Self-reported Social Anxiety Symptoms Research Articles

School completion and progression to higher education in adolescents with social anxiety: a linkage between Young-HUNT3 and national educational data (2008-2019), Norway.

Social anxiety disorder (SAD) most commonly develops in adolescence-a period of life that includes a transition to upper secondary school. The aim of this study is to investigate the extent to which social anxiety in adolescence is associated with the completion of upper secondary school and progression to higher education. This longitudinal study includes 8,192 adolescents aged 13-19 years who participated in the Norwegian Young-HUNT 3 population-based study. Social anxiety is measured employing (1) diagnostic interview screening questions (interview) and (2) a self-reported symptom index (questionnaire). Notably, we define the cohorts based on these two methods. Using national educational data (2008-2019), we follow educational attainment among the cohorts until they turn 25 years of age. We found that adolescents who screened positive (SP) for SAD had a predicted probability of upper secondary school completion at 21 years of age that was 14% points lower than those who screened negative (SN). Further, differences remained when looking at completion rates at age 25 years. Moreover, predicted probabilities for completion were inversely associated with increasing levels of self-reported social anxiety symptoms. Similarly, the proportion of the completers of an academic program in the SP group that were enrolled in higher education by 25 years of age, were lower than for the SN group (87 vs. 92%). Social anxiety in adolescence, both self-reported symptoms and diagnostic screening, has long-term negative impact on upper secondary school completion and to some extent enrollment to higher education.

Attention Bias Modification Treatment Versus a Selective Serotonin Reuptake Inhibitor Or Waiting List Control for Social Anxiety Disorder: A Randomized Clinical Trial.

Social anxiety disorder is common and impairing. The efficacy of pharmacotherapy is moderate, highlighting the need for alternative therapies. This study compared the efficacy of gaze-contingent music reward therapy (GC-MRT), an eye-tracking-based attention bias modification treatment, with a selective serotonin reuptake inhibitor (SSRI) treatment or a waiting list control condition in reducing social anxiety disorder symptoms. Superior clinical effects of similar magnitude were expected for the active treatments relative to the control condition. Participants were 105 treatment-seeking adults with social anxiety disorder, randomly allocated to 12 weeks of GC-MRT, SSRI, or waiting list control. Mean changes in clinician-rated and self-reported social anxiety symptoms from baseline to mid- and posttreatment assessments were compared between groups using generalized estimating equations. Changes in attentional dwell time on threat were also examined. Analysis indicated a significant differential reduction in symptoms between groups. Patients in the GC-MRT and SSRI groups had lower social anxiety scores at the mid- and posttreatment assessments compared with patients in the waiting list group. The efficacy of the active treatments did not differ. Only patients in the GC-MRT group showed reduction in dwell time on threat from baseline to posttreatment assessment. Eye-tracking-based attention bias modification is an acceptable and effective treatment option for social anxiety disorder.

Does prediction error during exposure relate to clinical outcomes in cognitive behavior therapy for social anxiety disorder? A study protocol.

Facing your fears, or exposure therapy, is an effective psychological intervention for anxiety disorders that is often thought to work through fear extinction learning. Fear extinction learning is a type of associative learning where fear reduces through repeated encounters with a feared situation or stimulus in the absence of aversive outcomes. Laboratory research suggests fear extinction learning is driven by threat prediction errors, defined as when fearful predictions do not eventuate. Threat prediction error and its relationship to exposure therapy outcomes haven't been studied enough in actual therapy settings. It remains unclear whether prediction error and extinction learning are central mechanisms of exposure therapy. We are conducting a longitudinal and observational study of how threat prediction error during exposure in social anxiety disorder (SAD) treatment relates to session-by-session symptom change and treatment outcome in addition to exposure surprise and learning outcome. We aim to recruit 65 adults with a primary diagnosis of SAD through an outpatient psychology clinic. Participants will receive 12 sessions of individual manualized cognitive behavioral therapy (CBT), adapted from an efficacious group protocol, that includes graded exposure. Exposure processes, including self-report measures of anxiety, threat prediction, threat outcomes, surprise, and learning outcome, will be measured with smartphone-based event-contingent ecological momentary assessments (EMAs) of all behavioral experiments completed during treatment. Clinical outcomes include self-reported social anxiety symptoms and social threat appraisals, at each session, post and 3-months after treatment. Prediction error will be operationalized as the mismatch between the threat prediction and threat outcome. The joint effect of threat prediction and threat outcome on session-by-session symptom change, treatment outcome, exposure surprise, and learning outcome will be explored using multilevel modeling. The present study will help determine whether threat prediction error during exposures in SAD treatment is related to theoretically implied clinical outcomes. This would contribute to the larger research aim of clarifying exposure therapy mechanisms.

