Examining the Relationship Between Social Motivation and Internalizing Symptoms in Autistic People: A Systematic Review and Meta-Analysis.

Only 15 studies were included, and the number of studies in each meta-analysis was small (3 to 5), limiting the ability to detect moderators like age or gender. Most studies used the SRS-2 social motivation subscale, which has poor discriminant validity and may measure social avoidance due to anxiety rather than true motivation. There is a risk of single-rater bias, as most studies used the same informant (often parents) for both social motivation and internalizing symptoms, which can inflate the association. The samples were predominantly male, limiting generalizability to autistic girls and women. The cross-sectional nature of the included studies means the direction of the relationship cannot be determined.

The authors declare no conflicts of interest. The work was funded by the National Institute for Health and Care Research (NIHR).

Do not assume that low social motivation causes anxiety or depression. The data is cross-sectional, so it is equally possible that anxiety causes social avoidance, which is then misinterpreted as low motivation. The measurement tools used in most studies cannot reliably distinguish between these two states.