Social Anxiety vs Autism: Understanding Differences and Similarities

Navigating the world of social interaction can be challenging for various reasons, making it crucial to understand the nuances of social anxiety vs autism. While both can involve significant social difficulties and anxiety, they are fundamentally distinct conditions: social anxiety is characterized by intense fear of judgment in social situations, whereas autism spectrum disorder is a neurodevelopmental condition impacting core social communication and interaction. This page will clarify their differences and similarities, covering their key symptoms, diagnostic processes, and effective management strategies for each.

What Is Social Anxiety and What Are Its Key Symptoms?

Social anxiety, also known as Social Anxiety Disorder or social phobia, is a mental health condition characterized by an intense, persistent fear of social situations where an individual anticipates negative evaluation, scrutiny, or judgment from others. This profound apprehension goes beyond normal shyness, leading to significant distress and avoidance of social interactions, profoundly affecting daily life and relationships. Unlike some other social difficulties, social anxiety is primarily driven by a deep-seated fear of social humiliation or embarrassment. Key symptoms often involve a combination of emotional, physical, and behavioral responses, including:

• Intense fear of being judged, scrutinized, or rejected in various social settings, such as meeting new people, speaking in public, or even routine interactions.
• Excessive self-consciousness and worry about embarrassing oneself, making mistakes, or appearing anxious.
• Avoidance of social situations entirely or enduring them with extreme discomfort and anxiety.
• Physical symptoms like blushing, trembling, sweating, a rapid heartbeat, or nausea, often accompanied by a fear that others will notice these signs of anxiety.
• Difficulties with social communication, such as avoiding eye contact, speaking softly, or struggling to initiate or maintain conversations.
• Over-analyzing social interactions after they occur, dwelling on perceived flaws or mistakes in one's behavior.

What Is Autism Spectrum Disorder and What Are Its Core Characteristics?

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition that affects how individuals perceive and interact with the world, leading to persistent challenges in social communication and interaction. The "spectrum" in its name means that while all individuals with ASD share certain core characteristics, these manifest with a wide range of symptoms, abilities, and varying needs for support. Its primary features include persistent difficulties with social communication, such as understanding social cues, making eye contact, or engaging in back-and-forth conversations. Additionally, ASD is characterized by restricted, repetitive patterns of behavior, interests, or activities this can involve repetitive movements, a strong adherence to routines, intense and focused interests, or unusual sensory sensitivities.

How Do Social Anxiety and Autism Compare in Symptoms and Behavioral Traits?

Social anxiety and autism share some notable overlaps in social and behavioral traits, but they are fundamentally distinct conditions. While individuals with autism frequently experience social anxiety, these conditions stem from different core origins and manifest with unique patterns in how social communication and interactions are approached. Understanding these comparisons, including shared difficulties, underlying causes, and specific behavioral expressions, is key to telling them apart, as we will explore in the upcoming sections.

Overlapping Social Difficulties and Anxiety

The overlap between social difficulties and anxiety is a key area of convergence when considering social anxiety vs autism, as both conditions often involve significant social challenges and heightened feelings of apprehension in social settings. This means individuals with either social anxiety or autism spectrum disorder may exhibit similar struggles, such as avoiding social interactions, facing difficulties with social communication, and experiencing intense unease when engaging with others. For instance, perceived awkwardness and poor communication in social situations can be a manifestation of either condition, blurring the lines between them. This shared presentation can complicate diagnosis, making it challenging for professionals to distinguish between the core issues and potentially leading to untreated co-occurring anxiety in autistic individuals. When anxiety is present alongside autism, it can heighten existing social difficulties, underscoring the necessity for a thorough evaluation to ensure accurate diagnosis and tailored support.

Distinct Origins and Biological Differences

The core distinction between social anxiety and autism lies in their origins: autism spectrum disorder is a neurodevelopmental condition, stemming from fundamental differences in brain development and function from early in life. This involves variations in biological brain structures and genetic influences, impacting how individuals process social information and interact with the world, often reflecting unique individual DNA differences. In contrast, social anxiety is primarily a mental health condition rooted in psychological and learned fear responses to social situations. While some neural mechanisms underlying temperamental differences might predispose individuals to anxiety, its manifestation is more closely tied to cognitive patterns and experiences rather than a pervasive developmental impact on core social communication.

