D. (1991). Wechsler Intelligence Scale for Children, WISC-III (3rd edn.). New York: Psychological Corporation.Google Scholar
  50. Wittchen, H. U., & Beloch, E. (1996). The impact of social phobia on quality of life. International Clinical Psychopharmacology, 11(3), 15–23.PubMedCrossRefGoogle Scholar
  51. Wittchen, H. U., Stein, M. B., & Kessler, R. C. (1999). Social fears and social phobia in a community of adolescents and young adults: prevalence, risk factors and comorbidity. Psychological Medicine, 29, 309–323.PubMedCrossRefGoogle Scholar
  52. World Health Organization (WHO). (1993). Tenth revision of the international classification of disease. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Sanna Kuusikko
    • 1
    • 2
  • Rachel Pollock-Wurman
    • 3
  • Katja Jussila
    • 1
  • Alice S. Carter
    • 4
  • Marja-Leena Mattila
    • 1
  • Hanna Ebeling
    • 1
  • David L. Pauls
    • 3
  • Irma Moilanen
    • 1
  1. 1.Clinic of Child PsychiatricUniversity and University Hospital of OuluOuluFinland
  2. 2.Child Psychiatric ClinicUniversity Hospital of OuluOuluFinland
  3. 3.Massachusetts General Hospital, Harvard Medical SchoolBostonUSA
  4. 4.University of Massachusetts BostonBostonUSA

Personalised recommendations