Social anxiety is a very common problem in individuals with autism. This applies to individuals of all ages on the spectrum, including children and adolescents. Children on the autism spectrum may be anxious for all reasons, such as school, family, and health, whereas children with normal development may be. However, there are additional challenges that can create additional social anxiety and come with autism.
It is an undeniable fact that social anxiety, which is known to have such a high frequency in autism spectrum disorder, is associated with a lack of social interaction and loneliness. According to studies and clinical data, social anxiety is the most common disorder in school-age children and adolescents with autism. While the rate of social anxiety in children with normal development is 5%, this rate varies between 11% and 84% in children with autism. The diagnosis and treatment of social anxiety with such a high frequency should be effective.
Studies show that speaking and self-expression are directly related to social anxiety in children with normal development. To put it more clearly, children and adolescents with speech disorders (language and speech disorders, stuttering, selective mutism) show more anxiety symptoms and are diagnosed with more anxiety than children with normal development.
In addition, although the reason why anxiety is very common in children with autism is not fully explained, studies have tried to explain that there are structural and neurochemical problems and that individuals with autism are predisposed to anxiety. The neurochemical disorder and predisposition hypothesis eliminate the idea that it is a natural consequence of social interaction disorder.
Apart from all of these, some studies show that there is a connection between social anxiety and the autism gene. Although it is not known exactly which of these studies are certain in today’s conditions, it shows that disorders in social interaction will help predict social anxiety.
Autism, Communication, and Social Anxiety
Children with autism experience more social interaction problems than even children with developmental delays. Symptoms such as inability to make eye contact, not speaking, and introversion, which we can define as a lack of social interaction, are the first symptoms that we can be aware of as the first signs of social anxiety in the beginning.
Social interaction disorder is thought to be associated with autism, which has a direct effect on anxiety. One example is that individuals with high-functioning autism have difficulty communicating with their peers. A person with high-functioning autism is aware of their own social interaction disorder, and their social anxiety increases as they misinterpret social cues and experience social failure.
Some researchers state that children with high-functioning autism have higher anxiety tendencies than other children on the autism spectrum. They explain this by saying that the functionality level of the child with autism is low because they have difficulty expressing their anxiety experience. In other words, researchers state that it is under-reported because these children cannot express their social anxiety correctly.
What Are the Conditions That Can Cause Social Anxiety in Individuals With Autism?
Cognitive Rigidity: People on the spectrum tend to process the world in detail. This can be a great strength for them because these are traits like having a strong memory. However, they may experience anxiety at times of processing, change, or transition based on the details of the situation rather than the context. An individual on the spectrum can become confused when changes occur unexpectedly or when a sudden shift from one situation to another is required. This confusion can quickly lead to anxiety.
Sensory Sensitivities: Children on the spectrum have difficulty regulating sensory input. Emotions that would not bother most children can be very bothersome to the child on the spectrum, leading to high levels of distress. Sensitivities may occur in the senses such as hearing, vision, taste, touch, and smell, but may extend to other senses such as balance, temperature, and pain.
Communication Problems: There is a high rate of speech and language processing disorders in autism. When the situation cannot be adapted and situations that require high demands on communication skills, it can cause frustration and social anxiety in individuals with autism.
Social Challenges: Social situations can present a variety of challenges for children on the spectrum. Difficulty understanding social rules and nuances can create social anxiety. They experience social anxiety on a large scale, especially in unstructured and sudden situations.
What Is Social Anxiety?
Social anxiety begins with an individual’s anxiety about how he is perceived and evaluated by others. For example, reading poetry in front of all students or speaking to a large audience may cause social anxiety in the individual. For some, exposure to the evaluation of others, such as new acquaintances, job interviews, oral exams, or interviews, may also be among the main situations that cause social anxiety. The common point of these situations is that the attention of others is focused on the individual.