Differences in Social Communication and Interaction

While both social anxiety and autism can lead to observable social communication challenges, their underlying reasons and manifestations differ significantly in the context of social anxiety vs autism. For individuals with social anxiety, difficulties such as avoiding eye contact or struggling to initiate conversations stem primarily from an intense, overriding fear of negative judgment and potential embarrassment. This means the capacity for typical social communication is often present, but inhibited by anxiety. In contrast, for autistic individuals, differences in social communication and interaction are a core aspect of their neurodevelopmental profile, often reflecting a distinct way of processing social information. Their social communication skills are frequently different rather than lacking compared to neurotypical people, impacting areas like understanding nonverbal cues, social norms, and the nuances of language. For example, autistic people may interpret language very literally, finding it challenging to understand sarcasm or jokes. They might also show a preference for one-on-one interactions or smaller groups over large social gatherings, or a preference for solitary play in younger children, which arises from distinct social processing and energy rather than a fear of social scrutiny.

Avoidance Behaviors and Anxiety Manifestations

Avoidance behaviors are a key manifestation of anxiety, particularly in social anxiety, where individuals actively steer clear of situations, people, or activities that trigger their fear or discomfort. These behaviors initially serve as a coping mechanism, offering temporary relief from immediate anxious feelings. However, this temporary escape unfortunately reinforces and maintains the anxiety cycle in the long run. For instance, someone with social anxiety might make excuses to avoid social gatherings or presentations, go out of their way to avoid interactions at work, or decline party invitations. Such actions prevent individuals from learning that their feared situations are often not truly dangerous, leading to increased isolation and disruption to careers, relationships, and overall quality of life, which is a critical aspect when considering social anxiety vs autism.

How Are Social Anxiety and Autism Diagnosed Differently?

While both involve social difficulties, social anxiety and autism are diagnosed differently by focusing on distinct clinical criteria and underlying causes. The diagnostic process for social anxiety disorder primarily assesses intense fear of negative judgment in social situations and resulting avoidance, while autism spectrum disorder diagnosis centers on persistent neurodevelopmental differences in social communication and interaction, along with restricted or repetitive patterns of behavior. Professionals perform a thorough assessment, carefully distinguishing between these two conditions, a complexity further explained in the following sections.

Diagnostic Criteria for Social Anxiety Disorder

For a formal diagnosis of Social Anxiety Disorder, mental health professionals rely on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These criteria go beyond simply experiencing social difficulties, requiring a pattern of intense fear or anxiety in social situations that is both persistent and significantly disruptive. The key diagnostic criteria include:

• Marked fear or anxiety about one or more social situations where the individual might be scrutinized by others, such as interacting, being observed, or performing.
• Fear that one will act in a way or show anxiety symptoms that will be negatively evaluated, leading to humiliation or embarrassment.
• Social situations almost always provoke this fear or anxiety, and they are either avoided or endured with intense discomfort.
• The fear or anxiety experienced is out of proportion to the actual threat posed by the social situation and the sociocultural context.
• This fear, anxiety, or avoidance is persistent, typically lasting for six months or more.
• It causes clinically significant distress or impairment in important areas of functioning, such as social, occupational, or other daily activities.
• Crucially, the fear, anxiety, or avoidance cannot be better explained by the physiological effects of a substance, another medical condition, or symptoms of another mental disorder, such as autism spectrum disorder. This is particularly important for distinguishing between social anxiety vs autism, ensuring an accurate diagnosis that guides appropriate support.

