Social Anxiety in Individuals With Autism

The coexistence of social anxiety and autism spectrum disorder is common in the school period of children with autism. While the rate of anxiety experienced by children with normal development at this age is 5%, this rate is up to 84% in children with autism. The fact that it is encountered so often shows that one should be careful about the proper treatment.

Knowing the difference between autism and social anxiety can help you understand effective coping mechanisms or treatment in certain situations where social interaction is essential. Social anxiety includes signs of social interaction with other people, fear of negative judgment, or evaluation. The main difference between the two is that if someone has a social anxiety disorder, he/she has fear and excessive anxiety in social situations, whereas an individual with autism can be anxious. However, being on the autism spectrum increases the risk of social anxiety disorder.



According to studies, we come across the conclusion that children with speech disorders show more anxiety symptoms. Speech disorders include situations such as stuttering, selective mutism, and selective speech disorder. The anxiety rate of a child or adolescent with any of the language and speech disorders is much higher than the anxiety rate of a stutterer. We can say that the higher the intensity of the disorder, the higher the anxiety rate.

In autism spectrum disorder, the relationship between anxiety disorder, which is known to have such a high prevalence, and the lack of social interaction, its effect on loneliness, and the validity and reliability of measuring instruments that can be used in measuring this is an issue open to discussion by professionals.

Autistic spectrum disorder is a neurodevelopmental disorder characterized by advanced and complex disabilities. It consists of five separate categories. These are autism, Asperger’s syndrome, atypical autism, childhood disintegrative disorder, and Rett syndrome. Autism is only one of the disorders in this category.

Clinical data indicate that anxiety is the most common disorder in school-age children and adolescents with autism. While this rate is 5% in children with normal development, this rate varies between 11% and 84% according to different studies in children with autism. The diagnosis and treatment of a condition with such a high frequency should be done effectively.



Studies show that speaking and self-expression are directly related to social anxiety in children with normal development. To be more precise, children and adolescents with speech disorders (language and speech disorder, stuttering, selective mutism) show more anxiety symptoms and are diagnosed than other children with normal development.

The anxiety score of an adolescent with stuttering was significantly higher than that of a normally developing adolescent. In addition, the anxiety score of the individual with one of the language or speech disorders in addition to stuttering was found to be significantly higher than the individual with only stuttering. As the disorder increases, so does anxiety.

Although it is not fully explained why anxiety is so common in children with autism, studies have tried to explain that there are structural and neurochemical disorders and that individuals with autism are prone to anxiety. The neurochemical disorder and susceptibility hypothesis eliminates the idea that social interaction disorder is a natural consequence.

In addition, some studies show that there is a link between anxiety and the autism gene. Which of these is not exactly known at the moment. However, it shows that the disorders in social interaction will help us to predict social anxiety.



Autism, Communication and Social Anxiety


It is a well-known fact that children with autism experience much more social interaction problems than children with developmental delays. Approximately 30% to 50% of individuals with autism cannot reach the appropriate level of speech. Lack of social interaction (eye contact, speech, introversion, etc.) is one of the first symptoms that strike us in making the diagnosis.

Social interaction disorder is thought to be associated with autism and this has a direct effect on anxiety. Difficulty communicating with their peers is an example (more common in individuals with high-functioning autism). A high-functioning autistic person is aware of his or her social interaction disorder, and his anxiety increases as he misinterprets social cues and experiences social failure.

Some researchers say that children with high-functioning autism have higher anxiety tendencies than those with low-functioning. They explain this by saying that the functionality level of the child with autism is low because he will have difficulty in expressing his anxiety experience. In other words, they say that because the individual with autism cannot express his anxiety correctly, it is under-reported.

Different results have been obtained according to the results of the latest studies by comparing 3 groups. When communication problems increase in children with autism, lower anxiety symptoms are observed. When the group with pervasive developmental disorder increases the communication problem, they show higher symptoms of anxiety. When communication problems increase in children who are not diagnosed with any psychological disorder, they exhibit higher anxiety problems.



Unlike the studies conducted so far, in this study, as the communication problems of children with autism increase, their anxiety decreases, which is contrary to the studies conducted so far. This information is incompatible with literature.

Different results were reported according to the results of another research. The highest score for the whole sample was observed as separation anxiety. The lowest score belongs to harm avoidance anxiety. Social interaction disorder is observed in an individual with autism who reports high anxiety. Individuals who report high social anxiety experience more loneliness. There is a correlation between social anxiety and loneliness scores.

