Brief Form of the Social Phobia and Anxiety Inventory (SPAI-B) for Adolescents

The relationship among several social anxiety measures and a semistructured interview in an adolescent Spanish-speaking sample is examined. Construct validity and test-retest reliability were tested. A principal axis factor analysis was also explored. Results revealed good construct validity and alpha coefficients for the assessment instruments such as the Social Phobia and Anxiety Inventory (SPAI), the Social Anxiety Scale for Adolescents (SAS-A), the Fear of Negative Evaluation Scale (FNES) and the Social Avoidance Distress Scale (SADS). Among these, data strongly support the validity of the Social Phobia and Difference measures of the SPAI and Total SAS-A score as assessment measures in the adolescent population even in non-American cultures and languages. Furthermore, results appear to support the presence of a single higher-order dimension, “social anxiety,” as measured by the instruments used in this study.

The development, reliability, and discriminative ability of a new instrument to assess social phobia are presented. The Social Phobia and Anxiety Inventory (SPAI) is an empirically derived instrument incorporating responses from the cognitive, somatic, and behavioral dimensions of social fear. The SPAI has high lest-retest reliability and good internal consistency. The instrument appears to be sensitive to the entire continuum of socially anxious concerns and is capable of differentiating social phobics from normal controls as well as from other anxiety patients. The utility of this instrument for improved assessment of social phobia and anxiety and its use as an aid for treatment planning are discussed. Social phobia is perhaps the least understood and the least researched of the anxiety disorders. Although there are several scales available to measure social anxiety, most were constructed prior to publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-lII; American Psychiatric Association, 1980), where the diagnostic criteria for social phobia were first introduced. Because social anxiety is experienced by individuals with many psychiatric disorders as well as by normals, these scales may not be specific to social phobia. Preparation of an instrument designed more specifically to assess social phobia requires consideration of several issues, including the critical features of the disorder, its cognitive, physiological, and behavioral dimensions (Lang, 1977), and the capability to sample behavior across a range of potentially distressful social situations. In addition, because social phobics differ in the degree of distress or functional impairment resulting from the disorder, the ability to assess level of severity would be a particularly positive feature of such an instrument. The Social Phobia and Anxiety Inventory (SPAI) is a new, empirically derived self-report inventory. Its construction was based on the behavioral-analytic model outlined by Goldfried and D'Zurilla (1969). It assesses specific somatic symptoms, cognitions, and behavior across a range of potentially fear-producing situations. In order to assess severity, a Likert-scale format is used. This article describes the development and initial psychometric characteristics of the SPAI.

Social anxiety disorder (SAD) in adolescents is considerably underdetected and undertreated despite the availability of efficacious treatments. Our main study objective was to examine brief, valid, and reliable screening measures for adolescent social anxiety, and to then conduct diagnostic interviews to evaluate the measures' ability to identify adolescents with SAD. We examined 7 brief and valid social anxiety measures and compared their diagnostic accuracy with diagnoses established by a semistructured interview. The sample included 421 Spanish adolescents with and 613 without a clinical diagnosis of SAD. Data revealed that short social anxiety measures are accurate in detecting Spanish-speaking socially anxious adolescents. All questionnaires showed good or excellent discriminating ability, with the Social Anxiety Scale for Adolescents (SAS-A) and the Social Phobia and Anxiety Inventory-Brief (SPAI-B) having the best sensitivity and specificity values, respectively. Excellent areas under the receiver operating characteristic curves were found for most measures, except for the Liebowitz Social Anxiety Scale for Children and Adolescents and the Mini-Social Phobia Inventory, which had good discriminatory ability. There was little statistical difference in the ability of the brief social anxiety measures to identify cases accurately, although the SPAI-B cutoff score yielded the best balance between sensitivity and specificity and the highest Youden Index. Overall, results suggest that brief measures for social anxiety symptoms can be effective in detecting SAD in Spanish-speaking adolescents. Depending on the purpose of the study, SAS-A may be especially useful for reducing false negatives and the SPAI-B for false positives.

