Suitability of the DSM-5 social anxiety disorder severity scale for autistic adults.
Simon G Brett, Jacquiline E den Houting, Melissa H Black and 3 others
PMID 39699032WHAT IT FOUND
The DSM-5 social anxiety severity scale does not work as intended for autistic adults.
Autistic respondents often endorsed items due to fatigue, sensory overload, or masking rather than social fear. Scores dropped when these reasons were accounted for, but the measure still failed to confirm a single underlying construct.
Key findings
01The scale showed a unidimensional structure in non-autistic adults but failed to confirm this in autistic adults.
02Autistic adults frequently attributed their responses to non-anxiety factors such as fatigue, sensory overwhelm, and masking, leading to lower scores when these were excluded.
03Rescoring the scale to exclude non-anxiety factors did not improve its validity, revealing a two-factor structure instead of the expected single dimension.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample included very few participants with intellectual disability, limiting generalisability to autistic people with higher support needs. Follow-up questions were only asked about specific ambiguous items, not the whole scale. Free-text responses were brief, which limited the depth of the content analysis. Participants may have misunderstood the follow-up questions, potentially underestimating the number of non-anxiety responses.
Declared interests
The authors declared no conflicts of interest. Funding was provided by the Cooperative Research Centre for Living with Autism (Autism CRC) and the Australian Government’s Cooperative Research Centres Programme.
The easy way to misread this
Do not assume that a high SAD-D score in an autistic adult confirms a diagnosis of social anxiety disorder. The scale measures a mix of social anxiety and autistic experiences like masking and sensory overwhelm, so the score alone cannot distinguish between fear of judgment and other reasons for social avoidance.