Social interaction disorder and social anxiety are expected to lead to loneliness and social isolation. However, we do not have enough data to create cause and effect between anxiety symptoms and social problems, or between anxiety and social isolation in children with autism.

There are certain limitations in the diagnosis of autism and social anxiety, and some of their features are similar to autism. For example, avoidance, fears, abnormal sleep habits, irritability, and so on.

More than 50% of people with autism suffer from speech problems and their relations with the world are so limited. Individuals with autism, who cannot explain how they feel a lot because they cannot speak, cannot express comorbid diagnoses such as anxiety.



According to recent studies, individuals with autism are characterized by large speech disorders and low anxiety symptoms. Anxiety symptoms were more severe in high-functioning individuals. The reason why this information comes out in this way is that individuals with high-functioning autism have higher expressive abilities and show more anxiety symptoms. Low-functioning individuals have low cognitive capacity and low expressiveness, so they cannot express their emotions in a healthy way.

Similarly, there are difficulties in measuring anxiety in children with autism. As a result, measuring instruments prepared for normally developed individuals cannot be very successful in measuring individuals with autism. There can be no mention of its validity and reliability. In addition, the individual with autism cannot have insight in expressing himself while describing the symptoms.

For some studies, the application of the test to the family and individual or only the test to the family does not affect the results of the test very much (no significant difference). There are also various discussions about administering the test directly to the individual with autism or applying the test to the parent. Different anxiety levels or types when applied to the family, the prejudice of the family, and its own interpretation have a detrimental effect. This affects the results.

Although it is misunderstood about individuals with autism, they are thought to choose loneliness and do not want to establish a relationship, but they are aware that they have serious difficulties in social integration, and they state that they experience more loneliness than those with normal development. In social interaction, the traits have more difficulty in starting the first conversation with their peers. These social difficulties begin to increase further towards middle school and high school, and the child begins to realize this deficiency, and eventually, this awareness causes the development of an anxiety problem.



Relation Between Social Anxiety and Autism


There is a link between social anxiety and autism. Although it cannot be said exactly which one causes the other, it is a fact that social interaction disorders have an effect on anxiety. A child with autism experiences many problems when trying to communicate with other peers because of his developmental delay. When we look at the majority of them, we see that they cannot reach the appropriate level of speech. This naturally makes it difficult to communicate.

Social interaction disorder, like anxiety and autism, is thought to be directly related to each other in individuals with autism. A highly functional autistic person is aware that they have a social interaction disorder. This causes his anxiety to increase due to the awareness of his difficulties in social communication.



How Can A Person With Autism Overcome Anxiety?


Medication can be used to overcome anxiety. Of course, the drugs used for children with autism are much different. These drugs also provide relief to individuals in subjects such as hyperactivity, obsession, anger attacks, and sleep disorders. How many doses to be taken depends on the level of discomfort of the person. Although there are not many side effects, it is known that the most common side effect is weight gain.

Individuals with autism have great problems, especially in the initial conversation phase. It is well-known that they tend to choose loneliness. However, many individuals with autism are aware that they will have difficulty communicating with normally developing people and they prefer loneliness. This causes them to trigger anxious behaviors. As they start to adapt to social life, for example when they start school and they need to be in contact with more people, the situation of social anxiety problems is observed.

If you are a parent or caretaker of an individual with autism, it is useful to be prepared for the problems that he or she may experience. When you start seeing symptoms, it will thus be possible for you to act more consciously about how to behave. You can help the child relax and improve social communication with the help of certain games in problems such as anxiety that may arise.



Sibling Effect on Child with Autism Who Have a Social Anxiety


When the average of social anxiety and sibling relationships according to the presence of siblings with autism is examined, the social anxiety levels of those who have siblings with autism are significantly higher than those who do not have siblings with autism.

The sibling relationships of those who do not have siblings with autism are more meaningful than those who have siblings with autism. When comparing social anxiety and sibling relationships in adolescents with siblings on the autism spectrum according to descriptive characteristics, sibling age, sibling gender, sibling age difference, gender, sibling education level with autism, sibling autism degree, number of family children, family’s region and family socioeconomic status variables were found to be significant. It has been determined that it does not make a difference.

When comparing the social anxiety and sibling relationships in adolescents with no siblings on the autism spectrum according to the descriptive characteristics, it was observed that the social anxiety levels of those with a sibling age of 1-3 were higher than those of those with a sibling age of 4-6.



