Does the Presence of Anxiety and ADHD Symptoms Add to Social Impairment in Children with Autism Spectrum Disorder?
Anxiety and ADHD each worsen different social domains in kids with ASD—screen and target these co-occurring conditions during assessment.
01Research in Context
What this study did
The team asked parents to fill out the SRS-2 about their child with autism. They also had parents rate anxiety and ADHD symptoms. Then they looked at which symptoms lined up with worse social scores.
The study used a quasi-experimental design. It focused on how anxiety and ADHD each add to social problems in kids who already have ASD.
What they found
Anxiety symptoms made social-communication scores worse on the SRS-2. ADHD symptoms pushed up restricted and repetitive behavior scores. Each problem hit a different social area.
The results show that anxiety and ADHD do not just tag along. They each intensify specific parts of the autism profile.
How this fits with other research
Dellapiazza et al. (2021) extends these findings. They compared kids with ASD+ADHD to kids with ADHD only. The ASD+ADHD group showed the highest social impairment, proving the combo is worse than either alone.
O'Hagan et al. (2023) conceptually replicated the pattern in teens. Autistic teens with anxiety or ADHD had higher SRS scores than those with autism alone. The same additive effect appears across age groups.
Johnston et al. (2017) seems to disagree at first glance. They found depression, not anxiety, predicted social competence. The key difference is the measure: Smith used the SCQ, while S et al. used the SRS-2. Different tools capture different social angles, so the papers actually complement each other.
Why it matters
When you see a child with ASD, do not stop at the autism label. Screen for anxiety and ADHD using quick parent checklists. If anxiety shows up, expect extra trouble with back-and-forth conversation. If ADHD flags, watch for more repetitive play or rigid routines. Target the added symptom in your plan: add coping skills for anxiety, or use movement breaks and clear routines for ADHD. Treating the autism alone will miss the real drivers of social difficulty.
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02At a glance
03Original abstract
Children with autism spectrum disorder (ASD) experience internalizing and externalizing problems at higher rates than typically developing children, which could worsen social impairment. The present study compared impairment scores (social responsiveness scale, 2nd edition; SRS-2 scores) in 57 children (3-17 years, 82.5% male) with ASD, either with or without heightened levels of anxiety or ADHD symptoms, all per parent report. Children with heightened anxiety problems showed higher scores on four SRS-2 subscales (Social Cognition, Social Communication, Social Motivation, and Restricted Interests and Repetitive Behavior). Children with heightened ADHD traits showed higher scores on two subscales (Social Communication and Social Awareness). These findings suggest similarities and differences in how social deficits in ASD may worsen with anxiety or ADHD symptoms.
Journal of autism and developmental disorders, 2017 · doi:10.1007/s10803-016-3025-9