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Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth

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Title: Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth
Language: English
Authors: Alan H. Gerber (ORCID 0000-0002-8133-3995), Jason W. Griffin, Cara M. Keifer, Matthew D. Lerner, James C. McPartland
Source: Journal of Autism and Developmental Disorders. 2025 55(3):927-939.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 13
Publication Date: 2025
Sponsoring Agency: National Institute of Mental Health (NIMH) (DHHS/NIH)
Contract Number: 1R01MH10742601
MH18268
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Symptoms (Individual Disorders), Interpersonal Relationship, Interaction, Antisocial Behavior, Children, Adolescents, Age Differences, Severity (of Disability), Gender Differences, Depression (Psychology), Anxiety
DOI: 10.1007/s10803-024-06266-w
ISSN: 0162-3257
1573-3432
Abstract: Purpose: Social anhedonia is a transdiagnostic trait that reflects reduced pleasure from social interaction. It has historically been associated with autism, however, very few studies have directly examined behavioral symptoms of social anhedonia in autistic youth. We investigated rates of social anhedonia in autistic compared to non-autistic youth and the relative contributions of autism and social anhedonia symptoms to co-occurring mental health. Methods: Participants were 290 youth (M[subscript age]=13.75, N[subscript autistic]=155) ranging in age from 8 to 18. Youth completed a cognitive assessment and a diagnostic interview. Their caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions. Results: Autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth. There was a significant positive relationship between age and social anhedonia symptom severity, but there was no association between sex and social anhedonia. Dominance analysis revealed that social anhedonia symptom severity had the strongest association with symptoms of depression and social anxiety, while symptoms of ADHD, generalized anxiety, and separation anxiety were most strongly associated with autism symptom severity. Conclusion: This was the first study to tease out the relative importance of social anhedonia and autism symptoms in understanding psychiatric symptoms in autistic youth. Findings revealed higher rates of social anhedonia in autistic youth. Our results indicate that social anhedonia is an important transdiagnostic trait that plays a unique role in understanding co-occurring depression and social anxiety in autistic youth. Future research should utilize longitudinal data to test the transactional relationships between social anhedonia and internalizing symptoms over time.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1460740
Database: ERIC
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  Value: <anid>AN0183072073;aut01mar.25;2025Feb19.02:51;v2.2.500</anid> <title id="AN0183072073-1">Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth </title> <p>Purpose: Social anhedonia is a transdiagnostic trait that reflects reduced pleasure from social interaction. It has historically been associated with autism, however, very few studies have directly examined behavioral symptoms of social anhedonia in autistic youth. We investigated rates of social anhedonia in autistic compared to non-autistic youth and the relative contributions of autism and social anhedonia symptoms to co-occurring mental health. Methods: Participants were 290 youth (M<sub>age</sub>=13.75, N<sub>autistic</sub>=155) ranging in age from 8 to 18. Youth completed a cognitive assessment and a diagnostic interview. Their caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions. Results: Autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth. There was a significant positive relationship between age and social anhedonia symptom severity, but there was no association between sex and social anhedonia. Dominance analysis revealed that social anhedonia symptom severity had the strongest association with symptoms of depression and social anxiety, while symptoms of ADHD, generalized anxiety, and separation anxiety were most strongly associated with autism symptom severity. Conclusion: This was the first study to tease out the relative importance of social anhedonia and autism symptoms in understanding psychiatric symptoms in autistic youth. Findings revealed higher rates of social anhedonia in autistic youth. Our results indicate that social anhedonia is an important transdiagnostic trait that plays a unique role in understanding co-occurring depression and social anxiety in autistic youth. Future research should utilize longitudinal data to test the transactional relationships between social anhedonia and internalizing symptoms over time.</p> <p>Keywords: Autism Spectrum Disorders; Social Anhedonia; Depression; Social Anxiety; Youth; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Clinical Sciences</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Social anhedonia has long been recognized as a transdiagnostic trait, reflecting reduced pleasure from social interaction (Meehl, [<reflink idref="bib48" id="ref1">48</reflink>]; Myerson, [<reflink idref="bib50" id="ref2">50</reflink>]; Ribot, [<reflink idref="bib57" id="ref3">57</reflink>]). It is associated with poorer social function and greater risk for co-occurring psychiatric symptoms in a range of mental health conditions (Barkus & Badcock, [<reflink idref="bib7" id="ref4">7</reflink>]). Although social anhedonia is not an explicit diagnostic criterion for autism, it has historically been associated with autism since the early behavioral descriptions (Kanner, [<reflink idref="bib38" id="ref5">38</reflink>]). Nonetheless, only two studies have examined behavioral facets of social anhedonia in autistic youth, and none have investigated whether these symptoms contribute to the development of co-occurring psychiatric symptoms above and beyond autism symptoms. This study addresses this need by comparing symptoms of social anhedonia in autistic youth and a community sample of non-autistic youth and investigating their relative contributions to co-occurring mental health while accounting for autism symptoms.</p> <hd id="AN0183072073-2">Social Anhedonia</hd> <p>The desire for social interaction is among the most important and basic human needs (Baumeister & Leary, [<reflink idref="bib8" id="ref6">8</reflink>]). Social anhedonia is characterized by a trait-like reduction in pleasure from social interactions. It is observed in a range of psychiatric conditions, including depression, psychotic disorders, post-traumatic stress disorder, and eating disorders (Barkus, [<reflink idref="bib6" id="ref7">6</reflink>]; Barkus & Badcock, [<reflink idref="bib7" id="ref8">7</reflink>]; Blanchard et al., [<reflink idref="bib11" id="ref9">11</reflink>]; Nawijn et al., [<reflink idref="bib51" id="ref10">51</reflink>]; Pelizza & Ferrari, [<reflink idref="bib53" id="ref11">53</reflink>]; Setterfield et al., [<reflink idref="bib59" id="ref12">59</reflink>]; Tchanturia et al., [<reflink idref="bib63" id="ref13">63</reflink>]). Although socially anxious individuals may also avoid social interactions, this is presumed to reflect increase in negative affect during interaction rather than the reduction in positive affect characteristic of social anhedonia (Brown et al., [<reflink idref="bib14" id="ref14">14</reflink>]). Social anhedonia is associated with increased symptom severity, reduced quality of life, and poorer treatment response across multiple psychiatric conditions (see Barkus & Badcock, [<reflink idref="bib7" id="ref15">7</reflink>]). Compared to physical anhedonia (e.g., taste, smell), social anhedonia is specifically associated with elevated suicidality and suicide attempts (Kollias et al., [<reflink idref="bib44" id="ref16">44</reflink>]; Sagud et al., [<reflink idref="bib58" id="ref17">58</reflink>]). Although social anhedonia peaks in adulthood, there is considerable variation across development (Dodell-Feder & Germine, [<reflink idref="bib26" id="ref18">26</reflink>]).