Short report: Social communication difficulties and restricted repetitive behaviors as predictors of anxiety in adults with autism spectrum disorder.

The data were cross-sectional, so the study cannot show that social communication difficulties or repetitive behaviors caused anxiety. All data were self-reported by adults able to complete online surveys, so the results may not apply to autistic adults who cannot self-report or complete surveys. The analysed sample was older and included more females than the original Netherlands Autism Register adults who did not take part in the 2016 to 2018 data collection, so it may not represent younger or more male autistic adults. The social communication measure was not a pure social communication measure because it included routine and switching items that may overlap with higher-order repetitive behaviors. No treatment was tested, so the paper cannot show that reducing routines or repetitive behaviors would lower anxiety.

The authors declared no potential conflicts of interest. The Netherlands Autism Register was financially supported by NWO and ZonMW.

Do not conclude that treating repetitive behaviors will reduce anxiety, or that social communication difficulties are irrelevant. This was a cross-sectional survey of self-reported associations, not an intervention study, and social communication difficulties did predict anxiety before higher-order repetitive behaviors were added.