Although social anxiety is known to be common among adolescents, there are no self-report measures with demonstrated reliability and validity for this population. The Social Phobia and Anxiety Inventory (SPAI) is a measure of social anxiety developed for adults. The purpose of this study was to determine the reliability and validity of the SPAI for adolescents. The sample consisted of 223 adolescents ages 12 to 18 from both clinical and community sources. Confirmatory factor analysis established the validity of the 2 separate factors of Social Phobia and Agoraphobia. Reliability estimates by Cronbach alpha were acceptable for the SPAI subscales and total. The SPAI demonstrated good construct validity, showing statistically significant relationships with independent measures of social phobia and other anxiety variables. The results demonstrate that the SPAI is a reliable and valid measure of social phobia for adolescents. Social phobia is a common and important psychiatric disorder with substantial comorbidity, including other psychiatric disorders, increased suicidal ideation, and financial dependency (Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992). Studies have found that social phobia most often begins in adolescence (Thyer, Parrish, Nesse, & Cameron, 1985). Data from the National Institute of Mental Health Epidemiologic Catchment Area Program, for example, show that the mean age of onset of social phobia is 15.5 years (Schneier et al., 1992). A growing body of research suggests that adolescent social phobia is an important psychiatric disorder (Clark, Smith, Neighbors, Skerlec, & Randall, 1994), and that it may have deleterious consequences in adolescents, including increased alcohol abuse (Clark & Jacob, 1992; Clark S Silverman & Nelles, 1988). However, social anxiety is also common in normal adolescents (Bell-Dolan, Last, & Strauss, 1990), and diagnostic systems do not capture the range and severity of social anxiety symptoms. Interview measures are labor intensive and may not be feasible for some research. Self-report measures are therefore needed to determine the presence and severity of social phobia. At present, there are no generally accepted measures of social

Summary: Social phobia is becoming increasingly recognized as an important disorder among adolescents. The body of research on assessment measures in adolescents with social phobia has grown considerably. Unfortunately, little is known about the relationship among these measures and its invariance across clinical and community samples. The objective of the present study is to examine this issue. Results show that all of these measures are invariant among samples and assess a single higher-order factor, labeled as “social anxiety,” although each measure appears to tap a specific symptom (cognitive, behavioral, and somatic). Further, results do support the Social Phobia and Anxiety Inventory (SPAI) and the Social Anxiety Scale for Adolescents (SAS-A) as first-line assessment measures for adolescents' social anxiety.

The SPAI-18, a brief version of the Social Phobia and Anxiety Inventory: Reliability and validity in clinically referred and non-referred samples

An abbreviated version of the Social Phobia and Anxiety Inventory (SPAI) was developed using methods based in nonparametric item response theory. Participants included a nonclinical sample of 1,482 undergraduates (52% female, mean age = 19.4 years) as well as a clinical sample of 105 individuals (56% female, mean age = 36.4 years) diagnosed with either generalized (73%) or specific social phobia (27%). Twenty-three of the 45 SPAI items demonstrated good discrimination along the social anxiety continuum. In addition, option characteristic curves (OCCs) indicated that the SPAI's 7-point scale may generate errors in ranking individuals. Thus, options were collapsed to improve item performance. No gender differences emerged between any of the items' OCCs, suggesting that items function similarly among men and women. The abbreviated version also correlated highly with the original 45-item SPAI and exhibited similar patterns of correlations with measures of social anxiety. The SPAI-23 has considerable practical benefits, including a screening of both social and agoraphobic anxiety as well as decreased assessment and scoring time.

