On the surface, social anxiety disorder and autism may look the same.
Both autistic people and those with social anxiety may experience social situations differently than others.
While social anxiety and autism can occur together, the two are very different conditions.
Still, even doctors sometimes get the two mixed up, leading to misdiagnoses.
Want to understand the difference between autism and social anxiety disorder? Read on to learn more.
A major similarity between social anxiety disorder and autism spectrum disorder (ASD) is that both conditions present differently in every person.
There are plenty of similarities, including symptoms and services offered.
That said, it’s important to understand that social anxiety is not a form of autism and vice versa.
One reason social anxiety and autism are sometimes confused is because some symptoms appear the same.
According to educational psychologist and therapist Richelle Whittaker, PhD, overlapping symptoms of autism and social anxiety disorder include:
- limited social communication
- difficulty adapting to changing plans
- lack of eye contact
A psychologist can diagnose autism and social anxiety disorder using the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5). It’s a handbook published by the American Psychiatric Association that helps healthcare professionals make diagnoses.
A healthcare professional will ask about symptoms and may observe a person in social situations before making a diagnosis.
The amygdala, which affects the brain’s response to fear, may play a role in both ASD and social anxiety disorder.
Ultimately, brain functioning is very different in social anxiety and autism, and the neurological causes of autism aren’t yet fully understood.
There’s no cure for social anxiety or autism. In addition, not everyone wants to “manage” or “fix” characteristics associated with autism.
People can live fulfilling lives with customized support based on their goals, Whittaker says.
Treatment and support options for ASD include:
- occupational therapy
- social skills training
- applied behavioral analysis
- cognitive behavioral therapy
Occupational therapy is often a first-line service for autism. It may also help people cope with social anxiety.
Whittaker says it can help with situations and experiences such as:
- transitioning from one activity to the next
- personal space
- body awareness
- fine motor skills, such as handwriting
- personal skills, such as brushing hair and teeth
“When someone starts to feel anxious, [occupational therapists] help them with relaxation techniques [and] how to conserve energy throughout the day, helping them to overcome upcoming events,” Whittaker says.
Social skills training
Social skills training is another common service for autistic people, and Whittaker says it can be effective for social anxiety disorder too.
“Social skills training teaches those skills that [neurotypical people] often take for granted or don’t think about,” Whittaker says.
She adds that people may learn how to read facial expressions and ask someone about their day.
A small 2013 study involving 58 autistic adolescents aged 11 to 16 suggests that people who participated in social skills training had more get-togethers and reduced social anxiety.
A 2014 study that included 106 adults suggests that social skills training was an effective way to treat social anxiety disorder.
Researchers also indicated that social effectiveness therapy, a form of exposure therapy, may be more helpful.
Applied behavior analysis
Applied behavior analysis (ABA) is another widely available service for autism that may also aid in social anxiety disorder.
“It helps to decrease some behaviors that are atypical, and that would cause that a lot of attention to be brought to that person,” Whittaker says. “They tend to replace those behaviors with something more acceptable.”
For instance, many autistic people are prone to stimming, or self-stimulating behaviors involving repetitive movements or sounds.
Instead of a stimming behavior that’s distracting, disruptive, or inappropriate, an ABA therapist may help the person find a socially acceptable replacement.
Not everyone wants to replace these behaviors, though.
Whittaker also notes that ABA therapy often doesn’t take an individualized approach.
In recent years, alternative interventions like dietary changes have been suggested to help with ASD.
But a 2019 review of six studies found that only participants undergoing ABA and pharmaceutical therapies experienced a decrease in symptoms and increase in productivity.
Whittaker says ABA therapy can help with social anxiety as well.
For example, a person can learn to perform deep breathing instead of leaving a social situation.
Cognitive behavioral therapy
Research suggests that cognitive behavioral therapy (CBT) can help people with social anxiety disorder.
A 2016 randomized controlled trial suggests that people with social anxiety disorder who still experience symptoms after taking antidepressants could benefit from CBT.
CBT may also help autistic people with co-occurring anxiety.
One 2012 study of autistic children also experiencing anxiety found that those who received CBT therapy had improved social interactions and reduced anxiety symptoms after 16 weeks.
High-functioning autism and social anxiety disorder
The current diagnostic process for ASD involves three potential levels of support needed:
- level 1: requiring some support
- level 2: requiring substantial support
- level 3: requiring very substantial support
Whittaker says that level 1 autism is still autism.
