Adolescent Social Anxiety Research Articles

A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder.

The Program for the Evaluation of the Enrichment of Relational Skills (PEERS), a social skills intervention for high functioning adolescents with autism spectrum disorder (ASD), has been proven efficacious in randomized control trials. However, the effectiveness of the PEERS program in community settings has not been studied. The present small-scale pilot study examined the effectiveness of the PEERS program in a community setting. Five adolescents and their caregivers participated in the PEERS intervention. Results indicated that the adolescents showed significant improvement in their social engagement, social cognition, social communication, social motivation, and knowledge of PEERS skills and concepts from pre- to post-intervention. Furthermore, adolescents showed significant reductions in their internalizing and autistic symptoms from pre- to post-intervention. The findings from this small-scale pilot study support the effectiveness of the PEERS program in community-based settings.

Multi-Informant Assessments of Adolescent Social Anxiety: Adding Clarity by Leveraging Reports from Unfamiliar Peer Confederates

Adolescent social anxiety (SA) assessments often include adolescent and parent reports, and low reporting correspondence results in uncertainties in clinical decision-making. Adolescents display SA within non-home contexts such as peer interactions. Yet, current methods for collecting peer reports raise confidentiality concerns, though adolescent SA assessments nonetheless would benefit from context-specific reports relevant to adolescent SA (i.e., interactions with unfamiliar peers). In a sample of 89 adolescents (30 Evaluation-Seeking; 59 Community Control), we collected SA reports from adolescents and their parents, and SA reports from unfamiliar peer confederates who interacted with adolescents during 20-minute mock social interactions. Adolescents and parents completed reports on trait measures of adolescent SA and related concerns (e.g., depressive symptoms), and adolescents completed self-reports of state arousal within mock social interactions. Adolescents’ SA reports correlated with reports on parallel measures from parents in the .30s and with peer confederates in the .40s to .50s, whereas reports from parent-confederate dyads correlated in the .07 to .22 range. Adolescent, parent, and peer confederate SA reports related to reports on trait measures of adolescent SA and depressive symptoms, and distinguished Evaluation-Seeking from Community Control Adolescents. Confederates’ SA reports incrementally predicted adolescents’ self-reported SA over and above parent reports, and vice versa, with combined Rs ranging from .51 to .60. These combined Rs approximate typical correspondence levels between informants who observe adolescents in the same context (e.g., mother-father). Adolescent and peer confederate (but not parent) SA reports predicted adolescents’ state arousal in social interactions. These findings have implications for clarifying patterns of reporting correspondence in clinical assessments of adolescent SA.

A Multi-Informant Approach to Measuring Depressive Symptoms in Clinical Assessments of Adolescent Social Anxiety Using the Beck Depression Inventory-II: Convergent, Incremental, and Criterion-Related Validity

Among adolescents, depressive symptoms commonly co-occur with social anxiety, with social anxiety often developmentally preceding depressive symptoms. Thus, evidence-based assessments of adolescent social anxiety should be augmented with assessments of depressive symptoms using measures that can be administered across developmental transitions (e.g., adolescence into adulthood). The widely used self-report measure, Beck Depression Inventory-II (BDI-II), was designed to assess depressive symptoms among adolescents and adults. Yet, scarce work exists on the psychometric properties of BDI-II self-reports among adolescents, and we know of no prior study that tested the properties of BDI-II parent reports. We examined the BDI-II within a mixed clinical/community sample of 89 adolescents and their parents, who each provided BDI-II reports about the adolescent. Further, adolescents completed self-reports and parents provided reports of adolescents on measures of adolescent trait social anxiety and other associated features of adolescent depressive symptoms (e.g., parent–adolescent conflict; attention-deficit/hyperactivity disorder symptoms). Adolescents self-reported their state arousal within a 20-min mock social interaction period. Parent–adolescent dyads displayed low-to-moderate correspondence between their BDI-II reports. Further, adolescents’ and parents’ BDI-II reports related to measures of associated features of adolescent depressive symptoms, and established cut scores on the BDI-II significantly distinguished adolescents on these same features. Adolescents’ BDI-II reports predicted adolescents’ self-reported arousal within social interactions and distinguished adolescents on referral status. Adolescents and parents can provide psychometrically sound reports on the BDI-II. These findings have important implications for evidence-based assessments of adolescent depressive symptoms, when clinically assessing adolescent social anxiety.

