© Marking a Difference Tips for Clinicians no. 1 Autism Spectrum Disorder versus Social Anxiety Disorder Differential diagnosis is important because neurological underpinnings, etiologies, and prognoses vary for different disorders. Diagnosed behaviorally, Autism Spectrum Disorder and Social Anxiety Disorder both present with deficits in social interaction; additionally, ASD and SAD may overlap and diverge throughout development. Although several features of the two disorders are similar, there are important differences that should be considered for diagnosis and treatment. The checklist below is provided to help practitioners distinguish between Autism Spectrum Disorders and Social Anxiety Disorder (also known as Social Phobia). This sheet is meant to be used as a support for experienced practitioners. If in doubt, practitioners should consult directly with specialists in relevant fields. Similarities Deficits in: • Reduced eye contact • Social interaction • Awkward nonreciprocal • Social interests interactions • Social skills • Lack of communication • Expressing emotion • Social withdrawal • Challenges and biases in • Preference for being alone reading facial expressions • Passivity Differences Autism Spectrum Disorders Social Anxiety Disorder • Early onset • Onset typically in early adolescence • Delays in socialization • Early temperament labeled as “shy” • Less responsive to emotional contagion or • Capable of age-appropriate friendships facial mimicry • Fear of social evaluation • Weak theory of mind • Diverts attention away from self • Language delays or deficits • Unrealistic social standards • Repetitive and restricted behaviors • Fidgeting and nervous habits • Repetitive motor mannerisms • Amygdala hyperactivity • Below normal amygdala activity • Attentional bias towards threatening • Avoidance and social fears are not core stimuli (hypervigilance) features of ASD Key Questions: 1. Does the individual demonstrate age appropriate insight into self and others? (more characteristic of SAD) 2. Does the individual devote excessive attention to details, and experience difficulty shifting from routine activities? (more characteristic of ASD) Courtesy of: Julie Davies, Ph.D. Daniel Masler, M.A., L.M.H.C.A . 206-718-0906 206-406-2624 [email protected] [email protected] Sources: Baron-Cohan & Belmonte, 2005; Settipani, et al., 2012; Tyson & Cruess, 2012; White, Bray, & Ollendick, 2011; van Steensel, Bogels, Wood & Gadow, 2010. .