Childhood Social Phobia Research Articles

A Review on Pediatric Social Phobia and Selective Mutism

Selective mutism (SM) is a psychological disease that affects children and is defined by a complete lack of speech in certain social contexts while speech production appears normal in others. Separation anxiety disorder, social anxiety disorder (previously known as social phobia), agoraphobia, and panic disorder, as well as shyness and anxiety, can all be associated with selective mutism. SM is a rather uncommon condition. Estimates of its point prevalence have been found in clinic or school samples in a variety of countries, and typically range between 0.03 percent and 1.9 percent depending on the setting. To properly establish the disorder's diagnosis, clinicians can use the SM module of the Anxiety Disorders Interview Schedule for Children and Parents (ADIS-C/P) or the Schedule for Affective Disorders and Schizophrenia for Children (Kiddie- or K-SADS). Nonmedication and medication-based therapies are the two basic types of treatment for selective mutism. Psychodynamic therapy, behavioural therapy, and family therapy are among the most common nonmedication-based or psychotherapy treatments. Selective seratonin reuptake inhibitors (SSRIs) (fluoxetine in particular) have been demonstrated to improve mutism and anxiety when used as a treatment option. The study aims to evaluate and treat selective silence and social phobia in children.

Successful Use of Graded Exposure Therapy in the Treatment of Social Phobia in a 10 year old Child

Social phobia is one of the most common psychological disorders seen in children and adolescents. The paucity of literature and lack of training in the behavioural treatment of  children with social phobia among health care professionals has made their treatment  difficult. The purpose of the present case report was to demonstrate the utility of behavioral treatment (graded exposure therapy) for social phobia in children.

The Effectiveness of Social Skills Training on Improving Cognitive Emotion Regulation Strategies and Social Phobia in Children with Hearing Impairment

The Effectiveness of Social Skills Training on Improving Cognitive Emotion Regulation Strategies and Social Phobia in Children with Hearing Impairment

Developmental risk factors in generalized anxiety disorder and panic disorder

BackgroundThere is a lack of clarity regarding specific risk factors discriminating generalized anxiety disorder (GAD) from panic disorder (PD). GoalThis study investigated whether GAD and PD could be discriminated through differences in developmental etiological factors including childhood parental loss/separation, psychological disorders, and maternal and paternal attachment. MethodTwenty people with adult generalized anxiety disorder (GAD), 20 with adult panic disorder (PD), 11 with adult comorbid GAD and PD, and 21 adult non-anxious controls completed diagnostic interviews to assess symptoms of mental disorders in adulthood and childhood. Participants also reported on parental attachment, loss and separation. ResultsChildhood diagnoses of GAD and PD differentiated clinical groups from controls as well as from each other, suggesting greater likelihood for homotypic over heterotypic continuity. Compared to controls, specific phobia was associated with all three clinical groups, and childhood depression, social phobia, and PTSD were uniquely associated with adult GAD. Both maternal and paternal attachment also differentiated clinical groups from controls. However, higher levels of subscales reflecting maternal insecure avoidant attachment (e.g., no memory of early childhood experiences and balancing/forgiving current state of mind) emerged as more predictive of GAD relative to PD. There were no group differences in parental loss or separation. ConclusionsThese results support differentiation of GAD and PD based on developmental risk factors. Recommendations for future research and implications of the findings for understanding the etiology and symptomatology of GAD and PD are discussed.

Selective Mutism: The Fraternal Twin of Childhood Social Phobia

Background: Selective mutism (SM) is an anxiety disorder with a close link to childhood social phobia (SP). Our studies compare behavioral problem profiles in children and adolescents with SM and SP and control groups and assess the comorbidity patterns of SM and SP. Methods: Participants aged 3-18 years with SM (n = 95), SP (n = 74) and internalizing disorders (INT, n = 46) and a typically developing control group (CG, n = 119) were assessed with the Child Behavior Checklist (CBCL); adolescents were additionally assessed with the Youth Self-Report (YSR). Comorbidity was assessed in SM and SP participants with a diagnostic interview. Results: SP was detected in 94% of children with SM. SM participants showed different behavioral and psychiatric symptoms than SP: they were more frequently affected by lifetime separation anxiety disorder (SM: 45%, SP: 26%) and oppositional defiant disorder (SM: 22%, SP: 5%), and less by generalized anxiety disorder (SM: 6%, SP: 20%) and major depression (SM: 12%, SP: 26%). Adolescents with SM showed high rates of agoraphobia (SM 27%; SP 10%) and more social problems (YSR), and were more withdrawn (CBCL, YSR) than those with SP alone. Specific behavioral problems of SM and SP compared to INT and CG were observed. Conclusion: SM and SP represent separate but closely related disorders, distinct from other INT and CG, with specific patterns of lifetime comorbidities.

