RESEARCH ARTICLE
Diametrically Opposed Associations Between Academic Achievement
and Social Anxiety Among University Students With and Without
Autism Spectrum Disorder
Gil Zukerman
, Gili Yahav, and Ester Ben-Itzchak
Research findings indicate that anxiety, social anxiety in particular, is the most common experience reported by individuals
with autism spectrum disorder (ASD) attending postsecondary education. Among students without ASD, higher levels of social
anxiety have been postulated to correlate with impaired academic achievement; restriction of one’s social network because of
anxiety is thought to lead to reduction of access to resources important for learning such as social/emotional support and collaborative learning. However, despite growing interest in the outcomes of young students with ASD, no research has studied
the associations between academic achievement and anxiety among students with ASD. This study examined the association
between social anxiety and grade point average (GPA) among university students: 55 diagnosed with ASD, 31 without ASD
but high levels of social anxiety, and 25 without ASD and with low levels of social anxiety (controls). GPAs were significantly
lower for the ASD group than for the two non-ASD groups. Among students without ASD, a negative correlation between
social anxiety and grades was observed whereas the reverse pattern was found for the ASD group, meaning that for students
with ASD, higher levels of social anxiety were associated with higher grades. Additionally, in a regression analysis, ASD diagnosis, social anxiety, and the interaction of group × social anxiety significantly predicted GPA. Possible explanations for this
finding, as well as implications for interventions among this population of high-functioning students with ASD, are discussed.
Autism Res 2019, 12: 1376–1385. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
Lay Summary: This study compared the relationship between levels of social anxiety and grades in students with autism spectrum disorder (ASD) and in students without ASD who had either high social anxiety or low social anxiety (controls). Among
the group with ASD, higher levels of social anxiety were associated with higher grades, whereas the reverse pattern was found
among the other groups. This finding’s implications for interventions among students with ASD are discussed.
Keywords: academic; ASD; social anxiety; grade point average
Introduction
Interest in the outcomes of young adults with autism spectrum disorder (ASD) has increased, fueled by its rising prevalence (1:59 according to the Centers for Disease Control
[2014]), the aging of ASD cohorts previously studied as children, and reports of poor outcomes in adults with ASD
resulting in social and financial costs to society [reviewed in
Steinhausen, Mohr Jensen, & Lauritsen, 2016; Volkmar,
Jackson, & Hart, 2017]. Although almost half of those with
ASD are considered to have average or above average cognitive ability [i.e., 43.9% with an Intelligence Quotient (IQ)
>85, Christensen et al., 2016] and expected to yield “optimal outcomes,” studies of this subpopulation have reported
a high frequency of unemployment and lacking social and
economic independence [Anderson, Liang, & Lord, 2014;
Gotham et al., 2015; Roy, Prox-Vagedes, Ohlmeier, & Dillo,
2015]. As only a minority of such young adults with ASD
have a university education [full 4 years of college; 14%,
Helles, Wallinius, Gillberg, Gillberg, & Billstedt, 2016;
17.4%, Newman et al., 2011], it appears that, beyond intellectual ability, other factors may significantly influence academic achievement among this population.
Postsecondary education is a significant predictor of positive outcomes in the general population, as well as those
with ASD [Newman et al., 2011]. For students with ASD,
however, the challenges of achieving it are manifold; beyond
academic demands, they also include the burden of
adjusting to new social environments, poor planning and
organizational skills, and difficulties adapting to unfamiliar
settings with new routines. All of these factors might disrupt
successful functioning in campus life for individuals with
ASD [Volkmar et al., 2017]. Gelbar, Smith, and Reichow
[2014], who reviewed the literature concerning college students with ASD, reported that the research is scarce, mostly
case reports, and with little focus on academic achievement.
From the Department of Communication Disorders, School of Health Sciences, Ariel University, Ariel, Israel (G.Z., G.Y., E.B.-I.); Bruckner Center for
Research in Autism Spectrum Disorder, Ariel University, Ariel, Israel (E.B.-I.)
Received December 9, 2018; accepted for publication May 7, 2019
Address for correspondence and reprints: Gil Zukerman, Department of Communication Disorders, School of Health Sciences, Ariel University, Ariel,
Israel. E-mail: gilzu@ariel.ac.il
Published online 21 May 2019 in Wiley Online Library (wileyonlinelibrary.com)
DOI: 10.1002/aur.2129
© 2019 International Society for Autism Research, Wiley Periodicals, Inc.