Elevated social anxiety symptoms across childhood and adolescence predict adult mental disorders and cannabis use

AimWe assessed the heterogeneous development of self-reported social anxiety symptoms across childhood and adolescence (ages 10 to 18; N = 701) and examined whether these groups predicted clinically derived diagnoses of social anxiety disorder (SAD), generalized anxiety disorder (GAD), depressive episodes, panic disorder (PD), agoraphobia, obsessive compulsive disorder (OCD), and substance use in adulthood (ages 19 to 22). ResultsThree distinct social anxiety symptom trajectories were found: a high increasing group (15.5%), a moderate group (37.3%), and a low group (47.2%). The high increasing and moderate trajectory groups were differentiated from the low trajectory group on the adult mental disorders examined: SAD (high OR = 15.74; moderate OR = 11.72), GAD (high OR = 13.08; moderate OR = 8.98), depressive episode (high OR = 19.75), PD (high OR = 8.43; moderate OR = 5.90), agoraphobia (high OR = 16.39; moderate OR = 9.68), and OCD (high OR = 3.49; moderate OR = 2.98). The high and moderate groups were not differentiated on SAD, GAD, PD, or OCD but were differentiated on depressive episodes (OR = 3.24). Relative to the low and moderate trajectory groups, the high increasing social anxiety symptoms trajectory group also predicted cannabis use, but not alcohol use in adulthood. Gender, ethnicity, household income, and parental education were accounted for when predicting adult outcomes. ConclusionThese results highlight the importance of early treatment of symptoms of childhood social anxiety in the prevention of mental health problems in adulthood.

School Functioning and Educational Aspirations in Adolescents With Social Anxiety-The Young-HUNT3 Study, Norway.

Social anxiety disorder (SAD) typically emerges during childhood or early adolescence and often has long-term effects on several areas of an individual's life, including school and education. The purpose of this study is to examine whether social anxiety is associated with (1) school functioning in terms of behavioral difficulties (hyperactivity and/or attention problems), school dissatisfaction, social exclusion, truancy, and learning difficulties, and (2) educational aspirations (educational level). We use data from the population-based Young-HUNT3 study (2006–2008), where 8,199 Norwegian adolescents participated. Social anxiety is measured both as self-report [the Social Phobia and Anxiety Inventory for Children (SPAI-C)], and as screening information from diagnostic interviews [Anxiety Disorder Interview Schedule for DSM IV: child version (ADIS-C)]. ADIS-C screening positives (n = 388) reported higher rates of behavioral difficulties (RR = 1.06), school dissatisfaction (RR = 1.15), social exclusion (RR = 1.24), truancy (RR = 1.05), and learning difficulties (RR = 1.10) compared to screened negatives. Self-reported social anxiety symptoms showed similar patterns. Further, higher mean scores of self-reported social anxiety symptoms and being ADIS-C screening positive were negatively associated with aspirations of higher education (OR = 0.92 and OR = 0.74, respectively). However, as regards to having aspirations for the future (aspirations of higher education and/or aspirations of vocational training), no associations were found. The results indicate that social anxiety in adolescence is related to unfavorable/poorer school functioning and lower tendency of aspirations of higher education, which may have consequences for future educational pathways and later work life.

Neurophysiological predictors of gaze-contingent music reward therapy among adults with social anxiety disorder

Social anxiety disorder (SAD) is associated with fear of negative evaluation and heightened performance monitoring. The best-established treatments help only a subset of patients, and there are no well-established predictors of treatment response. The current study investigated whether individual differences in processing errors might predict response to gaze-contingent music reward therapy (GC-MRT). At baseline, healthy control subjects (HC; n = 20) and adults with SAD (n = 29), ages 19–43 years, completed the Flanker Task while electroencephalography (EEG) data were recorded. SAD participants then received up to 12 sessions over 8 weeks of GC-MRT, designed to train participants’ attention away from threatening and toward neutral faces. Clinical assessments were completed 9- (post-treatment) and 20-weeks (follow-up) after initiating the treatment. At baseline, compared to HC, SAD performed the task more accurately and exhibited increased error-related negativity (ERN) and delta power to error commission. After controlling for age and baseline symptoms, more negative ERN and increased frontal midline theta (FMT) predicted reduced self-reported social anxiety symptoms at post-treatment, and FMT also predicted clinician-rated and self-reported symptom reduction at the follow-up assessment. Hypervigilance to error is characteristic of SAD and warrants further research as a predictor of treatment response for GC-MRT.

