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Are Autism and Social Anxiety Disorder the Same?

By Olivia Guy-Evans, published March 28, 2022

by Saul Mcleod, PhD


How are autism and SAD similar?

Autism spectrum disorder (ASD) and social anxiety disorder (SAD) are often difficult to distinguish in individuals.

One reason they are sometimes confused is because some symptoms appear the same. Some of the overlapping symptoms can include the following traits:

Difficulties in social skills

A key trait of ASD is differences in social interaction such as having difficulty maintaining eye contact, different body posture, and speech qualities such as tone, volume, and rate.

Although this is not the case for all people with ASD, many with this disorder prefer limited social communication and might appear quiet or withdrawn in social situations. 

Although the cause of social difficulties in both ASD and SAD differs, many of the same symptoms are present in both disorders.

Due to those with SAD being anxious in social situations, they are also likely to not speak so much, talking quietly, and may present with a less confident posture. 

Spending time alone

Those with ASD and SAD may be more likely to want to spend time alone than be in social situations, although the reasons for avoiding these situations are different.

They are likely to avoid situations that require social interaction and may actively avoid people at times, especially those who are unfamiliar.

They may prefer, and be happier when isolating themselves from others, spending more time alone than with anyone else. 

Some of the questions or statements on tests for ASD and SAD can be very similar such as having questions asking whether the individual wants to avoid social situations and whether they prefer spending time alone. 

These kinds of overlaps in testing can make it difficult to distinguish whether someone has ASD or SAD. 

Anxiety 

An obvious trait of SAD is severe anxiety symptoms, especially in social situations. It is also common for people with ASD to experience extreme anxiety in social situations such as feeling nervous or only being comfortable around a few certain people.

Those with ASD may have difficulty recognising and regulating their emotions so it is not uncommon for people with ASD to develop mental health issues alongside their autism.

Likewise, during autism shutdowns, they can become so overwhelmed that they completely withdraw or find they are unable to talk, which others may confuse as being socially anxious. 

Difficulty building friendships

Those with ASD and SAD may also find trouble with building and maintaining friendships. Reasons for this can include all the above difficulties associated with their social skills, wanting to spend time alone, and anxiety they may experience in social settings.

Combined, it can be very challenging for someone with ASD or SAD to form friendships, especially with people they are not as familiar with.


What are the differences between autism and SAD?

While ASD and SAD share a lot of similarities to each other, they are distinct conditions in many ways.

The main difference being that ASD is a neurodevelopmental condition while SAD is a mental health condition.

Below are some of the other key differences between these disorders:

Differences in symptoms

Although those with ASD and SAD may prefer to avoid social situations, the reasoning behind their avoidance is where the differences lie:

  • Those with ASD may experience confusion and sensory overstimulation in social situations and therefore may be less inclined to seek out social activity. 

  • Those with SAD do not experience sensory issues, choosing to withdraw from social situations for fear of being judged. 

  • Those with ASD can struggle to guess what others are thinking which can be stressful and could result in social mistakes and bullying and may display nervousness because they have had bad experiences. 

  • Those with SAD may not have difficulty reading facial expressions and body language but may experience cognitive distortions in social situations.

People with ASD and SAD also have differences in their social skills:

  • Those with ASD may not know how to respond to many social situations since they may not possess the needed social skills. 

  • Those with SAD often have the needed social skills but are too scared to use them – their fear of socialising makes it difficult to use these skills.

  • SAD often causes people to stutter, blush, or make their mind go ‘blank’ in social situations, making it difficult to execute a conversation. Consequently, they appear to have poor social skills when in reality they are just anxious. When the person with SAD is in a comfortable situation, it is likely these symptoms will cease.

  • A person with ASD may fidget in social situations, however this is their normal body language to help them be comfortable and they will continue to do it outside of social situations. 

  • Many people with ASD are not withdrawn and quiet – they can speak loudly, stand too close to another person, and can appear tactless or rude without meaning to. 

  • In comparison, those with SAD will often speak quietly or too softly, prefer to stand far away from others and avoid eye contact out of fear. 

  • Those with ASD are not necessarily avoiding eye contact out of fear, they may just find it uncomfortable or over-stimulating to do so.

  • 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. Whereas those with SAD may intentionally avoid conversations because of fear of embarrassment or negative judgement. 

There are also other symptoms which are present in ASD which are not common in those with SAD. People with ASD will often:

  • Have atypical development such as hitting milestones differently.

  • Present with repetitive or unusual movements and noises – stimming.

  • Have passionate special interests.

  • Have sensory issues. 

  • Have motor skill delays or difficulties.

  • Be unable to take hints or understand certain humour.

  • Have meltdowns and/or shutdowns when overwhelmed. 

There are also physical symptoms which are present in SAD when in social situations but are not common in those with ASD:

  • Sweating

  • Rapid heartbeat

  • Feeling breathless 

  • Shaking or trembling

Differences in diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) describes a set of criteria that an individual must meet before being diagnosed with ASD and SAD.

The diagnostic criteria for both disorders are very different. For ASD, the DSM includes:

  • Persistent difficulties in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact.

  • Repetitive patterns of behaviour. 

  • Symptoms were present in early development, even if they went unnoticed. 

  • The symptoms interfere with daily functioning. 

For SAD, the DSM includes:

  • A fear of judgement 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. 

  • The fear must be present for at least 6 months and not attributed to another mental health condition. 

It is important to note the age of onset for these conditions. SAD can develop at any age, in childhood, or with adults who have never experienced social anxiety before.