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Autism Research 12: 1376–1385, 2019
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Studying a sample of 35 college students with ASD, Gelbar,
Shefyck, and Reichow [2015] reported a relatively high grade
point average (GPA) of 3.27 (on a 4.0 scale), with 80%
reporting a GPA above 3.0. Newman et al. [2011], however,
reported that students with ASD had a lower likelihood
of completing their degree (38.8%) compared to students
from the general population (52.4%) and to those with
disabilities in general (40.7%). Additionally, among studies
describing the feelings of students with ASD, anxiety
was most common, followed by loneliness, depression,
and feelings of isolation from peers [Gelbar et al., 2014;
Jackson, Hart, Brown, & Volkmar, 2018; White, Ollendick, &
Bray, 2011]. In a survey study conducted in Australia, students
reported an ability to cope with their academic workload but frequent struggling with mental health issues: anxiety (90.2%),
depression (70.7%), and loneliness (61%) were reported as
“moderate” to “big” concerns [Anderson, Carter, & Stephenson,
2018]; similar findings were reported among American students in another survey study [Jackson et al., 2018].
Anxiety disorders, particularly social anxiety [Maddox &
White, 2015; Spain, Sin, Linder, McMahon, & Happé,
2018], are one of the most frequent comorbidities among
the ASD population [reviewed in Howlin & Magiati, 2017]
even among those who are cognitively able [Gillberg,
Helles, Billstedt, & Gillberg, 2016; Lever & Geurts, 2016;
Moss, Howlin, Savage, Bolton, & Rutter, 2015]. Social anxiety is characterized by marked fear or anxiety about social
situations because of possible negative evaluation or scrutiny by others [DSM-5, American Psychiatric Association
(APA), 2013]. The negative evaluation that may arise when
attending social interactions (e.g., having a conversation,
meeting new people), being observed in daily situations
(e.g., eating or drinking), or performing in front of others
(e.g., presenting an argument in a meeting, making a
speech) [DSM-5, APA, 2013]. Sufferers of social anxiety frequently assume others are highly critical, possess maladaptive negative beliefs regarding their social competence (“I
am boring”), and dread acting in a way that will reveal anxiety or unintentionally offend others [Clark & Wells, 1995;
Leary, Kowalski, & Campbell, 1988; Niles et al., 2014;
Rapee & Heimberg, 1997]. Often, this leads to marked
avoidance of social interaction. In some cases, high levels
of social anxiety symptoms may result in a diagnosis of social
anxiety disorder (SAD), also known as social phobia [Diagnostic and Statistical Manual of Mental Disorders (DSM-5), APA,
2013]. Although the high prevalence of anxiety disorders
among individuals with ASD has led to studies utilizing cognitive behavioral therapy [CBT; Murphy et al., 2017; Reaven
et al., 2018; Wise et al., 2019], most have been conducted with
children or adolescents, and have used general CBT protocols
not specifically designed for addressing social anxiety. As
social anxiety may significantly affect the ability to adapt to
everyday independent functioning among students without
and with ASD [Kraper, Kenworthy, Popal, Martin, & Wallance,
2017], remedying this gap in adult ASD research is necessary.
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Social anxiety has been postulated to influence academic
achievement by affecting the availability of social resources
that may carry psychological gains (e.g., social and emotional support) as well as instrumental gains (participating
in collaborative learning). As larger social networks (i.e., a
network of social interactions and personal relationships)
are thought to increase available resources [Blansky et al.,
2013; Crosnoe, Cavanagh, & Elder, 2003; Goguen, Hiester, &
Nordstrom, 2010], social anxiety, characterized by fear and
avoidance of social interaction, may lead to lesser social ties,
smaller social networks, and reduced academic performance
[Russell & Topham, 2012]. Indeed, a longitudinal study of
Brook and Willoughby [2015] indicated a significant negative association between levels of social anxiety and students’ academic grades. However, a systematic review of the
literature on anxiety disorders and academic outcomes
among typically developing adolescents has revealed mixed
findings [de Lijster et al., 2018].