</p> <p>Adolescence is a critical time in social development, marked by important social and neurobiological changes associated with the onset of puberty (Andrews et al., [<reflink idref="bib3" id="ref19">3</reflink>]; Pfeifer & Allen, [<reflink idref="bib54" id="ref20">54</reflink>]). The cascade of social and neurodevelopmental changes make adolescence a particularly vulnerable period for the development of social anhedonia (Barkus & Badcock, [<reflink idref="bib7" id="ref21">7</reflink>]). Indeed, it increases at the highest rates between ages 9 and 15 (Dodell-Feder & Germine, [<reflink idref="bib26" id="ref22">26</reflink>]). Little research has examined the developmental antecedents of social anhedonia; one study indicated that observed sociability at age 3 predicted social anhedonia symptoms at age 12 (Mumper et al., [<reflink idref="bib49" id="ref23">49</reflink>]). This relationship was only found for males, indicating possible sex differences in developmental pathways towards social anhedonia. Relatedly, there also appears to be higher social anhedonia symptom severity in males relative to females (Dodell-Feder & Germine, [<reflink idref="bib26" id="ref24">26</reflink>]; Yang et al., [<reflink idref="bib66" id="ref25">66</reflink>]). Overall, findings suggest that early social experiences may establish risk for the onset of social anhedonia in adolescence.</p> <hd id="AN0183072073-3">Social Anhedonia in Autism</hd> <p>Description of social anhedonia in autistic individuals dates back to original phenotypic characterizations (e.g., Kanner, [<reflink idref="bib38" id="ref26">38</reflink>]) despite not being included as a core diagnostic feature in the DSM-5 (American Psychiatric Association, [<reflink idref="bib1" id="ref27">1</reflink>]). Many leading theories of autism posit differences in the salience of social stimuli during sensitive developmental periods leading to a withdrawal from social interactions as children and adults (Chevallier et al., [<reflink idref="bib18" id="ref28">18</reflink>]; Clements et al., [<reflink idref="bib20" id="ref29">20</reflink>]; Dawson et al., [<reflink idref="bib23" id="ref30">23</reflink>]; Dichter & Rodriguez-Romaguera, [<reflink idref="bib25" id="ref31">25</reflink>]; Klin et al., [<reflink idref="bib42" id="ref32">42</reflink>]). Inherent in these developmental theories is that behavioral symptoms of social anhedonia will be elevated in autistic individuals.</p> <p>Despite its theoretical importance, there is a relatively small amount of literature examining the relationship between autism and social anhedonia. Several studies have found elevated social anhedonia in autistic adults compared to non-autistic adults using a variety of self-report questionnaires (Berthoz et al., [<reflink idref="bib10" id="ref33">10</reflink>]; Carré et al., [<reflink idref="bib16" id="ref34">16</reflink>]; Han et al., [<reflink idref="bib35" id="ref35">35</reflink>]). Other studies have demonstrated a relationship between autistic traits and social anhedonia symptoms in non-clinical adult samples (Foulkes et al., [<reflink idref="bib28" id="ref36">28</reflink>]; Novacek et al., [<reflink idref="bib52" id="ref37">52</reflink>]; Pieslinger et al., [<reflink idref="bib56" id="ref38">56</reflink>]). However, very little research has focused specifically on social anhedonia in autistic youth. Chevallier et al. ([<reflink idref="bib17" id="ref39">17</reflink>]) found elevations in self-reported social anhedonia, but not physical anhedonia, in a small sample of adolescent autistic males compared to non-autistic youth matched on age and cognitive ability. In addition, Gadow and Garman ([<reflink idref="bib29" id="ref40">29</reflink>]) examined parent-report of social anhedonia in autistic youth relative to clinically referred youth, finding higher rates of social anhedonia in the autistic youth. They found no relationship between sex and social anhedonia regardless of diagnostic status; however, their results generally revealed elevations in social anhedonia in older youth.</p> <p>Anhedonia more broadly appears to be central to a number of symptom clusters including attention deficit hyperactivity disorder (ADHD), anxiety, depression, and autism (Guineau et al., [<reflink idref="bib34" id="ref41">34</reflink>]). However, very little work has examined the relationship between social anhedonia and co-occurring psychiatric symptoms in autistic individuals. In a sample of autistic and clinically referred youth, Gadow and Garman ([<reflink idref="bib29" id="ref42">29</reflink>]) found that, regardless of autism status, social anhedonia was associated with elevated symptoms of social anxiety, depression, and schizophrenia. While this work represents a first step in understanding the role of social anhedonia in autism, it does not address the relative contributions of social anhedonia and autism to co-occurring psychiatric symptoms. It is critical to understand whether symptoms of social anhedonia account for meaningful variance above and beyond autism symptoms as this has important clinical implications for assessment and treatment planning for autistic youth.</p> <hd id="AN0183072073-4">The Current Study</hd> <p>Few studies have examined parent-report of social anhedonia in autistic youth, with none reporting on social anhedonia in autistic youth compared to a non-clinical sample. Further, no work has explored how social anhedonia contributes to the profile of co-occurring psychiatric symptoms in autistic youth above and beyond autism symptoms. This study aimed to investigate rates of social anhedonia in autistic youth compared to non-autistic youth and whether it is associated with age or sex. Finally, this work aimed to determine the relative contributions of autism and social anhedonia symptoms to co-occurring mental health in autistic youth.</p> <p>We hypothesized that (<reflink idref="bib1" id="ref43">1</reflink>) autistic youth would be more likely to meet cutoff for social anhedonia than non-autistic youth via the Child & Adolescent Symptom Inventory – Fifth Edition (CASI-5)-derived subscale developed by Gadow and Garman ([<reflink idref="bib29" id="ref44">29</reflink>]). We also hypothesized that (<reflink idref="bib2" id="ref45">2</reflink>) social anhedonia would increase with age and (<reflink idref="bib3" id="ref46">3</reflink>) be higher in males than females. Finally, using dominance analysis, (<reflink idref="bib4" id="ref47">4</reflink>) we directly compared the contributions of social anhedonia and autism symptoms to several of the most common co-occurring psychiatric symptoms to determine which was the important predictor (i.e., more dominant). Specifically, we examined symptoms of ADHD, social anxiety, generalized anxiety, separation anxiety, and depression (Kerns et al., [<reflink idref="bib40" id="ref48">40</reflink>]; Simonoff et al., [<reflink idref="bib61" id="ref49">61</reflink>]).</p> <hd id="AN0183072073-5">Method</hd> <p></p> <hd id="AN0183072073-6">Participants</hd> <p>Participants were 290 youth (155 autistic), ranging in age from 8 to 18 (<emph>M</emph> = 13.75 years, <emph>SD</emph> = 2.25). Data for this study was collected at two different research centers in the Northeast region of the United States. Youth from the two sites differed in age and sex; however, there were no differences in cognitive ability (IQ) or autism symptomatology across the two sites (see Table 1). Autistic youth were older and more likely to be male than non-autistic youth (see Table 2). In addition, autistic youth had lower mean IQ composite scores, specifically verbal composite scores (although both groups were in the average range), and higher parent-report of autism symptoms compared to non-autistic youth.