Social Phobia In Adolescents Research Articles

Potential Risk Factors and Early Experiences to the Development of Social Phobia in Adolescents

This paper explores potential risk factors and underlying experiences associated with the development of social phobia in adolescents, emphasizing the importance of early intervention and treatment. Factors investigated include gender roles, cultural influences, socioeconomic status, parental psychopathology, alcohol use, early memories, and family environment. Gender differences reveal higher rates of social phobia among females, while collectivist cultures and adverse childhood experiences significantly contribute to its prevalence. Dysfunctional family environments are associated with an increased risk and higher persistence of social phobia, particularly due to their influence on childhood experiences. Alcohol use may exacerbate symptoms and lead to higher persistence due to its link to alcohol dependence. Parental psychopathology demonstrates a higher prevalence and co-occurrence with other comorbidities across all ages. Low socioeconomic status and popularity serve as additional risk factors. The paper critiques understudied aspects of these factors and suggests future research directions to enhance understanding and inform effective prevention strategies.

At Eighteen: A Screenplay Dealing with Social Phobia in Adolescence

Feeling nervous before performing in front of many people or worried in a new place is normal. However, if it significantly affects our daily lives, this might be a sign of fear of being judged or evaluated by people around us. This creative work, At Eighteen, intends to raise awareness of social phobia in adolescence by discussing the cause, effects, and a way to recover. All of these are based on theories by Rapee and Heimberg’s cognitive-behavioral model and Stallard’s cognitive behavioral therapy (CBT). The work is a screenplay about a high school writing champion, Elizabeth, who dreamed of attending college. Her journey was not easy as she moved to her mother’s hometown, transferred to public school, and failed to fulfill her own and her surroundings expectations with her writing skills. After seeing her avoiding people many times, Elizabeth was diagnosed with social phobia because she was afraid of getting negative evaluations. She recovered after attending several therapy sessions that helped change her dysfunctional thoughts to positive ones. This work falls under the drama genre to show Elizabeth’s personal life story and process of overcoming obstacles.

Childhood multi-trajectories of shyness, anxiety and depression: Associations with adolescent internalizing problems

This study tested the specificity of associations between childhood multi-trajectories of shyness, anxiety and depression symptoms and adolescent social phobia, generalized anxiety disorder (GAD) and depression, as well as functional impairment. A population sample of 1596 singletons was followed over 15 years. Mothers rated child shyness, anxiety and depression between 1½ and 8 years-old. Adolescents self-reported symptoms of social phobia, GAD and depression at 15 years-old. Multi-trajectories of childhood internalizing symptoms showed developmental heterogeneity. Controlling for perinatal risk factors, low anxiety and depression in childhood were associated with lower GAD, depression and impairment in adolescence. Higher childhood shyness was associated with adolescent social phobia. Higher shyness in girls was a protective factor for GAD, depression and impairment due to depression, while low shyness in boys was linked to higher risk for GAD and impairment due to depression. Our results underline the importance of distinguishing between shyness and different internalizing symptoms.

Associations between adolescent social phobia, sickness absence and unemployment: a prospective study of twins in Sweden.

Little is known about adolescent mental health problems, including social phobia, as risk factors for future work incapacity. The aim of this study was to investigate the association between social phobia in adolescence and unemployment and sickness absence (SA) in early adulthood, also evaluating the role of familial factors (genetics and shared environment). A sample of 2845 Swedish twins born in 1985-86 in Sweden was followed longitudinally in the population-based and prospective Twin study of CHild and Adolescent Development. Information on twins' social phobia was collected at ages 13-4, 16-7 and 19-20 years. Logistic regression providing odds ratios (OR) with 95% confidence intervals (95% CI) was used to analyze the associations between social phobia, unemployment and SA during the follow-up 2006-12. The influence of familial factors was evaluated by conditional logistic regression. Presence of social phobia during adolescence was associated with increased odds for unemployment and SA in young adulthood. For unemployment, the highest OR was at the age of 13-4 years (1.58 [95% CI: 1.22-2.06]), and the associations became null after adjusting for familial factors. For SA, the highest OR was at the age of 19-20 years (1.73 [95% CI: 1.13-2.65]), and the estimates changed slightly after adjusting for familial factors. : Results suggest that social phobia experienced in adolescence contribute to early adulthood unemployment and SA. Familial factors seemed to explain the association between social phobia and unemployment.