Social anxiety and interpretation bias: examining clinical and subclinical components in adolescents.

This study aimed to examine whether different components of interpretation bias are clinical or dimensional features of adolescent social anxiety. The study analyzed the components of this bias at a subclinical level of Social Anxiety Disorder (SAD) and compared these with a clinical sample of adolescents with SAD. Adolescents in the age range 13-17years participated. A group with SAD (n=30) was compared with a group with subclinical SAD (n=60), and a non-socially anxious group (n=95). Negative interpretation bias for social situations was found to be a dimensional aspect of social anxiety. In contrast, belief in negative interpretations of social situations appears to be a clinical feature. Contrary to expectations, endorsement of positive interpretations did not differ between the three groups. The results suggest that a screening instrument based on negative interpretations of social situations could be useful to detect adolescents at-risk of developing SAD. In a clinical setting, the belief in negative interpretations and the presence of the bias in nonsocial situations should also be considered.

Interaction between oxytocin gene variants and perceived parenting in relation to social anxiety in adolescents: Evidence for differential susceptibility effects

IntroductionAdolescence is a period of increasing demands in independent social functioning where parenting style may have an impact on social anxiety. A context-dependent effect of oxytocin on human social behavior has been suggested, however research on the gene coding for oxytocin (OXT) has mostly been reported without considering contextual factors.AimThis study investigated interactions between parenting style and polymorphic variations in the OXT gene in association with social anxiety symptoms in a community sample of adolescents.MethodsThe study group consisted of 1359 adolescents. Two single nucleotide polymorphisms located near OXT, rs4813625 and rs2770378, were genotyped. Social anxiety and perceived parenting style were assessed by behavioral questionnaires.ResultsSignificant joint effects in line with the differential susceptibility framework were observed for rs4813625 with parenting style. The levels of social anxiety among C allele carriers were conditional on the level of supportive parenting style whereas homozygote G carriers’ levels of social anxiety were unaffected by supportive parenting style. The nature of the interactions between rs2770378 and parenting style was in line with the diatheses-stress model. However, associations of rs2770378 and parenting style with social anxiety became nonsignificant in nonlinear models.ConclusionsThe study provides preliminary evidence for a modifying effect of supportive parenting style on the relationship between rs4813625 and social anxiety symptoms in adolescents, independent of sex. The findings may be interpreted from the perspective of the social salience hypotheses of oxytocin, with rs4813625 affecting social anxiety levels along a perceived unsafe–safe social context dimension.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Social anxiety as a basic factor shaping anti-vital and suicidal behaviour among contemporary adolescents

IntroductionIn adolescence, social anxiety (SA) and anti-vital and suicidal behavior (AB and SB) constitute a single syndrome.AimThe aim is to define the role of SA and its components in shaping adolescent AB, with a subsequent risk of SB.Materials and methodsA total of 981 adolescents participated in the survey. The authors’ proprietary Anti-vitality and Resilience Questionnaire and Social Anxiety and Social Phobia Questionnaire; statistic methods: ANOVA, Correlation analysis.Results and discussionTwenty-four percent from the sample have high SA levels, and 21.8% have clinical SA levels connected with high risk of AB and SB. Adolescents find themselves in unstable conditions of the psychological field reorganization (crisis), and they are in need of actualization of means to satisfy their social motives. It makes them vulnerable to mental disorganization under evaluation conditions, and the situation is aggravated with the absence of internalized mental regulation tools. AB, SB is higher, the higher the SA in adolescents is. SA as a subjective perception of insufficient means to influence the surroundings in order to satisfy social needs can play one of the key roles in the accumulation of negative affect in the system of mental activity, and lead ultimately to its failure.ConclusionInability to satisfy their actual motives, lack of strategy for self-realization and dealing with failures, and inability to keep the targeted priority in evaluation situations lead to feeling loss of life purpose and negative evaluation of the future and shape AB, SB.Disclosure of interestThe research was supported by Russian Science Foundation (Altai State University).