</p> <hd id="AN0183072073-7">Procedure</hd> <p>Participants at both sites were recruited from the community via flyers and local events. Each participant attended an in-person visit at one of the two research sites. Youth completed a cognitive assessment and a diagnostic interview, while a parent or caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions (see Measures). Study eligibility included an overall IQ greater than 70 and a parent or caregiver able to fill out questionnaires in English. Autism status was determined by the clinician completing the diagnostic measures according to DSM-5 clinical criteria and confirmed with the Autism Diagnostic Observation Schedule, Second Edition (Lord et al., [<reflink idref="bib46" id="ref50">46</reflink>]). Study procedures were approved by the respective IRBs of each research center and informed consent was obtained from each participant.</p> <hd id="AN0183072073-8">Measures</hd> <p></p> <hd id="AN0183072073-9">Autism Status and Symptom Severity</hd> <p>The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2; Lord et al., [<reflink idref="bib46" id="ref51">46</reflink>]) is a semi-structured diagnostic interview designed to assess autism symptomatology. Trained examiners administer a series of social prompts that are intended to elicit spontaneous social behaviors and potential restrictive and repetitive behaviors. All ADOS-2 assessments were completed by research reliable clinicians. The ADOS-2 produces a diagnostic classification and calibrated severity score (CSS) based on normed cutoffs. Only autistic youth completed an ADOS-2, which was used to confirm an autism diagnosis. All participants completed a module intended for individuals with fluent speech (either Module 3 or 4).</p> <p>The Social Responsiveness Scales, Second Edition (SRS-2; Constantino & Gruber, [<reflink idref="bib21" id="ref52">21</reflink>]) is a 65-item questionnaire completed by a parent or caregiver. All caregivers completed the school age version. The SRS-2 produces a standardized T-score based on normed cutoffs stratified by sex, which was used to measure autism symptom severity. Higher T-scores indicate greater symptom severity.</p> <hd id="AN0183072073-10">Cognitive Assessment</hd> <p>The Kaufman Brief Intelligence Test - Second Edition (KBIT-2; Kaufman & Kaufman, [<reflink idref="bib39" id="ref53">39</reflink>]) is a brief clinician-administered cognitive assessment. The KBIT-2 produces a standardized IQ score comprised of nonverbal and verbal subscales. Standard scores are computed using age-specific norms. The KBIT-2 was completed by participants who were assessed at Site 1.</p> <p>The Differential Ability Scales-II (DAS-II; Elliott, [<reflink idref="bib27" id="ref54">27</reflink>]) is a relatively brief clinician-administered test that assesses cognitive ability and information processing. The core battery assesses verbal and nonverbal IQ and produces a standardized IQ score that is normed by age. All participants who were assessed at Site 2 completed the DAS-II school-age version.</p> <hd id="AN0183072073-11">Co-Occurring Psychiatric Symptoms</hd> <p>The Child and Adolescent Symptom Inventory-5 (CASI-5; Gadow & Sprafkin, [<reflink idref="bib31" id="ref55">31</reflink>]) and Child and Adolescent Symptom Inventory-4R (CASI-4R; Gadow & Sprafkin, [<reflink idref="bib30" id="ref56">30</reflink>]) were used to evaluate co-occurring psychiatric symptoms. Participants who were assessed at Site 1 completed the CASI-5, while participants from Site 2 completed the CASI-4R. While the CASI-5 contains new items to reflect changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, [<reflink idref="bib1" id="ref57">1</reflink>]), it also retains all the original items and norms from the CASI-4R. Both questionnaires are completed by a parent or caregiver and provide standardized T-scores. For the purposes of this study, the subscales assessing ADHD, social anxiety, generalized anxiety, separation anxiety, and depression symptoms were used. Note that for the social anxiety subscale, standardized T-score are only available for youth ages 5–12 (<emph>n</emph> = 75).</p> <hd id="AN0183072073-12">Social Anhedonia</hd> <p>The CASI-5/4R social anhedonia subscale scores were calculated as per Gadow and Garman ([<reflink idref="bib29" id="ref58">29</reflink>]). Content of the subscale is consistent with traditional questionnaire measures of social anhedonia, reflecting reduced interest in social interaction (e.g., acting emotionally cold) and a preference for being alone. In contrast, the content of the social anxiety scale of the CASI-5/4R is focused on behavioral symptoms of shyness or clear anxiety in social situations (e.g., freezing/crying in social situations). Therefore, the social anhedonia subscale specifically excludes items from the social anxiety subscale or those that are directly related to social skills difficulties. The six items of the social anhedonia subscale are drawn from the depression, schizoid personality, and autism subscales. Specifically, it includes all three items from the schizoid personality subscale (<emph>prefers to be alone rather than with friends or family; shows little interest in having close relationships; is emotionally cold or indifferent to people</emph>). In addition, there is one item (of seven) from the depression subscale (<emph>shows little interest in or enjoyment of pleasurable activities</emph>), and two (of sixteen) from the autism subscale (<emph>not interested in making friends; is unaware or takes no interest in other people's feelings</emph>). Items are rated from 0 (Never) to 3 (Very Often). The raw score on the social anhedonia scale is calculated by totaling the six items of the scale, with higher scores reflecting greater symptom severity. As per Gadow and Garman ([<reflink idref="bib29" id="ref59">29</reflink>]), youth with two or more symptoms rated a 2 (often) or above were classified as having social anhedonia, whereas those with no symptoms were classified as not having social anhedonia. Youth with only one symptom were not assigned a classification to reduce overlap across groups and were not included in categorical analyses, however, they were still included in dimensional analyses using the total scores. Coefficient alpha of the social anhedonia symptom severity scores was 0.89 for the total sample, indicating excellent reliability of the subscale.</p> <hd id="AN0183072073-13">Data Analytic Plan</hd> <p>First, means and standard deviations for each of the primary demographic and clinical variables were calculated. In addition, first-order correlations between these variables were examined as part of preliminary analysis. All analyses were completed in R version 4.2.1 (R Core Team, [<reflink idref="bib22" id="ref60">22</reflink>]).</p> <p>To evaluate whether autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth (Hypothesis 1), a <emph>χ</emph><sups><emph>2</emph></sups>analysis comparing the proportion of youth meeting criteria for rates social anhedonia in autistic and non-autistic youth was conducted. Next, a linear regression was used to examine the relationship between social anhedonia and age (Hypothesis 2). Finally, to test for sex differences in social anhedonia (Hypothesis 3), an additional <emph>χ</emph><sups><emph>2</emph></sups>analysis was run comparing the proportion of social anhedonia in males compared to females.