To the best of our knowledge, no research thus far has
compared academic achievement among adult students
with ASD to typically developed students or to students
with other anxiety disorders, or examined factors that
might affect their academic performance such as mental
health disorders that are prevalent in ASD [Howlin &
Magiati, 2017]. Moreover, as individuals with ASD are characterized by diminished interest in collaborative activities,
social anhedonia, and more restricted social networks [van
Asselt-Goverts, Embregts, Hendriks, Wegman, & Teunisse,
2015; Baminger & Kasari, 2000; Chamberlain, Kasari, &
Rotheram-Fuller, 2007; Chevallier, Grèzes, Molesworth,
Berthoz, & Happé, 2012; Chevallier, Molesworth, & Happé,
2014], their use of social resources to influence learning
may be less frequent, resulting in a different relationship
between social engagement and academic performance. In
addition, significant negative correlations between academic performance and general trait anxiety (a disposition
to perceive stressful situations as dangerous or threatening
[Endler & Kocovski, 2001]) have been reported [ChamorroPremuzic & Furnham, 2003; Macher et al., 2012; Pintrich &
DeGroot, 1990]. Associated with less efficient cognitive
strategies and reduced investment of personal resources
[Cassady & Johnson, 2002; Mathews, Davies, Westerman, &
Stammers, 2000], trait anxiety, and its possible effects on
academic performance among college students with ASD
were also examined in this study.
The current study had two main goals: (a) to compare academic achievement (GPA) in university students with ASD
to those without ASD (with low or high levels of social anxiety symptoms); and (b) to evaluate the association between
academic achievement, anxiety (social and trait anxiety),
and autistic traits. High social anxiety symptoms [Spain
et al., 2018] and a 22%–50% prevalence of SAD among individuals with ASD have been reported across studies
[Maddox & White, 2015]. To the best of our knowledge, the
level of social anxiety among university students with ASD
Zukerman et al./Academics and social anxiety in ASD
1377
(defined as “optimal outcome”) has not been studied. To do
so, our sample consisted of three groups: students with ASD
(ASD group), and students without ASD whose scores on a
self-report questionnaire indicated either high levels of
social anxiety symptoms beyond the cutoff point for social
phobia (SP group) or low levels of social anxiety (control
group). We hypothesized that: (a) the ASD and SP groups
would exhibit lower academic achievement (GPA) compared to controls; (b) across all groups, autistic trait severity
would be negatively correlated with GPA; and (c) among
the non-ASD groups, anxiety levels (social anxiety, in particular) would be negatively associated with academic performance (GPA).
Methods
Participants
The study population included 111 first-degree (Bachelor’s)
students (13 females; mean age = 24.21, SD = 2.69), studying in a medium size (15,000 students) public university.
Fifty-five participants (four females; mean age = 23.56,
SD = 2.81) were diagnosed with ASD (ASD group). Thirtyone participants had no ASD diagnosis but a high level of
social anxiety (SP group; five females; mean age = 25.06,
SD = 2.62). The third group included 25 participants
(four females; mean age = 24.56, SD = 2.18) with no ASD
diagnosis and a low level of social anxiety. The high male to
female ratio in the ASD group reflects the strong male bias
in ASD consistently reported in the literature [Werling &
Geschwind, 2013a, 2013b]. An inclusion criteria for the
study involved being a full-time university student.
Inclusion criteria for the ASD group included a diagnosis of
ASD from a licensed neurologist or psychiatrist, and a score
≥32 on the autism spectrum quotient (AQ) [Baron-Cohen,
Wheelwright, Skinner, Martin, & Clubley, 2001]. This score
was associated with clinically significant levels of autistic
traits, and is used as a screening tool for autism spectrum
conditions among the general population [Baron-Cohen
et al., 2001]. All participants in the ASD group had met the
university’s entry requirements and had interviewed with
the university’s “integration program” that provides support
services to students with ASD. Only candidates demonstrating potential to adjust to on-campus living were accepted. Of
the ASD group, 78.3% were residing in university dormitories, 16.3% at home, and about 5.4% in rented apartments
near the university. For the non-ASD groups, inclusion
criteria included a score ≤31 on the AQ. The participant’s
score on the Liebowitz Social Anxiety Scale [LSAS; von Glischinski et al., 2018] was used as an inclusion criterion for the
SP group. Non-ASD participants whose LSAS score was ≥35
[considered an optimal cutoff point for social phobia, von
Glischinski et al., 2018] were included in the social phobia
(SP) group; those scoring <35 were included in the control
group. The initial study sample had 119 participants. Eight
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participants were excluded because of AQ scores not meeting
inclusion criteria (two participants with ASD scored ≤31 and
six participants without ASD scored ≥32).
