Peer rejection as a mediator between socio-emotional function and internalizing symptoms in autistic adolescents

Peer rejection is a distressing experience, which has been found to mediate the association between socio-emotional function and internalizing symptoms in neurotypical adolescents. To examine whether peer rejection statistically links socio-emotional function and internalizing symptoms in autistic adolescents, we measured their socio-emotional function (social skill, alexithymia, empathy), peer rejection, and internalizing symptoms. Autistic adolescents (<i>N</i> = 71), aged between 10 and 16 years (<i>M</i> = 12.73 years), completed questionnaires measuring peer rejection, socio-emotional function (alexithymia, empathy), and internalizing symptoms (depression, anxiety, social anxiety), and their parents completed the Autism-Spectrum Quotient questionnaire measuring adolescents' social skills. Our results revealed that peer rejection was associated with internalizing symptoms, and peer rejection mediates the relationships between socio-emotional function (social skill, alexithymia, empathy) and internalizing symptoms. These findings underscore the importance of relational factors in the mental health of autistic adolescents and highlight the importance of addressing peer rejection through inclusive practices and social acceptance initiatives.Lay abstractTeenagers often find peer rejection distressing. It is also linked to mental health issues such as anxiety and depression. For autistic adolescents, experiencing peer rejection is even more common, but its associations with mental health are less understood. This study aimed to find out if peer rejection is related to anxiety and depression in autistic adolescents. We also wanted to see how social skills, emotional awareness (alexithymia), and empathy relate to peer rejection, and whether these associations extend to emotional distress (depression, anxiety, social anxiety). We surveyed autistic adolescents aged 10 to 16 about their social experiences, socio-emotional function, and emotional distress. Their parents provided social-skill information. Autistic adolescents who felt more rejected by their peers had higher levels of emotional distress. Moreover, teens who struggled more with social skills and emotional functions tended to feel more rejected by peers and to experience higher levels of emotional distress. Our findings suggest that relationships play a crucial role in the mental health of autistic adolescents. While building individual social and emotional skills is important, fostering supportive peer environments may also play a key role in promoting their well-being.