Diagnostic Criteria for Autism Spectrum Disorder

The formal diagnosis for Autism Spectrum Disorder (ASD) is based on specific criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). This standardized framework guides healthcare professionals by focusing on persistent deficits in social communication and interaction, alongside restricted, repetitive patterns of behavior, interests, or activities. This detailed diagnostic process is crucial for distinguishing ASD from other conditions, such as social anxiety, where social difficulties stem from different core origins. For an ASD diagnosis, individuals must meet criteria across these two core domains, plus several accompanying conditions:

• Persistent deficits in social communication and social interaction across multiple contexts, requiring evidence of all three of the following:
  • Deficits in social-emotional reciprocity, such as challenges with back-and-forth conversation, or reduced sharing of interests, emotions, or affect.
  • Deficits in nonverbal communicative behaviors used for social interaction, including abnormal eye contact, difficulties understanding or using gestures, and a lack of varied facial expressions.
  • Deficits in developing, maintaining, and understanding relationships, which can manifest as difficulties adjusting behavior to suit various social contexts, or an absence of interest in peers.
• Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following:
  • Stereotyped or repetitive motor movements, use of objects, or speech (e.g., hand flapping, lining up toys, or repeating phrases).
  • Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, rigid thinking patterns, or specific greetings).
  • Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to unusual objects, or excessive preoccupation with specific topics).
  • Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., indifference to pain or temperature, adverse responses to certain sounds or textures, or unusual smelling or touching of objects).
• Symptoms must be present in the early developmental period, although they might not become fully apparent until social demands exceed an individual's capacities, or they may be masked by learned coping strategies in later life.
• The symptoms must cause clinically significant distress or impairment in social, occupational, or other important areas of current functioning.
• The disturbances cannot be better explained by an intellectual disability or global developmental delay, helping to ensure an accurate diagnosis for targeted support.

Challenges in Differentiating Between the Two Conditions

Differentiating between social anxiety and autism is genuinely complex for clinicians because many outward social behaviors can look strikingly similar, despite originating from fundamentally different underlying causes. For instance, social withdrawal, reduced eye contact, or difficulties initiating conversations can be seen in both conditions, stemming either from an intense fear of negative judgment in social anxiety or from intrinsic differences in social processing and communication in autism. This diagnostic complexity is amplified by the high rate of social anxiety as a co-occurring condition for individuals with autism, where the anxiety symptoms can mask or exacerbate autism's core characteristics. This makes it challenging to discern which condition is primarily driving specific behaviors, presenting puzzles or other tasks that need effort to solve, and requiring highly skilled professional evaluation to ensure accurate diagnosis and appropriate support.

What Treatment and Management Options Exist for Social Anxiety and Autism?

Social anxiety and autism, while distinct conditions, are both treatable, and effective management options typically involve a combination of therapy, medication, and supportive strategies. Given that social anxiety often co-occurs and complicates social interactions for individuals with autism, appropriate and tailored interventions are crucial for improving overall well-being. This section will delve into the specific therapies and interventions for social anxiety, outline support and therapies for autism spectrum disorder, and discuss strategies for managing co-occurring social anxiety in autism.

Therapies and Interventions for Social Anxiety

Therapies and interventions for social anxiety are highly effective in helping individuals manage and overcome intense fear of judgment in social situations. The most widely recognized and effective treatment is Cognitive Behavioral Therapy (CBT), which focuses on challenging negative thought patterns and gradually exposing individuals to feared social situations. CBT sessions teach crucial coping skills, enabling people to gain confidence and engage in social interactions with greater ease. A core component, Exposure Therapy, directly helps reduce avoidance behaviors and safety behaviors by slowly confronting social fears, proving that feared outcomes are often exaggerated. Other beneficial therapies include Acceptance and Commitment Therapy (ACT), which helps individuals live according to their values while accepting anxious feelings, and Interpersonal Therapy (IPT), which focuses on improving relational patterns. Treatment plans often involve individual therapy or group therapy, where individuals can practice new social skills and challenge negative beliefs in a supportive environment. While therapy is often the first line of defense, medication can also be considered as a complementary approach to further reduce the intensity of social anxiety symptoms.

Support and Therapies for Autism Spectrum Disorder

Support and therapies for Autism Spectrum Disorder (ASD) are highly individualized and essential for helping individuals develop crucial skills, manage challenges, and enhance their overall well-being throughout life. These interventions often encompass a range of approaches, including behavioral therapies like Applied Behavior Analysis (ABA), developmental approaches, speech and language therapy to improve communication, and occupational therapy to assist with daily living skills. Medications can also be a part of the treatment plan for specific co-occurring conditions, and some individuals explore alternative therapies. The goal of these tailored therapies and support services is to address the unique challenges that come with ASD, such as difficulties in social communication and interaction, which can sometimes be mistaken for or coexist with conditions like social anxiety. By fostering essential skills and coping strategies, these supports empower individuals with autism to navigate social situations more effectively, express themselves, and ultimately improve their quality of life.