Comparing ages across the three groups revealed a significant group effect F(2, 110) = 3.51, P = 0.033. Post-hoc testing
indicated that participants in the ASD group were significantly younger than the SP group. Male dominance was
observed in the entire sample. However, no significant difference in sex between the ASD and non-ASD groups (SP, control) was found [χ 2(2, 111) = 2.07, P = 0.354]. As depression
was reported as a major comorbidity among those with ASD
[Anderson et al., 2018], we examined depression levels using
the Beck Depression Inventory-Second Edition [BDI-II; Beck,
Steer, & Brown, 1996]. The average depression scores in all
three groups indicated nondepression levels [BDI score <13;
Beck et al., 1996; Whisman & Richardson, 2015].
Participants were designated to one of three academic
affiliation types based on their major: (a) social sciences;
(b) exact sciences (including natural sciences, architecture,
and engineering); or (c) health sciences. Table 1 presents
the academic affiliation distribution. No significant difference in academic affiliation type between the groups was
observed (χ 2(4, 105) = 6.77, P = 0.148).
Measures
LSAS. The LSAS assesses social interaction and social performance anxiety and includes 24 Likert scale items (0–3)
that tap into fear and avoidance in social situations
[Liebowitz, 1987]. High reliability (r = 0.82, test–retest
reliability) and validity (r = 0.83 with other social anxiety
inventories) were reported for the self-report version used
in this study [Baker, Heinrichs, Kim, & Hofmann, 2002].
State Trait Anxiety Inventory. The State Trait Anxiety
Inventory (STAI) is self-report questionnaire that measures
anxiety symptoms, and includes state (STAI-S) and trait
(STAI-T) anxiety subscales [Spielberger, Gorsuch, Lushene,
Vagg, & Jacobs et al., 1983]. High internal consistency
coefficients [0.86–0.95; Spielberger et al., 1983] as well
as moderate validity, expressed by a high correlation
with other measures of anxiety (0.73–0.85), were reported
[Taylor, 1953].
AQ. A self-report questionnaire that quantifies autistic
traits among adults with normal IQs [Baron-Cohen et al.,
Table 1. Academic Affiliation Type Distribution Among Study
Groups
Social sciences
Exact sciences
Health sciences
ASD
Social phobia
Control
13
35
1
7
24
0
7
15
3
Abbreviation: ASD, autism spectrum disorder.
Zukerman et al./Academics and social anxiety in ASD
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2001]. Scores range from 0 to 50; the higher the score,
the more autistic traits a person possesses. Participants
rate to what extent they agree with statements on a
4-point Likert scale. Relatively good internal consistency
(Cronbach’s alpha ranging from 0.63 to 0.77) was
reported [Baron-Cohen et al., 2001]. In this study, as in
previous studies [Golan, Baron-Cohen, Hill, & Golan,
2006], criteria for the ASD group included AQ scores ≥32
(associated with clinically significant levels of autistic
traits [Baron-Cohen et al., 2001] along with a formal ASD
diagnosis. Criteria for the non-ASD groups included AQ
scores below the cutoff (≤31) and absence of an ASD
diagnosis.
GPA. GPAs from the first semester of the current academic year and academic affiliation were obtained from
an official university-generated report. GPAs were represented by numeric values ranging from 0 to 100. All but
six participants gave permission to access grades, and an
additional six participants did not take any tests during
their first semester, so a GPA was unavailable; therefore,
GPA scores were available for 99 participants.
Procedure
University Ethics Committee approval was obtained prior
to study onset. Participants gave signed informed consent
to participate (including permission to access grades). Students with ASD were already required to complete questionnaires as part of participation in the university’s integration
program; their involvement in the study was limited to consent for use of their data. Participants without ASD were recruited through advertisements in various campus locations
and were financially compensated. The questionnaires utilized (LSAS, STAI, AQ) were self-report (a research assistant
was available, as necessary). Data from the LSAS and the AQ
questionnaires was available for 111 participants. State and
trait anxiety subscales of the STAI data were available from
101 and 102 participants, respectively.
Data Analysis
Analyses were conducted using SPSS version 25 (Arkmonk,
NY; IBM Corp., 2013). Completion of missing data was performed only for the STAI-T. Imputation was conducted only
when ≤20% of the data was missing and used the “expectation maximization” technique only when data was missing
completely at random, using Little’s “missing completely at
random” test.