</p> <p>To examine whether social anhedonia accounted for greater variance in common co-occurring psychiatric symptoms than symptoms of autism (Hypothesis 4), five separate multiple regression analyses were run predicting each of the five co-occurring psychiatric symptoms by autism and social anhedonia symptoms. There were significant differences in age and sex across the two samples as well as differences in IQ between the autistic and non-autistic youth in the study. Therefore, these variables, along with the sample where the data came from, were also included as covariates in all regression analyses.</p> <p>Dominance Analysis using the domir R package (Luchman, [<reflink idref="bib47" id="ref61">47</reflink>]) was utilized to examine whether social anhedonia symptom severity accounted for greater variance in co-occurring psychiatric symptoms than autism symptom severity (Kraha et al., [<reflink idref="bib45" id="ref62">45</reflink>]). Dominance analysis is a technique that is used to compare the relative importance of predictor variables in a multiple regression model (Azen & Budescu, [<reflink idref="bib4" id="ref63">4</reflink>]; Budescu, [<reflink idref="bib15" id="ref64">15</reflink>]). It produces General Dominance Weights (GDWs), which reflect the amount of variance accounted for by each specific predictor. The percentage of the total variance accounted for by each predictor was calculated by dividing each GDW by the model <emph>R</emph><sups>2</sups> value. Variables can then be ranked in order of the amount of variance they account for in the model. Dominance analysis is being utilized more frequently in autism research to understand the relative contribution of co-occurring psychiatric traits compared to autism symptomatology (e.g., Bloch et al., [<reflink idref="bib12" id="ref65">12</reflink>]; Hargitai et al., [<reflink idref="bib36" id="ref66">36</reflink>]; Shah et al., [<reflink idref="bib60" id="ref67">60</reflink>]).</p> <hd id="AN0183072073-14">Results</hd> <p>Descriptive analyses are presented in Table 3. Parent report of psychiatric symptoms generally correlated across questionnaires. Age was associated with higher parent-reported depression and social anhedonia scores on the CASI-5. Social anhedonia was also associated with higher autism symptom severity on the ADOS-2. Lastly, males had higher ADOS-2 symptom severity scores.</p> <hd id="AN0183072073-15">Social Anhedonia and Autism</hd> <p>Results demonstrated that autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth (χ<sups>2</sups> = 29.19, <emph>p</emph> <.001; see Fig. 1). There were 27 autistic and 9 non-autistic youth whose parents endorsed only one symptom of social anhedonia and therefore were not given a qualitative classification (see methods). Of the 128 autistic youth remaining in the sample, 67 (52%) were classified as having social anhedonia. Of the 126 non-autistic youth remaining in the sample, 24 (19%) were classified as having social anhedonia. Distributions of social anhedonia total scores by group are shown in Fig. 2.</p> <hd id="AN0183072073-16">Social Anhedonia and Demographic Variables</hd> <p>Results of a linear regression revealed a significant positive association between age and social anhedonia symptom severity (<emph>b</emph> = 0.35, <emph>se</emph> = 0.12, <emph>p</emph> =.002; see Fig. 3). Age accounted for 3.20% of the variance in social anhedonia symptom severity, <emph>F</emph>(<reflink idref="bib1" id="ref68">1</reflink>, 288) = 9.51, <emph>p</emph> <.01. An interaction between age and diagnosis was not significant. Finally, there was no difference in proportion of males and females meeting criteria for social anhedonia (χ<sups>2</sups> = 2.68, <emph>p</emph> =.102).</p> <hd id="AN0183072073-17">Dominance Analysis</hd> <p>Results of linear regression models and dominance analysis predicting each co-occurring psychiatric symptom are presented in Table 4. A comparison of predictors across models utilizing dominance analysis is displayed in Fig. 4.</p> <hd id="AN0183072073-18">ADHD</hd> <p>The overall regression model predicting ADHD symptom severity was significant (F(<reflink idref="bib6" id="ref69">6</reflink>,<reflink idref="bib278" id="ref70">278</reflink>) = 49.98, <emph>p</emph> <.001). Higher autism symptom severity was related to higher ADHD symptom severity, while higher social anhedonia symptom severity was associated with lower ADHD symptom severity (see Table 4). Dominance analysis indicated that autism symptom severity was the strongest predictor and accounted for 77.1% of the explained variance in ADHD symptom severity (see Fig. 4).</p> <hd id="AN0183072073-19">Social Anxiety</hd> <p>Results of a regression analysis predicting social anxiety symptom severity were significant (F(<reflink idref="bib6" id="ref71">6</reflink>,<reflink idref="bib68" id="ref72">68</reflink>) = 11.82, <emph>p</emph> <.001). Higher autism and social anhedonia symptom severity were related to higher social anxiety symptom severity (see Table 4). Dominance analysis indicated that social anhedonia symptom severity was the strongest predictor and accounted for 56.3% of the explained variance in social anxiety symptom severity (see Fig. 4).</p> <hd id="AN0183072073-20">Generalized Anxiety</hd> <p>An overall regression analysis predicting generalized anxiety symptom severity was significant (F(<reflink idref="bib6" id="ref73">6</reflink>,<reflink idref="bib279" id="ref74">279</reflink>) = 30.35, <emph>p</emph> <.001). Higher autism symptom severity was related to higher generalized anxiety symptom severity (see Table 4). Dominance analysis showed that autism symptom severity was the strongest predictor and accounted for 73.2% of the explained variance in generalized anxiety symptom severity (see Fig. 4).</p> <hd id="AN0183072073-21">Separation Anxiety</hd> <p>Results from a regression analysis predicting separation anxiety symptom severity were significant(F(<reflink idref="bib6" id="ref75">6</reflink>,<reflink idref="bib279" id="ref76">279</reflink>) = 8.59, <emph>p</emph> <.001). Higher autism symptom severity was related to higher separation anxiety symptom severity (see Table 4). Dominance analysis demonstrated that autism symptom severity was also the strongest predictor and accounted for 69.8% of the explained variance in separation anxiety symptom severity (see Fig. 4).</p> <hd id="AN0183072073-22">Depression</hd> <p>Overall regression analysis predicting depression symptom severity was significant (F(<reflink idref="bib6" id="ref77">6</reflink>,<reflink idref="bib279" id="ref78">279</reflink>) = 32.03, <emph>p</emph> <.001). Higher autism and social anhedonia symptom severity were related to higher depression symptom severity (see Table 4). Dominance analysis showed that social anhedonia symptom severity was the strongest predictor and accounted for 45.1% of the explained variance in depression symptom severity (see Fig. 4). Sensitivity analysis removing the overlapping depression item from the social anhedonia subscale produced similar results.</p> <hd id="AN0183072073-23">Discussion</hd> <p>This was one of the first studies to examine social anhedonia in autistic youth compared to non-autistic youth and the first to utilize dominance analysis to tease out the relative importance of social anhedonia and autism symptoms. Consistent with our hypotheses, findings revealed higher rates of social anhedonia in autistic youth. Further, symptoms of social anhedonia increased with age regardless of autism status. Contrary to our expectations, we found no sex differences in rates of social anhedonia. Finally, through the use of dominance analysis, our findings support a unique role for social anhedonia symptoms in understanding co-occurring depression and social anxiety in autistic and non-autistic youth.