Pertinence de l'échelle de sévérité du trouble d'anxiété sociale du DSM-5 pour les adultes autistes

Titre original en anglais : Suitability of the DSM -5 social anxiety disorder severity scale for autistic adults

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Brett, S., Houting, J. d., Black, M. H., Lawson, L. P., Trollor, J. N., & Arnold, S. R. C. (2024). Suitability of the DSM -5 social anxiety disorder severity scale for autistic adults. Autism, 29(3), 659-672. https://doi.org/10.1177/13623613241290547

Date de publication: 19/12/2024 Ajout dans AutiHub: 05/07/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
6
Auteur·ices de la publication identifié·es comme autistes
1 / 6 (16,7 %)
  1. Simon Brett
  2. Jacquiline den Houting *
  3. Melissa H. Black
  1. Lauren P. Lawson
  2. Julian N Trollor
  3. Samuel R. C. Arnold

Résumé

Chez les adultes autistes, les outils de mesure peuvent ne pas différencier adéquatement les caractéristiques autistiques et les manifestations de l'anxiété. Cela peut être particulièrement manifeste dans le cas du trouble d'anxiété sociale ; toutefois, peu de mesures du trouble d'anxiété sociale ont été validées pour les adultes autistes. Les évaluations sont plutôt souvent réalisées à l'aide de mesures conçues et validées pour des adultes non autistes. Pour y remédier, nous avons examiné la pertinence de la Severity Measure for Social Anxiety Disorder autoévaluée chez 284 adultes autistes. Nous avons évalué ses propriétés psychométriques, exploré une version recotée visant à tenir compte des différences autistiques dans la manière de répondre et réalisé une analyse de contenu des retours qualitatifs de participants autistes. L'analyse factorielle confirmatoire n'a pas confirmé la structure unidimensionnelle de la Severity Measure for Social Anxiety Disorder chez les adultes autistes, et plus de la moitié des participants ont attribué au moins une réponse à un facteur autre que l'anxiété sociale (p. ex., la fatigue). L'analyse factorielle exploratoire d'une version recotée de la Severity Measure for Social Anxiety Disorder, fondée sur les réponses des adultes autistes afin de refléter celles dues uniquement à l'anxiété sociale, a révélé qu'une solution à deux facteurs était la plus appropriée, suggérant de nouveau que l'anxiété sociale n'était pas une variable latente unique. Nos résultats recommandent la prudence lors de l'utilisation de la Severity Measure for Social Anxiety Disorder auprès d'adultes autistes, et notre analyse de contenu peut éclairer de futures mesures plus précises. Résumé grand public Les mesures de santé mentale utilisées auprès d'adultes autistes ne sont souvent évaluées que pour une utilisation auprès d'adultes non autistes, ce qui peut entraîner des mesures inexactes. Cela est important lors de la mesure du trouble d'anxiété sociale, car certaines manifestations recoupent les caractéristiques sociales de l'autisme. Cette étude a évalué un questionnaire autoévalué de mesure du trouble d'anxiété sociale, la Severity Measure for Social Anxiety Disorder. La Severity Measure for Social Anxiety Disorder repose sur des critères de diagnostic du trouble d'anxiété sociale, et nous avons cherché à comprendre sa pertinence pour les adultes autistes. La Severity Measure for Social Anxiety Disorder a été remplie par 284 adultes autistes et 80 adultes non autistes, auxquels cinq questions de suivi ont ensuite été posées concernant des questions ambiguës de la Severity Measure for Social Anxiety Disorder. Nous avons constaté que plus de la moitié de notre échantillon d'adultes autistes, pour au moins une question, attribuaient leur réponse à autre chose qu'à l'anxiété. En outre, chez les adultes autistes, un seul construit sous-jacent d'anxiété sociale ne reliait pas entre elles leurs réponses à la Severity Measure for Social Anxiety Disorder, ce qui suggère que la Severity Measure for Social Anxiety Disorder pourrait ne pas être adaptée pour saisir le trouble d'anxiété sociale chez les adultes autistes. Afin d'améliorer la mesure, nous avons recoté les réponses lorsque les participants déclaraient que leur réponse était due à autre chose qu'à l'anxiété sociale ; toutefois, la Severity Measure for Social Anxiety Disorder recotée ne saisissait pas non plus uniquement l'anxiété sociale chez les adultes autistes. Enfin, nous avons analysé les raisons autres que l'anxiété sociale dont les adultes autistes ont dit qu'elles influençaient leurs réponses. Nous avons regroupé leurs réponses en 10 catégories, par exemple, « fatigue », « surcharge sensorielle » et « masquage ». Dans l'ensemble, nos résultats suggèrent la prudence lors de l'utilisation de la Severity Measure for Social Anxiety Disorder auprès d'adultes autistes, et les catégories identifiées peuvent indiquer comment mesurer plus précisément l'anxiété sociale chez les adultes autistes.