Individuals with social anxiety feel inadequacy, humiliated, and disappointed with the thought that other people judge and negatively evaluate them. People with high social anxiety feel like they will do or say the wrong thing as if people will make fun of them, insult them, or humiliate them in public. It seems like everyone is looking at them when they talk. The smallest mistakes become very big for them and they think they are disgraced.
The individual experiences social anxiety not only when being watched and evaluated by others, but also when it comes to the possibility of this happening. Therefore, social anxiety also occurs when the person is alone, the idea of what others will think of them is enough for the anxiety to arise.
Individuals with high levels of social anxiety may also have hypersensitivity to criticism and rejection, difficulty in defending their rights, low self-esteem, or lack of self-confidence. Individuals with a high need for approval from others experience more social anxiety.
Individuals with high social anxiety avoid entering social environments in order not to experience these feelings. Avoidance reduces the performance of individuals at home, at work, at school, and in other social environments and leads to the deterioration of relationships. As a result, their school success decreases, their productivity decreases at work or they have difficulty making friends and maintaining this relationship. The resulting social isolation causes the person to feel unhappy and inadequate most of the time. This is often accompanied by a lack of self-confidence.
Social anxiety is the fear of being humiliated and negatively evaluated in social environments. The physical symptoms of social anxiety are usually flushing, palpitations, sweating, trembling, tension, stomach discomfort, dry mouth, difficulty breathing, fainting, dizziness, and tinnitus.
The most characteristic feature of children with high social anxiety is the fear and avoidance reaction in the presence of unfamiliar people or when others are watching them. The most fearful situations are determined as speaking in front of others, meeting new people, acting assertively, and speaking with people in authority.
Psychosocial approaches to reducing social anxiety generally include the cognitive-behavioral approach, psychoeducation, somatic control exercises, cognitive therapy, social skills and assertiveness training, and exposure experiences.
Another technique often used when working with children and young people with social anxiety is social skills training. This technique includes training young people to show their mistakes in various social situations and to behave more appropriately in the situation they are in.
Topics in social skills training programs generally focus on the ability to introduce oneself, start and maintain a conversation, study appropriate problem-solving methods, cope with anxiety-provoking situations, make written and oral presentations, express emotions appropriately, and cooperate effectively with others. In addition, it includes being able to display important social behaviors known as assertiveness training. For example, we can list them as asking for an address to a stranger, asking for information about homework to their peers, showing impulsive behavior, or warning others about undesirable behavior.
Cognitive techniques such as repetition of feared social situations, rehearsing the scene of the individual’s encounter with the feared situation, or giving positive feedback about the person’s behavior are included in the process.
Modeling and role-playing processes that we can include in social skills and assertiveness training provide rehearsals for important social behaviors, provide feedback that can improve social and performance skills, and provide the opportunity to work on real-life situations by exhibiting them.
Social skills also develop through observation and imitation. For this reason, it is extremely important for parents who have problems with their child’s shy and anxious behavior to first gain self-awareness and then model their children’s behavior.
The wide social circle of the family, inviting guests to the house, visiting others frequently, participating in events, or having a meal in a restaurant will increase the child’s social life and will be effective in the development of social skills appropriate to the environment. It is also extremely important that the parents motivate the child to participate in social environments. The fact that the family attaches too much importance to the opinions of others also leads to the development of the anxiety of being evaluated by others which are social anxiety.
Social anxiety manifests itself when the individual experiences distress in various social environments. Although the environmental characteristics that cause distress differ from person to person, shyness and fear of negative evaluation by others are common. Although it is known that social anxiety is related to genetic factors, the social environment, especially the family environment and parental attitudes and behaviors, can be counted among the causes of social anxiety in children. The parent’s negative model of avoidance and anxiety, overprotective attitude toward the child, the lack of socialization experience in the family, the parent’s love and affection for the child, and the lack of appreciation of the child’s ideas in the family affect the child’s self-perception negatively and may cause social anxiety.
For this reason, children who have been raised in an environment of love and compassion since infancy, who feel valued, whose thoughts and feelings are cared for in the family, who are supported to act independently, and who are motivated to participate in different social environments, experience less social anxiety.
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