Social Anhedonia in Children and Adolescents with Autism Spectrum Disorder and Psychiatry Referrals.

Social anhedonia (SA) is a widely accepted symptom phenotype in autism spectrum disorder (ASD), depression, and schizophrenia spectrum disorder; nevertheless, its clinical implications are relatively unstudied in populations of clinic-referred youth with and without ASD. Youth with ASD (n = 268) and nonASD psychiatry referrals (n = 641) between 6 and 18 years of age were evaluated for SA, ASD severity, co-occurring psychiatric symptom severity, and a wide range of common clinical correlates. Participants were parsed into youth with and without parent-defined SA, and the latter were further subdivided into youth with (SA+ alone) and without (SA/-alone) a preference for being alone. Two thirds of the ASD group met criteria for SA compared with one fourth of psychiatry referrals. SA was associated with higher rates of ASD social skill deficits, social anxiety, depression, and schizophrenia symptoms in both clinic samples. SA+ alone had the highest rates of social anxiety. Among the ASD sample, severity of social anxiety and ASD social skills deficits were relatively small predictors of SA. There was little evidence of divergence between youth with and without SA for a wide range of commonly studied biopsychosocial clinical correlates, for example, youth, family, medical, and treatment characteristics. Although factors associated with the ASD diathesis contribute to an increased risk of SA, they do not in and of themselves explain our results. Lack of syndrome specificity supports the notion that SA is a useful transdiagnostic symptom phenotype in referred youth and challenges traditional conceptualizations of ASD as a categorical clinical phenotype.