The Relationship between the Methods of Family Upbringing and the Emergency of Social Phobia in Children Aged between 11 and 13 Years

أساليب التنشئة الأسرية | الأسلوب المتسلط | الأسلوب المهمل | الأسلوب المرن | الفوبيا الاجتماعية | Methods of Family Upbringing | Authoritarian Style | Negligence Style | the Flexible Style | Social Phobia

Early Behavioral Inhibition and Increased Error Monitoring Predict Later Social Phobia Symptoms in Childhood

Behavioral inhibition (BI) is an early childhood temperament characterized by fearful responses to novelty and avoidance of social interactions. During adolescence, a subset of children with stable childhood BI develop social anxiety disorder and concurrently exhibit increased error monitoring. The current study examines whether increased error monitoring in7-year-old, behaviorally inhibited children prospectively predicts risk for symptoms of social phobia at age 9 years. A total of 291 children were characterized on BI at 24and 36months of age. Children were seen again at 7 years of age, when they performed aFlanker task, and event-related potential (ERP) indices of response monitoring were generated. At age 9, self- and maternal-report of social phobia symptoms were obtained. Children high in BI, compared to those low in BI, displayed increased error monitoring at age 7, as indexed by larger (i.e., more negative) error-related negativity (ERN) amplitudes. In addition, early BI was related to later childhood social phobia symptoms at age 9 among children with a large difference in amplitude between ERN and correct-response negativity (CRN) at age7. Heightened error monitoring predicts risk for later social phobia symptoms in children with high BI. Research assessing response monitoring in children with BI may refine our understanding of the mechanisms underlying risk for later anxiety disorders and inform prevention efforts.

Treating social phobia in children through group narrative therapy

This study explored the effectiveness of group narrative therapy in treating the symptoms of social phobia among boys. Twenty-four boys, aged 10–11 with a confirmed diagnosis of social phobia were randomly assigned to receive treatment (N=12) or placed on a waiting list (N=12) considered as a control group. The treatment group received fourteen 90-min sessions of narrative therapy twice a week. Results showed significant differences in the symptom scores for the intervention and waiting list groups. Assessment by parents and teachers showed that the group narrative therapy had a significant effect on reducing symptoms of social phobia among participants in the treatment group both at home and school settings one week after completion of treatment and sustained after thirty days.

Introduction to Special Issue on Social Phobia in Children

Social phobia (or social anxiety disorder) is characterised by ‘a marked and persistent fear of one or more social or performance situations’ (American Psychiatric Association, 1994). It is one of the most common forms of psychopathology, with a prevalence rate of around 7% in both children and adults (Furmark, 2002; Stein & Stein, 2008). Social phobia typically begins early in life, with approximately half of socially anxious adults reporting onset before the age of 11 (Stein & Stein, 2008). The significant impact of social phobia on the lives of children is increasingly recognised. For example, socially anxious children are less likely to have close friendships, and more likely to drop out of school early and are less liked by their peers than non-anxious children (La Greca & Lopez, 1998; Stein & Kean, 2000; Verduin & Kendall, 2008). Furthermore, if left untreated, social phobia during childhood increases risk for substance abuse and other mental health problems later in life (Crum & Pratt, 2001; Stein et al., 2001). Despite the prevalence and negative consequences of social phobia in children, understanding of the aetiology of this disorder remains limited. In this special issue, a series of papers are presented that take an experimental approach to further understanding of the pathogenesis of social phobia in children. As the ultimate goal of this experimental research is to contribute to the improvement of treatments for social phobia, the final paper presents a review of treatment research.

