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What is the difference between social anxiety and autism?

Autism and social anxiety are two separate conditions. Autism is neurodevelopmental condition and presents in early childhood, whereas social anxiety disorder is a mental health condition that can develop in childhood or adulthood. People can have one or both.

healthline.com - Social Anxiety vs. Autism: Differences, Similarities, and Treatment

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Share on Pinterest Nemanja Glumac/Stocksy United On the surface, social anxiety disorder and autism may look the same. Both autistic people and those with social anxiety may experience social situations differently than others. While social anxiety and autism can occur together, the two are very different conditions. Still, even doctors sometimes get the two mixed up, leading to misdiagnoses. Want to understand the difference between autism and social anxiety disorder? Read on to learn more. How autism and social anxiety disorder are different The main difference between autism and social anxiety is that autism is a neurodevelopmental condition, while social anxiety is a mental health condition. Experts say it’s essential to get the diagnosis correct. “It’s important because accurate conceptualization and diagnosis informs good treatment… and may increase understanding from others in the individual’s life,” says Megan Lawson, a licensed psychologist at Clarity Child Guidance Center in San Antonio, Texas. Though a formal diagnosis is best made by a licensed professional, understanding the differences between social anxiety and autism can empower people to seek an evaluation. Because autism and social anxiety are distinct conditions, they have nuanced symptoms and diagnostic criteria. Symptoms Autistic people and those with social anxiety may seem to avoid eye contact. Importantly, autistic people aren’t necessarily “avoiding” eye contact out of nervousness or fear. They’re simply not making eye contact in the first place, which is a distinct difference. A 2016 study tracked the eye movement of autistic people and compared it with people who have social anxiety disorder. Researchers suggested that autistic individuals looked toward a person more slowly, while people with social anxiety looked away faster. Whittaker reminds people that autism is a spectrum, and people may communicate in different ways. Some may not speak at all, while others may engage in one-sided conversations or miss social cues. On the other hand, she says people with social anxiety intentionally avoid conversations because of fear. Diagnosis The diagnostic criteria for social anxiety disorder and ASD are different. The DSM-5 diagnostic criteria for autism include: persistent differences in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact

repetitive patterns of behaviors, such as lining up toys

symptoms were present in early development, even if they went unnoticed

symptoms interfere with daily functioning, such as schoolwork The DSM-5 diagnostic criteria for social anxiety disorder include: fear of judgment in social situations

consistent anxiety in social situations that does not fit the context

avoidance of social interaction

a fear of social interaction that impedes day-to-day life

have fear for at least 6 months (and the fear cannot be attributed to another mental health condition, such as panic or substance use disorder, or a disease like Parkinson’s) Social anxiety can develop in children or adults. “Social anxiety can be the result of trauma,” Whittaker says. “Your brain is compensating for something that happened or trying to prevent something from happening or being relived.” Social anxiety is different from autism because autism isn’t triggered by an event, experience, or trauma. Brain function The amygdala may be implicated in both autism and social anxiety disorder, but Whittaker says current research supports the idea that autism is neurodevelopmental. Social anxiety, on the other hand, is mental-emotional. A 2011 study found a link between increased brain activity in the amygdala and social anxiety disorder. A 2016 study involving 32 participants with social anxiety disorder found they displayed a greater response in the amygdala during social interactions. And a 2010 study involving 24 people, half of whom were autistic, suggests the autistic participants had stronger connectivity between the amygdala and the prefrontal cortex, a network that affects emotional regulation. Autistic participants had weaker connectivity between the amygdala and temporal lobe, a pathway that aids in identifying facial cues. “The fact that [those on the spectrum] have brains that are wired differently explains why… they have difficulty processing their feelings and emotions,” Whittaker says. Treatment Though there is some overlap in support and services, some options are more suited for people with social anxiety disorder. Treatment options for social anxiety include: cognitive behavioral therapy (CBT)

group therapy

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medication Group therapy In group therapy, people typically sit and discuss symptoms and how they’re coping. A 2013 review of 11 studies indicates that CBT group therapy could be an effective intervention for social anxiety disorder, though researchers noted the quality of the studies was “moderate.” Still, Whittaker thinks it can help. “I do think group therapy is beneficial for people with social anxiety,” Whittaker says. “Part of anxiety is feeling like you’re the only one feeling like this. Being in a group helps with that, and desensitizes people with social anxiety to being with other people.” For autistic people, Whittaker typically recommends social skills training over group therapy. She says autistic people may want to learn more about how to have effective social interactions rather than how to soothe anxiety. Medication Healthcare professionals may prescribe autistic people medications to manage co-occurring conditions, such as attention deficit hyperactivity disorder (ADHD) or anxiety. Autism is also often diagnosed at a young age, when caregivers may not want to use pharmaceutical interventions. “Early intervention, autism-specific therapies, and any necessary adjunct services, like occupational therapy and speech therapy, are often recommended [first],” Lawson says. A 2017 research review suggests selective serotonin reuptake inhibitors (SSRIs) may be an effective treatment for social anxiety disorder, though researchers noted the evidence was low to moderate quality. Whittaker says a trained psychologist can help people with social anxiety disorder find the best course of treatment for them.