</p> <hd id="AN0183072073-24">Social Anhedonia in Autistic Youth</hd> <p>About half of the autistic youth in our sample exhibited behavioral symptoms of social anhedonia, providing support to theories that posit reduced pleasure from social interactions as a core characteristic of autism (Chevallier et al., [<reflink idref="bib18" id="ref79">18</reflink>]; Dawson et al., [<reflink idref="bib23" id="ref80">23</reflink>]; Klin et al., [<reflink idref="bib42" id="ref81">42</reflink>]). Nonetheless, there was considerable variability in our sample and a significant portion did not appear to experience behavioral symptoms of social anhedonia. This is consistent with literature demonstrating high levels of heterogeneity in response to socially rewarding feedback in autistic individuals (Bottini, [<reflink idref="bib13" id="ref82">13</reflink>]; Clements et al., [<reflink idref="bib19" id="ref83">19</reflink>]). These findings suggest that there may be a common phenotype within autistic youth that does not experience reductions in pleasure from social interactions. One possibility then is that the challenges with social interaction for this phenotype are driven by difficulties in other areas (e.g., social information processing, elevated alexithymia, etc.), rather than reductions in social pleasure (Garman et al., [<reflink idref="bib32" id="ref84">32</reflink>]; Gerber et al., [<reflink idref="bib33" id="ref85">33</reflink>]). Given that many interventions in autism aim to increase naturalistic reinforcement in social interactions, it is possible that this treatment approach may be less effective for this phenotype (Jaswal & Akhtar, [<reflink idref="bib37" id="ref86">37</reflink>]). Thus, understanding and assessing social anhedonia in autistic youth represents an important consideration when planning for intervention.</p> <p>We also found that among youth between the ages of 8 and 18, social anhedonia increased with age, regardless of autism status, consistent with Gadow and Garman ([<reflink idref="bib29" id="ref87">29</reflink>]). Rather than being specific to autistic youth, this effect appears to reflect broad developmental trends in the general population (Barkus & Badcock, [<reflink idref="bib7" id="ref88">7</reflink>]; Dodell-Feder & Germine, [<reflink idref="bib26" id="ref89">26</reflink>]). Adolescence can be a turbulent period marked by increasing social complexity and escalating rates of mood disorders (Kessler et al., [<reflink idref="bib41" id="ref90">41</reflink>]). It is a particularly difficult period for autistic youth, who are already experiencing greater social difficulties, and are primed for withdrawal as social interactions become more challenging to navigate (Picci & Scherf, [<reflink idref="bib55" id="ref91">55</reflink>]). One study found that observed sociability at age 3 was predictive of social anhedonia symptoms at age 12 (Mumper et al., [<reflink idref="bib49" id="ref92">49</reflink>]), however, no research has examined risk factors for the development of social anhedonia in autistic adolescents. Thus, future longitudinal work could investigate individual risk factors for social anhedonia in adolescence for autistic youth.</p> <hd id="AN0183072073-25">Social Anhedonia and Co-Occurring Psychiatric Symptoms</hd> <p>Consistent with Gadow and Garman ([<reflink idref="bib29" id="ref93">29</reflink>]), our results demonstrate patterns of association between social anhedonia and co-occurring psychiatric symptoms regardless of autism status. Extending prior work, we demonstrate that social anhedonia has a stronger association with symptoms of depression and social anxiety than autism symptoms in both autistic and non-autistic youth, highlighting its role as a key transdiagnostic marker of risk for psychiatric symptoms. It is important to acknowledge that broad anhedonia is a core symptom of depression, and thus the relationship between social anhedonia and depressive symptoms might be expected. However, although one item on the social anhedonia scale overlaps with the depression subscale, sensitivity analyses revealed a similar pattern of results when this item was removed. Further, social anxiety is conceptually distinct from social anhedonia and reflects a hypersensitivity to social experience rather than the hyposensitivity associated with social anhedonia. Nonetheless, social anhedonia is associated with loneliness in the general population (Badcock et al., [<reflink idref="bib5" id="ref94">5</reflink>]; Tan et al., [<reflink idref="bib62" id="ref95">62</reflink>]), suggesting that the desire for social interactions is intact despite reduction in pleasure experienced from social interactions. These findings add to the conceptual understanding of the development of internalizing symptoms in autistic youth.</p> <p>This interpretation is consistent with theoretical models of the development of internalizing symptoms in autistic youth (Wood & Gadow, [<reflink idref="bib65" id="ref96">65</reflink>]; Yarger & Redcay, [<reflink idref="bib67" id="ref97">67</reflink>]). These theories posit that autism symptoms lead to early negative social experiences and result in a downstream consequence of internalizing symptoms. It is likely then that symptoms of social anhedonia begin to emerge as a consequence of these early negative experiences and play a significant role in the development of internalizing symptoms. Research indicates that internalizing symptoms fully mediate the relationship between autism diagnosis and quality of life (Andersen et al., [<reflink idref="bib2" id="ref98">2</reflink>]). Therefore, it will be critical to assess for symptoms of social anhedonia in autistic youth to identify those at risk for developing significant internalizing symptoms.</p> <p>Our findings also demonstrated that autism symptom severity was most strongly associated with co-occurring symptoms of ADHD, generalized anxiety, and separation anxiety. The relationship between autism symptoms and co-occurring generalized and separation anxiety is consistent with elevated rates of these conditions in autistic youth (van Steensel et al., [<reflink idref="bib64" id="ref99">64</reflink>]). Although Gadow and Garman ([<reflink idref="bib29" id="ref100">29</reflink>]) found higher symptoms of generalized and separation anxiety in socially anhedonic youth, they did not control for autism symptoms in their analyses. Our results suggest that this relationship may be better explained by elevations in autism symptoms in youth meeting criteria for social anhedonia.</p> <p>It is noteworthy that in our analyses symptoms of social anhedonia were negatively associated with co-occurring ADHD symptoms. To our knowledge, no prior research has examined the association between behavioral symptoms of social anhedonia and symptoms of ADHD. Consistent with our results, one prior study found that children and adolescents with ADHD display a hyperresponsiveness to social rewards relative to monetary rewards (Kohls et al., [<reflink idref="bib43" id="ref101">43</reflink>]). Further, Baumeister et al. ([<reflink idref="bib9" id="ref102">9</reflink>]) found that symptoms of ADHD in autistic youth may attenuate the reduced neural response to reward in autistic youth. This raises the possibility of distinct, but overlapping phenotypes in autistic youth characterized by either hyper- or hyporesponsiveness to social reward (e.g., Yi et al., [<reflink idref="bib68" id="ref103">68</reflink>]), which may have differential relationships with co-occurring psychiatric symptoms. In contrast, another study found that youth with ADHD demonstrated hyporesponsiveness to social relative to monetary rewards (Demurie et al., [<reflink idref="bib24" id="ref104">24</reflink>]). Thus, more work will be needed to understand this relationship.