Skip to main content
SpringerLink
Log in

Can Autism Spectrum Disorders and Social Anxiety Disorders be Differentiated by the Social Responsiveness Scale in Children and Adolescents?

  • Original Paper
  • Published:
Journal of Autism and Developmental Disorders Aims and scope Submit manuscript

Abstract

Autism spectrum disorder (ASD) as well as social phobia (SP), and selective mutism (SM) are characterised by impaired social interaction. We assessed the validity of the Social Responsiveness Scale (SRS) to differentiate between ASD, and SP/SM. Raw scores were compared in 6–18 year old individuals with ASD (N = 60), SP (N = 38), SM (N = 43), and typically developed (N = 42). Sensitivity and specificity were examined. The three disorders showed overlapping SRS scores. Especially in boys with SM (ROC–AUC = .81), presence of ASD was overestimated by the SRS. A combination of three disorder specific questionnaires resulted in marginally improved diagnostic accuracy. For the clinically very relevant differential diagnosis of SP/SM, SRS results must be interpreted with caution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Achenbach, T. M. (1998). Elternfragebogen über das Verhalten von Kindern und Jugendlichen; Deutsche Bearbeitung der Child Behavior Checklist (CBCL/4-18). Köln, Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik.

  • Adornetto, C., Suppinger, A., In-Albon, T., Neuschwander, M., & Schneider, S. (2012). Concordances and discrepancies between ICD-10 and DSM-IV criteria for anxiety disorders in childhood and adolescence. Child and Adolescent Psychiatry and Mental Health, 6(1), 40.

    Article  PubMed Central  PubMed  Google Scholar 

  • Aldridge, F. J., Gibbs, V. M., Schmidhofer, K., & Williams, M. (2012). Investigation the clinical usefulness of the Social Responsiveness Scale (SRS) in a tertiary level, autism spectrum disorder specific assessment clinic. Journal of Autism and Developmental Disorders, 42(2), 294–300.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Andersson, C. B., & Thomsen, P. H. (1998). Electively mute children: An analysis of 37 Danish cases. Nordic Journal of Psychiatry, 52(3), 231–238.

    Article  Google Scholar 

  • Aster, M., Neubauer, A., & Horn, R. (2006). Wechsler Intelligenztest für Erwachsene (WIE). Frankfurt am Main: Harcourt Test Services.

    Google Scholar 

  • Baird, G., Simonoff, E., Pickles, A., Chandler, S., Loucas, T., Meldrum, D., et al. (2006). Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: The Special Needs and Autism Project (SNAP). The Lancet, 368(9531), 210–215.

    Article  Google Scholar 

  • Bergman, R. L., Piacentini, J., & McCracken, J. T. (2002). Prevalence and description of selective mutism in a school-based sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8), 938–946.

    Article  PubMed  Google Scholar 

  • Black, B., & Uhde, T. W. (1992). Elective mutism as a variant of social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 31(6), 1090–1094.

    Article  PubMed  Google Scholar 

  • Black, B., & Uhde, T. W. (1995). Psychiatric characteristics of children with selective mutism: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 34(7), 847–856.

    Article  PubMed  Google Scholar 

  • Bölte, S., & Poustka, F. (2006). Fragebogen zur Sozialen Kommunikation—Autismus Screening (FSK). Deutsche Fassung des Social Communication Questionnaire (SCQ). Bern, Hans Huber, Hogrefe AG.

  • Bölte, S., & Poustka, F. (2008). Skala zur Erfassung Sozialer Reaktivität (SRS). Bern, Hans Huber, Hogrefe AG.

  • Bölte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: Cross-Cultural validation of the Social Responsiveness Scale (SRS). Autism Research, 1, 354–363.

    Article  PubMed  Google Scholar 

  • Bölte, S., Rühl, D., Schmötzer, G., & Poustka, F. (2006). Diagnostisches Interview für Autismus—Revidiert. Deutsche Fassung des Autism Diagnostic Interview—Revised von Michael Rutter, Ann LeCouteur und Catherine Lord; 1. Auflage. Bern, Hans Huber, Hogrefe AG.

  • Bölte, S., Westerwald, E., Holtmann, M., Freitag, C., & Poustka, F. (2011). Autistic traits and autism spectrum disorders: The validity of two measures presuming a continuum of social communication skills. Journal of Autism and Developmental Disorders, 42(1), 66–72.

