Social needs in daily life in adults with Pervasive Developmental Disorders
Introduction
Deficits in social interaction are considered to be the core symptom of Pervasive Developmental Disorders (PDD), such as autism and Asperger's syndrome. The core social deficits in PDD as mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria include impairments in the use of multiple nonverbal behaviours, failure to develop peer relationships appropriate to developmental level, a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people and lack of social or emotional reciprocity (APA, 2000).
Whereas most studies have focused on social deficits in children with PDD (e.g. (Koning and Magill-Evans, 2001), a review paper by Seltzer et al. (2004) showed that social impairments remain a persistent component of the behavioural phenotype in adolescence and adulthood. Although symptoms can abate over time, most of the adults with autism spectrum disorder still experience problems especially in the domain of social interactions (Billstedt et al., 2007, Seltzer et al., 2003). A study by Orsmond et al. (2004) reported reduced participation in social and recreational activities as well as a lower prevalence of having friends and peer relationships in adults with PDD. A question that many have posed is whether the lack of social relationships in patients with PDD is due to a lack of desire to relate to other people or rather to a lack of skills needed to form relationships (Orsmond et al., 2004, Rutter, 1970, Seltzer et al., 2004).
The latter question has an interesting correspondence with the literature relating to differences between social anhedonia and social anxiety (Brown et al., 2007). Social anhedonia which is described as a diminished social need has been characterised by social disinterest and a lack of pleasure from social interactions (Brown et al., 2007, Kwapil, 1998) whereas social anxiety is characterised as a conflict between a desire to interact on the one hand and fear of rejection or humiliation on the other (Asendorpf, 1990, Beidel and Turner, 1998, Brown et al., 2007). Social anhedonia and social anxiety have been studied at the level of every day functioning with social anhedonia corresponding to an enjoyment of solitude, based on lower positive affect and a preference to be alone when in company, and social anxiety being reflected in levels of negative affect depending on the type of social context with increased negative affect in company of less familiar people (Brown et al., 2007, Kashdan and Steger, 2006).
In the current study, we have adopted a similar approach and used a structured diary technique, the Experience Sampling Method (ESM) (Myin-Germeys et al., 2009), to investigate whether patients with PDD compared to controls show in the context of daily life a diminished social interest, as is seen in social anhedonia, or rather a thwarted social need as is seen in social anxiety. We investigated social functioning in daily life by 1) comparing the activities and social context of individuals with PDD compared to healthy controls, 2) studying whether patients with PDD more often prefer to be alone when in social company as well as judge their company as less pleasant, and 3) relating mood, expressed as negative affect, positive affect and anxiety, to the social context in patients with PDD compared to controls.
Section snippets
Participants
The sample consisted of 8 subjects (7 males, 1 female) with a Pervasive Developmental Disorder, who were all under current treatment and had contact with their case-manager (social psychiatric nurse) at least on a monthly rate. All subjects met criteria for PDD-NOS (3 subjects) or Asperger's syndrome (5 subjects) according to DSM-IV and were diagnosed as such by an experienced clinician. In addition, the Childhood Autism Rating Scale (CARS) (Schopler et al., 1988) was used to assess the
Descriptives
The sample consisted of 8 PDD and 14 control subjects. One control subject did not comply with the research protocol (< 20 valid reports) and was therefore excluded from the analyses. The mean number of valid reports was 43 for the control subjects (range 27–56, minimum 4 valid reports a day) and 48 for the PDD subjects (range 32–60, minimum 5 valid reports a day). Sociodemographic variables are shown in Table 1. Most of the PDD subjects were incapable of work or unemployed, while none of the
Discussion
This is the first study, to our knowledge, investigating activities and social interactions in the reality of daily life in adults diagnosed with PDD. Overall, the findings support the hypothesis that patients with PDD do have social needs in the realm of daily life. Patients with PDD did not spend more time alone compared to healthy control subjects and they were equally involved in social activities. In addition, they did not prefer to be alone more often compared to controls and they judged
Conclusion
This is the first study investigating social interaction in the reality of daily life in adult patients diagnosed with PDD. The data suggests that patients with PDD do have a desire for social interaction. However, their social needs seem thwarted as they experience an increase in negative feelings such as anxiety and depression, and a decrease in positive feelings when they are in the company of less familiar people. Overall, patients with PDD seem to benefit from interacting with other
Acknowledgements
Inez Myin-Germeys was supported by a 2006 NARSAD Young Investigator Award and by the Dutch Medical Council (VIDI-grant).
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