Graphical representations of adolescents' psychophysiological reactivity to social stressor tasks: Reliability and validity of the Chernoff Face approach and person-centered profiles for clinical use.

Low-cost methods exist for measuring physiology when clinically assessing adolescent social anxiety. Two barriers to widespread use involve lack of (a) physiological expertise among mental health professionals, and (b) techniques for modeling individual-level physiological profiles. We require a "bridge approach" for interpreting physiology that does not require users to have a physiological background to make judgments, and is amenable to developing individual-level physiological profiles. One method-Chernoff Faces-involves graphically representing data using human facial features (eyes, nose, mouth, face shape), thus capitalizing on humans' abilities to detect even subtle variations among facial features. We examined 327 adolescents from the Tracking Adolescents' Individual Lives Survey (TRAILS) study who completed baseline social anxiety self-reports and physiological assessments within the social scenarios of the Groningen Social Stressor Task (GSST). Using heart rate (HR) norms and Chernoff Faces, 2 naïve coders made judgments about graphically represented HR data and HR norms. For each adolescent, coders made 4 judgments about the features of 2 Chernoff Faces: (a) HR within the GSST and (b) aged-matched HR norms. Coders' judgments reliably and accurately identified elevated HR relative to norms. Using latent class analyses, we identified 3 profiles of Chernoff Face judgments: (a) consistently below HR norms across scenarios (n = 193); (b) above HR norms mainly when speech making (n = 35); or (c) consistently above HR norms across scenarios (n = 99). Chernoff Face judgments displayed validity evidence in relation to self-reported social anxiety and resting HR variability. This study has important implications for implementing physiology within adolescent social anxiety assessments. (PsycINFO Database Record

The role of stress reactivity in the long-term persistence of adolescent social anxiety symptoms

Social Anxiety Disorder (SAD) symptoms demonstrate a marked persistence over time, but little is known empirically about short-term processes that may account for this long-term persistence. In this study, we examined how self-reported and physiological stress reactivity were associated with persistence of SAD symptoms from early to late adolescence. A community sample of 327 adolescents (56% boys, Mage=13.01 at T1) reported their SAD symptoms for 6 successive years and participated in a public speaking task, during which self-reported (i.e., perceived nervousness and heart rate) and physiological (i.e., cortisol and heart rate) measures of stress were taken. Overall, our results point to a developmental process in which adolescents with a developmental history of higher SAD symptoms show both heightened perceived stress reactivity and heart rate reactivity, which, in turn, predict higher SAD symptoms into late adolescence.

Social Anxiety Scale for Adolescents (SAS-A) Short Form: Longitudinal Measurement Invariance in Two Community Samples of Youth.

In this study, we examined the longitudinal measurement invariance of a 12-item short version of the Social Anxiety Scale for Adolescents (SAS-A) in two 4-year longitudinal community samples ( Nsample 1 = 815, Mage T1 = 13.38 years; Nsample 2 = 551, Mage T1 = 14.82 years). Using confirmatory factor analyses, we found strict longitudinal measurement invariance for the three-factor structure of the SAS-A across adolescence, across samples, and across gender. Some developmental changes in social anxiety were found from early to mid-adolescence, as well as gender differences across adolescence. These findings suggest that the short version of the SAS-A is a developmentally appropriate instrument that can be used effectively to examine adolescent social anxiety development.

