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Background: Autism spectrum disorder (ASD) is a lifelong developmental disability characterized by deficits in social communication and social interaction across multiple contexts. Existing literature on social relationships and well-being among adolescents with ASD in Asian countries is scant. Aims: This study compared the perceptions of adolescents with ASD with those of their neurotypical peers toward their friendship quality, activity participation, and emotional well-being, and examined the relationships between friendship quality, activity participation, and emotional well-being. Methods: The study participants—101 adolescents with ASD and 101 neurotypical peers, aged 10–19 years—completed the following self-administered questionnaires: the Friendship Quality Questionnaire, the Child and Adolescent Scale of Participation, the Beck Anxiety Inventory, and the short-form UCLA loneliness scale. Results: Adolescents with ASD reported lower friendship quality, lower school participation, and higher levels of anxiety and loneliness compared to their neurotypical peers. Loneliness correlated negatively with friendship quality and school participation and positively with anxiety. Adolescents with ASD experienced increased levels of anxiety when low friendship quality was accompanied by greater loneliness. Conclusions and significance: These findings reveal that friendship quality, school participation, and loneliness have a considerable effect on the emotional well-being of adolescents with ASD, thus indicating the need for therapeutic interventions that address interpersonal relationships and emotional well-being.

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