Autism is neurologically based, which makes it different from social anxiety disorder, regardless of communication abilities or any overlap in symptoms.
The main difference between autism and social anxiety is that autism is a neurodevelopmental condition, while social anxiety is a mental health condition.
Experts say it’s essential to get the diagnosis correct.
“It’s important because accurate conceptualization and diagnosis informs good treatment… and may increase understanding from others in the individual’s life,” says Megan Lawson, a licensed psychologist at Clarity Child Guidance Center in San Antonio, Texas.
Though a formal diagnosis is best made by a licensed professional, understanding the differences between social anxiety and autism can empower people to seek an evaluation.
Because autism and social anxiety are distinct conditions, they have nuanced symptoms and diagnostic criteria.
Autistic people and those with social anxiety may seem to avoid eye contact.
Importantly, autistic people aren’t necessarily “avoiding” eye contact out of nervousness or fear. They’re simply not making eye contact in the first place, which is a distinct difference.
A 2016 study tracked the eye movement of autistic people and compared it with people who have social anxiety disorder. Researchers suggested that autistic individuals looked toward a person more slowly, while people with social anxiety looked away faster.
Whittaker reminds people that 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.
On the other hand, she says people with social anxiety intentionally avoid conversations because of fear.
The diagnostic criteria for social anxiety disorder and ASD are different.
The DSM-5 diagnostic criteria for autism include:
- persistent differences in social communication, including but not limited to lack of back-and-forth conversations and differences in eye contact
- repetitive patterns of behaviors, such as lining up toys
- symptoms were present in early development, even if they went unnoticed
- symptoms interfere with daily functioning, such as schoolwork
The DSM-5 diagnostic criteria for social anxiety disorder include:
- fear of judgment 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
- have fear for at least 6 months (and the fear cannot be attributed to another mental health condition, such as panic or substance use disorder, or a disease like Parkinson’s)
Social anxiety can develop in children or adults.
“Social anxiety can be the result of trauma,” Whittaker says. “Your brain is compensating for something that happened or trying to prevent something from happening or being relived.”
Social anxiety is different from autism because autism isn’t triggered by an event, experience, or trauma.
The amygdala may be implicated in both autism and social anxiety disorder, but Whittaker says current research supports the idea that autism is neurodevelopmental.
Social anxiety, on the other hand, is mental-emotional.
A 2011 study found a link between increased brain activity in the amygdala and social anxiety disorder.
A 2016 study involving 32 participants with social anxiety disorder found they displayed a greater response in the amygdala during social interactions.
And a 2010 study involving 24 people, half of whom were autistic, suggests the autistic participants had stronger connectivity between the amygdala and the prefrontal cortex, a network that affects emotional regulation.
Autistic participants had weaker connectivity between the amygdala and temporal lobe, a pathway that aids in identifying facial cues.
“The fact that [those on the spectrum] have brains that are wired differently explains why… they have difficulty processing their feelings and emotions,” Whittaker says.
Though there is some overlap in support and services, some options are more suited for people with social anxiety disorder.
Treatment options for social anxiety include:
- cognitive behavioral therapy (CBT)
- group therapy
In group therapy, people typically sit and discuss symptoms and how they’re coping.
A 2013 review of 11 studies indicates that CBT group therapy could be an effective intervention for social anxiety disorder, though researchers noted the quality of the studies was “moderate.”
Still, Whittaker thinks it can help.
“I do think group therapy is beneficial for people with social anxiety,” Whittaker says. “Part of anxiety is feeling like you’re the only one feeling like this. Being in a group helps with that, and desensitizes people with social anxiety to being with other people.”
For autistic people, Whittaker typically recommends social skills training over group therapy.
She says autistic people may want to learn more about how to have effective social interactions rather than how to soothe anxiety.
Healthcare professionals may prescribe autistic people medications to manage co-occurring conditions, such as attention deficit hyperactivity disorder (ADHD) or anxiety.
Autism is also often diagnosed at a young age, when caregivers may not want to use pharmaceutical interventions.
“Early intervention, autism-specific therapies, and any necessary adjunct services, like occupational therapy and speech therapy, are often recommended [first],” Lawson says.
A 2017 research review suggests selective serotonin reuptake inhibitors (SSRIs) may be an effective treatment for social anxiety disorder, though researchers noted the evidence was low to moderate quality.