Social phobia in adolescence, sickness absence and unemployment: a prospective twin study

Social phobia in adolescence, sickness absence and unemployment: a prospective twin study

Examination of the Correlation Between Internet Addiction and Social Phobia in Adolescents.

This was a descriptive and cross-sectional study conducted with adolescents to examine the correlation between Internet addiction and social phobia. The population of the study consisted of 24,260 students aged between 11 and 15 years. Sampling method was used from population with known number, and 1,450 students were calculated as sample of the study. In this study, 13.7% of the adolescents had an Internet addiction, and 4.2% spent more than 5 hr on the computer every day. There was a positive correlation between Internet addiction and social phobia. The form of time spent on Internet was examined in terms of addiction and social phobia; although Internet addiction was related to games, dating sites, and web surfing, social phobia was related to homework, games, and web surfing. It was hypothesized that adolescents with social phobia were Internet addicts, and the participants used the Internet to spend time rather than socialize.

Social Phobia and Educational and Interpersonal Impairments in Adolescence: A Prospective Study.

We examined longitudinal associations between social phobia (SP) and educational and interpersonal impairments among Finnish adolescents. Participants were 3278 adolescents (9th grade; M age=15.5 years) who completed measures of SP and depressive symptoms; 2070 participated in follow-up two years later. Indicators for educational and interpersonal functioning were assessed for each sex separately. Multivariate analyses, controlling for depression and relevant socioeconomic covariates, indicated that for boys, age 15 SP predicted slow academic progression, being without a close friend or not having a romantic relationship, and poor support from friends and significant others at age 17. However, for girls, age 15 SP only predicted not having been involved in a romantic relationship by age 17. In conclusion, we found striking sex differences for adolescent SP as a predictor for subsequent educational and interpersonal impairments in late adolescence. SP may have a more devastating effect on boys' social and academic functioning relative to that of girls.

Homicidal/violent thoughts, suicidal ideation and violent behavior in adolescents with social phobia in Metropolitan Lima, Perú.

Social phobia and violent behavior are both important mental health problems among adolescent populations in different parts of the world. This study attempts to evaluate possible connections between social phobia, homicidal/violent thoughts, suicidal ideation, and subsequent violent behavior among adolescents living in the metropolitan area of Lima, Perú. A sample of 991 adolescents, part of the 2002 Epidemiological Study in Metropolitan Lima, conducted by the National Institute of Mental Health "Honorio Delgado-Hideyo Noguchi" (INSM "HD-HN") was studied. Social phobia was diagnosed on the basis of clinical assessment and the use of MINI, and suicidal ideation, homicidal/violent thoughts, and violent behavior were identified through the Mental Health Questionnaire. Odds ratio (OR) statistical analyses adjusted by logistic regression controlling for age and gender were performed. Variables associated with social phobia were homicidal thoughts in the last month (OR: 5.19, confidence interval [CI] at 95% 4.95-5.40), an impulse to hit known (OR: 1.56; 95% CI, 1.53-1.59) and unknown (OR: 3.98, 95% CI,3.89-4.07) persons, the wish to take revenge for a past offense (OR: 2.60, 95% CI 2.54-2.64), getting involved in fights with different kinds of weapons (OR: 1,78, 95% CI 1.70-1.87), suicidal ideation throughout lifetime (OR: 4.74, 95% CI 4.65-4.83), and life prevalence of suicidal attempt (OR: 5.39, 95% CI 5.23-5.55). Social phobia in adolescents of this Peruvian sample seems to be closely associated with both homicidal/violent thoughts, violent behavior, and suicidal ideation.

