Research Review: The relationship between social anxiety and social cognition in children and adolescents: a systematic review and meta-analysis.

Bhismadev Chakrabarti,Cathy Creswell,Samantha Pearcey,Kate Gordon,Helen Dodd,Brynjar Halldorsson

doi:10.1111/jcpp.13310

Abstract

Childhood Social Anxiety Disorder (SAD) is common and impairing. The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, particularly given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent. This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). An alternative approach is to examine the association between social anxiety and the social cognitive capacities that underpin social skills. This paper aims to examine the association between social anxiety and social cognition in children and adolescents, and examine conceptual and methodological moderators of this relationship. Papers published between 1980 and 2019 were screened systematically. Fifty studies were identified from which an effect size could be calculated for the relationship between social anxiety and social cognition, including 15,411 children and adolescents. An overall significant, but moderate effect (r=-.15) was identified, where increased social anxiety was associated with lower social cognitive ability. Moderation analyses revealed specific associations within studies examining social anxiety among participants with and without ASD who were older than 7 years old, and studies assessing the relationship between social anxiety and specific aspects of Theory of Mind (ToM). No significant association was identified between social anxiety and emotion recognition. Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition. This reinforces the importance of accurately identifying and treating social anxiety within ASD populations. In addition, treatments for social anxiety among neurotypical populations may benefit from targeting particular aspects of ToM rather than emotion recognition and other broad social skills.

Highlights

Social anxiety disorder (SAD) is one of the most common mental health difficulties across the life span (8.6% prevalence; Kessler et al, 2005)
For papers that reported a between groups analysis, but did not report Cohens d, this was calculated from the means and standard deviations of each group (Field & Gillett, 2010) and converted to an approximation of rp
Effect sizes were transformed, where required, so that negative effects indicated that higher levels of social anxiety were related to lower ability in social cognition and vice versa

Summary

Introduction

Social anxiety disorder (SAD) is one of the most common mental health difficulties across the life span (8.6% prevalence; Kessler et al, 2005). The recommended treatment is a disorder specific form of cognitive behavioural therapy (CBT) that includes social skills training and, whilst they appear to be more effective than more general treatments, it is not clear whether social skills training is the critical component involved in improved outcomes, given that evidence for the relationship between social anxiety and social skills deficits in children is inconsistent This may be partly due to an overlap in their observable features, and because the nature of the association may vary in different contexts (e.g. according to child age). Conclusions: Significant associations between social anxiety and social cognitive abilities appear to be accounted for by elevated social anxiety among children with ASD, and those with difficulties in specific aspects of ToM but not broader social skills, such as emotion recognition.

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