In autistic adults, measurement tools may not adequately differentiate between autistic characteristics and features of anxiety. This may be particularly evident in the case of social anxiety disorder; however, few measures of social anxiety disorder have been validated for autistic adults. Instead, assessments are often made using measures designed and validated for non-autistic adults. To address this, we examined the suitability of the self-report Severity Measure for Social Anxiety Disorder in 284 autistic adults. We evaluated its psychometric properties, explored a rescored version that aimed to account for autistic differences in reporting and conducted content analysis on qualitative feedback from autistic participants. Confirmatory Factor Analysis did not confirm the unidimensional structure of the Severity Measure for Social Anxiety Disorder for autistic adults and over half attributed at least one response to a factor other than social anxiety (e.g. fatigue). Exploratory Factor Analysis of a rescored version of the Severity Measure for Social Anxiety Disorder based on autistic adults' responses to reflect those just due to social anxiety, revealed that a two-factor solution was most appropriate, again suggesting social anxiety was not a solitary latent variable. Our findings recommend caution be applied when using the Severity Measure for Social Anxiety Disorder with autistic adults and our content analysis may inform more precise future measurement.Lay abstractMental health measures used with autistic adults are often only evaluated for use with non-autistic adults, which may cause inaccurate measurement. This is important when measuring social anxiety disorder as some features overlap with social characteristics of autism. This study evaluated one self-report questionnaire measure of social anxiety disorder, the Severity Measure for Social Anxiety Disorder. The Severity Measure for Social Anxiety Disorder is based upon criteria for diagnosis of social anxiety disorder, and we aimed to understand its suitability for autistic adults. The Severity Measure for Social Anxiety Disorder was completed by 284 autistic adults and 80 non-autistic adults who were then asked five follow-up questions about ambiguous questions on the Severity Measure for Social Anxiety Disorder. We found that over half our sample of autistic adults, on at least one question, attributed their answer to something other than anxiety. Furthermore, in autistic adults, one underlying construct of social anxiety did not link their answers on the Severity Measure for Social Anxiety Disorder together, suggesting the Severity Measure for Social Anxiety Disorder might not be suited to capturing social anxiety disorder in autistic adults. To improve measurement, we rescored answers where participants said their response was due to something other than social anxiety, however, the rescored Severity Measure for Social Anxiety Disorder did not only capture social anxiety in autistic adults either. Finally, we analysed the reasons other than social anxiety autistic adults said influenced their answers. We grouped their responses into 10 categories, for example, 'fatigue', 'sensory overwhelm', and 'masking'. Overall, our findings suggest caution when using the Severity Measure for Social Anxiety Disorder with autistic adults, and the categories identified may suggest how to measure social anxiety more accurately in autistic adults.

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Références citées
62
Nombre total de références citées intégrées pour cette publication.
Références citées avec un·e auteur·ice identifié·e comme autiste
2 / 62 (3,2 %)
Occurrences d’auteur·ices cité·es identifié·es comme autistes
2 / 232 (0,9 %)
Parmi les occurrences rattachées à des auteurices intégré·es à la base de données AutiHub : 2 / 63 (3,2 %). Auteurices cité·es distinct·es identifié·es comme autistes : 1 / 201 (0,5 %).
Occurrences citées rattachées à la base AutiHub
63 / 232 (27,2 %)
Auteurices cité·es distinct·es rattaché·es : 50 / 201 (24,9 %)
Occurrences rattachées, non identifiées comme autistes
61 / 63 (96,8 %)
Parmi les seules occurrences rattachées. Sur l’ensemble des occurrences d’auteurices cité·es : 61 / 232 (26,3 %). Auteurices cité·es distinct·es rattaché·es, non identifié·es comme autistes : 49 / 50 (98,0 %).
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