Autism Vs. Social Anxiety: Understanding the Difference

What Is Autism Spectrum Disorder (ASD)?

Autism is a neurological condition that primarily impacts how an individual interacts with others and the world around them. Symptoms of autism include difficulties with socialization, communication problems, and repetitive behaviors.

The behaviors and expressions of autistic individuals may pose challenges throughout childhood and into adulthood. As children, autistic stimming or repetitive behaviors may interfere with a person’s schooling or activities. In adulthood, autistic individuals may experience issues that are more so related to how they interact with and get along with others.

Common symptoms of autism include:

Communication differences

• Difficulties forming and maintaining relationships
• Echolalia 
• Challenges expressing emotions
• Rigid adherence to rules
• Problems handling transitions or changes
• Verbally or physically aggressive behaviors when angry

Behavioral differences

• Repetitive behaviors
• Stimming
• Yelling or screaming at inappropriate times
• Refusing to talk with other people
• Limited social interactions
• Frequent arguments

What Is Social Anxiety?

Social anxiety disorder is a psychological condition that involves an excessive fear of being negatively perceived or judged by others.¹ It can frequently result in impaired social functioning, and can sometimes be tied to specific situations, such as public speaking. Unlike autism, which is present throughout a person’s life, social anxiety disorder tends to begin sometime around one’s early adolescence.² The symptoms of anxiety one experiences range considerably with this condition, but they primarily impact a person’s ability to interact with people.

Those with social anxiety disorder may often be described as “shy,” but social anxiety is different from shyness. While shyness may cause some discomfort for a person, social anxiety can result in one becoming completely overwhelmed in social situations.

Common symptoms of social anxiety disorder include:

• Fears of being judged by others
• Rumination on previous social interactions
• Avoidance of any social situation
• Intense nervousness around other people
• Refusal to do things that involve social situations

Similarities Between Social Anxiety & Autism

Autism and social anxiety can both contribute to a limited readiness to engage in social interactions. Some research suggests that the prevalence of social anxiety disorder and autism is 50% or more, meaning that nearly half of autistic individuals experience this type of anxiety.³. Determining if both conditions are present can be difficult, as the ways in which symptoms present are often similar.⁴

Similar characteristics between social anxiety and autism include:

• Difficulties forming relationships: Because of the potential for being negatively perceived by others, those with social anxiety may struggle to form new relationships.⁵ Autistic people may find social interactions not as stimulating as other experiences, which may decrease their interest in seeking and forming new relationships.
• Avoidance behaviors: When someone faces difficulties in a particular situation, they may avoid it whenever possible. Those with either social anxiety disorder or autism may engage in avoidance behaviors in order to limit anxieties related to social interactions.
• Selective mutism: Due to struggles with interactions, a person with social anxiety or autism may engage in selective mutism.⁶ This occurs when the person appears unable to speak in social situations.
• Problems handling uncertainty: Autistic individuals find it challenging to adapt to unexpected changes in routine. Handling uncertainty is also difficult for those with social anxiety, as they can not prepare ahead of time for an immediate change in plans.⁷
• Apparent lack of empathy: Both autistic folks and those with social anxiety disorder may not possess the same social skills as others, which can impact how they react to and understand another person’s feelings.⁸

Differences Between Autism & Social Anxiety

Autism is a condition a person is born with, whereas social anxiety disorder develops over time. Beyond this difference, it is important to note that social anxiety results from fears of being judged by others. Autism, on the other hand, impacts a person’s communication skills, but an autistic individual may not necessarily be bothered by this. They may only think negatively about themselves if others react poorly to their behaviors.

Differences between social anxiety and autism include:

Perception of Social Cues

Autistic folks tend to have difficulties recognizing social cues, and may not react to another person’s various facial expressions or changes in tone. This can result in autistic individuals responding inappropriately or in unexpected ways during conversation. For example, they may not show comfort to someone when they are sad, or fail to back off from a topic that is clearly causing the other person to become upset.

Social cues are typically not a problem for those with social anxiety disorder. Individuals with this condition are generally able to understand when displays of comfort are needed or when a topic is off limits. They can recognize how they are supposed to respond in a social situation, but choose to avoid it instead.

Sensory Issues

Autistic individuals will often experience problems handling certain textures, sounds, or tastes.  They may limit what they are willing to eat or what they wear. Sensory processing issues can also lead one to become agitated, or even aggressive, when in an environment that becomes overstimulating or uncomfortable. Sensory issues are not typically a problem in social anxiety, as the neurological differences associated with autism are not present in this disorder.

Anxiety Symptoms

Social anxiety disorder is an anxiety disorder, but autism is not. Anxiety is not directly associated with autism, and does not need to be present for a diagnosis to be given. Conversely, social anxiety disorder is characterized by a person’s anxiety symptoms.

An autistic individual can certainly become anxious when facing social situations. However,  feeling nervous about something is not the same as having an anxiety disorder. The key here is recognizing that not every autistic person will also experience anxiety to the degree that warrants being diagnosed with social anxiety disorder.

Diagnostic Process

There are many differences in what healthcare professionals look for when determining which condition represents the most accurate diagnosis. With autism, a doctor or therapist will look for evidence that one’s symptoms have been present throughout their life. These will include those associated with social difficulties, communication problems, and repetitive behaviors.

Furthermore, when assessing for autism, much of the diagnostic process emphasizes what others observe from an individual in various situations. A doctor may ask people in a person’s life about the individual’s behaviors to see if the three symptoms of autism have been present since childhood.

When diagnosing social anxiety disorder, healthcare professionals will seek evidence that one’s anxiety notably impacts what they are able or willing to do. Social anxiety disorder largely relates to the degree to which fear and negative self-statements limit one’s functioning in certain circumstances.