Managing Co-occurring Social Anxiety in Autism

Managing co-occurring social anxiety in autism is vital because anxiety can significantly exacerbate an individual's existing social challenges and overall well-being. Individuals with Autism Spectrum Disorder (ASD) frequently experience co-occurring anxiety, with social anxiety often being the most common, impacting up to 42 percent of autistic people and making social interactions more challenging. This co-occurrence can introduce additional difficulties, including increased loneliness, tendencies towards aggression, and a higher risk of self-harm or suicidal ideation, highlighting why management is so essential. Effective management involves a personalized approach that includes therapy and coping strategies tailored to address both the core characteristics of autism and the specific symptoms of social anxiety. Individuals with autism managing co-occurring conditions may need to receive treatment and therapy for each condition, such as Cognitive Behavioral Therapy (CBT) and other therapeutic interventions, alongside medication, to reduce symptom load and improve their overall functioning.

When Should You Seek Professional Evaluation for Social Anxiety or Autism?

You should seek a professional evaluation for social anxiety or autism when symptoms become persistent, significantly interfere with daily life, relationships, or schooling, or when you notice concerning social or behavioral patterns. This step is crucial because conditions like social anxiety vs autism can present with overlapping social difficulties, making a professional assessment essential for an accurate diagnosis and to unlock appropriate support and interventions. We will explore specific signs in children and adults, and how professional help guides both diagnosis and treatment in the following sections.

Signs Indicating the Need for Assessment in Children

Parents should consider a professional assessment for children when certain behaviors or emotional patterns become frequent, intense, and significantly impact their daily functioning at home, school, or with peers. These persistent indicators can suggest underlying challenges, potentially including conditions like social anxiety or autism, that warrant expert evaluation. Look for these signs:

• Persistent or extreme anxiety and excessive worry, especially around social situations or interactions.
• Significant social withdrawal, introverted behavior, or a total lack of interest in developing and maintaining relationships or adjusting to social settings.
• Sudden, constant, or aggressive behavior changes, mood swings, increased irritability, or frequent tantrums and meltdowns.
• A decline in school performance or extracurricular activities, struggles with focus, attention, or unusual difficulty grasping new concepts.
• Changes in sleep or eating patterns, or frequent complaints of unexplained physical symptoms like stomachaches or headaches.
• Self-destructive behaviors, self-harm, or any expression of suicidal thoughts, which require immediate professional help.

Early recognition of these signs is key to providing timely support and intervention.

Signs Indicating the Need for Assessment in Adults

Adults should consider a professional assessment when they recognize persistent and impactful signs that interfere with their quality of life, relationships, or career. Individuals need to recognize signs that help is needed when they are struggling to cope with everyday life demands or experiencing significant problems in one or more areas of living. These indicators can alert individuals to seek assistance for potential conditions like social anxiety or autism. Specific signs indicating the need for assessment in adults include:

• Consistent and intense social discomfort or avoidance: This goes beyond typical shyness, manifesting as an overwhelming fear of judgment or scrutiny in various social settings, which is a hallmark of social anxiety.
• Difficulties with social communication and understanding: Noticeable struggles with reading nonverbal cues, understanding social nuances, initiating or maintaining conversations, or feeling disconnected in social interactions, which can point towards autism.
• Inflexible routines or highly focused interests: A strong need for routine or an intense, absorbing interest that significantly impacts daily functioning or limits social engagement.
• Pronounced sensory sensitivities: Unusual reactions to sounds, textures, lights, or tastes that cause significant distress or lead to avoidance behaviors.
• Frequent emotional dysregulation or heightened anxiety: Experiencing frequent mood swings, intense irritability, or persistent, unexplained anxiety, particularly in social contexts.
• Persistent feeling of "being different": A long-standing sense that one processes the world or interacts socially in a fundamentally distinct way, impacting overall well-being.