</p> <hd id="AN0183072073-26">Limitations</hd> <p>There are several limitations to consider when interpreting the findings from this study. First, parent-report may not fully distinguish between social anhedonia and internalizing symptoms due to the overlap in behavioral presentation. Specifically, an avoidance of social interactions may characterize both social anhedonia and social anxiety. Thus, parent-report of social anhedonia may also be capturing variance due to internalizing symptoms and inflating their relationship in these results. Further, although the CASI-5 social anhedonia subscale has face validity and has been used before with autistic youth, its psychometrics have not been well-established. One particular challenge is that some of the items overlap with the depression and autism subscales making it challenging to disentangle the variance among them. However, the use of dominance analysis mitigates some of this metholological issue. In addition, two different cognitive assessments were utilized and IQ scores from both measures were harmonized. Lastly, this is not a longitudinal study, which restricts making inferences related to development. Thus, we cannot conclude that social anhedonia increases with age at the within person level and cannot determine developmental predictors of social anhedonia.</p> <hd id="AN0183072073-27">Future Directions</hd> <p>Research indicates that elevations in social anhedonia occur at the trait level in schizophrenia and appear to be state dependent in depression (Blanchard et al., [<reflink idref="bib11" id="ref105">11</reflink>]), however, no work has examined variability of social anhedonia across time in autistic youth. It will be important for future research to examine within-person stability and change over time in social anhedonia in autistic youth. Specifically, understanding whether social anhedonia increases over time at the within-person level, and for whom it increases, will be critical for determining individual risk. In addition, there is little to no literature exploring the longitudinal relationships between social anhedonia and internalizing symptoms in autistic youth. Longitudinal data will permit testing developmental theories (e.g., Wood & Gadow, [<reflink idref="bib65" id="ref106">65</reflink>]; Yarger & Redcay, [<reflink idref="bib67" id="ref107">67</reflink>]) of the transactional relationships between social anhedonia and withdrawal with internalizing symptoms over time.</p> <p>Table 1 Demographic and clinical characteristics of the sample (<emph>N</emph> = 290)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="4"><p>Value</p></th></tr><tr><th align="left"><p>Characteristic</p></th><th align="left"><p>Total (<italic>N</italic> = 290)</p></th><th align="left"><p>Site 1 (<italic>n</italic> = 182)</p></th><th align="left"><p>Site 2 (<italic>n</italic> = 108)</p></th><th align="left"><p>t or χ<sup>2</sup> value</p></th></tr></thead><tbody><tr><td align="left"><p>Age, mean (SD), y</p></td><td align="left"><p>13.75 (2.25)</p></td><td align="left"><p>14.03 (1.96)</p></td><td align="left"><p>13.26 (2.59)</p></td><td char="." align="char"><p>2.65<sup>**</sup></p></td></tr><tr><td align="left"><p>Male (%)</p></td><td align="left"><p>199 (69%)</p></td><td align="left"><p>133 (73%)</p></td><td align="left"><p>66 (61%)</p></td><td char="." align="char"><p>3.97*</p></td></tr><tr><td align="left"><p>Autistic (%)</p></td><td align="left"><p>155 (53%)</p></td><td align="left"><p>91 (50%)</p></td><td align="left"><p>64 (59%)</p></td><td char="." align="char"><p>1.98</p></td></tr><tr><td align="left"><p>ADOS-2 CSS (only autistic youth)</p></td><td align="left"><p>7.71 (1.97)</p></td><td align="left"><p>7.80 (2.14)</p></td><td align="left"><p>7.58 (1.70)</p></td><td char="." align="char"><p>0.73</p></td></tr><tr><td align="left"><p>Composite IQ score</p></td><td align="left"><p>104.31 (16.74)</p></td><td align="left"><p>103.90 (15.80)</p></td><td align="left"><p>105.01 (18.26)</p></td><td char="." align="char"><p>0.52</p></td></tr><tr><td align="left"><p>Verbal IQ score</p></td><td align="left"><p>104.30 (17.38)</p></td><td align="left"><p>102.85(15.70)</p></td><td align="left"><p>106.75 (19.74)</p></td><td char="." align="char"><p>1.75</p></td></tr><tr><td align="left"><p>Nonverbal IQ score</p></td><td align="left"><p>103.52 (16.34)</p></td><td align="left"><p>103.36 (15.67)</p></td><td align="left"><p>103.79 (17.50)</p></td><td char="." align="char"><p>0.21</p></td></tr><tr><td align="left"><p>SRS-2</p></td><td align="left"><p>64.59 (15.00)</p></td><td align="left"><p>65.73 (13.79)</p></td><td align="left"><p>62.65 (16.74)</p></td><td char="." align="char"><p>1.61</p></td></tr></tbody></table> </ephtml> </p> <p>Note. ADOS-2 CSS = ADOS-2 = Autism Diagnostic Observation Schedule, Second Edition Calibrated Severity Score; SRS-2 = Social Responsiveness Scale, Second Edition <sups>*</sups><emph>p</emph> <.05. <sups>**</sups><emph>p</emph> <.01</p> <p>Table 2 Group differences in demographic and clinical characteristics (<emph>N</emph> = 290)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="3"><p>Value</p></th></tr><tr><th align="left"><p>Characteristic</p></th><th align="left"><p>Autistic (<italic>n</italic> = 155)</p></th><th align="left"><p>Non-Autistic (<italic>n</italic> = 135)</p></th><th align="left"><p>t or χ<sup>2</sup> value</p></th></tr></thead><tbody><tr><td align="left"><p>Age, mean (SD), y</p></td><td align="left"><p>14.06 (2.30)</p></td><td align="left"><p>13.38 (2.13)</p></td><td char="." align="char"><p>2.61<sup>**</sup></p></td></tr><tr><td align="left"><p>Male (%)</p></td><td align="left"><p>115 (74%)</p></td><td align="left"><p>84 (62%)</p></td><td char="." align="char"><p>4.26<sup>*</sup></p></td></tr><tr><td align="left"><p>Composite IQ score</p></td><td align="left"><p>101.41 (18.65)</p></td><td align="left"><p>107.65 (13.54)</p></td><td char="." align="char"><p>3.29<sup>**</sup></p></td></tr><tr><td align="left"><p>Verbal IQ score</p></td><td align="left"><p>100.48 (18.71)</p></td><td align="left"><p>108.70 (14.60)</p></td><td char="." align="char"><p>4.20<sup>**</sup></p></td></tr><tr><td align="left"><p>Nonverbal IQ score</p></td><td align="left"><p>102.49 (18.31)</p></td><td align="left"><p>104.70 (13.72)</p></td><td char="." align="char"><p>1.17</p></td></tr><tr><td align="left"><p>SRS-2</p></td><td align="left"><p>72.36 (12.13)</p></td><td align="left"><p>55.65 (12.87)</p></td><td char="." align="char"><p>11.29<sup>**</sup></p></td></tr></tbody></table> </ephtml> </p> <p>Note. SRS-2 = Social Responsiveness Scale, Second Edition <sups>*</sups><emph>p</emph> <.05. <sups>**</sups><emph>p</emph> <.01</p> <p>Table 3 Means, standard deviations, and correlations of demographic and clinical variables</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Variable</p></th><th align="left" colspan="2"><p>M</p></th><th align="left"><p>SD</p></th><th align="left"><p>1</p></th><th align="left"><p>2</p></th><th align="left"><p>3</p></th><th align="left"><p>4</p></th><th align="left"><p>5</p></th><th align="left"><p>6</p></th><th align="left"><p>7</p></th><th align="left"><p>8</p></th><th align="left"><p>9</p></th><th align="left"><p>10</p></th></tr></thead><tbody><tr><td align="left" colspan="2"><p>1. Age</p></td><td align="left"><p>13.75</p></td><td align="left"><p>2.25</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>2. Male</p></td><td align="left"><p>0.69</p></td><td align="left"><p>0.46</p></td><td align="left"><p>0.13<sup>*</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>3. ADOS-2 CSS</p></td><td align="left"><p>6.17</p></td><td