Chi-square analysis was used to compare the distribution
of academic affiliation and sex ratios among the three
groups. Data were examined for normal distribution using
SPSS Kolmogrov–Smirnov Test [Lilliefors corrections;
Elliott & Woodward, 2007]. Normality was tested individually for the ASD and non-ASD (SP, control) groups as well as
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for each group separately (ASD, SP, control). Additionally, a
nonparametric (Kruskal–Wallis) analysis was conducted to
test group differences in study variables.
A one-way analysis of variance was conducted to evaluate
group differences for age. As the groups differed in age, age
served as a covariate in all analyses. Separate univariate analyses of covariance (ANCOVA), with age as a covariate, were
conducted to examine group differences in grades as well as
severity of autistic symptoms (AQ scores). A multivariate
analysis of covariance (MANCOVA), with age as a covariate,
was conducted to examine group differences in social anxiety (LSAS) and trait anxiety (STAI-T). Separate ANCOVAs for
each variable followed the MANCOVA with Bonferroni post
hoc testing. Pearson correlation analysis was conducted for
academic achievement (GPA) and anxiety measures (social
anxiety, trait/state anxiety). A high correlation between
trait and state anxiety on the STAI was observed (r = 0.833).
Thus, we reported on data related only to trait anxiety. In
addition, a four-step hierarchical linear regression analysis
was performed in order to identify the relative contribution
of the study’s variables to the variance in academic achievements (GPA). The analysis was conducted according to
Dawson [2014]. The GPA served as an outcome variable,
while, in the first step, independent variables included sex
and age as demographic control variables. Group affiliation
(ASD, non-ASD) was entered in the second step, social anxiety (LSAS score) in the third, and the interaction of group
and LSAS score in the fourth.
Results
Normal distribution was evident for all variables (GPA,
LSAS, STAI-T) for ASD and non-ASD (SP, control) groups.
Testing three groups separately (ASD, SP, control) indicated
a normal distribution for GPA (grades) and STAI-T (trait anxiety) for all groups. LSAS scores (social anxiety) were normality distributed for the ASD and control groups but not
for the SP group. Table 2 presents the group differences in
GPA, LSAS, STAI, and AQ indices. The average GPA across
the entire sample was 77.15 (SD = 13.80). Univariate analysis of mean differences in GPAs between the three groups
yielded a significant group effect (Table 2). The control
group had the highest GPA, followed by the SP group, then
the ASD group. However, the only significant difference in
GPA was between the ASD and control groups (Bonferroni
post-hoc tests).
Psychiatric symptom severity between the three groups
was also compared (Table 2). Multivariate analysis for the
anxiety measures (LSAS, STAI-T) indicated a significant
group effect [F(4, 192) = 14.31, P < 0.001, η2p = 0.23]. Univariate analyses for each anxiety measure indicated significant
group effects for social anxiety severity (LSAS) as well as for
trait anxiety (STAI-T). By definition, the SP group’s average
total LSAS score was >35, a threshold suggestive of social
Zukerman et al./Academics and social anxiety in ASD
1379
phobia [von Glischinski et al., 2018]. Among the ASD
group, the average LSAS score was also >35. Bonferroni
post-hoc testing indicated that both ASD and SP groups had
significantly higher levels of social anxiety compared to
controls, whose level of social anxiety was in the nonclinical range. Additionally, the mean STAI trait anxiety
score for the ASD and SP groups was significantly higher
than for controls. As expected, the level of autistic traits
(AQ) differed between the groups (Table 2); the ASD group
had a higher mean AQ score than the non-ASD groups,
above the cutoff score (32) for identifying clinically significant autistic traits [Baron-Cohen et al., 2001], whereas both
groups without ASD (SP, control) had levels of autistic traits
slightly below mean levels of the general population
[Ruzich et al., 2015]. A nonparametric analysis (Kruskal–
Wallis) also indicated a significant effect of group affiliation
on all study measures. No significant effects of age as a
covariate were observed for any of the analyses.
Correlations between first semester academic achievement (GPA), anxiety measures (social anxiety: LSAS; trait
anxiety: STAI-T), and autistic traits (AQ) were examined.
Across all participants, a significant negative correlation
between first semester GPA and autistic traits (AQ) was
observed r(99) = −0.20, P = 0.024. No significant correlations
between GPA and the other study variables were found.