Examining the relation between adolescent social anxiety, adolescent delinquency (abstention), and emerging adulthood relationship quality

ABSTRACTBackground and Objectives: Social anxiety symptoms and delinquency are two prevalent manifestations of problem behavior during adolescence and both are related to negative interpersonal relationships in adolescence and emerging adulthood. This study examined the relation between social anxiety and delinquency in adolescence and the interplay between adolescent social anxiety and delinquency on perceived relationship quality in emerging adulthood. Design and Methods: In a 10-year long prospective study (T1, n = 923; T2, n = 727; Mage T1 = 12; 49% female), we examined competing hypotheses using regression analyses: the protective perspective, which suggests social anxiety protects against delinquency; and the co-occurring perspective, which suggests social anxiety and delinquency co-occur leading to increased negative interpersonal outcomes. Results: In adolescence, the relation between social anxiety and delinquency was consistent with the protective perspective. In emerging adulthood, consistent with the co-occurring perspective, ever-delinquents (but not delinquency abstainers) with higher social anxiety reported less perceived best friend, mother, and father support compared to delinquents with lower social anxiety. There was no interaction between anxiety and delinquency in predicting perceived conflict. Conclusion: This study highlights the importance of examining the relation between social anxiety and delinquency with regards to different interpersonal outcomes.

Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety: Two-year follow-up of a randomized controlled trial

Background and ObjectivesThis two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. MethodsIn this RCT, moderately socially anxious adolescents (N=240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design. ResultsPrimary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire. LimitationsThere was a substantial (50%) though seemingly non-selective attrition at follow-up. ConclusionsThis RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years.

Young people with higher social anxiety are less likely to adopt the perspective of another: Data from the Director task

Background and objectivesYoung people with social anxiety display poor social functioning but it is unclear whether this is underscored by difficulties in key social cognitive abilities, such as perspective taking. Here, we examined whether increased social anxiety is associated with reduced accuracy on a perspective taking task and whether this relationship is stronger at particular periods within adolescence. MethodsFifty-nine adolescents aged 11–19 years completed the computerised Director Task (DT) and the Social Anxiety Scale for Adolescence. In the DT, participants virtually move objects by following either instructions given by the ‘Director’ (who can see only some objects), or a simple rule to ignore certain objects. ResultsParticipants who scored above the clinical cut-off for social anxiety (n = 17) were less accurate when they had to take the perspective of the Director into account than those scoring below cut-off, yet performed similarly on control trials. Preliminary analysis indicated that poorer performance was most strongly associated with social anxiety in mid-adolescence (14–16.5 years). LimitationsThe DT has been used previously to measure online perspective taking but the underlying cognitive mechanisms have not been fully elucidated. Extending these findings using additional measures of perspective taking would be valuable. ConclusionsAdolescents with higher social anxiety were less accurate at taking the perspective of a computerised character, with some suggestion that this relationship is strongest during mid-adolescence. If replicated, these findings highlight the importance of addressing specific social cognitive abilities in the assessment and treatment of adolescent social anxiety.

Adolescent Social Anxiety and Substance Use: The Role of Susceptibility to Peer Pressure

The aim of this study was to further our understanding of the link between social anxiety and substance use in adolescents, in particular the role susceptibility to peer pressure plays in this link. The relation between social anxiety and susceptibility to peer pressure was studied in two community samples (n=534 and n=117) each consisting of two age groups (12-13 and 15–17 years). The relation of these two variables with substance use was evaluated in the second sample using regression analysis. Social anxiety was related to susceptibility to peer pressure in both groups and not related to substance use in the younger group and negatively related to substance use in the older group. Susceptibility to peer pressure acted as a suppressor in the relation between social anxiety and substance use. Results suggest that socially anxious adolescents basically avoid substance use but, if susceptible, may yield to peer pressure and start using substances. Parents, teachers, and therapists should be aware of this susceptibility to possibly negative peer pressure of socially anxious adolescents.

Feasibility of Virtual Reality Environments for Adolescent Social Anxiety Disorder

Purpose: This study assessed the feasibility of virtual reality (VR) exposure as an assessment and treatment modality for youth with social anxiety disorder (SAD). Methods: Forty-one adolescents, 20 of which were identified as having SAD, were recruited from a community sample. Youth with and without SAD were exposed to two social virtual environments—party and public speaking—and two neutral virtual environments. Results: All youth reported significantly higher ratings on the Subjective Units of Distress Scale (SUDS) during the party and public speaking scenarios compared to the two neutral environments, while youth with SAD reported significantly higher SUDS in the public speaking and party environments than those without SAD. Youth also demonstrated acceptable levels of presence and immersion in the VR environments. Discussion: VR exposure treatment appears to be feasible for youth with SAD, highlighting the need for further research on its development.