align="left"><p>3.03</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.21<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>4. Composite IQ</p></td><td align="left"><p>104.31</p></td><td align="left"><p>16.74</p></td><td align="left"><p>− 0.04</p></td><td align="left"><p>− 0.04</p></td><td align="left"><p>− 0.25<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>5. SRS-2 Total T-Score</p></td><td align="left"><p>64.59</p></td><td align="left"><p>15.00</p></td><td align="left"><p>0.10</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.39<sup>**</sup></p></td><td align="left"><p>− 0.20<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>6. CASI-5 ADHD T-Score</p></td><td align="left"><p>63.05</p></td><td align="left"><p>15.56</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.23<sup>**</sup></p></td><td align="left"><p>− 0.14<sup>*</sup></p></td><td align="left"><p>0.70<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>7. CASI-5 Social Anxiety T-Score</p></td><td align="left"><p>58.25</p></td><td align="left"><p>18.45</p></td><td align="left"><p>0.16</p></td><td align="left"><p>0.10</p></td><td align="left"><p>0.24</p></td><td align="left"><p>− 0.01</p></td><td align="left"><p>0.62<sup>**</sup></p></td><td align="left"><p>0.39<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>8. CASI-5 Generalized Anxiety T-Score</p></td><td align="left"><p>64.26</p></td><td align="left"><p>15.49</p></td><td align="left"><p>0.10</p></td><td align="left"><p>0.06</p></td><td align="left"><p>0.15<sup>*</sup></p></td><td align="left"><p>− 0.04</p></td><td align="left"><p>0.61<sup>**</sup></p></td><td align="left"><p>0.62<sup>**</sup></p></td><td align="left"><p>0.50<sup>**</sup></p></td><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>9. CASI-5 Separation Anxiety T-Score</p></td><td align="left"><p>56.51</p></td><td align="left"><p>17.31</p></td><td align="left"><p>0.03</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.03</p></td><td align="left"><p>− 0.14<sup>*</sup></p></td><td align="left"><p>0.37<sup>**</sup></p></td><td align="left"><p>0.38<sup>**</sup></p></td><td align="left"><p>0.40<sup>**</sup></p></td><td align="left"><p>0.49<sup>**</sup></p></td><td align="left" /><td align="left" /></tr><tr><td align="left" colspan="2"><p>10. CASI-5 Depression T-Score</p></td><td align="left"><p>64.41</p></td><td align="left"><p>16.92</p></td><td align="left"><p>0.21<sup>**</sup></p></td><td align="left"><p>0.11</p></td><td align="left"><p>0.09</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.55<sup>**</sup></p></td><td align="left"><p>0.49<sup>**</sup></p></td><td align="left"><p>0.50<sup>**</sup></p></td><td align="left"><p>0.68<sup>**</sup></p></td><td align="left"><p>0.35<sup>**</sup></p></td><td align="left" /></tr><tr><td align="left" colspan="2"><p>11. CASI-5 Social Anhedonia Total</p></td><td align="left"><p>4.81</p></td><td align="left"><p>4.46</p></td><td align="left"><p>0.18<sup>**</sup></p></td><td align="left"><p>0.08</p></td><td align="left"><p>0.25<sup>**</sup></p></td><td align="left"><p>− 0.02</p></td><td align="left"><p>0.68<sup>**</sup></p></td><td align="left"><p>0.41<sup>**</sup></p></td><td align="left"><p>0.68<sup>**</sup></p></td><td align="left"><p>0.40<sup>**</sup></p></td><td align="left"><p>0.22<sup>**</sup></p></td><td align="left"><p>0.57<sup>**</sup></p></td></tr></tbody></table> </ephtml> </p> <p>Note. ADOS-2 CSS = ADOS-2 = Autism Diagnostic Observation Schedule, Second Edition Calibrated Severity Score; SRS-2 = Social Responsiveness Scale, Second Edition; CASI-5 = Child & Adolescent Symptom Inventory, Fifth Edition <sups>*</sups><emph>p</emph> <.05. <sups>**</sups><emph>p</emph> <.01</p> <p>Table 4 Results of linear regression models and dominance analysis predicting co-occurring psychiatric symptoms</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Predictors</p></th><th align="left" colspan="2"><p>ADHD</p></th><th align="left" colspan="2"><p>Social Anxiety</p></th><th align="left" colspan="2"><p>Generalized Anxiety</p></th><th align="left" colspan="2"><p>Separation Anxiety</p></th><th align="left" colspan="2"><p>Depression</p></th></tr><tr><th align="left" /><th align="left"><p>β (SE)</p></th><th align="left"><p>GDW</p></th><th align="left"><p>β (SE)</p></th><th align="left"><p>GDW</p></th><th align="left"><p>β (SE)</p></th><th align="left"><p>GDW</p></th><th align="left"><p>β (SE)</p></th><th align="left"><p>GDW</p></th><th align="left"><p>β (SE)</p></th><th align="left"><p>GDW</p></th></tr></thead><tbody><tr><td align="left"><p>Autism Symptoms</p></td><td align="left"><p><bold>0.82 (0.06)</bold><sup><bold>***</bold></sup></p></td><td align="left"><p><bold>0.40</bold></p></td><td align="left"><p>0.30 (0.14)<sup>*</sup></p></td><td align="left"><p>0.20</p></td><td align="left"><p><bold>0.68 (0.07)</bold><sup><bold>***</bold></sup></p></td><td align="left"><p><bold>0.29</bold></p></td><td align="left"><p><bold>0.46 (0.09)</bold><sup><bold>***</bold></sup></p></td><td align="left"><p><bold>0.11</bold></p></td><td align="left"><p>0.36 (0.07)<sup>***</sup></p></td><td align="left"><p>0.17</p></td></tr><tr><td align="left"><p>Social Anhedonia Symptoms</p></td><td align="left"><p>-0.49 (0.20)<sup>*</sup></p></td><td align="left"><p>0.09</p></td><td align="left"><p><bold>2.40 (0.59)</bold><sup><bold>***</bold></sup></p></td><td align="left"><p><bold>0.29</bold></p></td><td align="left"><p>-0.27 (0.23)</p></td><td align="left"><p>0.08</p></td><td align="left"><p>-0.30 (0.30)</p></td><td align="left"><p>0.03</p></td><td align="left"><p><bold>1.19 (0.24)</bold><sup><bold>***</bold></sup></p></td><td align="left"><p><bold>0.18</bold></p></td></tr><tr><td align="left"><p>Age</p></td><td align="left"><p>-0.34 (0.30)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>-1.23 (2.03)</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.16 (0.34)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>-0.13 (0.44)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.58 (0.36)</p></td><td align="left"><p>0.02</p></td></tr><tr><td align="left"><p>IQ</p></td><td align="left"><p>0.01 (0.04)</p></td><td align="left"><p>0.01</p></td><td align="left"><p>-0.02 (0.11)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>0.08 (0.04)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>-0.07 (0.06)</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.09 (0.05)</p></td><td align="left"><p>0.00</p></td></tr><tr><td align="left"><p>Sex (Male)</p></td><td align="left"><p>0.45 (1.42)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>-1.40 (3.36)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.17 (1.58)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>-0.25 (2.06)</p></td><td align="left"><p>0.00</p></td><td align="left"><p>1.88 (1.68)</p></td><td align="left"><p>0.01</p></td></tr><tr><td align="left"><p>Research Center (Site 2)</p></td><td align="left"><p>-4.28 (1.38)<sup>**</sup></p></td><td align="left"><p>0.02</p></td><td align="left"><p>-3.60 (4.28)</p></td><td align="left"><p>0.01</p></td><td align="left"><p>-3.76 (1.54)<sup>*</sup></p></td><td align="left"><p>0.02</p></td><td align="left"><p>-3.22 (2.01)</p></td><td align="left"><p>0.01</p></td><td align="left"><p>-4.29 (1.63)<sup>**</sup></p></td><td align="left"><p>0.02</p></td></tr><tr><td align="left"><p>R<sup>2</sup></p></td><td align="left" /><td align="left"><p>0.52</p></td><td align="left" /><td align="left"><p>0.51</p></td><td align="left" /><td align="left"><p>0.39</p></td><td align="left" /><td align="left"><p>0.16</p></td><td align="left" /><td align="left"><p>0.41</p></td></tr></tbody></table> </ephtml> </p> <p>Note. Standardized regression coefficients (β) with standard errors (SE). General dominance weights (GDW) were