It can be influenced in some way by genetics, but SAD can also be triggered by trauma or stressful life events. 

Autism on the other hand is not triggered by environmental factors and is persistent since birth. Autism is also a lifelong condition that cannot be cured, whereas SAD can be effectively treated.

Even those with ASD who were diagnosed late can look back and recognise signs of autism in their childhood.

Differences in brain function

Neuroimaging studies of brain function have shown that for most people, the amygdala is activated when understanding facial expressions.

For those with ASD, the prefrontal cortex – the centre of the brain responsible for judgement and planning – become active when processing facial images.

This activation suggests that people with ASD try to logically figure out the meaning of a facial expression rather than experiencing an automatic emotional reaction that those without ASD can do.

Studies have also shown a heightened sensitivity of the amygdala in those with SAD – this evidence makes it even more clear that the two disorders are very different. 

Do all autistic people have anxiety?

A considerable proportion of individuals with ASD also fulfil the criteria for SAD, meaning it is possible to have both disorders. It is thought that around 30% of autistic children qualify for a diagnosis of social phobia.

A reason for this may be because those with ASD often struggle socially and are at risk of being bullied. As a result of the trauma of being bullied and fear of this happening again, these individuals may develop social anxiety as a result. 

It is not just SAD which is common in those with ASD – in a review of around 30 studies of autistic children, almost 40% had at least one associated anxiety disorder.

Due to the struggles of trying to navigate a neurotypical world, those with ASD may find life very anxiety-inducing which may be why so many of them develop anxiety disorders.

Although a lot of people with ASD experience anxiety, not all of them do and find that they can navigate their way through the world in a way which is comforting to them. 

Can autism be misdiagnosed as SAD?

Often due to similarities in socially related traits in both ASD and SAD, a misdiagnosis of SAD may be given when it could be in fact autism.

This is most likely to happen for girls and women with ASD who present struggles with social situations. 

There are a number of reasons why females are more likely to be diagnosed with SAD than ASD. The first being that autism is typically viewed as a mostly male disorder.

Much of the early research and theorists which helped develop our understanding of autism, used primarily male individuals with ASD in their studies. 

There is now an understanding that autism can present differently in females than in males. Females with autism tend to struggle more socially than males.

They may be more likely to experience bullying from their peers for acting ‘socially inappropriate’ in conversations and so a lot of autistic females have learnt to camouflage their symptoms.

This means that they have learnt to hide their autistic traits by forcing eye contact, using learned phrases, mirroring other’s social behaviour, and imitating facial expressions.

Since females with autism can be good at hiding their autistic traits, this can make it harder for others to notice that they are autistic, and the anxiety in social situations becomes more prominent, meaning they can be more likely to be diagnosed with SAD than ASD.

How to tell whether it is autism or SAD

The best way to differentiate between SAD and ASD is through a formal diagnosis from a healthcare professional such as a psychologist or neurologist. 

The screening for autism can be a lengthy process and involves observations of the individual and can include interviews with teachers, caregivers, and the person being evaluated.

ASD is typically diagnosed in childhood, but some autistic adults may have never received a formal evaluation. It can be a lot more difficult to receive an autism diagnosis in adulthood, which leads many to self-diagnose themselves.

A diagnosis is usually easier as this may just involve talking through the symptoms with the patient and assessing whether they meet the diagnostic criteria. When diagnosing, it is important not to rule out the possibility that the individual may have both disorders. 

One way to tell the difference between ASD and SAD is to notice how the person responds to invites to social events. Someone with SAD may be more likely to avoid the social event altogether or choose to attend but endure it with a lot of anxiety.

Those with ASD may choose not to attend because they would just prefer not to, or they may attend but might not be interactive or their conversations may be one-sided.

Do you need mental health help?

USA

Contact the National Suicide Prevention Lifeline for support and assistance from a trained counselor. If you or a loved one are in immediate danger: https://suicidepreventionlifeline.org/

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Contact the Samaritans for support and assistance from a trained counselor: https://www.samaritans.org/; email [email protected].

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Rethink Mental Illness: rethink.org

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Fact Checking
Simply Psychology content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication.

About the Author

Olivia Guy-Evans obtained her undergraduate degree in Educational Psychology at Edge Hill University in 2015. She then received her master’s degree in Psychology of Education from the University of Bristol in 2019. Olivia has been working as a support worker for adults with learning disabilities in Bristol for the last four years.

How to reference this article:

Guy-Evans, O. (2022, March 25). Are Autism and Social Anxiety Disorder the Same. Simply Psychology. www.simplypsychology.org/social-anxiety-vs-autism.html

Sources

Ansell Elfer, E. (n.d.). Understanding the Difference Between Social Anxiety Disorder and Autism. The Autism Site. Retrieved 2022, March 24 from: https://blog.theautismsite.greatergood.com/social-anxiety-disorder-vs-autism/

Rose, L. (2021, April 8). How to Distinguish Between Social Anxiety and Autism. Wiki How. https://www.wikihow.com/Distinguish-Between-Social-Anxiety-and-Autism

Jefferson, J. W. (2001). Social anxiety disorder: More than just a little shyness. Primary care companion to the Journal of clinical psychiatry, 3(1), 4.

Maddox, B. B., & White, S. W. (2015). Comorbid social anxiety disorder in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(12), 3949-3960.

Mayer, B. A. (2021, November 3). How to Tell the Difference Between Social Anxiety and Autism. Healthline. https://www.healthline.com/health/autism/social-anxiety-vs-autism

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