The manuscript by Herbert, Bellack, and Hope (1991) entitled "Concurrent validity of the Social Phobia and Anxiety Inventory," presented additional psychometric data on this instrument. Specifically, concurrent validity data for the Social Phobia and Anxiety Inventory (SPAI) were reported. Also, the authors reached a number of conclusions regarding the manner in which the subscales of the SPAI should be used. We do not agree with the authors' conclusions in this regard and wish to point out what we believe are problems with their recommendations. First, Herbert et al. (1991) concluded that the SPAI social phobia subscale score is a slightly better measure of social phobia symptoms than the Difference score. This conclusion primarily was based on Herbert and co-workers' interpretation that the correlations between the SPAI social phobia subscale and the instruments used to establish its concurrent validity are larger than the correlations between the SPAI Difference score and these measures. However, no statistical test was performed on these data. Also, in several cases, the correlation coefficients presented in Table I of the study by Herbert et aL (t991) differ by only one or two points, making it highly unlikely that they are statistically significant. Furthermore, because the SPAI was developed specifically to measure social phobia, and the other instruments used by Herbert et al. (1991) to establish its concurrent validity were not, one needs to use caution in interpreting patterns of correlation.

Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social anxiety scales for children and adolescents were identified. An overview about the scientific support accumulated by these scales is offered. Our main results are consistent with recent reviews that consider the Social Phobia and Anxiety Scale for Children (SPAI-C) and the Social Anxiety Scale for Adolescents (SAS-A) among the most pertinent and empirically supported measures of social anxiety for youngsters. However, after considering the existing evidence, we highly recommend another couple of scales that proved to be empirically supported (i.e., the Social Phobia Inventory-SPIN, and the Liebowitz Social Anxiety Scale for Children and Adolescents-LSAS-CA).

This study reports a one-year prospective investigation of the relations between overt and relational victimization and social anxiety and phobia in a sample of adolescents. The Social Experience Questionnaire-Self Report Form (SEQ-S), Social Anxiety Scale for Adolescents (SAS-A), and Social Phobia and Anxiety Inventory for Children (SPAI-C) were administered to 144 ninth grade adolescents. A follow-up assessment with the SEQ-S, SAS-A, and SPAI-C was conducted one year later. Results indicated that relational victimization predicted symptoms of social phobia but not general social anxiety and avoidance one year later. Overt victimization was not a significant predictor of social anxiety and phobia one year later. Social anxiety and phobia did not predict peer victimization one year later. However, increases in social anxiety and social phobia symptoms (for boys) over time were positively associated with increases in relational victimization over time. Implications of these findings for peer victimization and social anxiety in the development of social phobia and negative peer experiences are discussed.

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.

School-Based Behavioral Treatment for Social Anxiety Disorder in Adolescents: Results of a Pilot Study

The social phobia and anxiety inventory: Concurrent and external validity

Background: Social anxiety disorder (SAD) is characterized by a fear of humiliation and/or embarrassment in social situations, which may lead to significant avoidance and distress. A preponderance of research suggests that the prevalence of SAD is higher in females than in males and that gender differences of SAD varies cross-culturally. According to numerous studies, attention to the diagnosis and adequate assessment of anxiety disorders in primary care settings is lacking. A deficiency of easily administered well-validated diagnostic tools and limited time for thorough (i.e., structured clinical interview) evaluation may contribute to the above finding. Procedure: Our principal aims were two-fold: 1) to focus on emergent gender differences in self- reported social anxiety (SA) symptoms, and 2) to evaluate newly translated Finnish versions of the Social Phobia and Anxiety Inventory (SPAI) and Brief Fear of Negative Evaluation Scale -Straightforward Items (BFNE-S) in a general Finnish parent sample (N = 597). Results and Conclusions: Results from our sample using the SPAI estimated that 6.7% of females and 5.0% of males met criteria for a probable diagnosis of SAD. Non socially-anxious females scored significantly higher than did their male counterparts on social interaction and focus of attention fears, whereas socially-anxious males scored higher than socially-anxious females on behavioural avoidance. The SPAI and BFNE-S are useful additions to Finnish screening tools to detect SA symptoms in adults.

Asthma and Social Anxiety in Adolescents