Sociodemographic Correlates and Mental Health Comorbidities in Adolescents With Social Anxiety: The Young-HUNT3 Study, Norway.

Social anxiety is highly prevalent in adolescents and is often associated with great individual suffering and functional impairment. Psychiatric comorbidity is common and further adds to this burden. The purposes of this study were: (1) to describe the occurrence of diagnosed and self-reported social anxiety among 8,199 Norwegian adolescents aged 13–19 years who participated in the population-based Young-HUNT3 study (2006–2008); (2) to examine associations between sociodemographic characteristics and different subgroups of social anxiety; and (3) to describe the psychiatric health comorbidities among adolescents diagnosed with social anxiety disorder (SAD). In total, 388 (5.9%) of the adolescents screened positive for SAD and were invited into a diagnostic interview, performed by professional nurses, using Anxiety Disorders Interview Schedule for DSM IV: child version (ADIS-C) (response rate = 54.6%). A SAD diagnosis was indicated in 106 individuals (50% of the interview subjects), and more than two-thirds of the adolescents diagnosed with SAD had one or more comorbid psychiatric disorders. Higher mean scores of self-reported social anxiety symptoms, poor self-rated health, sleep problems, poor family economic situation, low physical activity, and having sought professional help within the last year were associated with higher odds of being in the screening positive subgroup. Screening positive subjects who did not meet for a diagnostic interview did not differ notably from the rest of the screening positive group in terms of these sociodemographic characteristics. Based on our results and the fact that individuals with social anxiety often fear interview situations, the use of ADIS-C, screening questions and self-reports seem to be sufficient when aiming to identify epidemiologically representative cohorts of adolescents at risk of social anxiety.

Discrete electrocortical predictors of anxiety and anxiety-related treatment response in youth with autism spectrum disorder

There are two established electroencephalogram (EEG) indices that putatively relate to anxiety symptoms: a) the error-related negativity (ERN), which reflects endogenous threat sensitivity, and b) resting-state EEG relative right frontal activity (rRFA), which relates to approach/withdrawal motivation. We examined these indices conjointly to better elucidate differential mechanisms underlying the common anxiety phenotype in youth with autism spectrum disorder (ASD), in relation to subjective reports of symptomatology and treatment response. EEG was recorded from 53 youth with ASD who participated in a 10-week social skills intervention (SSI). More negative ERN related to higher self-reported social anxiety symptoms at baseline, and predicted improvements in self-reported social anxiety symptoms following SSI. Although rRFA did not relate to anxiety symptoms at baseline, more rRFA predicted improvement in parent-reported anxiety domains but worsening in self-reported anxiety symptoms. This study provides evidence for unique neural mechanisms of anxiety symptoms and changes in anxiety after SSI in youth with ASD.

Real-time social stress response and subsequent alcohol use initiation among female adolescents.

Adolescents who are particularly sensitive to social stress may be vulnerable to earlier alcohol consumption and related problems. Although a small literature supports this contention, previous studies mostly relied on retrospective self-report. The current study used discrete-time survival analysis (DTSA) to test whether real-time social stress responding (via laboratory induction) and social anxiety symptoms predicted 12-month alcohol onset in an alcohol-naïve sample of young female adolescents. Anxiety elicited by the task was expected to predict greater and earlier rates of alcohol incidence, particularly among girls with higher levels of self-reported social anxiety symptoms. Participants were 104 community-recruited girls (ages 12-15 years) who completed a modified Trier Social Stress Test and questionnaires; follow-up calls were conducted at 3, 6, 9, and 12 months after the laboratory visit. Self-reported anxiety was assessed in response to the stressor following acclimation (baseline), instruction (anticipation), and speech (posttask). By 12 months, 30.8% of the sample had consumed a full alcoholic beverage. The DTSA revealed that girls with higher levels of social anxiety and greater elevations in anticipatory (but not posttask) anxiety compared to baseline had earlier alcohol initiation. This is the first study to examine the role of both laboratory-induced anxious responding and retrospective reports of social anxiety as prospective predictors of alcohol incidence. These preliminary findings suggest that adolescent girls who are more sensitive to social stress may be at risk for experimenting with alcohol earlier than their peers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining the Relation Between Adolescent Social Anxiety and Positive Affect Regulation: Self-Report vs. Observation.