When examining correlations between GPA and other
study variables for each group separately (ASD, SP, control), a significant positive correlation emerged between
GPA and LSAS scores for the ASD group: higher grades
were associated with higher social anxiety (Table 3). In
contrast, for participants without ASD (SP, control), GPA
was significantly negatively correlated with LSAS scores,
indicating higher grades were associated with lower social
anxiety. Fisher’s Z transformation indicated a significant
difference in correlations between ASD and non-ASD
groups (Z = −2.76, P = 0.003). No significant correlations
between GPA and trait anxiety scores were observed in
any group.
Finally, we performed a four-step hierarchical regression
with academic achievement (GPA) as the dependent variable. Independent variables included sex, a demographic variable strongly associated with ASD [Hartley & Sikora, 2009],
and age, in the first step. Group (ASD, non-ASD [SP, control])
Table 3. Academic Achievement and Anxiety Measures
(LSAS, STAI-trait) Among Study Groups
GPA
r
n
r
n
r
n
r
n
ASD
SP
Control
Non-ASD (SP, control)
LSAS-total
STAI-trait
0.30*
47
−0.16
27
−0.12
25
−0.29*
52
0.02
41
0.15
27
0.00
25
0.00
52
*P ≤ 0.05; **P ≤ 0.01.
Abbreviations: ASD, Autism Spectrum Disorder; GPA, grade point average; LSAS, Liebowitz Social Anxiety Scale; STAI, State Trait Anxiety Inventory; SP, social phobia.
was entered into the analysis in the second step. Social anxiety (LSAS score), which was significantly correlated with
GPA, was entered in the third step. The interaction of
group × LSAS score was entered in the fourth step, in a stepwise fashion. Group (ASD, non-ASD), LSAS score (social anxiety), and the interaction of group × LSAS score significantly
predicted GPA (academic achievement). Table 4 exhibits the
results of the regression analysis. A medium effect size for the
regression (Cohens f2) was found [Cohen, 1988; Selya, Rose,
Dierker, Hedeker, & Mermelstein, 2012].
Discussion
Despite growing interest in the transition of young adults
with ASD to university study [White et al., 2016], our findings are novel in a field that includes little empirical research.
Our first hypothesis, that both ASD and the SP groups would
exhibit lower academic achievement compared to controls,
was partially validated. The academic performance (GPA) of
university students with ASD was significantly lower than
their peers without ASD and low symptoms of social anxiety
(controls). Although the SP group had lower academic performance than the controls as well, the difference was not significant. Thus, we suggest that ASD may be associated with
lower academic achievement, even among high-functioning
cognitively able students.
Table 2. Study Measure Means and Standard Deviations Among Study Groups With and Without ASD
ASD
GPA
LSAS
STAI-trait
AQ
SP
Control
n
M
SD
n
M
SD
n
M
SD
F
P
Partial eta squared
47
55
46
55
74.03
44.17
44.49
44.18
14.74
23.22
8.98
3.81
27
31
31
31
77.02
49.59
40.80
14.65
14.01
14.06
10.33
3.22
25
25
25
25
83.17
17.54
33.68
15.28
9.79
9.65
9.98
2.76
4.01
23.56
9. 93
940
<0.05
<0.01
<0.01
<0.01
0.08
0.31
0.17
0.95
Abbreviations: AQ, Autism Spectrum Quotient; ASD, autism spectrum disorder; GPA, grade point average; LSAS, Liebowitz Social Anxiety Scale; SP,
social phobia; STAI, State Trait Anxiety Inventory.
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Zukerman et al./Academics and social anxiety in ASD
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Table 4.
Hierarchical Regression Model for Academic Achievement (Grades)
Step
Variable
B
SE
β
P
R2
P
R 2Δ
1
Age
Sex
Age
Sex
Group
Age
Sex
Group
LSAS
Age
Sex
Group
LSAS
Group × LSAS
0.15
2.01
−1.40
0.03
−6.91
−1.49
−0.00
−7.38
0.73
−1.76
1.56
−7.03
−3.97
8.24
1.47
4.24
1.56
4.21
3.00
1.58
4.22
3.14
1.37
1.51
4.08
3.01
2.02
2.68
−0.00
0.04
0.09
0.00
−0.25
−0.10
0.00
−0.26
0.05
−0.12
0.03
−0.25
−0.30
0.46
0.992
0.633
0.371
0.994
0.024
0.348
0.999
0.021
0.594
0.247
0.702
0.022
0.052
0.003
0.00
0.888
0.00
0.05
0.145
0.05
0.024
0.05
0.226
0.00
0.594
0.15
0.011
0.087
0.003
2
3
4
P
Abbreviation: LSAS, Liebowitz Social Anxiety Scale.