Recognizing these persistent patterns identifies indicators that an individual requires assistance. Even a preliminary self-screening score suggesting a possible indication of a disorder should prompt contacting a healthcare provider. However, it's important to remember that self-assessment cannot replace a professional evaluation by a qualified healthcare provider for accurate diagnosis and tailored support.

How Professional Help Can Support Diagnosis and Treatment

Professional help is vital because it provides the specialized expertise necessary for both accurate diagnosis and the creation of personalized treatment plans. Given the complex overlap in symptoms between conditions like social anxiety vs autism, a professional diagnosis requires a thorough clinical interview and comprehensive assessment by a qualified mental health professional. These experts are critical for not only achieving an accurate diagnosis but also for developing effective long-term treatment plans that include proper medication and therapy management. Their specialized guidance ensures that interventions are precisely tailored to an individual's unique needs, enabling them to navigate challenges and significantly improve their overall well-being.

Social Anxiety Books for Deeper Understanding and Self-Help

Social anxiety books offer a powerful pathway to deeper understanding and self-help for individuals navigating intense social fears. These resources provide in-depth information about social anxiety, offering insights, practical tips, and coping strategies that can empower you to manage your symptoms effectively, bringing comfort and encouragement. Many highly recommended self-help books are written by experienced cognitive-behavioral therapists, such as "Social Anxiety for Dummies" by Laura Johnson, LMFT, LPCC, A-CBT, and "Overcoming Shame-Based Social Anxiety & Shyness: A CBT Workbook" by Larry Cohen, LICSW, A-CBT. They can be an affordable and accessible tool, serving as a valuable first step in managing social anxiety, sometimes even acting as a supportive alternative or complement to professional therapy. Discover more helpful social anxiety books to begin your journey toward greater confidence and calm.

Finding Social Anxiety Psychiatrists in Omaha for Expert Care

Finding expert care for social anxiety in Omaha often begins with locating a qualified psychiatrist, who can provide personalized treatment. A person seeking care for social anxiety disorder can search for a psychiatrist with expertise in this specific condition, which is crucial given the nuanced differences even from other conditions like social anxiety vs autism. These mental health professionals offer valuable individual assessment and advice, creating effective personalized social anxiety treatment plans. To find social anxiety psychiatrists in Omaha, you can consult online directories or professional associations that list qualified local healthcare providers specializing in anxiety disorders. Many online psychiatry providers also offer psychiatric evaluations and medication prescribing, allowing for consultations with licensed psychiatrists and personalized anxiety treatment from the comfort of your home. For a comprehensive list of resources, visit our dedicated page on Social Anxiety Psychiatrists in Omaha.

Locating Social Anxiety Therapists in Omaha for Personalized Support

Locating a qualified social anxiety therapist in Omaha is a vital step for receiving effective, personalized support tailored to your unique needs. Omaha Anxiety Therapy Services are committed to providing personalized and well-rounded support, often through customized treatment plans developed in collaboration between therapists, psychiatrists, and primary care providers. This integrated approach ensures that your specific situation is thoroughly understood, which is particularly important given the nuanced differences between conditions like social anxiety vs autism, where tailored interventions are key. You'll find that personalized support significantly enhances the effectiveness of the therapeutic process, guiding you towards managing intense social fears. Many local therapists specialize in evidence-based methods such as Cognitive Behavioral Therapy (CBT), mindfulness techniques, and mental performance coaching to address social anxiety directly. To begin your search, consulting online directories that list mental health professionals in Omaha is highly recommended, allowing you to find therapists experienced in treating anxiety disorders. For a comprehensive guide to finding therapists who can offer this specialized care, visit our dedicated page on Social Anxiety Therapists in Omaha.

Frequently Asked Questions About Social Anxiety and Autism

This section provides answers to common questions regarding social anxiety and autism, helping to clarify their distinct characteristics and the complex ways they often interact. Understanding why social difficulties manifest in autistic individuals, often due to communication style mismatches with the neurotypical world or past negative social experiences, is a frequent area of inquiry. While social anxiety is not a defining characteristic of autism, it commonly co-occurs, leading to challenges such as overanalyzing social interactions, excessive worrying about social situations, and difficulties with eye contact, which can significantly hinder engagement and community participation. Addressing these specific queries is crucial for fostering clarity and ensuring appropriate support.