Attention Bias for Angry Faces in Children with Social Phobia

Attention bias towards threatening stimuli is a well-established cognitive correlate of anxiety disorders. In tasks using angry faces, accumulating results link paediatric anxiety to biased attention. Nevertheless, at least in childhood social phobia, there is mixed evidence regarding the direction of this bias as some findings suggest that socially anxious children show increased attention bias towards threat, whereas other evidence suggests they have an increased bias away from threat. The present study examined attention bias for angry (and happy) faces in 27 children with a principal diagnosis of social phobia and 27 non-clinical healthy volunteers between 5 and 13 years of age. Children completed a visual probe task in which pairs of angry and neutral faces and happy and neutral faces were presented for 500 ms followed by an asterisk probe in either the same or opposite location as the emotional face. Participants were instructed to respond quickly by key-press to indicate the position of the probe. Results showed that only socially phobic children with high symptom severity showed a significant attention bias towards angry faces relative to neutral ones. In contrast, children with social phobia with lower levels of symptom severity showed a significant attention bias away from angry faces. Non-anxious volunteers showed no significant bias for angry faces. There were no significant between-group differences for happy faces. Results are discussed in terms of prior work on attention and emotion regulation.

Fluoxetine for the Treatment of Childhood and Adolescence Social Phobia: Factors playing a role in Efficacy

Objective: The aim of this study was to investigate the stepwise efficacy, after 8 and 12 weeks of fluoxetine treatment, on social anxiety disorder (SAD) in 7 to 17 year-old children and adolescent...

Subjective, Autonomic, and Endocrine Reactivity during Social Stress in Children with Social Phobia

Reports of exaggerated anxiety and physiological hyperreactivity to social-evaluative situations are characteristic of childhood social phobia (SP). However, laboratory research on subjective, autonomic and endocrine functioning in childhood SP is scarce, inconsistent and limited by small sample sizes, limited breadth of measurements, and the use of non-standardized stressor tasks. We exposed 8-12-year-old children with DSM-IV SP (n = 41) and matched healthy control children (HC; n = 40) to the Trier Social Stress Test for Children (TSST-C) while measuring subjective anxiety, heart rate (HR) and salivary alpha-amylase (sAA) as well as salivary cortisol. The SP children showed heightened reactivity to the TSST-C on subjective anxiety compared to the HC children but not a heightened reactivity in HR, sAA or cortisol. However, the SP children showed chronically elevated HR levels throughout the whole laboratory session. Whereas subjective anxiety seems to respond specifically to social-evaluative stress in childhood SP, HR levels may be chronically elevated suggesting a more generalized autonomic hyperreactivity.

Do Pharmacological and Behavioral Interventions Differentially Affect Treatment Outcome for Children With Social Phobia?

In a randomized trial for children with social phobia (SP), Social Effectiveness Therapy for Children (SET-C; a treatment consisting of exposure and social skills training) and fluoxetine were more effective than pill placebo in reducing social distress and behavioral avoidance, but only SET-C demonstrated significantly improved overall social skill and social competence. In the current study, the authors examined the specific social skills enhanced by SET-C using a recently developed coding schema. At posttreatment, children treated with SET-C displayed a more effective ability to manage the conversational topic (pragmatic social behaviors) and more appropriate motor movement, facial orientation, and posture (paralinguistic social behaviors) than children treated with fluoxetine or placebo. In contrast, children treated with fluoxetine displayed no more pragmatic or paralinguistic skill than children given a pill placebo. There were no group differences on ratings of voice volume and vocal inflection (speech and prosodic social behaviors). Furthermore, only children treated with SET-C improved from pre- to posttreatment on all three skill variables. Findings suggest that pharmacological interventions that only target reduction in anxious arousal may not have an impact on social skill deficits and may not be adequate to optimally treat SP. The relationship of social skill to social avoidance and the importance of social skills training to enhance social competence in the treatment of childhood SP are discussed.

The Treatment of Social Phobia in a Young Boy With Asperger's Disorder

Anxiety disorders, including social phobia, occur often in children with autism spectrum disorders (ASD; Gillott, Furniss, & Walter, 2001; Leyfer et al., 2006; Simonoff et al., 2008); however, little is known about the conceptualization and treatment of social phobia in this population. The current study presents the case of “James,” a 6-year-old male with comorbid Asperger's disorder and social phobia. A cognitive-behavioral treatment (CBT) package, including parent training, psychoeducation, graduated exposure, and reinforced practice, was implemented to decrease avoidance behaviors in social settings. Results showed that James's avoidance behaviors were reduced significantly following intervention, suggesting that a CBT approach may be effective in treating social phobia in children with ASD. The significant influence of CBT on decreasing avoidance behavior in comorbid social phobia and ASD highlights the need for continued investigation of adapting CBT for use with children with ASD.

