Social needs in daily life in adults with Pervasive Developmental Disorders

Abstract

Although social deficits remain a persistent component of the behavioural phenotype of Pervasive Developmental Disorders (PDD) in adulthood, it remains unclear whether these represent diminished social needs, as is seen in social anhedonia, or rather thwarted social needs, as is seen in social anxiety. This study used the Experience Sampling Method (ESM) – a structured diary technique – to examine social interaction in daily life of 8 adults with PDD, compared to 14 healthy controls. Multilevel linear regression analyses showed that PDD subjects a) did not spend more time alone, b) had no increased preference to be alone when in company, and c) spent more time with familiar people, compared to control subjects. Patients experienced more negative affect and anxiety when in the company of less familiar people compared to when they are alone, whereas no difference in affect could be found between being alone or being with familiar people. All these lines of evidence suggest that PDD subjects do have a desire to interact. However, this may be thwarted as is seen in social anxiety. Therapeutic interventions should aim at decreasing negative affect and anxiety in social interactions possibly by improving social skills to fulfil the existing social needs in adults with PDD.

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.