Examining Social Barriers in Adults With ADHD: The Role of Autistic Traits, Empathy, Theory of Mind in Social Anxiety and Avoidance

Introduction: This case–control study examined social barriers in adults with ADHD compared to non-neurodivergent adults, focusing on autistic traits, cognitive/affective empathy, theory of mind (ToM), and social anxiety/avoidance. Methods: A total of 142 adults with ADHD and 104 non-neurodivergent groups were assessed using the following self-report measures: the Adult ADHD Self-Report Scale, the Hospital Anxiety Depression Scale, the Autism Spectrum Quotient, the Empathy Quotient, and the Liebowitz Social Anxiety Scale. ToM was evaluated using the Reading the Mind in the Eyes Test. Additionally, psychiatric interviews were conducted, incorporating diagnostic evaluation via the Structured Clinical Interview for DSM-5 Disorders—Clinician Version, along with collection of sociodemographic and clinical data, and documentation of real-life narratives of social struggles to contextualize and deepen the interpretation of the quantitative findings. Results: Adults with ADHD exhibited significantly higher levels of autistic traits and social anxiety/avoidance, along with lower cognitive and affective empathy scores, compared to controls, while ToM abilities did not differ significantly between groups. Moreover, regression analyses indicated that challenges in social skills and communication, low cognitive empathy, heightened affective empathy, and difficulties in attention switching accounted for variance in social anxiety/avoidance, independent of confounding sociodemographic and clinical factors, including the presence of co-occurring psychiatric conditions and the severity of ADHD, depression, and anxiety symptoms. Conclusion: While adults with ADHD exhibit intact basic ToM abilities, challenges in social-cognitive processes are associated with their social barriers. Targeted interventions such as social skills training, executive function coaching, and anxiety management may improve social outcomes and quality of life, as also highlighted by the real-life narratives—although further longitudinal, multi-method research is warranted.