Social anxiety and stress reactivity in Autism Spectrum Disorders

Individuals with ASD are vulnerable for anxiety and stress (Baron et al. 2006).
Although research in ASD is mainly focused on children and adolescents, there
is some evidence for high levels of social anxiety in high functioning adults
with ASD. It is not known which factors contribute to the development of
anxiety in individuals with ASD (Kim et al. 2000). Besides high levels of
social anxiety, individuals with ASD demonstrate poor stress management skills
(White et al., 2009).
Clinically, they are often observed to react abnormally to environmental
influences that are not stressful for individuals who are not diagnosed with
ASD. Recent research among children with ASD demonstrated increased reactivity
of the hypothalamic-pituitary-adrenal (HPA) axis to stressful stimuli, measured
by levels of the stress-hormone cortisol (Spratt et al., 2012), however studies
on adults with ASD are scarce.
Thus, there is a lack of understanding social anxiety and stress reactivity in
the daily lives of adults with ASD. In addition the interaction between these
variables, the association with physiological reactivity (cortisol) and the
influence of contextual determinants has not been elucidated.
In order to examine the phenomenology of social anxiety, psychological and
physiological reactivity in adults with ASD, daily life assessments will be
done with the Experience Sampling Method (ESM). This is a structured diary
technique, meaning that participants fill in short questionnaires via an app on
their smartphone (PsyMate), several times per day after a random signal. At the
same time points, they will be asked to collect a saliva sample in order to
measure the stress hormone cortisol. The ESM method has been used before in a
few (pilot) studies on ASD (Chen, Bundy, Cordier & Einfeld, 2014; Chen, Cordier
& Brown, 2014; Hall, Dawson, van Os & Myin-Germeys, 2010).

The main objective of this study is to compare levels of stress reactivity,
social anxiety and cortisol in daily life between adults with ASD and healthy
controls. Besides, fluctuations and interactions of these variables over time
and their contextual determinants in real life will be examined.
We expect that adults with ASD, with respect to controls, experience higher
levels of social anxiety and higher levels of negative affect (NA) during
stressful events, also known as stress reactivity. Moreover, we expect to find
that higher cortisol reactivity in adults with ASD is associated with increased
psychological stress reactivity. Lastly, based on phenomenological,
neurobiological and genetic overlap between ASD and the psychosis spectrum
(King & Lord, 2011). We expect not only expect to find increased NA in response
to stress, but also increased subclinical psychosis in response to stress in
patients with ASD.

The current study is an observational study. During 10 days, data will be
collected through the PsyMate application (10 random signals per day), on which
a short questionnaire (3 minutes) should be filled out. Hereby, daily life
symptoms/experiences, contexts and activities are registered. At the same
random beep moments, a saliva sample will be collected for cortisol
measurements. In addition, a short electronic questionnaire (1 min)
pops up daily after waking up and before sleeping. At the start and at the end
of the PsyMate weeks participants are asked to fill in 3 regular (pen and
paper) questionnaires. Furthermore they will be asked about their experiences
with the PsyMate.

The total investment in time for participants in this study is about 10 hours.
There is no risk associated with any of the tasks of this study (filling out
questionnaires, participating in interviews and collecting saliva samples). In
addition, previous studies using the same methods have shown that there are no
health risks involved for the participants.