Social Anxiety


Social anxiety is a type of phobia that manifests itself with extreme excitement and fear in other people’s environments. Avoidance of public speaking and public speaking are the most common behaviors in social anxiety.

In children, social anxiety is seen as staying away from establishing relationships with strangers, being afraid of saying something wrong, and being disgraced. These children avoid contact with people other than their family and acquaintances.

The presence of other people or people, especially strangers, causes the child to feel severe anxiety, distress, restlessness, and shyness. At school, they are afraid of speaking in classes, as they are afraid of giving wrong answers to the questions asked by the teacher.

Any activity that requires assertiveness and breakthrough, courage and confidence, increases this uneasiness for them. They feel great pressure when they have to do a job that requires any responsibility. These children are particularly dependent on the mother because they are afraid of doing something or going somewhere alone. For this reason, they have difficulty in establishing and maintaining friendships. There are certain behaviors that children with social anxiety can avoid doing.



  • They hesitate to read aloud in class.
  • They have trouble participating in an artistic or sporting activity.
  • Participating in or starting a conversation is very difficult for them.
  • They are incapable of talking and building relationships with adults.
  • They experience exam anxiety more intensely than their peers.
  • They do not like to operate within the group.
  • They have trouble answering a question posed to them.
  • They never take a photo, especially when it is in the foreground.
  • They have trouble using public toilets.
  • They don’t like talking on the phone.
  • They do not eat in front of other people.
  • They don’t ask for help from the teacher.
  • They don’t like to make eye contact while talking.
  • They are not open to trying new things.
  • They avoid talking to someone in authority.

Does Every Timid Child Have Social Anxiety?


Babies do not differentiate foreigners in the first months. However, from the 8th month, when they are not present with their mother, they feel uncomfortable being in the same environment as a stranger. The child, who can establish a safe relationship with the mother in the early period, can more easily tolerate such situations. From the age of 3, children start to be in social environments outside the home. Since being shy has to do with genetic transmission, not every child may be able to show the same sociability in these new social situations.



For example, there may be children in kindergarten who have difficulty participating in games with other children or conducting a joint activity. However, we cannot call children with all timid behaviors in social anxiety. There are some physiological reactions accompanying this kind of avoidance and avoidance behaviors. These reactions occur especially when they are exposed to behaviors they avoid.

Since being in social situations is a source of stress for these children, their anxiety levels increase. As a result, physical reactions such as rapid heartbeat, sweating of the hands, shortness of breath, tightness and shaking in the muscles, discomfort in the stomach, hot or cold flashes, and headache are observed.

Children with social anxiety attach extreme importance to what other children think of them because of their high desire to be socially liked. Their belief that they will be evaluated negatively increases the negative selectivity in their attention. That’s why they fear being humiliated in front of others and think that the best way to prevent this from happening is to do nothing. But sometimes they even have to do things they don’t want to do because they have difficulty saying ‘no’. They refuse to participate in games because they think they will laugh or be ridiculed. They always find themselves wrong and unsuccessful. They do not participate in activities that require physical or artistic activity.

According to researches, social anxiety can be caused by genetic, biological, and environmental factors. Looking at the studies conducted from a biological point of view, it is thought that the imbalance of serotonin, which is one of the chemicals that provide inter-nervous communication in the brain, and the overwork of the amygdala, one of the parts of the brain, are related to social anxiety.

In studies on genetics, this situation has also been found in the parents of children with social anxiety. In addition, environmental factors such as oppressive and overprotective parental attitude, modeling parents who have problems in communication and interaction, and emotional and physical abuse also pose risks for the formation of social anxiety.



Other Disorders Accompanying Social Anxiety in Children


School Phobia: It is one of the most common conditions with social anxiety in children. There were many cases that started with school phobia and continued as social anxiety. Although school is an environment where children can feel safe and comfortable, these children think the opposite. For them, a school is a place that increases their anxiety level. The main reason for fear of school is separation anxiety from the mother. In addition, teacher changes, distressing events at school, or the birth of a new sibling are among the other reasons. As in all anxiety disorders, the frequency of school phobia and social phobia is higher in girls.

Stuttering: Many stuttering children show signs of social anxiety. Stuttering is seen in children due to the increase in anxiety level, especially when he will make a speech or reading in the classroom. Stiffness in speech disrupts the communication of the child at school. With the feeling of embarrassment this brings about, the child prefers not to speak and not to speak in lessons. Stuttering is a more common disorder in boys.