Do Parents and Overweight, Treatment-Seeking Youth Provide Similar Ratings of Youths' Psychosocial Functioning and Fatigue?

Patterns of agreement between parent and child ratings of psychosocial functioning and fatigue in children with obesity were examined. Analyses demonstrated moderate agreement for social anxiety in elementary children and small agreement for social anxiety in adolescents. Results of analyses of overall quality of life revealed small agreement in children under the age of 8, large agreement in children ages 8-12, and moderate agreement in adolescents ages 13-18. Overall ratings of fatigue demonstrated moderate agreement both in elementary children and in adolescents. A meaningful relationship was found between each factor measured by a parent and a child. Patterns which were unexpected given the existing literature were found; possible hypotheses explaining these patterns are presented; and the need for further research is highlighted.

Preventing Adolescent Social Anxiety and Depression and Reducing Peer Victimization: Intervention Development and Open Trial.

Social anxiety disorder (SAD) and depression are common among adolescents, frequently comorbid, and resistant to change. Prevention programs for adolescent SAD are scant, and depression prevention programs do not fully address peer-risk factors. One critical peer-risk factor for SAD and depression is peer victimization. We describe the development and initial evaluation of a transdiagnostic school-based preventive intervention for adolescents with elevated symptoms of social anxiety and/or depression and elevated peer victimization. We modified Interpersonal Psychotherapy-Adolescent Skills Training for depression, incorporating strategies for dealing with social anxiety and peer victimization. Our open trial assessed the feasibility, acceptability, and preliminary benefit of the modified program (called UTalk) for adolescents at risk for SAD or depression and who also reported peer victimization. Adolescents (N=14; 13-18 years; 79% girls; 86% Hispanic) were recruited and completed measures of peer victimization, social anxiety, and depression both pre- and post-intervention and provided ratings of treatment satisfaction. Independent evaluators (IEs) rated youths' clinical severity. The intervention (3 individual and 10 group sessions) was conducted weekly during school. Regarding feasibility, 86% of the adolescents completed the intervention (M attendance=11.58 sessions). Satisfaction ratings were uniformly positive. Intention-to-treat analyses revealed significant declines in adolescent- and IE-rated social anxiety and depression and in reports of peer victimization. Additional secondary benefits were observed. Although further evaluation is needed, the UTalk intervention appears feasible to administer in schools, with high satisfaction and preliminary benefit. Implications for research on the prevention of adolescent SAD and depression are discussed.

The effects of social anxiety on alcohol and cigarette use across adolescence: Results from a longitudinal twin study in Finland.

Conflicting reports exist on the direction of the relationship between social anxiety (SA) and alcohol/cigarette use (AU/CU) and alcohol/nicotine dependence (AD/ND), with both positive and negative associations reported. A prospective, longitudinal sample of Finnish twins (n = 1,906) was used to test potential explanations for these discrepancies. Specifically, this study used peer, parent, and teacher ratings of SA, and a clinical interview screening item for social anxiety disorder (SAD-Sc) to examine associations between SA and AU/CU and AD/ND from early adolescence into young adulthood. Peer-rated SA was negatively associated with AU, CU, and AD from age 14 through age 22, implying a protective effect (β = -0.01 to -.03). Teacher- and parent-rated SA associations were in the same directions but weaker or nonsignificant, indicating that aspects of SA that are recognizable by peers may be most relevant to AU/CU. Self-reported SAD-Sc was also negatively associated with AU, but positively associated with AD symptoms in young adulthood (β = 0.38). Our findings partially support the existence of different associations between SA and AU versus AD, but only in the context of SAD-Sc rather than trait SA. Neither trait SA nor SAD-Sc significantly predicted ND symptoms, although SAD-Sc was associated with both cigarette abstinence and daily smoking. These findings suggest that adolescent SA is modestly associated with lower AU/CU, although there may be some individuals with more severe SA who develop alcohol problems later in life. There was little evidence of a common underlying liability contributing to both SA and alcohol/cigarette use. (PsycINFO Database Record