    Article  Google Scholar 

  • Carbone, D., Schmidt, L. A., Cunningham, C. C., McHolm, A. E., Edison, S., St. Pierre, J., et al. (2010). Behavioral and socio-emotional functioning in children with selective mutism: A comparison with anxious and typically developing children across multiple informants. Journal of Abnormal Child Psychology, 38(8), 1057–1067.

    Article  PubMed  Google Scholar 

  • Charman, T., Baird, G., Siminoff, E., Loucas, T., Chandler, S., Meldrum, D., et al. (2007). Efficacy of three screening instruments in the identification of autistic-spectrum disorders. British Journal of Psychiatry, 191, 554–559.

    Article  PubMed  Google Scholar 

  • Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Cohan, S., & Stein, M. B. (2007). Selective mutism and social anxiety disorder: All in the family? Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1464–1472.

    Article  PubMed  Google Scholar 

  • Cholemkery, H., Kitzerow, J., Rohrmann, S., & Freitag, C. M. (2013). Validity of the Social Responsiveness Scale to differentiate between autism spectrum disorders and disruptive behavior disorders. European Child and Adolescent Psychiatry. doi:10.1007/s00787-013-0427-5.

    PubMed  Google Scholar 

  • Constantino, J., Davis, S., Todd, R., Schindler, M., Cross, M., Brophy, S., et al. (2003a). Validation of a brief quantitative measure of autistic traits: Comparison of the Social Responsiveness Scale with the autism diagnostic interview-revised. Journal of Autism and Developmental Disorders, 33(4), 427–433.

    Google Scholar 

  • Constantino, J. N., & Gruber, C. P. (2005). Social Responsiveness Scale. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Constantino, J. N., Hudziak, J. J., & Todd, R. D. (2003b). Deficits in reciprocal social behaviour in male twins: Evidence for a genetically independent domain of psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 42(4), 458–467.

    Article  PubMed  Google Scholar 

  • Constantino, J. N., Przybeck, T., Friesen, D., & Todd, R. (2000). Reciprocal social behaviour in children with and without pervasive developmental disorders. Developmental and Behavioral Pediatrics, 21(1), 2–11.

    Article  Google Scholar 

  • DeLong, R. (2004). Autism and familial major mood disorder: Are they related? The Journal of Neuropsychiatric and Clinical Neuroscience, 16, 199–213.

    Article  Google Scholar 

  • Döpfner, M., Görtz-Dorten, A., & Lehmkuhl, G. (2008). DISYPS-II: Diagnostik System für psychische Störungen nach ICD-10 und DSM-IV für Kinder und Jugendliche-II. Göttingen: Huber.

    Google Scholar 

  • Döpfner, M., Schmeck, K., Berner, W. (1994). Handbuch: Elternfragebogen über das Verhalten von Kindern und Jugendlichen. Forschungsergebnisse zur deutschen Fassung der Child Behavior Checklist (CBCL/4-18). Köln, Arbeitsgruppe Kinder-, Jugend- und Familiendiagnostik (KJFD).

  • Field, A. (2009). Discovering statistics using SPSS. And sex and drugs and rock ‘n’ roll. London: Sage.

    Google Scholar 

  • Fombonne, E. (2003). Epidemiological surveys of autism and other pervasive developmental disorders: An update. Journal of Autism and Developmental Disorders, 33(4), 365–382.

    Article  PubMed  Google Scholar 

  • Gadow, K. D., Devincent, C. J., Pomeroy, J., & Azizian, A. (2005). Comparison of DSM-IV symptoms in elementary school-age children with PDD versus clinic and community samples. Autism, 9, 392–415.

    Article  PubMed  Google Scholar 

  • Ghaziuddin, M. (2002). Asperger syndrome: Associated psychiatric and medical conditions. Focus on Autism and Other Developmental Disabilities, 17, 138–144.

    Article  Google Scholar 

  • Glascoe, F. P. (2005). Screening for developmental and behaviorial problems. Mental retardation and developmental disabilities research reviews, 11(3), 173–179.

    Article  PubMed  Google Scholar 

  • Grzadzinski, R., Di Martino, A., Brady, E., Mairena, M. A., O’Neale, M., Petkova, E., et al. (2011). Examining autistic traits in children with ADHD: Does the autism spectrum extend to ADHD? Journal of Autism and Developmental Disorders, 41, 1178–1191.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hartley, S. L., & Sikora, D. M. (2009). Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children? Autism, 13(5), 485–509.