Social anxiety symptomatology is associated with disruptions in positive affect, though no study has examined deficits in responses to positive affect related to adolescent social anxiety symptoms. The present study tested whether adolescents' self-reported and observed social anxiety symptoms were uniquely associated with specific responses to positive affect. Moreover, we examined whether adolescent gender moderated these relations. Ninety adolescents (ages 11 to 18, Mage = 14.26, SD = 2.03; girls = 62%; white = 79%) completed self-report measures, participated in a social stressor task, and engaged in two positively-valenced interaction tasks with their female caregivers. Adolescent self-reported social anxiety symptoms were not uniquely associated with responses to positive affect. However, observed social anxiety symptoms were uniquely related to greater self-reported inhibiting positive affect responses and fewer observed positive affect maximizing behaviors. These findings highlight the need to examine self-reported and observed social anxiety symptoms in understanding associated disruptions in positive affect regulation.

A pilot of acceptance and commitment therapy for public speaking anxiety delivered with group videoconferencing and virtual reality exposure

Two pilot studies (N = 11; N = 15) assessed the feasibility and efficacy of a weekly 6-session ACT group videoconferencing intervention for public speaking anxiety with participants in separate physical locations. Both studies found significant improvements in self-reported social anxiety symptoms from pre-treatment to follow-up, with high levels of patient satisfaction. Results provide support for group videoconferencing as a viable format for delivering behavioral treatments including acceptance-based interventions. The second study also found significant improvements in behavioral performance and supported the feasibility and utility of videotaped virtual audiences for homework exposure exercises. No significant differences in anxiety levels were experienced during in vivo homework exposures compared to virtual homework exposures. Practically, clinicians are encouraged to pay particular attention to optimizing physiological arousal during exposures and to consider technological and ethical factors of these formats.

Statistical learning as a predictor of attention bias modification outcome: A preliminary study among socially anxious patients

Attention bias modification (ABM) is a novel therapy designed to modulate attentional biases towards threat typically observed among anxious individuals. Bias modification is allegedly achieved via extraction of a statistical regularity embedded within the treatment task. However, no prior study examined prediction of ABM therapeutic response in relation to patients' capacity to extract statistical properties from the environment, a capacity known as “statistical learning”. Here, 30 treatment-seeking patients with social anxiety disorder completed a gold-standard statistical learning task at baseline and then received six sessions of ABM therapy. Results indicate that baseline statistical learning capacity predicts treatment outcome: the better patients' statistical learning capacity, the greater their reduction in clinician-rated and self-reported social anxiety symptoms. Restricted capacities for statistical learning could account for the moderate effect sizes of ABM therapy in clinical trials. Poor response may occur in patients who fail to extract the underlying contingency embedded in ABM.

Pre-treatment CBT-Mindedness Predicts CBT Outcome

While CBT is considered efficacious for a range of mental health conditions, identifying pre-treatment predictors of differential response to CBT is an important direction for research. This study investigated whether pre-treatment attitudes aligned with cognitive behaviour therapy (CBT) (termed CBT-mindedness) predicts CBT outcome within a clinical sample of adults diagnosed with social phobia (N = 50). Pre-treatment CBT-mindedness, measured by the CBT Suitability Scale, was found to predict treatment outcome immediately and 3 months following treatment. Higher CBT-mindedness was associated with lower clinician-rated diagnostic severity and client self-reported social anxiety symptoms following CBT. CBT-mindedness predicted self-reported, but not clinician-reported severity, even when controlling for existing client-factors that predict outcome (expectancy for symptom change and treatment credibility). However, CBT-mindedness was not associated with therapy session attendance. Results suggest that pre-treatment CBT-mindedness is a promising predictor of CBT outcome. Clinical implications for this predictor of CBT response are discussed.

Randomized controlled trial of acceptance and commitment therapy versus traditional cognitive behavior therapy for social anxiety disorder: Symptomatic and behavioral outcomes

Only two trials have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) in the treatment of social anxiety disorder (SAD), with both finding no significant differences. These trials did not examine effects on observer-rated behavioral outcomes and did not explicitly quantify the dose of exposure therapy within each treatment. In a replication trial, one hundred and two individuals with SAD (per DSM-IV criteria) were randomized to 12 sessions of ACT (n = 49) or tCBT (n = 53) controlling for exposure dose and assessing behavioral outcomes. Assessments were completed at pre- and post-treatment using clinician-rated and self-report measures of social anxiety, quality of life, and overall functioning. Observer-rated behavioral measures of social performance were completed for a subsample of participants. Results indicated that participants across conditions received equivalent doses of exposure. Those who received tCBT evidenced greater improvements in self-reported social anxiety symptoms and overall functioning, which contrasts with prior studies finding no differences between tCBT and ACT in the treatment of social anxiety. Medium effect sizes, while not statistically significant, indicate that ACT participants may have had greater improvements in observer-rated social behavior than tCBT participants. The discrepancy between these symptom and behavioral outcomes, building upon prior literature, calls for more research to assess the differences between tCBT and ACT treatments in behavioral domains.

