Social Anxiety vs Autism: How to Tell the Difference

What is Social Anxiety?

Social anxiety disorder is a type of anxiety disorder that causes extreme, persistent fear of social events or environments.

Research suggests that an estimated 12% of adults will experience social anxiety symptoms at some point in their life. Social anxiety can lead to avoidance behaviors, as people will go to great lengths to not have to deal with their fear. As a result, this is a type of anxiety that can profoundly impact the ability to function daily and hinder quality of life, but with therapy (and sometimes medication), it is very treatable.

Symptoms of social anxiety disorder:

• Having a deep fear of social situations
• Avoiding social settings or attending in significant distress
• Sweating
• Trembling
• Rapid heart rate
• Nausea
• Fearing being judged or embarrassed
• Finding it difficult to make eye contact
• Overanalyzing social interactions
• Having anxiety before events or a social situation

What is Autism?

Autism spectrum disorder is a neurological and developmental condition that impacts how people communicate and interact with others. It makes social interactions challenging for an autistic person due to an inability to recognize social cues, like body language or facial expressions, easily. This, combined with limited interests and repetitive behaviors, can make establishing and maintaining deep connections with others hard for autistic individuals.

ASD is a spectrum disorder, which means symptom severity can widely range. An estimated 1 out of 36 children and 1 out of 45 adults live with autism in the United States. Early intervention and treatment with therapy and medication offer promise for improvement in symptoms.

Symptoms of autism spectrum disorder (ASD):

• Challenges with social communication
• Difficulty recognizing nonverbal cues
• Restricted interests
• Fixation on specific subjects or objects
• Repetitive behaviors, like rocking or hand-flapping
• Sensory aversions, including heightened sensitivity to lights, sounds, or textures
• Finding transitions or routine changes hard
• Delay in spoken language
• Difficulty expressing or regulating emotions

*Not all symptoms will be present for everyone on the autism spectrum

Social interaction challenges

Social interaction is challenging for people living with social anxiety disorder or autism, although the challenges manifest differently.

People with social anxiety have an intense fear of being humiliated or judged by others. This fear can cause severe anxiety and discomfort leading up to and during social gatherings. Most people who have social anxiety are very self-conscious and excessively worry about how others perceive them. This can extend to social anxiety at work, causing people with this condition to seek certain jobs for social anxiety to avoid interacting with people.

With autism, on the other hand, autistic traits such as not being able to pick up on social norms or individual cues can cause social difficulty and complicate interactions. This can be especially true if the other person isn’t aware that autism is the cause and, therefore, doesn’t understand the reasoning behind certain behaviors.

Autism can make initiating and maintaining conversations hard. Some autistic individuals don’t understand social boundaries or unwritten rules of social engagement.

Anxiety in social situations

The anxiety experienced in social situations can present distinct challenges for those with SAD or ASD. It can be painful, causing people with either condition to avoid social settings to cope.

People living with social anxiety often dread even just the thought of having to do anything social. Their fear of being in the spotlight, made fun of, or judged dominates their thoughts, and a tendency to catastrophic social interactions also drives anxiety. The type of social anxiety they experience may vary, heightening in certain situations more than others.

People with autism have trouble understanding familiar social cues, which leads to discomfort or uncertainty (usually for the person they’re interacting with). Because social situations can have an element of unpredictability — and routine is essential for many people on the spectrum — social settings can exacerbate anxiety. Sensory sensitivities can also be overwhelming for an autistic person in social environments.

Misinterpretation by others

Being misunderstood is a frequent occurrence for those with autism and social anxiety disorder. When others aren’t educated about these conditions, it can lead to confusion or misinterpretation about certain behaviors.

"Social anxiety and autism can be misconstrued for one or the other. There are definite commonalities when it comes to the two but the key is what makes the two different. Unfortunately, in social situations, those around us are not sure if the awkwardness that is displayed comes from social anxiety or autism. It tends to make it harder for others to want to interact because they aren’t sure of how to navigate the situation either. Sometimes, just stating that you are nervous in new situations helps dispel the unsureness of others."