    PubMed Central  PubMed  Google Scholar 

  • Hus, V., Bishop, S., Gotham, K., Huerta, M., & Lord, C. (2013). Factors influencing scores on the social responsiveness scale. Journal of Child Psychology and Psychiatry, 54(2), 216–224.

    Article  PubMed Central  PubMed  Google Scholar 

  • Koyama, T., Tachimori, H., Osada, H., & Kurita, H. (2006). Cognitive and symptom profiles in high-functioning pervasive developmental disorder not otherwise specified and attention deficit/hyperactivity disorder. Journal of Autism and Developmental Disorders, 36, 373–380.

    Article  PubMed  Google Scholar 

  • Kristensen, H. (2000). Selective mutism and comorbidity with developmental disorders/delay, anxiety disorders, and elimination disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39(2), 249–256.

    Article  PubMed  Google Scholar 

  • Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A. S., Mattila, M.-L., Ebeling, H., et al. (2008). Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 38(9), 1697–1709.

    Article  PubMed  Google Scholar 

  • Mazzone, L., Ruta, L., & Reale, L. (2012). Psychiatric comorbidity in asperger syndrome and high functioning autism: Diagnostic challenges. Annals of general psychiatry, 11(1), 16.

    Article  PubMed Central  PubMed  Google Scholar 

  • Melfsen, S. & Warnke, A. (2009). Selektiver Mutismus. In S. Schneider & J. Margraf (Hrsg.), Lehrbuch der Verhaltenstherapie. Band 1: Grundlagen, Diagnostik, Verfahren, Rahmenbedingungen (pp. 555–572). Berlin: Springer.

  • Melfsen, S., Walitza, S., & Warnke, A. (2006). The extent of social anxiety in combination with mental disorders. European Child and Adolescent Psychiatry, 12(5), 11–117.

    Google Scholar 

  • Merikangas, K. R., Lieb, R., Wittchen, H. U., & Avenevoli, S. (2003). Family and high-risk studies of social anxiety disorders. Acta Psychiatrica Scandinavica Supplementum, 417, 28–37.

    Article  PubMed  Google Scholar 

  • Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales. A review of selected instruments. Autism, 14(4), 263–284.

    Article  PubMed  Google Scholar 

  • Petermann, F., & Petermann, U. (2010). Hamburg–Wechsler-Intelligenztest für Kinder-IV. Bern, Hans Huber.

  • Pine, D. S., Guyer, A. E., Goldwin, M., Towbin, K. A., & Leibenluft, E. (2008). Autism spectrum disorder scale scores in pediatric mood and anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 47(6), 652–661.

    Article  PubMed Central  PubMed  Google Scholar 

  • Piven, J., & Palmer, P. (1999). Psychiatric disorder and the broad autism phenotype: Evidence from a family study of multiple-incidence autism families. The American Journal of Psychiatry, 156, 557–563.

    PubMed  Google Scholar 

  • Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information of multiple sources in the diagnosis of autism spectrum disorders. Journal of American Academy of Child and Adolescent Psychiatry, 45(9), 1094–1103.

    Article  Google Scholar 

  • Rühl, D., Bölte, S., Feineis-Matthews, S., & Poustka, F. (2004). Diagnostische Beobachtungsskala für Autistische Störungen. Deutsche Fassung der Autism Diagnostic Observation Schedule. Bern, Hans Huber, Hogrefe AG.

  • Russell, E., & Sofronoff, K. (2005). Anxiety and social worries in children with Asperger syndrome. The Australian and New Zealand Journal of Psychiatry, 39, 633–638.

    Article  PubMed  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire (SCQ). Western Psychological Services.

  • Schneider, S., Unnewehr, S., & Margraf, J. (2009). Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (2nd ed.). Heidelberg: Springer.

    Google Scholar 

  • Settipani, C. A., Puleo, C. M., Conner, B. T., & Kendall, P. C. (2012). Characteristics and anxiety symptom presentation associated with autism spectrum traits in youth with anxiety disorders. Journal of Anxiety Disorders, 26(3), 459–467.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sharp, W. G., Sherman, C., & Gross, A. M. (2007). Selective mutism and anxiety: A review of the current conceptualization of the disorder. Journal of Anxiety Disorders, 21(4), 568–579.

    Article  PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 568–572.