Our second hypothesis, that the autistic trait severity
would be negatively correlated with GPA, was confirmed
for the entire sample. The ASD group’s average GPA of
74.03 (on a scale of 0–100) was nine points less than the
average control GPA (see Table 2), suggesting that an ASD
diagnosis and a high level of autistic traits are related to
reduced academic performance. Although this finding is in
contrast to a previous study of university students with ASD
that reported a relatively high GPA (3.27 on a 4.0 scale,
corresponding to 82–90 on a 0–100 scale), that study was
based on self-reported GPA, a smaller study sample, and no
control comparison groups [Gelbar et al., 2015].
Our third hypothesis, that anxiety levels (social anxiety, in
particular) would be negatively correlated with academic performance (GPA) among the non-ASD groups, was confirmed,
as has been previously reported [Brook & Willoughby, 2015;
Russell & Topham, 2012]. This relationship can be understood in the context of social capital [Crosnoe et al., 2003]—
the benefit derived from membership in social groups or networks [Jensen & Jetten, 2015]. In academic settings, one’s
social network provides access to psychological gains such as
emotional support and the sharing of positive values and
attitudes regarding academic success that help facilitate it
[Astin, 1999; Tinto, 2006]. An academic social network also
increases opportunities for instrumental gains such as academic knowledge and skills gathered through collaborative
learning [e.g., quality small group interactions in and out
of classroom settings; Hommes et al., 2012; VisschersPleijers, Dolmans, de Leng, Wolfhagen, & van der Vleuten,
2006]. Anticipation of social rejection and lack of peer intimacy, conversely, is said to disrupt the attainment of peer
support useful in achieving academic goals [Goguen et al.,
2010; Schlenker & Leary, 1982]. Moreover, the lack of significant correlations found between trait anxiety and academic
achievement across all study groups supports the specificity
of the relationship between social anxiety (i.e., distress
related to social situations) and academic achievement. In
INSAR
sum, wider social networks seem to enhance academic
achievement among university students, whereas reduced
social interactions impair it. Thus, social anxiety, leading to
avoidance of social interaction, may reduce academic
achievement. However, it is important to note that the effect
of social anxiety on the individual’s daily functioning may
include not only avoidance of social interaction with peers,
but also elevated anxiety when being observed or reduced
function when performing in front of others.
Our most interesting and novel finding was the diametrically opposed association between social anxiety and academic achievement among students with ASD, resulting
from our correlation and regression analyses. For students
without ASD, higher social anxiety was negatively associated with GPA, as expected. However, for students with
ASD, a positive association was found: higher social anxiety
was associated with a higher GPA.
Various explanations can be proposed for this fascinating
finding. Reduced social motivation [interest in engaging in
social interpersonal behavior, Constantino & Gruber, 2012]
may affect the relationship between social anxiety and
academic achievement in several ways. Reduced social motivation is considered a primary characteristic of ASD
[Bachevalier & Loveland, 2006; Chevallier et al., 2014; Riby &
Hancock, 2008]. This is evidenced by diminished interest in
collaborative activities, social anhedonia, and more restricted
social networks among individuals with ASD [Chevallier
et al., 2012; van Asselt-Goverts et al., 2015]. Thus, it is possible
that social avoidance (as a result of social anxiety) less negatively affects this population because of their already
restricted use of social interaction as a resource for beneficial
academic outcomes. In addition, collaborative learning,
which often involves being observed and “performing” in
front of others by demonstrating knowledge, may elicit elevated anxiety among socially anxious individuals (DSM-5,
APA). Thus, it is possible that, among those with ASD, social
anxiety and avoidance lead to reduced exposure to fearful
Zukerman et al./Academics and social anxiety in ASD
1381
situations and facilitate more effective independent learning
whereas their academic performance is “protected” from a
negative impact that less social capital may have on a student
without ASD. Another possible explanation is that, among
those with ASD, higher social motivation is associated with
less ability to regulate emotion and, consequently, more
avoidance of social interactions [White et al., 2014]. Previous
research has found positive associations between social motivation and social cognition [Chevallier et al., 2014]; positive
correlations between social cognition and executive functioning [Fisher & Happé, 2005; Hughes & Graham, 2002] and IQ
[Ahmed & Miller, 2011] have been reported too. Although
ASD is typically associated with reduced social motivation
[Chevallier et al., 2014], it is possible that within our sample,
students with ASD who were characterized by high levels of
social anxiety (and presumed social avoidance), also possessed higher levels of social cognition and executive functioning that may have led to a higher GPA. This should be
evaluated in future research.