Visual search attentional bias modification reduced social phobia in adolescents

Background and objectivesAn attentional bias for negative information plays an important role in the development and maintenance of (social) anxiety and depression, which are highly prevalent in adolescence. Attention Bias Modification (ABM) might be an interesting tool in the prevention of emotional disorders. The current study investigated whether visual search ABM might affect attentional bias and emotional functioning in adolescents. MethodsA visual search task was used as a training paradigm; participants (n = 16 adolescents, aged 13–16) had to repeatedly identify the only smiling face in a 4 × 4 matrix of negative emotional faces, while participants in the control condition (n = 16) were randomly allocated to one of three placebo training versions. An assessment version of the task was developed to directly test whether attentional bias changed due to the training. Self-reported anxiety and depressive symptoms and self-esteem were measured pre- and post-training. ResultsAfter two sessions of training, the ABM group showed a significant decrease in attentional bias for negative information and self-reported social phobia, while the control group did not. There were no effects of training on depressive mood or self-esteem. LimitationsNo correlation between attentional bias and social phobia was found, which raises questions about the validity of the attentional bias assessment task. Also, the small sample size precludes strong conclusions. ConclusionsVisual search ABM might be beneficial in changing attentional bias and social phobia in adolescents, but further research with larger sample sizes and longer follow-up is needed.

A Randomized Controlled Trial of Individual Cognitive Therapy, Group Cognitive Behaviour Therapy and Attentional Placebo for Adolescent Social Phobia

Background: Very few studies have investigated the effects of individual disorder-specific treatment of social phobia (SP) in adolescents. The objective of this study was to compare the effects of individual cognitive therapy for SP, group cognitive behavioural therapy (CBTG) and attentional placebo (AP) among adolescents with a primary diagnosis of SP. Methods: A randomized controlled design was used, and a total of 279 adolescents were assessed. Fifty-seven adolescents, between 13 and 16 years old, were allocated to individual cognitive therapy, CBTG or AP. The participants were assessed before treatment, at the end of treatment and at a 12-month follow-up using both self-report and a semi-structured interview. Results: The individual cognitive therapy showed significant reductions in symptoms, impairment and diagnostic criteria both at the end of treatment and at the 12-month follow-up. Compared with CBTG and AP, the individual cognitive therapy group demonstrated significantly greater effects on both symptom reduction and impairment. There were no significant differences between CBTG and AP. Conclusions: In a direct comparison between the most commonly used treatments for adolescent SP, we found that individual therapy was the most effective, yielding better effects than both CBTG and AP.

Evidence Based Clinical Assessment of Child and Adolescent Social Phobia: A Critical Review of Rating Scales

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).

Characterizing the association between parenting and adolescent social phobia

ObjectivesFor characterizing the association between parenting and offspring social phobia (SP), contrasting maternal vs. paternal contributions, putative predictors of unfavorable parenting behaviors and its specificity for SP are warranted to delineate targeted prevention and intervention strategies. MethodsA population-based sample of 1053 adolescents was followed-up using the M-CIDI. Parenting was assessed via questionnaire in offspring passing the high risk period for SP-onset. Natal complications and childhood serious health problems as assessed by maternal reports were hypothesized to relate to unfavorable parenting. ResultsThe pattern of maternal overprotection, paternal rejection and lower emotional warmth was associated with SP, but not with other offspring anxiety disorders. Natal complications were related to overprotection and lower emotional warmth; trend-level associations emerged for serious health problems and unfavorable parenting. ConclusionsPaternal behavior appears particularly relevant for SP. The pattern of maternal overprotection, paternal rejection and lower emotional warmth was observed in SP only, suggesting that its detailed assessment provides a promising opportunity for targeted prevention and intervention in SP.