Whittaker says a trained psychologist can help people with social anxiety disorder find the best course of treatment for them.
The best way to differentiate between social anxiety disorder from autism is through a formal diagnosis from a healthcare professional, such as a psychologist or neurologist.
Here’s what the process will look like, as well as what you should look for in yourself and your loved ones.
A psychologist will use the DSM-5 to diagnose autism or social anxiety disorder. There’s no actual “test” for either condition.
Screening for autism will involve observations of the child or adult, and interviews with teachers, caregivers, and the person being evaluated.
Whittaker says a psychologist will interview a person about their symptoms.
Questions might include:
- How do you feel in social situations?
- Do you always feel this way? If so, how long have these feelings persisted?
- Do you avoid social situations?
- Is your fear of social interaction impacting your day-to-day functioning?
Having a basic understanding of the distinction between autism and social anxiety disorder can help caregivers seek the appropriate screenings and support for children.
“Say there is a group exercise, and your child is off to themselves and doesn’t engage at all,” Whittaker says. “That’s a sign it may be ASD and not social anxiety. In social anxiety, the child may be a part of the group but not saying anything, [or] sweating.”
Autism is typically diagnosed in childhood, but some autistic adults may have never received a formal evaluation.
Whittaker says one of the best ways to tell the difference between autism and social anxiety is to take stock of how the person responds to invitations to gatherings.
“If it’s social anxiety disorder, they may be avoiding social interactions and gatherings altogether,” she says. “[Those with] ASD, they may come, [but they may] not be interactive, or their conversations may be one-sided.”
The American Psychiatric Association removed Asperger’s syndrome from the DSM-5 in 2013.
Before that, Asperger’s was considered a form of autism that may not have needed as much support.
Today, an ASD diagnosis includes the entire spectrum of potential support needs.
While some symptoms between Asperger’s and social anxiety, like social behaviors, may overlap, Whittaker emphasizes that the causes of the symptoms are not the same.
Again, the difference comes down to neurological versus mental-emotional causes.
On Reddit, thread after thread features questions from users about possible misdiagnoses.
Whittaker says a misdiagnosis of autism rather than social anxiety disorder is rare.
She says a missed diagnosis of social anxiety in autistic people is more common, because even healthcare professionals may focus too heavily on a neurodevelopmental condition rather than mental health.
Still, patients and caregivers can question a diagnosis or seek a second opinion.
Questions to ask and points to make
Whittaker says asking questions and further discussing factors that may be triggering symptoms can help provide clarity on a diagnosis.
She recommends covering these bases:
- the age and year of the diagnosis
- anything going on at school or home at the time of the diagnosis
- description of symptoms, including how frequent and how long they’ve been present
How to seek a second opinion
Whittaker says you don’t have to discuss that you wish to seek a second opinion with your healthcare professional, though it can be helpful for the second practitioner to get the information from the initial diagnosis.
Your healthcare professional can also refer you to someone else. They’re used to patients asking for second opinions, Whittaker says.
From there, you can call different healthcare professionals to discuss your situation and unique needs.
Social anxiety and autism can feel overwhelming at times, but support is available. Whittaker shares several resources to help you navigate testing, therapy, and support.
A psychologist or neurologist will evaluate you or a loved one for social anxiety or autism, and can differentiate between the two.
You can find a psychologist or neurologist through:
- your insurance company
- a referral from your primary care doctor or pediatrician
- your child’s school
- early intervention programs
- referrals from therapists, including speech and occupational therapists
Once you or a loved one receive a diagnosis, you may want to pursue therapy for support.
To find a therapist, you can check with:
Support groups can benefit people with social anxiety, as well as loved ones of people with social anxiety or ASD.
In addition to the options listed above, you can find support groups through:
Autism and social anxiety are two separate conditions.
Autism is neurodevelopmental condition and presents in early childhood, whereas social anxiety disorder is a mental health condition that can develop in childhood or adulthood.
People can have one or both.
People with social anxiety have an intense fear of social situations, often fearing others’ judgment. People with autism often have difficulty reading social cues.
Interventions can include social skills training, occupational therapy, and cognitive behavioral therapy.
Everyone experiences autism and social anxiety disorder differently, so it’s important to find what works best for you or your loved one.
Healthcare professionals, personal referrals, and advocacy organizations can help you find support.
Beth Ann Mayer is a New York-based writer. In her spare time, you can find her training for marathons and wrangling her son, Peter, and three furbabies.