The current study has several strengths: the relatively
large sample size, especially in the ASD group; two non-ASD
comparison groups (high/low social anxiety); use of the
standardized AQ for screening participants for ASD, in addition to a formal diagnosis; use of standardized questionnaires to evaluate levels of anxiety and autism trait severity;
and officially obtained (not self-report) GPAs as a measure
of academic achievement.
The current study enables, for the first time, examination
of the relationship between anxiety (social anxiety, in particular) and academic performance among a cohort of young
adults with ASD in postsecondary education. Significant differences between the ASD and control groups were observed
in all study measures; effect size values (η2p, f2) suggest a large
(0.17–0.30) group effect on the psychiatric measures. A
medium effect size was observed in academic achievement
[Cohen, 1988] possibly because it is affected by many factors
(e.g., I.Q., motivation, self-perception) not tested in this
study. It is also important to note that a self-reported
social anxiety symptoms (LSAS) questionnaire was used as
an inclusion criterion for the SP group rather than formal
diagnosis of social anxiety [DSM-5, APA, 2013]; future
research may wish to include a formal diagnostic evaluation.
The study has several limitations. Receipt of treatment
(e.g., psychiatric medication, psychotherapy) was not factored into analyses (although such treatment would likely
reduce the negative impact of social anxiety on GPA rather
than enlarge it). Also noteworthy is the academic affiliation
of 71% of the ASD group with Exact Sciences departments;
this academic preference is in accord with previous research
suggesting an association between autistic traits and scientific skills [Baron-Cohen et al., 2001]. Because our comparison groups resembled this academic affiliation type
distribution, the findings may not fully represent the general
student population. Additionally, possible sex differences in
outcome variables were not examined in this study although
1382
sex differences in core ASD symptoms [van Backer, Koot,
Scheeren, & Begeer, 2017; Kreiser & White, 2014], as well as
executive function and play behavior, have been reported
[for review, see Hull, Mandy, & Petrids, 2017]. Previous
research has also reported greater social anxiety [Asher,
Asnaani, & Aderka, 2017] and higher GPAs [Conger & Long,
2010] among women. ASD is more commonly diagnosed in
males [Hull et al., 2017] and the study sample was characterized by male predominance, possibly making the findings
more applicable to men with ASD. However, because no significant group differences in male to female ratio were
observed, we believe that the study findings cannot be
explained by sex effects. Nevertheless, future studies might
use a more balanced male/female ratio to examine whether
the association between social anxiety and academic
achievement among those with ASD is affected by sex.
Lastly, it is also important to note that all students with ASD
participated in an integration program. Future research
would benefit from exploring the potential influence of each
of these factors.
The current study findings may have important implications for both future research and practical interventions
for high-functioning adult students with ASD. Social anxiety is characterized by fear of potential negative evaluation
and scrutiny by others [DSM-5, APA, 2013] and those with
high levels of social anxiety may hold negative cognitions
in relation to social situations such as assuming that others
are particularly critical [Leary et al., 1988; Niles et al.,
2014]. Accordingly, cognitive behavioral therapies utilized
for social anxiety/phobia usually advocate for altering
appraisals and diminishing negative cognitions related to
social interaction by using cognitive restructuring techniques such as focusing on negative outcome probability or
questioning the social cost of negative evaluations [Niles
et al., 2014; Rapee & Heimberg, 1997]. CBTs were previously
reported as useful in improving functioning among typically developing students with social phobia [Tillfors et al.,
2008]. Recent randomized controlled studies have also indicated positive effects of CBT on reduction of anxiety symptoms among individuals with ASD [Murphy et al., 2017;
Reaven et al., 2018; Wise et al., 2019]. However, most of
these studies were conducted with children or adolescents,
focused on reduction of different kinds of anxiety, and used
generic CBT protocols not specifically designed for treatment of social anxiety. This study’s findings suggest that,
differently than the general population, reduced social
motivation, which may be characteristic of those with ASD,
might play an important role in affecting the association
between their social anxiety and academic achievement.
Thus, standard cognitive behavioral therapies mainly
focused on reducing fear of negative social evaluation might
not meet the needs of the ASD population. A more suitable
intervention program, adapted for the special needs of this
population, may be warranted.
Zukerman et al./Academics and social anxiety in ASD
INSAR
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