Autistic Adolescents' Quality of Life: Perceived Social Competence and Social Anxiety as Key

Autistic adolescents often report lower social and overall quality of life (QoL) associated with limited social skills and behavioral challenges. Awareness of social limitations and social anxiety can worsen QoL, yet the specific roles of these factors remain underexplored. This study examined how social skills, challenging behaviors, social anxiety, and self-perceived social competence influence QoL in autistic adolescents. A total of 117 autistic participants (age = 12.6 ± 2.2 years; female = 13.7%, male = 86.3%) completed measures including the Pediatric Quality of Life Inventory, the Social Anxiety Scale for Adolescents, and the Self-Perception Profile for Children/Adolescents Social Competence Subscale. Caregivers assessed social skills and challenging behaviors using the Social Skills Improvement System Rating Scales. Linear regressions, controlling for age, sex, and autistic characteristics, revealed that lower overall QoL was significantly associated with higher social anxiety (β = -0.48, p < 0.001), lower perceived social competence (β = 0.21, p < 0.05), and more challenging behaviors (β = -0.24, p < 0.01) among autistic adolescents. Furthermore, lower social QoL was associated with social anxiety (β = -0.52, p < 0.001) and perceived social competence (β = 0.28, p < 0.01). These factors accounted for 45.5% of overall and 51.6% of social QoL variance. The findings highlighted the importance of supporting self-perception, addressing emotional distress, and managing behavioral challenges to improve QoL in autistic adolescents.