Striatal Functional Alteration During Incentive Anticipation in Pediatric Anxiety Disorders

Behavioral inhibition is an early childhood temperament recently associated with altered striatal response in adolescence to incentives of increasing magnitudes. Since early childhood behavioral inhibition is also associated with risk for adolescent social phobia, a similar pattern of striatal activation may manifest in social phobia. The present study compares striatal function in healthy adolescents, adolescents with social phobia, and adolescents with generalized anxiety disorder. Blood-oxygen-level-dependent signal in striatal regions was examined in 58 medication-free adolescents—14 with social phobia, 18 with generalized anxiety disorder but not social phobia, and 26 with no psychiatric disorder—matched on sex, age, puberty, IQ, and socioeconomic status. During functional magnetic resonance imaging, participants responded to incentive cues depicting potential monetary gains or losses of varying magnitudes. While anticipating incentives of increasing magnitude, adolescents with social phobia showed increasingly heightened caudate and putamen activation at a level greater than that seen in the healthy comparison and generalized anxiety disorder groups. The generalized anxiety disorder group showed a unique valence-specific putamen response relative to the healthy comparison or social phobia group. Both patient groups displayed more complex patterns in the nucleus accumbens than in the caudate or putamen. Caudate and putamen hypersensitivity to incentives of increasing magnitudes characterizes adolescent social phobia, relative to activation in this region in adolescents with generalized anxiety disorder as well as healthy adolescents. Thus, these findings resemble the pattern previously found in adolescents with early childhood behavioral inhibition, thereby implicating similar neural responses to anticipation of incentives in both early childhood behavioral inhibition and adolescent social phobia.

The Mini-Social Phobia Inventory: psychometric properties in an adolescent general population sample

BackgroundOnset of social phobia (SP) typically occurs in adolescence. Short screening instruments for its assessment are needed for use in primary health and school settings. The 3-item Mini–Social Phobia Inventory (SPIN) has demonstrated effectiveness in screening for generalized SP (GSP) in adults. This study examined the psychometrics of the Mini-SPIN in an adolescent general population sample. MethodsThree hundred fifty adolescents aged 12 to 17 years were clinically interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version for identification of SP and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I disorders, blind to their Mini-SPIN status. Associations between SP; subclinical SP; other anxiety, depressive, and disruptive disorders; and Mini-SPIN scores were examined, and diagnostic efficiency statistics were calculated. The association between Mini-SPIN scores and the generalized subtype of SP was also examined. ResultsAs in adults, the Mini-SPIN items differentiated subjects with SP from those without. A score of 6 points or greater was found optimal in predicting SP with a sensitivity of 86%, specificity of 84%, and positive and negative predictive values of 26% and 99%. The Mini-SPIN also possessed discriminative validity, as scores were higher for adolescents with SP than they were for those with depressive, disruptive, and other anxiety disorders. The Mini-SPIN was also able to differentiate adolescents with GSP from the rest of the sample. ConclusionsThe Mini-SPIN has good psychometrics for screening SP in adolescents from general population and may have value in screening for GSP.

The Pathology of Social Phobia Is Independent of Developmental Changes in Face Processing

While social phobia in adolescence predicts the illness in adulthood, no study has directly compared the neural responses in social phobia in adults and adolescents. The authors examined neural responses to facial expressions in adults and adolescents with social phobia to determine whether the neural correlates of adult social phobia during face processing also manifest in adolescent social phobia. Blood-oxygen-level-dependent (BOLD) responses were compared in 39 medication-free participants with social phobia (25 adults and 14 adolescents) and 39 healthy comparison subjects (23 adults and 16 adolescents) matched on age, IQ, and gender. During fMRI scans, participants saw angry, fearful, and neutral expression stimuli while making a gender judgment. Significant diagnosis-by-emotion interactions were observed within the amygdala and the rostral anterior cingulate cortex, as has previously been hypothesized. In these regions, both the adolescent and adult social phobia patients showed significantly increased BOLD responses relative to their respective age-matched comparison subjects, and there was no evidence of age-related modulation of between-group differences. These enhanced responses occurred specifically when viewing angry (rostral anterior cingulate cortex) and fearful (amygdala and rostral anterior cingulate cortex) expressions but not when viewing neutral expressions. In addition, the severity of social phobia was significantly correlated with the enhanced rostral anterior cingulate cortex response in the adults. The neural correlates of adult social phobia during face processing also manifest in adolescents. Neural correlates that are observed in adult social phobia may represent the persistence of profiles established earlier in life rather than adaptive responses to such earlier perturbations or maturational changes. These cross-sectional observations might encourage longitudinal fMRI studies of adolescent social phobia.

