Autism, early psychosis, and social anxiety disorder: understanding the role of social cognition and its relationship to disability in young adults with disorders characterized by social impairments

K L Pepper,O Piguet,E E Thomas,S H Park,I B Hickie,E A Demetriou,F Kumfor,A J Guastella,Y C Song,R Langdon,C Cacciotti-Saija

doi:10.1038/s41398-018-0282-8

Abstract

Impairments in social cognition are believed contribute to disability, particularly for disorders characterized by difficulties in social interaction. There has been little transdiagnostic investigation of this across social cognition domains in young adults. A total of 199 young adults diagnosed with autism spectrum disorder (ASD; N = 53), early psychosis (EP; N = 51), and social anxiety disorder (SAD; N = 64) were compared against neurotypical controls (NT; N = 31) on a battery of lower and higher-order and self-report social cognition measures. For both ASD and EP, participants showed impaired performance on all lower-order emotion recognition tasks and one higher-order social cognition test. Self-reports of empathy were reduced in all clinical groups and particularly in ASD. For SAD, despite showing no objective social cognition impairment, self-reported empathy was reduced to the same level as EP. Discriminant analysis revealed that self-reported empathy and lower-order emotion recognition tests provide best capacity to differentiate groups. Regressions predicting disability revealed depression as the strongest predictor across all disability measures. Empathy provided additional predictive value for social disability and social interaction anxiety. Overall, results support a similar social-cognitive development profile across ASD and EP. While self-reported empathy differentiated between groups, discrepancy between objective social cognition test performance and self-reported empathy in the SAD group suggests probable threat-related self-monitoring report biases that likely further influence all group outcomes. As depression and empathy were the most important predictors of disability, regardless of diagnostic group, research is required to explore targeted interventions for difficulties in these domains to reduce disability.

Highlights

Mental health problems are major contributors to disability burden for young adults in many developed countries[1]
As far as we are aware, this is the first study to compare higher-order and lower-order social cognition performance in young adults diagnosed by disorders characterized by social impairment who present to youth mental health services, including early psychosis (EP), autism spectrum disorder (ASD), and social anxiety disorder (SAD)
Results revealed that individuals diagnosed with ASD and EP showed greater impairments in lower and higher-order social cognition in comparison to both neurotypical controls (NT) and those diagnosed with SAD

Summary

Introduction

Mental health problems are major contributors to disability burden for young adults in many developed countries[1]. Social cognition has previously been defined as “the mental operations that underlie social interactions, including perceiving, interpreting, and Pepper et al Translational Psychiatry (2018)8:233 generating responses to the intentions, dispositions, and behaviours of others”[6] This can include being able to attend to relevant features of other people’s faces and social scenes[7], to recognise and label emotions[8], and to identify and attribute the intention and mental states of others in social scenarios[9,10]. Lower-order tests involve more rapid and less effortful responses (e.g. emotion recognition), and higher-order tests incorporate reflection, interpretation and deduction when responding to social situations (e.g. theory of mind, attributional accuracy)[14]

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Results

Conclusion