    Article  Google Scholar 

  • Strang, J. F., Kenworthy, L., Daniolos, P., Case, L., Wills, M. C., Martin, A., et al. (2012). Depression and anxiety symptoms in children and adolescents with autism spectrum disorders without intellectual disability. Research in Autism Spectrum Disorders, 6(1), 406–412.

    Article  PubMed Central  PubMed  Google Scholar 

  • Sukhodolsky, D. G., Scahill, L., Gadow, K. D., Arnold, L. E., Aman, M. G., McDougle, C. J., et al. (2008). Parent-rated anxiety symptoms in children with pervasive developmental disorders: Frequency and association with core autism symptoms and cognitive functioning. Journal of Abnormal Child Psychology, 36(1), 117–128.

    Article  PubMed  Google Scholar 

  • Tabachnick, B., & Fidell, L. (2007). Using mutivariate statistics (5th ed.). Boston, MA, Munich: Pearson Allyn and Bacon.

  • Taylor, M. J., Charman, T., Robinson, E. B., Plomin, R., Happé, F., Asherson, P., et al. (2012). Developmental association between traits of autism spectrum disorder and attention deficit hyperactivity disorder: A genetically informative, longitudinal twin study. Psychological Medicine, 16, 1–12.

    Google Scholar 

  • Towbin, K. E., Pradella, A., Gorrindo, T., Pine, D. S., & Leibenluft, E. (2005). Autism spectrum traits in children with mood and anxiety disorders. Journal of Child and Adolescent Psychopharmacology, 15(3), 452–464.

    Article  PubMed  Google Scholar 

  • Tyson, K. E., & Cruess, D. G. (2012). Differentiating high-functioning autism and social phobia. Journal of Autism and Developmental Disorders, 42(7), 1477–1490.

    Article  PubMed  Google Scholar 

  • van Steensel, F. J. A., Bögels, S. M., & Perrin, S. (2011). Anxiety disorders in children and adolescents with Autistic spectrum disorders: A meta-analysis. Clinical Child and Family Psychology Review, 14(3), 302–317.

    Article  PubMed Central  PubMed  Google Scholar 

  • van Steensel, F. J. A., Bögels, S. M., & Wood, J. J. (2013). Autism spectrum traits in children with anxiety disorders. Journal of Autism and Developmental Disorders, 43(2), 361–370.

    Article  PubMed Central  PubMed  Google Scholar 

  • Wang, J., Lee, L.-C., Chen, Y.-S., & Hsu, J.-W. (2012). Assessing autistic traits in a taiwan preschool population: cross-cultural validation of the Social Responsiveness Scale (SRS). Journal of Autism and Developmental Disorders, 42(11), 2450–2459.

    Article  PubMed  Google Scholar 

  • Weiss, R. H. (2006). CFT 20-R: Grundintelligenz Skala 2-Revision. Göttingen: Hogrefe.

    Google Scholar 

  • White, S. W., Bray, B. C., & Ollendick, T. H. (2012). Examining shared and unique aspects of social anxiety disorder and autism spectrum disorder using factor analysis. Journal of Autism and Developmental Disorders, 42(5), 874–884.

    Article  PubMed  Google Scholar 

  • White, S. W., Oswald, D., Ollendick, T., & Scahill, L. (2009). Anxiety in children and adolescents with autism spectrum disorders. Clinical Psychology Review, 29(3), 216–229.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge all families and their children who have dedicated their time and commitment to this study. The authors also thank Janina Kitzerow for helping with data collection, and Heiko Zerlaut for data preparation. This research was made possible by the grant Heinrich and Fritz Riese foundation of the Medical Faculty of the JW Goethe University Frankfurt / Main awarded to Hannah Cholemkery.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, JW Goethe University Hospital, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany

    Hannah Cholemkery, Laura Mojica, Angelika Gensthaler & Christine M. Freitag

  2. Department of Psychology, JW Goethe University, Frankfurt am Main, Germany

    Sonja Rohrmann

Authors
  1. Hannah Cholemkery
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Mojica
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sonja Rohrmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Angelika Gensthaler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christine M. Freitag
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hannah Cholemkery.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cholemkery, H., Mojica, L., Rohrmann, S. et al. Can Autism Spectrum Disorders and Social Anxiety Disorders be Differentiated by the Social Responsiveness Scale in Children and Adolescents?. J Autism Dev Disord 44, 1168–1182 (2014). https://doi.org/10.1007/s10803-013-1979-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-013-1979-4

Keywords

Search

Navigation