Social phobia in Finnish general adolescent population: prevalence, comorbidity, individual and family correlates, and service use

Few studies have investigated the epidemiology of social phobia (SP) among early to middle adolescents, at the time of suggested mean onset of the disorder. The objective of this study was to investigate the prevalence, comorbidity, individual and familial correlates, and service use associated with SP among Finnish 12-17-year-old adolescents in general population. A sample of 784 adolescents was screened with the Social Phobia Inventory, and a sub-sample (n=350) was interviewed with a semi-structured clinical interview to identify SP, sub-clinical SP (SSP), and a range of other axis I DSM-IV disorders. Individual and familial correlates, and service use associated with SP were also inquired. We found a 12-month prevalence of 3.2% for SP, and 4.6% for SSP. The prevalence rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41%). Adolescents with SP/SSP were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts. Two thirds (68%) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non-comorbid SP had been in contact with a mental health professional. We conclude that adolescent SP is a relatively frequent, undertreated and highly comorbid condition, associated with educational impairment, depression and anxiety in parents, and peer victimization.

Social phobia in Swedish adolescents

The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs. 1.8% boys, P < 0.001). No significant differences in prevalence of probable cases emerged across the ages. At sub-threshold level, marked social fear of at least one social situation was reported by 13.8% of the total group. "Speaking in front of class" and "calling someone unfamiliar on the phone" were the most feared social situations. In the social phobia group, 91.4% reported impairment in the school-domain due to their social fear. Social phobia is a common psychiatric condition in Swedish adolescents, especially in girls. As impairment in the school-domain is reported to a high degree, professionals and teachers need to recognize social phobia in adolescents so that help in overcoming the difficulties can be offered.

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

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

Social Fears in Adolescence

This study describes the development, factor structure, psychometric properties, and validity of the Social Anxiety and Avoidance Scale for Adolescents (SAASA). Two subscales assessing discomfort and avoidance of typical social situations faced by adolescents constitute the SAASA. Both subscales revealed good internal consistency and temporal stability. Convergent validity was determined comparing the Social Anxiety and Avoidance Scale for Adolescents (SAASA) scores to Social Anxiety Scale for Adolescents scores (SAS-A), scores for general anxiety (Revised Children’s Manifest Anxiety Scale, RCMAS), and scores for depression (Children’s Depression Inventory, CDI) . Confirmatory factor analyses supported six distinct factors revealing different dimensions of social fears. The SAASA effectively discriminated between adolescents with social phobia with and without comorbid diagnoses, and adolescents with social phobia from adolescents with other anxiety disorders or without any disorder. These results suggest that the SAASA is a valid instrument to use in the clinical assessment and research on adolescent social phobia.

Screening social phobia in adolescents from general population: The validity of the Social Phobia Inventory (SPIN) against a clinical interview

Social phobia (SP) has onset during early adolescence, and is associated with significant impairment in social and educational functioning of adolescents. Therefore, valid and easy-to-use tools for screening and identification of SP among adolescent community populations are needed. We investigated both construct and discriminative validity, and screening properties of the 17-item Social Phobia Inventory (SPIN) relative to SP diagnoses based on a semi-structured clinical interview (K-SADS-PL), in a sample of 752 12 to 17-year-old Finnish students from general population. The SPIN demonstrated good properties to differentiate adolescents with SP and those with sub-clinical SP symptoms (SSP), from adolescents without SP. The SPIN also differentiated adolescents with SP from those with depressive and disruptive disorders. In this sample 27% of participants scored above the previously suggested SPIN cut-off (15 points) for adolescent SP. We suggest using a somewhat higher cut-off score, 24 points, when using the SPIN as a screen for SP in general adolescent populations. This cut-off score resulted in a sensitivity of 81.2%, a specificity of 85.1%, a positive predictive value of 26.9%, and a negative predictive value of 98.6% in relation to the SP diagnosis in our sample. To screen for both SP and SSP, 19 points as a cut-off score produced satisfactory diagnostic efficiency statistics. The SPIN appears to have good properties for screening and identification of adolescent SP.