Voxel-based morphometry multi-center mega-analysis of brain structure in social anxiety disorder.

Social anxiety disorder (SAD) is a prevalent and disabling mental disorder, associated with significant psychiatric co-morbidity. Previous research on structural brain alterations associated with SAD has yielded inconsistent results concerning the direction of the changes in gray matter (GM) in various brain regions, as well as on the relationship between brain structure and SAD-symptomatology. These heterogeneous findings are possibly due to limited sample sizes. Multi-site imaging offers new opportunities to investigate SAD-related alterations in brain structure in larger samples.An international multi-center mega-analysis on the largest database of SAD structural T1-weighted 3T MRI scans to date was performed to compare GM volume of SAD-patients (n = 174) and healthy control (HC)-participants (n = 213) using voxel-based morphometry. A hypothesis-driven region of interest (ROI) approach was used, focusing on the basal ganglia, the amygdala-hippocampal complex, the prefrontal cortex, and the parietal cortex. SAD-patients had larger GM volume in the dorsal striatum when compared to HC-participants. This increase correlated positively with the severity of self-reported social anxiety symptoms. No SAD-related differences in GM volume were present in the other ROIs. Thereby, the results of this mega-analysis suggest a role for the dorsal striatum in SAD, but previously reported SAD-related changes in GM in the amygdala, hippocampus, precuneus, prefrontal cortex and parietal regions were not replicated. Our findings emphasize the importance of large sample imaging studies and the need for meta-analyses like those performed by the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Consortium.

Does attention redirection contribute to the effectiveness of attention bias modification on social anxiety?

Attention bias modification (ABM) is designed to modify threat-related attention bias and thus alleviate anxiety. The current research examined whether consistently directing attention towards targeted goals per se contributes to ABM efficacy. We randomly assigned 68 non-clinical college students with elevated social anxiety to non-valence-specific attend-to-geometrics (AGC), attention modification (AMC), or attention control (ACC) conditions. We assessed subjective, behavioral, and physiological reactivity to a speech task and self-reported social anxiety symptoms. After training, participants in the AMC exhibited an attention avoidance from threat, and those in the AGC responded more rapidly toward targeted geometrics. There was a significant pre- to post-reduction in subjective speech distress across groups, but behavioral and physiological reactivity to speech, as well as self-report social anxiety symptoms, remained unchanged. These results lead to questions concerning effectiveness of ABM training for reducing social anxiety. Further examination of the current ABM protocol is required.

Attentional control moderates the relationship between social anxiety symptoms and attentional disengagement from threatening information

Background and objectivesSocial anxiety is characterized by biased attentional processing of social information. However, heterogeneity of extant findings suggests that it may be informative to elucidate individual difference factors that modulate the processing of emotional information. The current study examined whether individual differences in components of attentional control (AC – shifting and focusing) moderated the link between social anxiety and attentional engagement and disengagement biases for threat-relevant cues. MethodsSeventy–five undergraduate students completed well-established measures of social anxiety symptoms, AC, and attentional bias for social threat information (modified probe detection task). ResultsModeration analyses revealed that at low levels of AC-shifting, increased social anxiety was associated with slower disengagement from threat-relevant compared to neutral social cues. In contrast, at high levels of AC-shifting, social anxiety was associated with faster disengagement from threat-relevant compared to neutral stimuli. Individual differences in AC-focusing did not moderate the social anxiety-attentional bias link. LimitationsCausal inferences cannot be made given the cross-sectional study design. The sample comprised individuals displaying a range of self-reported social anxiety symptoms; thus, generalizability to clinical samples remains to be established. The measurement of AC relied on subjective participant report. ConclusionsThe current findings underscore the importance of AC processes in understanding the nature of attentional bias mechanisms in anxiety.

Factors related to self-reported social anxiety symptoms among incoming university students.