Selective Mutism: It is a situation seen as the refusal of the child to talk to strangers and in public, although he has no problem with speaking. These children can talk comfortably with their family and acquaintances. However, he is quite anxious in social situations. Their anxiety levels increase in foreign environments and they refuse to speak. These children show extreme resistance and stubbornness to speech.



Treatment of Social Anxiety and Suggestions for Families


Since social anxiety is often perceived as an ordinary shyness, families do not care much about this situation and do not need treatment. However, social anxiety is a problem that can be eliminated with early diagnosis and correct treatment.

Psychotherapy is used extensively in the treatment of social anxiety. If deemed necessary, drug therapy should be used. Since social anxiety causes problems in all areas of a child’s life, the treatment team should be in cooperation with the family and school.

In psychotherapy, situations that cause anxiety in the child are determined and methods of coping with these situations are tried to be gained. In addition, wrong and negative thoughts in the child are tried to be changed. In order to get more positive results from the process, the school and the family should be more understanding towards the child, motivate the child by giving responsibilities appropriate for their age, and avoid displaying an oppressive or overprotective attitude.

Non-addictive drugs and psychotherapy that provide permanent treatment are used together in the treatment of social anxiety. In this approach, techniques of cognitive explanation, desensitization, rehearsal during the session, and assigning homework are used. First of all, situations that cause anxiety and bodily reactions during this time are defined. With the help of the therapist, the person develops strategies for dealing with situations that cause anxiety. In the behavioral treatment part of the therapy, exercises such as dealing with anxiety, role-playing during the session, and reinforcement are performed. In addition, relaxation techniques are taught to help the person behave more comfortably in situations that cause anxiety.



In the treatment of social anxiety in children, families also have some duties. First of all, they must be good models for their children and provide correct communication with their children. Parents should encourage and reward their children’s attempts to communicate with others. With the rewarding system, they increase the permanence of the behavior.

Helpful and Educational Toys For Social Anxiety in Individuals With Autism Spectrum Disorder


Luckoney 25 Pack Sensory Fidget Toys Set Liquid Motion Timer/Grape Ball/Flippy Chain/Stretchy String/Squeeze-a-Bean Soybeans/Slime/Mesh & Marble/Mochi Squishy for ADHD Autism Stress Anxiety Relief Adult Kids


In this set, each toy has different purposes and different advantages. It is an amazing set of toys for children with an autism spectrum disorder, children with attention deficit hyperactivity disorder, children with emotional disturbances, and every child who experiences meltdown frequently. They are perfect for all range of individuals, whether children or adults. They are very comfortable to use, easy to store, and easy to carry. Overall, it is highly recommended for children on the autism spectrum when they experience social anxiety because it can keep them busy and distracted. https://www.amazon.com/Sensory-Stretchy-Squeeze-Soybeans-Squishy/dp/B07D6NBLKG?ref_=ws_cp_8c39eb7b9cf08b68614d_p_1_i_pOpens in a new tab.



JOEYANK Fidget Cube New Version Fidget Finger Toys – Infinity Cube prime for Stress and Anxiety relief/ADHD, Ultra Durable


It is a great toy for relieving stress and anxiety. This feature makes it perfect for social anxiety. It is great for individuals on the autism spectrum and individuals with ADHD by making them relief. It keeps them focused and awake. It catches their attention easily. IT is very easy to carry and very easy to store. It has a very simple but cool design. Even though it is designed for fun, it has an educational side as well. https://www.amazon.com/JOEYANK-Fidget-Cube-Version-Finger/dp/B074J6KPWD?ref_=ws_cp_8c39eb7b9cf08b68614d_p_2_i_pOpens in a new tab.



VCOSTORE 12 Sided Fidget Cube, Dodecagon Fidget Toy for Children and Adults, Stress and Anxiety Relief Depression Anti for All Ages with ADHD ADD OCD Autism


It is specially designed in order to reduce stress and anxiety. It adds more fun to this process. It helps individuals with autism spectrum disorder while having social anxiety by developing focus and concentration. It helps them to direct their energy to this toy. There are 12 different textures and colors on it for fidget movements. It is made of plastic and silicone material which makes it more durable. It has a portable size to carry and store easily. Your children can take this with themselves everywhere. https://www.amazon.com/VCOSTORE-Dodecagon-Children-Anxiety-Depression/dp/B07GXPRMJM?ref_=ws_cp_8c39eb7b9cf08b68614d_p_6_i_pOpens in a new tab.