Psychotherapy Update for the Practicing Psychiatrist: Promoting Evidence-Based Practice

The last three decades have witnessed significant advances in psychotherapy. Numerous scholarly articles and books have been devoted to pertinent topics in the field, making it difficult for the practicing clinician to keep up with this rapidly growing area. The purpose of this article is to provide some guidelines on how to evaluate the empirical literature in psychotherapy and then to explore three key areas: evidence-based psychotherapies for patients with psychiatric disorders, individual variables that predict differential outcome to treatment, and the therapeutic alliance. Finally, two case examples will be presented to illustrate how knowledge of the empirical literature can facilitate an evidence-based approach to the daily practice of psychotherapy in general psychiatry.

The Relations among Measurements of Informant Discrepancies within a Multisite Trial of Treatments for Childhood Social Phobia

Discrepancies between informants' reports of children's behavior are robustly observed in clinical child research and have important implications for interpreting the outcomes of controlled treatment trials. However, little is known about the basic psychometric properties of these discrepancies. This study examined the relation between parent-child reporting discrepancies on measures of child social phobia symptoms, administered before and after treatment for social phobia. Participants included a clinic sample of 81 children (7-16 years old [M = 11.75, SD = 2.57]; 39 girls, 42 boys) and their parents receiving treatment as part of a multisite controlled trial. Pretreatment parent-child reporting discrepancies predicted parent-child discrepancies at posttreatment, and these relations were not better accounted for by the severity of the child's pretreatment primary diagnosis. Further, treatment responder status moderated this relation: Significant relations were identified for treatment non-responders and not for treatment responders. Overall, findings suggest that informant discrepancies can be reliably employed to measure individual differences over the course of controlled treatment trials. These data provide additional empirical support for recent work suggesting that informant discrepancies can meaningfully inform understanding of treatment response as well as variability in treatment outcomes.

Mediators and Moderators of Outcome in the Behavioral Treatment of Childhood Social Phobia

ObjectiveThe current study examined mediators and moderators of treatment response among children and adolescents (ages 7–17 years) with a primary diagnosis of social phobia. MethodParticipants were 88 youths participating in one of two randomized controlled treatment trials of Social Effectiveness Therapy for Children. Potential mediators included changes in observer-rated social skill and child-reported loneliness after 12 weeks of Social Effectiveness Therapy for Children. Age and depressive symptoms were examined as potential moderators. ResultsLoneliness scores and social effectiveness during a role-play task predicted changes in social anxiety and overall functioning at posttreatment. Changes in social anxiety were mediated by child-reported loneliness. Outcomes were not moderated by age or depressive symptoms. ConclusionsFindings support the role of loneliness as an important mechanism of change during treatment for childhood social phobia.

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

SET-C Versus Fluoxetine in the Treatment of Childhood Social Phobia

To determine the efficacy of fluoxetine, pill placebo, and Social Effectiveness Therapy for Children (SET-C) for children and adolescents with social phobia. Youths ages 7 to 17 were randomly assigned to one of the treatment conditions. Outcome was evaluated using self-reports, parent ratings, independent evaluator ratings, and behavioral assessment. Both fluoxetine and SET-C were more efficacious than placebo in reducing social distress and behavioral avoidance and increasing general functioning. SET-C was superior to fluoxetine on each of these measures and was the only treatment superior to placebo in terms of improving social skills, decreasing anxiety in specific social interactions, and enhancing ratings of social competence. Furthermore, whereas fluoxetine appears to exert maximum effect by 8 weeks, SET-C provides continued improvement through week 12. Both fluoxetine and SET-C are efficacious for social phobia, although SET-C appears to provide added benefit by enhancing social skills.

Parental Assessment of Childhood Social Phobia: Psychometric Properties of the Social Phobia and Anxiety Inventory for Children–Parent Report

Validity and parent–child agreement of the Social Phobia and Anxiety Inventory for Children–Parent Report (SPAI–C–P) were examined in a racially diverse sample of 158 students in Grades 5 through 8 (87 girls; ages 10 to 14; M = 11.53) and their caregivers. Children completed the Social Phobia and Anxiety Inventory for Children (SPAI–C), and caregivers completed the SPAI–C–P and the Child Behavior Checklist (CBCL). The SPAI–C–P demonstrated good internal consistency and was significantly correlated with child self-reported social anxiety. Confirmatory factor analysis supported a 3-factor model over a 5-factor model, and concurrent validity was evidenced. Implications and directions for future research are discussed.