Can Social Anxiety Occur Without Autism?

Yes, social anxiety can absolutely occur independently of autism. While individuals on the autism spectrum frequently experience co-occurring social anxiety, social anxiety is not a defining characteristic of autism spectrum disorder itself. Instead, it is a distinct mental health condition primarily characterized by an intense fear of negative judgment, scrutiny, or embarrassment in social situations. Many people experience this profound social fear and avoidance without having the core neurodevelopmental differences in social communication, interaction, or restricted, repetitive patterns of behavior that define autism, clearly highlighting the distinction when considering social anxiety vs autism.

Is Social Anxiety a Symptom of Autism?

No, social anxiety is not a core symptom of autism itself; instead, it is a distinct mental health condition that frequently co-occurs with autism spectrum disorder. While individuals on the autism spectrum often experience social anxiety, this isn't because social anxiety is a defining characteristic of autism. Rather, for autistic people, social anxiety often develops as a reaction to perplexing or negative social experiences, worries about communication barriers, or the sheer effort of navigating social situations. This means that while both conditions can lead to social difficulties, their underlying causes are different: autism involves fundamental neurodevelopmental differences in processing social information, whereas social anxiety is primarily characterized by an intense fear of being judged or scrutinized. Recognizing social anxiety as a separate, co-occurring condition in the context of social anxiety vs autism is vital for ensuring accurate diagnosis and providing targeted support that addresses both the core characteristics of autism and the specific anxieties an individual faces.

How Can I Tell If Someone Has Autism or Social Anxiety?

Determining if someone has autism or social anxiety can be complex due to their overlapping social difficulties, but understanding the underlying reasons for these challenges is key to identifying potential indicators. For social anxiety, difficulties like avoiding eye contact or struggling with conversation primarily stem from an intense fear of negative judgment or embarrassment, leading to excessive worrying about social situations and overanalyzing interactions. In contrast, for autism, social communication differences arise from fundamental variations in how social information is processed, impacting the understanding of nonverbal cues and social norms; autistic individuals may also exhibit restricted, repetitive behaviors or intense, focused interests, which are not core to social anxiety. Given that social anxiety commonly coexists with autism, and outward behaviors can appear strikingly similar, a formal diagnosis from a healthcare professional specializing in both conditions is the most reliable way to differentiate between them and determine accurate support for the individual.

Can Treatment for Social Anxiety Help People with Autism?

Yes, treatments traditionally used for social anxiety can indeed provide substantial help for people with autism, particularly because social anxiety is a common co-occurring condition that can significantly worsen existing social difficulties for autistic individuals. Therapies such as Cognitive Behavioral Therapy (CBT), which focuses on challenging negative thought patterns and gradual exposure to feared social situations, have been adapted to cater to the unique needs of autistic individuals, proving effective in reducing anxiety symptoms. For instance, modifications for anxiety treatment in people with autism may include using pictures, concrete language, or incorporating special interests to make therapy more accessible. Medication, including selective serotonin reuptake inhibitors (SSRIs), can also be a part of a personalized treatment plan to help manage anxiety symptoms. By addressing this co-occurring social anxiety, individuals with autism can experience reduced avoidance behaviors, greater comfort in social situations, and an improved overall quality of life, which is a critical aspect when navigating the complexities of co-occurring conditions that often blur the lines when considering social anxiety vs autism.

What Are the Long-Term Outcomes for Each Condition?

The long-term outcomes for both social anxiety and autism spectrum disorder primarily hinge on early diagnosis and consistent, tailored interventions aimed at fostering improvements in social functioning, overall quality of life, and independent living. For individuals with social anxiety, effective treatment typically leads to a significant reduction in fear and avoidance, enabling improved social interactions, better occupational functioning, and healthier interpersonal relationships over time. For autistic individuals, long-term support focuses on developing crucial social communication skills, managing sensory sensitivities, and achieving broader, sustainable changes in their conditions, which can lead to enhanced participation in various aspects of life. When considering social anxiety vs autism, untreated conditions, particularly when they co-occur, often result in more severe challenges, whereas a treated dual diagnosis consistently shows better outcomes in areas like mental health and social integration. Ongoing, personalized support is key to realizing these positive, sustained long-term effects.