How to tell whether it’s social anxiety or autism The best way to differentiate between social anxiety disorder from autism is through a formal diagnosis from a healthcare professional, such as a psychologist or neurologist. Here’s what the process will look like, as well as what you should look for in yourself and your loved ones. Screening A psychologist will use the DSM-5 to diagnose autism or social anxiety disorder. There’s no actual “test” for either condition. Screening for autism will involve observations of the child or adult, and interviews with teachers, caregivers, and the person being evaluated. Whittaker says a psychologist will interview a person about their symptoms. Questions might include: How do you feel in social situations?

Do you always feel this way? If so, how long have these feelings persisted?

Do you avoid social situations?

Is your fear of social interaction impacting your day-to-day functioning? In kids Having a basic understanding of the distinction between autism and social anxiety disorder can help caregivers seek the appropriate screenings and support for children. “Say there is a group exercise, and your child is off to themselves and doesn’t engage at all,” Whittaker says. “That’s a sign it may be ASD and not social anxiety. In social anxiety, the child may be a part of the group but not saying anything, [or] sweating.” In adults Autism is typically diagnosed in childhood, but some autistic adults may have never received a formal evaluation. Whittaker says one of the best ways to tell the difference between autism and social anxiety is to take stock of how the person responds to invitations to gatherings. “If it’s social anxiety disorder, they may be avoiding social interactions and gatherings altogether,” she says. “[Those with] ASD, they may come, [but they may] not be interactive, or their conversations may be one-sided.” What about Asperger’s? The American Psychiatric Association removed Asperger’s syndrome from the DSM-5 in 2013. Before that, Asperger’s was considered a form of autism that may not have needed as much support. Today, an ASD diagnosis includes the entire spectrum of potential support needs. While some symptoms between Asperger’s and social anxiety, like social behaviors, may overlap, Whittaker emphasizes that the causes of the symptoms are not the same. Again, the difference comes down to neurological versus mental-emotional causes. Misdiagnosis On Reddit, thread after thread features questions from users about possible misdiagnoses. Whittaker says a misdiagnosis of autism rather than social anxiety disorder is rare.

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She says a missed diagnosis of social anxiety in autistic people is more common, because even healthcare professionals may focus too heavily on a neurodevelopmental condition rather than mental health. Still, patients and caregivers can question a diagnosis or seek a second opinion. Questions to ask and points to make Whittaker says asking questions and further discussing factors that may be triggering symptoms can help provide clarity on a diagnosis. She recommends covering these bases: the age and year of the diagnosis anything going on at school or home at the time of the diagnosis description of symptoms, including how frequent and how long they’ve been present How to seek a second opinion Whittaker says you don’t have to discuss that you wish to seek a second opinion with your healthcare professional, though it can be helpful for the second practitioner to get the information from the initial diagnosis. Your healthcare professional can also refer you to someone else. They’re used to patients asking for second opinions, Whittaker says. From there, you can call different healthcare professionals to discuss your situation and unique needs. Resources for support Social anxiety and autism can feel overwhelming at times, but support is available. Whittaker shares several resources to help you navigate testing, therapy, and support. Testing A psychologist or neurologist will evaluate you or a loved one for social anxiety or autism, and can differentiate between the two. You can find a psychologist or neurologist through: your insurance company

a referral from your primary care doctor or pediatrician

your child’s school

early intervention programs

programs referrals from therapists, including speech and occupational therapists Therapy Once you or a loved one receive a diagnosis, you may want to pursue therapy for support. To find a therapist, you can check with: your insurance company

your primary care doctor or pediatrician

your child’s school (there may be one on campus)

Healthline’s FindCare directory

employee assistance programs

friend and family referrals

the National Alliance on Mental Illness (NAMI) Support groups Support groups can benefit people with social anxiety, as well as loved ones of people with social anxiety or ASD. In addition to the options listed above, you can find support groups through: local nonprofits