SpringFly Sensory Toys Bundle-Fidget Toys Set for Stress Relief and Anti-Anxiety for Kids and Adults, Sensory Fidgets and Squeeze Widget for Relaxing Therapy-Special Toys Assortment for Anxiety Autism


It is an amazing toy set for fidget movement and sensorial touches. It is especially perfect for individuals with autism in case of social anxiety. It keeps them distracted and focused while having anxiety. It is a very fun way as well. It provides stress and anxiety-reducing games and options. There are many of them in one set. Overall, it is highly recommended. https://www.amazon.com/Sensory-Set-Bike-Rainbow-Squeeze-Assortment/dp/B075WY6KCH/ref=sr_1_14?crid=3N17TBVXV1OMB&dchild=1&keywords=social+anxiety+toys&qid=1602667690&sprefix=social+an%2Caps%2C619&sr=8-14Opens in a new tab.



Mind Brain Parenting 52 Essential Conversations: The Life Skills Card Game for Children and Adults – Builds Social-Emotional, Critical Thinking, Growth Mindset & Vocabulary Skills – Created by Harvard Educators


It is an amazing educational card for individuals who have a speech problem or anxiety problems. If you have a child with an autism spectrum disorder, you are familiar with speech and communication problems. This set is perfect for you then. You can easily teach your child in which situation they need to tell. With the help of these educational cards, you can help your child to reduce his/her social anxiety. https://www.amazon.com/Essential-Conversations-Emotional-Vocabulary-Educators/dp/B07FKSQV47/ref=sr_1_1_sspa?crid=3N17TBVXV1OMB&dchild=1&keywords=social+anxiety+toys&qid=1602667690&sprefix=social+an%2Caps%2C619&sr=8-1-spons&psc=1&spLa=ZW5jcnlwdGVkUXVhbGlmaWVyPUEyWVNYSElQN1hEM1pRJmVuY3J5cHRlZElkPUEwMDQxOTA3RDlSVUJZUlZCOVdVJmVuY3J5cHRlZEFkSWQ9QTAzNjU2NDQzRzg2RDdXSEk3TjZOJndpZGdldE5hbWU9c3BfYXRmJmFjdGlvbj1jbGlja1JlZGlyZWN0JmRvTm90TG9nQ2xpY2s9dHJ1ZQOpens in a new tab.==



ARTAGIA Fun Social Skills and Therapy Game for Adults and Teenagers: CBT Therapeutic Family Game for Meaningful Conversations and Open Communication, Leading to Better Relationships. Great Counseling Tool.


It is an amazing toy for individuals who have social anxiety. It is a kind of conversation starter game for them. Thus, it is good for individuals with autism spectrum disorder who have a problem with being social. They can create trust and understanding thanks to this game and reduce their anxiety level. It is perfect for everyone from each age. It can be used as a therapeutic tool as well. It is highly recommended by teachers and Professionals. Overall, it is a great investment. https://www.amazon.com/Social-Skills-Therapy-Adults-Teenagers/dp/B07PFLCDPW/ref=sr_1_11?dchild=1&keywords=social+anxiety+autism+toys&qid=1602667738&sr=8-11Opens in a new tab.



Thought-Spot Store I Know What to Do Cards for Taking Control of Your Feelings/Emotions; Autism; ADHD; Helps Kids Identify Feelings and Make Positive Choices; Hardcover and Laminated; Tabs Help Locate Feelings/Emotion


If you have a child with social anxiety who have problems with communication and expressing themselves, this is great for them. It provides understanding and collaboration with them. It is a great educational stem toy and game. Any child can get benefit from it whether with autism or without autism. Children become more answer oriented and they express themselves compared to their past. There are 18 different cards with emojis. It is easy to find how you feel from there. It is specially designed in order to develop social skills. Overall, it is a highly recommended educational toy for individuals who are experiencing social anxiety. You and your child will be very satisfied and happy with this purchase. https://www.amazon.com/Thought-Spot%C2%AE-Feelings-Emotions-Children-Identify/dp/B07D4NSSY9/ref=sr_1_9?dchild=1&keywords=social+anxiety+autism+toys&qid=1602667738&sr=8-9Opens in a new tab.


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