The aim of this study was to explore the lifestyle/social, personality trait and mental factors among incoming university students with higher self-reported social anxiety symptoms (SAS). A total of 5126 incoming university students were recruited. The test battery included a self-administered questionnaire that examined personal lifestyle, the Measurement of Support Functions, the Chinese Internet Addiction Scale-Revision, the Organizational Citizenship Behaviour Scale, the Social Phobia Inventory, the suicide ideation from the Brief Symptoms Rating Scale and the Pittsburgh Sleep Questionnaire. SAS (23.7%) were prevalent. Using logistic regression analysis, we found that the significant predictors of higher levels of SAS were being an undergraduate student and a non-smoker, having lower Measurement of Support Functions score (poorer social support), having higher Chinese Internet Addiction Scale-Revision score (Internet addiction), having lower Organizational Citizenship Behaviour Scale score (less altruistic behaviour), having suicide ideation and having higher Pittsburgh Sleep Questionnaire score (poorer sleeper). Given the high prevalence of SAS among university students, it is necessary to build a better strategy to detect students with potential social anxiety-related problems/disorders or other mental problems early on.

Relationship of Salivary Alpha Amylase and Cortisol to Social Anxiety in Healthy Children Undergoing Laboratory Pain Tasks

Objective: Salivary alpha amylase (sAA) has been shown to be a sensitive and reliable marker of the autonomic nervous system (ANS) response to stress. A link between sAA, cortisol, and social/evaluative stress has been established in youth, but little is known about these relationships in response to other stressors in children, and how social anxiety might moderate these relationships. The current study explored the associations among sAA and salivary cortisol responses to laboratory pain tasks and self-reported social anxiety symptoms in a sample of healthy children. Method: Two hundred thirty-one children (114 girls; 49.4%) with a mean age 12.68 years (SD=3.0; range 7-18) participated in the study. Participants completed self-report questionnaires prior to undergoing a series of laboratory pain tasks involving cold, pressure, and heat pain. Saliva samples were collected upon arrival to the laboratory (pretask), following the completion of the pain tasks (post-task1), and 20 minutes after the completion of the pain tasks (post-task2). Results: Demographic factors (age, sex, pubertal stage) did not predict either sAA or cortisol levels. However, children reporting higher levels of social anxiety demonstrated significantly higher sAA but not cortisol levels across three salivary collection times, compared to children reporting lower levels of social anxiety. Further, it does not appear that reduced state levels of anxiety before or during the tasks buffer this relationship. Conclusion: These data highlight the possibility of identifying biomarkers of stress that are consistent across time and developmental stage. sAA appears to be a marker of stress response in children with self-reported social anxiety. There may also be a potentially unique relationship of sAA to stress in this population. In addition, sAA may reflect stable individual differences in levels of ANS arousal and may be a useful biomarker for identifying children at risk for stress.

Relationship of Salivary Alpha Amylase and Cortisol to Social Anxiety in Healthy Children Undergoing Laboratory Pain Tasks.

ObjectiveSalivary alpha amylase (sAA) has been shown to be a sensitive and reliable marker of the autonomic nervous system (ANS) response to stress. A link between sAA, cortisol, and social/evaluative stress has been established in youth, but little is known about these relationships in response to other stressors in children, and how social anxiety might moderate these relationships. The current study explored the associations among sAA and salivary cortisol responses to laboratory pain tasks and self-reported social anxiety symptoms in a sample of healthy children.MethodTwo hundred thirty-one children (114 girls; 49.4%) with a mean age 12.68 years (SD=3.0; range 7–18) participated in the study. Participants completed self-report questionnaires prior to undergoing a series of laboratory pain tasks involving cold, pressure, and heat pain. Saliva samples were collected upon arrival to the laboratory (pre-task), following the completion of the pain tasks (post-task1), and 20 minutes after the completion of the pain tasks (post-task2).ResultsDemographic factors (age, sex, pubertal stage) did not predict either sAA or cortisol levels. However, children reporting higher levels of social anxiety demonstrated significantly higher sAA but not cortisol levels across three salivary collection times, compared to children reporting lower levels of social anxiety. Further, it does not appear that reduced state levels of anxiety before or during the tasks buffer this relationship.ConclusionThese data highlight the possibility of identifying biomarkers of stress that are consistent across time and developmental stage. sAA appears to be a marker of stress response in children with self-reported social anxiety. There may also be a potentially unique relationship of sAA to stress in this population. In addition, sAA may reflect stable individual differences in levels of ANS arousal and may be a useful biomarker for identifying children at risk for stress.