Author: Bryan P. White
Original Publication: 04/18/2020
Autism spectrum disorder (ASD) is a challenging disorder to design health interventions for because of its wide variety of presentations (hence, a spectrum disorder) as well as a historical tendency of underreporting and underdiagnosing. Understanding how successful health interventions can be delivered to children with ASD is a critical factor towards achieving Healthy People 2020 goals (HP2020, 2020). In terms of HP2020 goals, increasing the proportion of adolescents receiving treatment for mental health disorders is a direct goal )“MHMD-6 Increase the proportion of children with mental health problems who receive treatment”), however, autism is not specifically listed as a targetable intervention component in HP2020. In the United States (US), the prevalence of autism is roughly 1 in 54 children, and more prevalent in boys (1/34) than in girls (1/144) (Autism Speaks: https://www.autismspeaks.org/autism-statistics). While boys are more likely to be diagnosed with ASD than girls, its unknown if this is because boys actually have a higher rate of ASD or girls are more adaptive at dealing with the negative symptoms, or experience a different range of phenotypes altogether from males (Frazier et al., 2014).
Since the prevalence of autism is so high in children in the US, this highlights the need for effective, high-efficiency/low-cost intervention solutions. The earlier that children are identified as ASD and understand what treatment methodologies work best for them (not every treatment or methodology will work for the same individual with ASD), the greater chance these individuals will have at successful social interactions, employment opportunities, and general independence and functionality later in life. One such type of intervention is an diffusion of innovation-style intervention using social media. Current theories surrounding the use of social media in health interventions are mixed, mostly because significant amount of research has shown that social media can have a negative psychological impact on health outcomes (Oberst et al., 2017), but positive outcomes are also possible (Radovic et al., 2017). Another issue with the use of social media in health interventions is the possible development of a health disparity due to communication inequalities (Glanz, 2020), where people in higher socioeconomic statuses have better access to health information. This potential for a health disparity further highlights the need for a better understanding of any potential positive side effects of social media use for those with ASD.
In 2016, Snethen et al. had proposed that social media use could have a positive health benefit on individuals with psychiatric disorders by creating a more effective means of community integration for people that might not otherwise engage in community interactions, but also warned of a negative consequence in undirected communications (anxiety-producing interactions). In a later study, van Schalkwy et al. (2017) introduce the idea of “friendship level” and a Social Media Experience Scale (SMES) as metrics to directly test the efficacy of a social media intervention in youths with ASD. In this 2017 study, the SMES scale was split into two parts - SMES-Anxiety (a negative experience) and SMES-Utility (a positive experience). A group of 100 adolescents aged 12 to 19 were recruited for the study, 44/100 of which had a diagnosis of ASD. The authors proposed two hypothesis: 1. The Increase Hypothesis - social media allows individuals with ASD to create new interactions that they would not have previously engaged in or 2. The Displacement Hypothesis - social media displaces otherwise normal social interactions, leading to a decrease in utility. In this study, the authors found that those with ASD but not high levels of social anxiety experienced an increase is SMES-Utility, but those with ASD and high-anxiety lost this increase effect and had no net change. The non-ASD group saw no indication of an increase in SMES-Utility. These results suggest that individuals with ASD are insulated from the Displacement effect and already experience poor friendship quality relative to the non-ASD group, whereas the ASD group may experience a displacement effect from social media use, leading to a net negative effect in the non-ASD group.
Overall, this suggests that social media use can be an effective health intervention for some group of individuals with ASD. The most likely mode of increase seen here is due to the elimination of social queues that would otherwise inhibit or prevent ASD individuals from engaging in social interactions (e.g., the ASD trait of being unable to identify facial expressions is eliminated in social media interactions). However, more research is needed to understand why high-anxiety ASD individuals do not experience an increase in SMES-Utility. This suggests social media interactions could be modified to provide a more robust support network for those with ASD, including those with high-anxiety symptoms.
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