Co-occurring anxiety is found in 40 percent of autistic individuals, but much about the relationship between anxiety symptoms and social functioning difficulties in autism remains unknown (Zaboski & Storch, 2018). Few studies have examined the role of social anxiety in response to social skills group treatments for autistic adults. TUNE In (Training to Understand and Navigate Emotions and Interactions) is a cognitive-behavioral and mindfulness-based program for autistic adults. The program consists of three components that aim to address different aspects of social functioning. Because social anxiety is so highly prevalent in autistic adults, we hypothesized that participants’ anxiety would be a key moderator in their responses to TUNE In. A randomized control trial (RCT) was conducted to test TUNE In’s effectiveness. Here, we tested the role that anxiety plays in variability in response to TUNE In. The primary outcome measure for this RCT was the Social Responsiveness Scale, Second Edition for Adults (SRS-2). The SRS-2 is a 65-item questionnaire used to measure social functioning through informant reports (SRS-2 IR) and self-reports (SRS-2 SR). Self-reports were given at baseline, after Component 1, after Component 2, and post-treatment. Informant reports were given at baseline and post-treatment. The Liebowitz Social Anxiety Scale (LSAS) was used to measure social anxiety in participants at baseline and post-treatment through self-reports. Reliable Change Index (RCI) was used to determine which participants were improving reliably in TUNE In. Hierarchical linear modeling was used to look at the change in SRS scores over time between the treatment and control groups, with LSAS included as a moderator variable. 

Overall, our results show that anxiety is a key moderator in participants’ responses to TUNE In, as indicated by reliable change scores. TUNE In is most effective for participants with any baseline anxiety and is especially effective for those with high baseline anxiety. These results suggest that social anxiety may play a larger role in social functioning. Thus, programs such as TUNE In (i.e., those that utilize mindfulness and cognitive behavioral therapy) may enhance social functioning through addressing and reducing social anxiety. The specific interplay between social anxiety and social functioning in outcomes and wellbeing for autistic adults warrants closer examination.

 References

Zaboski, B. A., & Storch, E. A. (2018). Comorbid autism spectrum disorder and anxiety disorders: A brief review. Future Neurology, 13(1), 31-37. https://doi.org/10.2217/fnl-2017-0030