— Minkyung Chung, MS, LMHC

Social anxiety disorder causes people to adopt avoidance behaviors to get them out of uncomfortable — even painful — social obligations. Their fear of embarrassment or judgment can be so strong that they’d often rather miss an event. Others might misinterpret this behavior tendency, thinking someone is unapproachable or disinterested in developing a relationship rather than having social anxiety.

When people with autism miss social cues, avoid eye contact, or seem uninterested in small talk, it can be confusing for those around them. Due to having autism, they might be unable to express themselves or understand social expectations and norms. They might even appear aloof or rude, even in conversation.

Origin of social challenges

Social challenges for people with social anxiety disorder arise from a fear of a negative evaluation by others. For those with autism, the challenges result from not fully understanding social norms or picking up on cues.

Awareness and response to social cues

How aware someone is of social cues and how they respond to them differs based on the condition they’re dealing with. Social anxiety disorder can make someone hyper-aware of social cues to the point they’re unable or too afraid to respond. It’s more common for autism to cause one to struggle with recognizing social cues in the first place, so they behave in ways that others may not understand.

"Individuals struggling with social anxiety understand and can respond to social cues. For instance, if a joke falls flat then they know to react appropriately by either apologizing or moving on. Individuals with autism struggle with understanding social cues, so they will continue to repeat the joke or continue on with the joke despite others' discomfort. The ability to “read a room” sets a person with social anxiety and autism apart."

— Minkyung Chung, MS, LMHC

Nature of interactions

Interactions with others for people with autism or social anxiety disorder can be similar — often awkward and misunderstood. However, whereas the thought of having to interact can be overwhelming or terrifying for someone with social anxiety, people with autism may not even be aware that their engagement is uncomfortable for the other person.

Cognitive and sensory processing

Cognitive and sensory processing issues can contribute to social challenges for people living with autism. This isn’t usually the case for someone with social anxiety. Instead, it’s their heightened sensitivity to perceived and feared judgment that drives their anxiety.

Development and onset

Social anxiety typically manifests in either adolescence or early adulthood. Autism is more often identified in early childhood and is a lifelong condition without a cure. However, treatment, especially with early intervention, can provide someone with autism with coping skills that result in significant improvement.

Treatment approaches

Social anxiety disorder is very treatable, even in extreme cases. Most of the time, successful treatment for social anxiety disorder can include:

• Talk therapy (i.e. cognitive behavioral therapy for social anxiety)
• Medication for social anxiety
• Support groups
• A combination approach

Treatment plans for autism are most effective when diagnosis and intervention are started earlier, according to research. While there is no cure for ASD, treatment can be very successful and can include:

• Social skills training
• Physical therapy
• Behavioral management therapy
• Education and school-based therapy
• Cognitive behavioral therapy (CBT)
• Occupational therapy
• Medication

Diagnosing social anxiety disorder

Diagnosing social anxiety disorder requires a comprehensive, professional assessment of symptoms, including how they impact daily life and relationships.

Critical steps in a SAD diagnosis include:

• Thorough clinical interviews to identify symptoms and assess the severity
• Standardized questionnaires and rating scales
• Ruling out other physical or mental conditions that can mimic anxiety symptoms
• Collaborating with other mental health professionals to ensure accurate diagnosis and an effective treatment plan is put in place

Diagnosing autism

Diagnosing autism spectrum disorder as early as possible is crucial. The earlier the intervention is implemented, the better the outcome. Developmental screening and an accurate autism diagnosis can make a huge difference in the overall quality of life and the ability to establish and maintain healthy, meaningful relationships.

Steps for getting an accurate ASD diagnosis include:

• Getting developmental screenings at recommended intervals
• Conducting comprehensive assessments
• Evaluating interaction patterns with peers and others
• Assessing social skills, repetitive behaviors, and breadth of interests
• Working with a care team of psychologists and developmental specialists, and, in cases of youth, a pediatrician