produced by dominance analysis. Strongest predictor in each model is in bold. Reference group for beta coefficients are in parentheses SRS-2 = Social Responsiveness Scale, Second Edition <sups>*</sups><emph>p</emph> <.05. <sups>**</sups><emph>p</emph> <.01. <sups>***</sups><emph>p</emph> <.001</p> <p>Graph: Fig. 1 Differences in social anhedonia between autistic and non-autistic youth. autistic youth were significantly more likely than non-autistic youth to meet criteria for social anhedonia than non-autistic youth. over half of autistic youth in this study met criteria for social anhedonia</p> <p>Graph: Fig. 2 Distribution of social anhedonia symptom severity across autistic and non-autistic youth. density figure presenting the distribution of social anhedonia symptom severity in autistic youth and non-autistic youth</p> <p>Graph: Fig. 3 The relationship between social anhedonia symptom severity and age in autistic and non-autistic youth. social anhedonia symptom severity increased with age (b = 0.35, se = 0.12, p =.002) across the entire sample of youth, F(<reflink idref="bib1" id="ref108">1</reflink>, 288) = 9.51, p <.01. There was no significant interaction, indicating that social anhedonia increased with age for both autistic and non-autistic youth</p> <p>Graph: Fig. 4 Percentage of variance in co-occurring psychiatric conditions explained by autism and social anhedonia. Note. Other predictors in the model (in light grey) include participant age, sex, IQ, and the study site. Variance accounted for by autism and social anhedonia symptom severity. Autism symptom severity accounted for the most variance in separation anxiety, generalized anxiety, and ADHD. Social anhedonia symptom severity accounted for the most variance in social anxiety and depression</p> <hd id="AN0183072073-28">Funding</hd> <p>This research was supported by NIMH grants to JCM (1R01MH107426-01) and MDL (1R01MH110585-01). In addition, effort by AG was supported by an NIMH T32 Fellowship (MH18268). The authors wish to thank all the participating families and staff for their time and effort.</p> <hd id="AN0183072073-29">Declarations</hd> <p></p> <hd id="AN0183072073-30">Ethical Approval</hd> <p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0183072073-31">Informed Consent</hd> <p>Informed consent was obtained from all individual participants included in the study.</p> <hd id="AN0183072073-32">Conflict of interest</hd> <p>JCM consults with Customer Value Partners, Bridgebio, Determined Health, and BlackThorn Therapeutics, has received research funding from Janssen Research and Development, serves on the Scientific Advisory Boards of Pastorus and Modern Clinics, and receives royalties from Guilford Press, Lambert, Oxford, and Springer. 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  Label: Title
  Group: Ti
  Data: Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Alan+H%2E+Gerber%22">Alan H. Gerber</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-8133-3995">0000-0002-8133-3995</externalLink>)<br /><searchLink fieldCode="AR" term="%22Jason+W%2E+Griffin%22">Jason W. Griffin</searchLink><br /><searchLink fieldCode="AR" term="%22Cara+M%2E+Keifer%22">Cara M. Keifer</searchLink><br /><searchLink fieldCode="AR" term="%22Matthew+D%2E+Lerner%22">Matthew D. Lerner</searchLink><br /><searchLink fieldCode="AR" term="%22James+C%2E+McPartland%22">James C. McPartland</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(3):927-939.
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  Label: Availability
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  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institute of Mental Health (NIMH) (DHHS/NIH)
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  Label: Contract Number
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  Data: 1R01MH10742601<br />MH18268
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  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
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  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Relationship%22">Interpersonal Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Interaction%22">Interaction</searchLink><br /><searchLink fieldCode="DE" term="%22Antisocial+Behavior%22">Antisocial Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Age+Differences%22">Age Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-024-06266-w
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose: Social anhedonia is a transdiagnostic trait that reflects reduced pleasure from social interaction. It has historically been associated with autism, however, very few studies have directly examined behavioral symptoms of social anhedonia in autistic youth. We investigated rates of social anhedonia in autistic compared to non-autistic youth and the relative contributions of autism and social anhedonia symptoms to co-occurring mental health. Methods: Participants were 290 youth (M[subscript age]=13.75, N[subscript autistic]=155) ranging in age from 8 to 18. Youth completed a cognitive assessment and a diagnostic interview. Their caregiver completed questionnaires regarding symptoms of autism and co-occurring psychiatric conditions. Results: Autistic youth were more likely to meet criteria for social anhedonia than non-autistic youth. There was a significant positive relationship between age and social anhedonia symptom severity, but there was no association between sex and social anhedonia. Dominance analysis revealed that social anhedonia symptom severity had the strongest association with symptoms of depression and social anxiety, while symptoms of ADHD, generalized anxiety, and separation anxiety were most strongly associated with autism symptom severity. Conclusion: This was the first study to tease out the relative importance of social anhedonia and autism symptoms in understanding psychiatric symptoms in autistic youth. Findings revealed higher rates of social anhedonia in autistic youth. Our results indicate that social anhedonia is an important transdiagnostic trait that plays a unique role in understanding co-occurring depression and social anxiety in autistic youth. Future research should utilize longitudinal data to test the transactional relationships between social anhedonia and internalizing symptoms over time.
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  Data: As Provided
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  Label: Entry Date
  Group: Date
  Data: 2025
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  Label: Accession Number
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  Data: EJ1460740
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        Value: 10.1007/s10803-024-06266-w
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 927
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Interpersonal Relationship
        Type: general
      – SubjectFull: Interaction
        Type: general
      – SubjectFull: Antisocial Behavior
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      – SubjectFull: Children
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      – SubjectFull: Adolescents
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      – SubjectFull: Gender Differences
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      – SubjectFull: Depression (Psychology)
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      – SubjectFull: Anxiety
        Type: general
    Titles:
      – TitleFull: Social Anhedonia Accounts for Greater Variance in Internalizing Symptoms than Autism Symptoms in Autistic and Non-Autistic Youth
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              Type: published
              Y: 2025
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