Association of Youth and Caregiver Anxiety and Asthma Care Among Urban Young Adolescents

ObjectiveTo examine the association of adolescent asthma-related anxiety, social anxiety, separation anxiety, and caregiver asthma-related anxiety with asthma care by urban adolescents. MethodsParticipants were 386 ethnic minority adolescents (mean age 12.8 years) with persistent asthma and their caregivers. Adolescents reported what they do to prevent asthma symptoms and to manage acute symptoms, and if they or their caregiver is responsible for their asthma care. Adolescents completed the Youth Asthma-Related Anxiety Scale, and the social and separation anxiety subscales of the Screen for Child Anxiety and Emotional Disorders (SCARED); caregivers completed the Parent Asthma-Related Anxiety Scale. Linearity of the associations was assessed by generalized additive models. When there was no evidence for nonlinearity, linear mixed effects models were used to evaluate the effects of the predictors. ResultsAdolescent asthma-related anxiety had a strong curvilinear relationship with symptom prevention (P < .001). Adolescents took more prevention steps as their anxiety increased, with a plateau at moderate anxiety. There was a linear relationship of adolescent asthma-related anxiety to symptom management (β = 0.03, P = .021) and to asthma responsibility (β = 0.11, P = .015), and of caregiver asthma-related anxiety to adolescent symptom prevention (β = 0.04, P = .001). Adolescent social and separation anxiety had weak to no relationship with asthma care. Results remained consistent when controlling for each of the other anxieties. ConclusionsAsthma-related anxiety plays an important, independent role in asthma care. When low, adolescents may benefit from increased support from caregivers and awareness of the consequences of uncontrolled asthma. When elevated, health providers should ensure the adolescents are not assuming responsibility for asthma care prematurely.

The focus of intervention for adolescent social anxiety: Communication skills or self-esteem

Social skills training is a long-standing intervention for adolescents with social anxiety, while self-esteem is often ignored. However, there is little evidence suggesting that those with social anxiety require social skills training or interventions associated with self-esteem. The aim of the research was to investigate whether social skills and self-esteem varied between three groups of adolescents (mean age = 14.53; SD = 1.60). Clustering the social anxiety scores resulted in a comparison group and two groups above the social anxiety cutoff: a socially anxious/shy (SA/Shy) group and an elevated social anxiety group. It was expected that there would be lower social skills and self-esteem scores associated with the socially anxious group, compared with other groups. The results were as anticipated for total and components of self-esteem (except home self-esteem). Contrary to expectations, between-group differences for social skills factors were not found. Results are interpreted in reference to appropriate interventions to assist socially anxious adolescents. Cutoffs for defining clinical status are also discussed. The conclusion is that interventions to deal with social anxiety and shyness should include a strong focus on self-esteem issues and less on social skills.

The Social Anxiety Scale for Adolescents: Measurement Invariance and Psychometric Properties Among a School Sample of Portuguese Youths.

Over the last decades there has been an increased interest in assessing social anxiety in adolescents. This study aims to validate the Social Anxiety Scale for Adolescents (SAS-A) to Portuguese youth, and to examine its invariance across gender as well as its psychometric properties. The participants were 782 Portuguese youths (371 males, 411 females), with an average age of 15.87years (SD=1.72). The results support the original three-factor structure of the SAS-A, with measurement invariance being found across gender, with females scoring higher than males on two subscales. High levels of internal consistency were found. Positive associations with empathy demonstrated that high socially anxious adolescents have elevated empathy tendencies. Mostly null or low negative associations were found with measures of psychopathic traits, callous-unemotional traits and aggression. Study findings provide evidence that the SAS-A is a psychometrically sound instrument that shows measurement invariance between genders, good reliability and positive correlations with empathy.