Interpersonal Relationships

An autistic person’s communication and social challenges will often be evident in their relationships. How another individual reacts to these differences will likely determine how comfortable an autistic person is with them. Depending on the type of relationship, these issues may simply be overlooked or talked through.

In comparison, the effects of a social anxiety disorder differ in how much it impacts a person’s close relationships. For example, someone’s anxiety is notably less when interacting with family members than it would be with acquaintances. When a person isn’t concerned about feeling judged, they tend to open more.

Restricted Interests

One way autism manifests itself is through restricted interests, which often include certain activities or topics. These relate back to repetitive behaviors in that an autistic person becomes hyperfocused on and constantly revisits this one particular interest, sometimes impairing their ability to engage in other things. These same behaviors are not evident or associated with social anxiety.

Social Motivation

Someone with social anxiety may very well have interest in making friends or being social, but simply be too anxious to do so. Conversely, autistic individuals may experience a limited desire to be socially engaged. They may decide instead to focus on other things they find more intriguing to them–such as a special interest.

Can Someone Have Both Social Anxiety & Autism?

As stated earlier, research estimates that social anxiety disorder and autism have a high comorbidity rate at nearly 50%.³ This may be due to the challenges that arise for autistic individuals when their behaviors receive negative reactions from other people. These behaviors themselves are not necessarily the problem–as they’re often used for self-expression.

When an autistic person frequently hears negative feedback about their differences, their social anxieties can become worse. This may also be problematic in the fact that discomfort can increase one’s repetitive behaviors. All of these factors feed into a cycle that may develop into a social anxiety disorder.

How to Tell Whether It Is Social Anxiety or Autism

When trying to distinguish between social anxiety and autism, it is important to look at a person’s symptom history. If challenges in one’s life have been present since childhood, these will likely stem from autism. If a more definitive starting point is identified, a social anxiety disorder diagnosis may be warranted. Additionally, this would also be the case if the person recognizes that their problems relate specifically to being worried, scared, or apprehensive about social interactions.

Can Social Anxiety & Autism Be Misdiagnosed?

Depending on the individual, both social anxiety disorders and autism will present differently.  Symptoms also change over time as the person ages. Because of this and the overlap in certain behaviors, social anxiety and autism may sometimes be misdiagnosed.

Additionally, there is also the chance of a person being diagnosed with social communication disorder. This refers to individuals who present with the social and communication differences associated with autism, but not the repetitive behaviors. To receive an accurate diagnosis, it is important to find a specialist who has experience in both conditions, as they will be better able to distinguish between autism and social anxiety disorder.

How Are Social Anxiety & Autism Treated?

There are various methods used to treat social anxiety disorder and certain autism symptoms. While some of these approaches are the same for both conditions, the techniques used throughout treatment may be different.

Support & Treatment for Autism

For an autistic person to benefit from therapy, it is important to find a neurodiversity-affirming therapist. A common treatment method in this case is applied behavioral analysis (ABA). While this approach has received criticism within the past few years, it is believed that some individuals may respond well to certain methods used. There are different types of individual or family therapy approaches that incorporate elements of applied behavior analysis into practice.

Treatment and support options for autism may include:

• Applied behavioral analysis (ABA): ABA uses behavioral approaches like positive reinforcement to help a person learn new skills. This can help autistic individuals replace behaviors that can sometimes prove problematic.
• Social skills training: This approach may often include classes where students are led through exercises designed to teach specific social skills.
• Functional analytic psychotherapy: This approach is useful for autistic individuals because therapy sessions focus on building the relationship between the therapist and client. This helps the person learn and use more effective social skills.¹²
• Cognitive-behavioral therapy (CBT): Sometimes, social and communication difficulties can negatively impact how a person views themselves. Cognitive behavioral therapy can help autistic individuals overcome negative self-talk or thoughts.¹³
• Dance therapy: Dance therapy can be particularly helpful for autistic individuals because of its focus on nonverbal communication.¹⁴ This approach uses movement to help the person express what is bothering them and find more effective ways to handle emotionally distressing situations.

Treatment for Social Anxiety

Psychotherapy is considered the most effective treatment approach for social anxiety disorder because it targets the specific difficulties this condition presents.¹⁵ Other treatment options for social anxiety, such as medications, do not directly address the root causes of a person’s fears. However, medication as a part of a treatment plan can be helpful in reducing one’s symptoms.

Treatment options for social anxiety may include:

• Cognitive behavioral therapy (CBT): CBT for social anxiety helps a person develop skills they can use to decrease negative feelings they have about themselves in social settings, particularly when interacting with other people.
• Exposure and response prevention therapy (ERP): ERP functions on the premise that the more a person engages in social situations that make them anxious, the easier it will become for them to manage their fears.
• Medications: Medications for social anxiety are available to help lessen symptoms, but are not considered a frontline treatment option.
• Psychodynamic psychotherapy: Research suggests that psychodynamic therapy can be beneficial for those with social anxiety disorder.¹⁶ This approach focuses on working through a client’s emotional difficulties associated with different relationships.
• Online psychotherapy: When it comes to social anxiety, online therapy options may be particularly effective because the client doesn’t need to subject themselves to traditional social settings in order to receive treatment. This can make it more likely that the person continues with therapy.
• Virtual reality psychotherapy: Using virtual reality in psychotherapy offers a way to ease clients into interacting with others.¹⁷ This practice helps to strengthen their comfort level in social settings.

Final Thoughts

Autism and social anxiety disorder are two distinct conditions that are treated differently.  Both have treatments shown to be effective that help people learn better skills for handling challenges each condition presents. Finding psychologists or other qualified mental health providers who are familiar with the condition is important for developing effective treatment plans.