(PS2-66) Lonely or Learning? The Complex Impact of Telehealth Social Skills Interventions on Autistic Youth

Autistic children experience elevated rates of social anxiety and loneliness compared to their neurotypical peers (Deckers et al., 2017; Spain et al., 2018). Social anxiety affects 3% to 13% of the general population (APA, 1994; Stein et al., 2000), yet its prevalence in autistic individuals is debated. One study found that 49% of autistic adolescents scored above the clinical threshold for social anxiety (Bellini, 2004). Additionally, research indicates that autistic individuals experience loneliness more frequently than their non-autistic peers (Quadt et al., 2023). Early observational studies suggested that autistic children preferred aloneness (Kasari & Sterling, 2013). However, aloneness differs from loneliness; loneliness stems from negative feelings about being alone or dissatisfaction with relationships (Margalit, 1994; Perlman & Peplau, 1982). Distinguishing between the two is essential for determining whether social withdrawal in autistic children reflects preference or distress, shaping intervention strategies accordingly. Although previous research has explored the link between social anxiety, autism, and loneliness in adolescents and adults, few studies have examined these relationships in elementary school-age children, particularly within a Telehealth-based social skills intervention (Reed et al., 2016). This study fills that gap by investigating whether social skills training alleviates distress or merely enhances social awareness, informing more effective treatment approaches. This quasi-experimental study examined 25 autistic children (n=25; 17 male, 8 female) in 2nd-5th grade with a pre-existing autism diagnosis and a Screen for Child Anxiety Related Disorders (SCARED) pre-test score of 8 or higher, indicating social anxiety traits. Participants completed a 12-week evidence-based social skills intervention via Telehealth. Anxiety was measured using the SCARED child-report questionnaire before and after treatment, while loneliness was assessed through pre- and post-intervention Child Loneliness Survey (CLS) scores. Results demonstrated significant reductions in social anxiety for males (p = 0.00198) and females (p = 0.0264), supporting the intervention’s effectiveness in reducing social anxiety. However, CLS comparisons did not show reduction in loneliness, though an improvement trend was observed in boys (p = 0.0717) and the overall sample (p = 0.05723). This suggests that while social skills training may have enhanced social understanding, it did not necessarily translate to reduced loneliness. One potential explanation is that prior to training, some autistic children had an inflated sense of social satisfaction due to limited awareness of social deficits. As they learned skills such as reciprocity, perspective-taking, and conflict resolution, their understanding of friendships deepened, potentially increasing awareness of loneliness despite genuine social skill gains. This finding highlights the complex relationship between social anxiety, loneliness, and intervention outcomes for autistic children. For treatment providers, this underscores the need to address both skill development and the emotional impact of increased social insight.